bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of nutritional risk factors on chronic non-communicable diseases
Authors: Grosso G
Published: November 2019

Background

modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention of chronic non-communicable diseases (NCD). Among various risk factors, poor nutrition quality has been identified as a leading determinant of NCD.

Methods

The Global Burden of Diseases (GBD) Study provided a comprehensive comparative risk assessment (CRA) of risk factor for NCD, quantifying the impact of behavioural, environmental and occupational, and metabolic risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. Special focus on nutritional risk factors will be dedicated, discussing the proportion of disease-specific burden attributable to each dietary risk factor and the level of intake associated with the lowest risk of mortality.

Results

In 2017, over 30 million deaths were attributable to risk factors. When ranked, high systolic blood pressure was the leading risk factor, accounting for more than 10 million deaths, followed by, high fasting plasma glucose, and high body-mass index. A total of 11 million deaths were attributable to dietary risk factors. High intake of sodium, low intake of whole grains, and low intake of fruits were the leading dietary risk factors for deaths globally. However, important differences between regions and outcome (i.e., cardiovascular disease vs. cancer) have been registered. Besides the major aforementioned factors, underrated dietary risk factors, such as low calcium intake, have been found important contributors to cancer burden in certain developed countries.

Interpretation

The combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in NCD at the global level. These data provide a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations.
Variations in the use of caesarean section: a Comparison between France and Australia
Authors: Chevreul K , Shand A , Korb D , LeRoux E , Nassar N , Sibony O , Bisits A , Alberti C
Published: November 2019

Background

There has been a rise in obstetric intervention during labour and birth including rates of caesarean section around the world. The rates of caesarean section are lower in France (20%) than Australia (34%). Both countries have universal health care systems. Australia has a well-established program of obstetric benchmarking and national data collection for comparing maternal and perinatal outcomes taking into account maternity units and maternal characteristics. Although the optimal caesarean section rate is not known, variation in caesarean section rates raise questions about what is driving variation in practice and whether the right care is being delivered. The World Health Organisation has recently released non-clinical recommendations aiming to reduce unnecessary caesarean sections, including that births are classified by Robson classification for easier comparison.

Methods

We aim to compare rates of mode of birth in 2 tertiary hospitals- one in France and one in Australia using Robson classification. This project will investigate differences in patient casemix, and obstetric management that may lead to differences in outcome. In addition, we will try to explore differences in the health systems including clinical activity, induction rates, staffing (number, type (medical, nursing, midwifery)), and models of care.

Outcomes

Caesarean section is one of the most common operations performed in hospitals. Important variations of surgical rates raise question regarding whether access to this procedure is optimized. Determining current practice and outcomes of women in two different settings will provide important data to inform hospital practice and further research. In addition, this research may inform national guidelines about indications for caesarean section.
Socio-economic inequalities in timing of childhood immunizations in Scotland
Authors: Pearce A , Henery P , Cameron C , Dundas R , Katikireddi V , Leyland A
Published: November 2019

In Scotland, like many other European countries, childhood immunization coverage is generally high, often exceeding levels typically required to achieve herd immunity (95%): uptake of the primary vaccines (excluding rotavirus) is ∼96% (at 12month(m)), with the 1st dose of measles, mumps and rubella (MMR) at 97% (by 5 years). However, the recommended age to receive these vaccines is 2-4m and 12-13m respectively. Delays beyond these ages may indicate vaccine hesitancy or barriers to access and can increase the likelihood of disease outbreaks, especially if clustered among certain geographical or social groups. We used quantile regression to examine the age by which 95% coverage was met in different groups.

We analyzed data from the Scottish Immunisation and Recall System, for all children born in Scotland 2010-12 (n∼200,000), estimating proportions immunized ‘on time’ with the primary (by age 5m) and MMR (by 14m) vaccines. Next we used quantile regression (with 95% cut-points) to calculate the age by which 95% coverage was reached among this cohort of children, overall and according to neighbourhood deprivation (Scottish Index of Multiple Deprivation[SIMD] deciles).

As in national reports, uptake of the primaries (at 12m) and MMR (at 5y) was >95%, with 91% and 89% immunized ‘on time’ (as defined above). Nationally, primary vaccines uptake reached 95% by age 7m. This varied by SIMD, from 6m in the least disadvantaged decile, to 9m in the most disadvantaged decile (difference 3m, CI: 2.7-3.3). Uptake of MMR reached 95% a year later than recommended (26m), with no discernible pattern by SIMD.

In Scotland, the age by which immunization levels meet those typically required to achieve herd immunity may be suboptimal, particularly for MMR and (for primary vaccines) disadvantaged neighborhoods. This same approach might be used in other nations with high coverage to identify population groups that may be experiencing barriers to access and inform local intervention content
Care trajectories of patients initiating dialysis as planned versus emergency procedure
Authors: Raffray M , Pladys A , Gao F , Couchoud C , Vigneau C , Bayat S
Published: November 2019

Background

Emergency dialysis is defined as a first dialysis session performed within 24 hours after the nephrologist’s assessment due to a life-threatening risk. Starting dialysis in emergency (ES) is associated with poorer outcomes compared to a planned start (PS). The aim of this study was to compare the pre-dialysis care trajectory between ES and PS patients.

Methods

Patients ≥ 18 years old who started dialysis in 2015 in France were included. Data from REIN were linked with the French national health database (SNDS). Individual characteristics at dialysis initiation, inpatient stays (number, duration and diagnosis), and consultations with general practitioners (GP) and nephrologists during the year before dialysis start were compared between ES and PS patients, as well as with national clinical practice guidelines.

Results

Among 8964 patients included, 30.6% started dialysis in emergency. These patients had more comorbidities than PS patients (19% of ES patients had 3 or more cardiovascular diseases versus 12.6% of PS patients, p < 0.001). In the year before dialysis start, ES patients had a lower median number of inpatient stays (1 versus 2 for PS patients, p = 0.001) but had a longer mean duration of hospital stay (8.1 days versus 5.8 days for PS patients, p < 0.001). ES patients had less consultations with a nephrologist (2.5 versus 4.5 for PS patients, p < 0.001). However, the number of GP consultations was not different between the two groups (9.7 versus 9.4 for PS patients, p < 0.064).

Conclusions

Nearly 1 in 3 patients started dialysis in emergency with more comorbidities at baseline than PS patients. Their one year pre-dialysis care trajectory was characterized by less frequent nephrological follow-up and a similar GP follow up, compared with PS patients. These results raise questions regarding access to coordinated care associating GPs and nephrologists. This issue of coordination will be investigated using qualitative methods.
Understanding the perspectives of older adults and elderly regarding vaccination; a snapshot in four European countries
Authors: Timen A , Eilers R , Lockhart S , Gavioli R , Paul S , Volo S
Published: November 2019

Prevention of infectious diseases in elderly by immunization is a prerequisite to ensuring healthy ageing. However, in order for the vaccine programs to be effective, these need to be provided by health care professionals who have up-to-date knowledge and high motivation. Furthermore, the knowledge and attitudes towards vaccination in the targeted age groups needs to be fully understood. When focusing on the information provision, it is important to know from whom or which institution older adults and elderly would like to receive and in which form.

In January 2019, an international project called the VITAL (The Vaccines and InfecTious diseases in the Ageing population) project was started, within the framework of IMI (Innovative Medicines Initiatives). One of the goals of the VITAL project is to develop strategies to educate and train health care professionals (HCPs) and to promote awareness among stakeholders involved in elderly care management.

We briefly focus on the results of studies undertaken in four European countries (Italy, France, The Netherlands and Hungary), which reveal the perspective of older adults and elderly regarding influenza, pneumococcal, herpes zoster vaccination and respiratory syncytial virus (RSV) as well as generic characteristics of the vaccines and diseases.

We will show how attitudes towards vaccination are represented in our study population and which determinants influence the decision-making process of accepting vaccination. Furthermore, we shall elaborate on how the decision-making process towards vaccination takes place and which additional information is needed.

In the second part of the session, we shall invite the audience to reflect on the findings and identify the factors they consider most important for setting up a training and education programme on vaccination.
Workshop: Tools and opportunities for health promotion
Authors:   Organised by: National Institute for Health and Welfare, Finland, EuroHealthNet, EU JointAction ChrodisPlus, EUPHA (HP), EUPHA (INJ),   Chair persons: Caroline Costongs - EuroHealthNet, Anne Lounamaa - EUPHA (INJ)
Published: November 2019

Health promotion acknowledges the reciprocal relationship between health-related behaviours and the environments in which people live, considers that the environment is made up of different subsystems and emphasises the relationships and dependencies between these subsystems. Our workshop acknowledges the multi-faceted nature of health promotion and intends to provoke thinking, ideas and tools for health promotion to help to expand skills and knowledge to develop health promotion strategies, policies and interventions.

This workshop will offer examples and provoke discussions on how to develop, evolve and improve health promotion practices. First, an overview of the European health promotion landscape is presented. This information is based on data collection conducted in 2018 in the European Joint Action Chrodis Plus. Next, we have two interlinked presentations to describe how to institutionalize health promotion thorough legislation, assess health promotion actions nationwide, and foster development in municipalities enforced by legislation. These presentations illustrate the developments in Finland, offer examples and highlight the importance of ministerial level actions for health promotion. The nationwide benchmarking system for assessment has existed for over ten years and offers an example for other countries.

The two last presentations address specific health and well-being issues: (1) tobacco control in Portugal and Israel and (2) the promotion of older people’s health and well-being in Iceland. The presentation on tobacco control is an example of inter-dependencies of different stake-holders. The presentation from Iceland will stimulate a discussion on how to start and conduct the nationwide implementation of an evidence based health promotion intervention and what the role governments, municipalities, and NGOs should be.

The workshop is a regular workshop. Time for discussion is offered in four spots, (1st) after the first presentation, (2nd) after the second and third presentations, (3rd) after the fourth and (4th) final discussion after the fifth presentation.

Key messages

Promising methods for health promotion exist. The challenge is how to implement effectively. Legislation is a powerful tool to enhance health promotion practices.
Assessing health promotion practice in Finland with a benchmarking tool
Authors: Ståhl T
Published: November 2019

The Finnish Benchmarking System for Health Promotion Capacity Building (BSHPCB) is a nationwide system developed to assess structures, capacities and actions taken to develop health promotion practices at local level. BSHPCB data is collected biannually from all Finnish municipalities in the following sectors of administration: primary healthcare, basic education, upper secondary education, vocational education, physical activity and sport, municipal management and culture.

The data collection form and reporting format are based on the theoretical health promotion capacity-building framework, which has seven dimensions that the organization should consider: (1) commitment of the organization to the promotion of population health; (2) management of health promotion; (3) population health monitoring, needs assessment, and evaluation; (4) resources for health promotion; (5) common working practices; (6) public participation/partnership in the planning and evaluation of activities and services; and (7) other core health-promotion functions. Data has been collected since 2010 and results are published on-line (www.teaviisari.fi) within two months of data collection.

The online benchmarking tool serves multiple purposes: first, it provides national actors evidence base for assessing law enforcement and drafting new legislation and developing national strategies and action plans; second it gives regional actors good understanding of municipalities’ work and capacities in their region in order to support them and, third municipalities get feedback of their work, are able to benchmark their situation to similar municipalities and develop their health promotion practices. The development and use of BSHPCB has been encouraging. The coverage of the data serves a sound base for further development of the tool. The next steps involve strengthening the quality of the data and auditing practices.
Tools and approaches towards sustainable investment for health equity
Authors: Buzeti T , Brown C
Published: November 2019

Issue

The drive to deliver better results for the economy and for society is challenged by the daily pressures faced by policy makers to contain the public expenditure while delivering improved outcomes. This is evident also in the health sector where costs are perceived to be spiralling. As a result, the sector faces huge pressure to cut budget and services. On the other hand, the health sector is a minor contributor towards health equity, as social, economic and environmental determinants of health are mostly responsibility of other sectors. Health equity and well-being are outcomes of societal values, culture and policy choices, that create the conditions for prosperous lives for all, leaving no one behind.

Description

There are different approaches and tools that can be used for advocating, planning and monitoring investments for health equity. To name a few that the health system can introduce: mainstreaming equity into health services, employment, procurement and purchasing practices for better social and economic benefits; Health Equity Impact Assessment that supports implementation of Health Equity in All Policies and Agenda 2030; voluntary national review reporting on SDGs - all stressing the need for disaggregation of data, new evidence and methods, and monitoring.

Results/Lessons

Health equity is a complex issue that needs comprehensive response combining various approaches and tools in advocating, planning, implementing and monitoring. Besides situation analysis, more and more WHO Member States are requesting evidence about what works and how to do it. Therefore, tailor made assessment, solution development and monitoring is becoming a standard. This needs to be supported with continuous training and capacity building. WHO European Office for Investment for Health and Development developed a Health Equity Status Report and a flagship course on Equity in Health in All Policies, built on the latest evidence and tailored to country / community needs.

Panelists: Marleen Bekker

EUPHA (PHPP)

Wageningen University & Research, Netherlands

Contact: marleen.bekker@wur.nl

Diana Sonntag

EUPHA (ECO)

University of Heidelberg, Germany

Contact: diana.sonntag@medma.uni-heidelberg.de

Aileen Clarke

Warwick Evidence, The University of Warwick, Coventry, UK

Contact: aileen.clarke@warwick.ac.uk

Ana M Carriazo

Regional Ministry of Health and Families, Andalusia, Seville, Spain

Contact: anam.carriazo@juntadeandalucia.es
Sleep problems among immigrants
Authors: Øien-Ødegaard C , Straiton M , Kjøllesdal M K R
Published: November 2019

Background

The prevalence of insomnia has increased from 11.9% to 15.5% between 2001 and 2011. At the same time, there has been a strong increase in immigration, and today immigrants constitute about 14% of the population. However, we do not know if these increases are related. There is limited information about immigrants’ mental health problems, and more specifically, their sleep problems. There is an established association between low socioeconomic status and higher chance of experiencing sleep problems, and we aim to investigate if this also is the case for immigrants in Norway, and whether being an immigrant is a risk factor.

Methods

Using the Living Conditions Survey for Immigrants 2016, we conducted logistic regression analyses to investigate associations between sleep problems and socioeconomic status among immigrant groups. We also preformed analyses comparing the results for immigrants as a whole and the majority population.

Preliminary results

The analysis indicates a strong relationship between socioeconomic status and sleep problems for immigrants and the majority alike, but also a strong moderating effect of being in the majority population. Women have higher odds of experiencing sleep problems than men, but the odds are much higher for immigrant women than for majority women. When taking origin country into the analysis, we see that only 3 of 12 countries have significantly different odds than the majority. Men from Iraq and Iran have particularly higher odds, while Eritrean women have lower.

Conclusions

Sleep problems are associated with other mental health problems, unemployment, substance abuse and increased mortality. Our finding, that immigrants have higher odds of sleep problems, is something medical professional and teachers should be aware of. Several barriers need to be addressed to increase the level of help seeking. This includes enhanced access of health information, and availability of mental health services.

Key messages

Immigrants have higher odds than the majority population for experiencing sleep problems, also when controlling for socioeconomic status. Immigrant women are particularly exposed to sleep problems, although there are considerable variations according to country of origin.
Immigration status and cervical test screening: more underscreening and inequality social health
Authors: Sassenou J , Rigal L , Ringa V
Published: November 2019

Introduction

In France, public health authorities recommend cervical cancer screening (CCS) by a Pap test every 3 years for all sexually active women aged 25 to 65 years. Socioeconomic inequalities are observed in CCS and disparities in screening practices according to immigration status has been reported. The aim of this study was to compare income inequalities in cervical screening depending on immigration status.

Methods

The study was based on the 2012-2016 baseline data in the Constances cohort (N = 28905 women). Delayed CCS was defined by having last CCS for more 3 years. The main independant variables were monthly household income and immigration status. The women’s origin was divided into the following categories: French women born to two French parents (French origin), French women born to at least one foreign parent (immigrant origin), and women born to two foreign parent (immigrants). Immigrants were divided into two categories: women with French or not nationality (naturalized or foreign immigrant). The slope index inequality (SII) was computed to measure the income inequality in CCS non-adherence. Interaction test was used to compare SII depending on immigration status. We used imputation model.

Results

We confirmed the existence of a gradient with respect to migration origin for delaying CCS (21,9 % women of French origin, 26,5 % women of immigrant origin, 28,8 % immigrant, p < 10-4). More income inequalities were observed depending on immigration status (SII French origin= 0,17 [0,16-0,18], SII immigrant origin= 0,28 [0,24-0,32], SII immigrant = 0,27 [0,25-0,31], p interaction <0,001). Among immigrant women, we observed difference in social inequalities depending on French nationality (SII naturalized= 0,19 [0,15-0,23], SII foreign immigrant= 0,35 [0,30-0,40], p interaction <10-4).

Conclusions

French women of immigrant origin and immigrant women are underscreened and social inequalities are stronger among them than French women of French origin.

Key messages

French women of immigrant origin and immigrant women are less detected for cervical cancer screening than French women. French women of immigrant origin and immigrant women are detected for cervical cancer screening with more social inequalities than French women of french origin.
Health of adolescents with migration background in Germany: cross-sectional results from KiGGS wave 2
Authors: Koschollek C , Bartig S , Rommel A , Lampert T , Santos-Hövener C
Published: November 2019

Background

Although 36.5% of minors in Germany had a migration background (MB) in 2017, data on their health situation is scarce. The project ‘Improving Health Monitoring in Migrant Populations’ (IMIRA) initiated in 2016 aims to expand health reporting on the health situation of people with MB, for which a core indicator set was developed. We are describing the health situation of adolescents based on selected core indicators.

Methods

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS wave 2) (2014-2017) are used; adolescents from 11 to 17 years are considered. Prevalences and 95% confidence intervals are calculated for the following indicators: General health status, overweight, hazardous alcohol consumption and use of pediatric or general practitioner’s services. These indicators are stratified along socio-demographic (gender, age, socio-economic status (SES)) and migration-related characteristics (MB, parents’ duration of stay, language spoken at home).

Results

There are hardly any migration-related differences in the general health status and the use of general medical services. While adolescents with MB are more often affected by overweight (without MB: 11.2%, one-sided: 18.9%, both-sided: 19.8%), they show less often risky alcohol consumption (without MB: 14.5%, one-sided: 7.8%, both-sided: 4.4%). There are differences in health behavior according to SES, parents’ duration of stay in Germany and language spoken at home.

Conclusions

Overall, the health of adolescents is good, regardless of their MB, and general medical services are used equally. Differences in health behavior cannot be reduced solely to the (non-)existence of a MB, but need a deeper consideration of more specific migration-related characteristics and the SES.

Key messages

The general health status and health care utilization do not differ between adolescents with and without MB. In contrast, the results on indicators of health behavior vary.
Development of a dictionary for transcultural care in Europe: a deliverable of the TNP project
Authors: Lavranos G , Prodromou M , Erken A
Published: November 2019

Background

Transcultural care remains a hot domain in current nursing practice, especially due to the challenges relating to increased population mobility due to both medical tourism and financial / political instability. The TNP (transcultural nursing for practice) Erasmus plus project was implemented between 2017-2019 to attempt to detect best practices regarding intercultural care in Europe as well as to develop suitable training materials to improve the communication among people of diverse ethnic, cultural and religious background.

Methods

A study was conducted in January 2019 in all six countries participating in the TNP project. 6 healthcare professionals per country we invited to identify key terms relevant to 15 distinct domains of healthcare and health-related cultural and educational topics. After initial open term brainstorming, the terms were graded by all participants according to their perceived relevance to the project aim using a 3 round Delphi approach.

Results

A total of 36 expert responders from all six countries agreed to participate of which 70% women. Age varied significantly between 35-75 years. After the final Delphi round, consensus was achieved, with a total of about 1100 words included in the final joined statement. The highest degrees of consensus was achieved for terms relating to parts of the body, common symptoms and conditions and healthcare-associated structures and professionals. On the other hand, a significantly lower degree of consent was determined regarding terms relevant to regional health topics, spiritual care, emotional / mental health and role of family and environment.

Conclusions

Transcultural care is a necessary component of everyday practice in modern healthcare provision institutions. Despite significant language and cultural barriers, the main priority domains are almost universally uniform, thus justifying the development of suitable health promotion / education materials to minimize the relevant gap.

Key messages

Transcultural care is a current challenge in health promotion. Despite cultural differences, major terms of healthcare provision remain largely uniform across Europe.
Workshop: MigHealthCare - strengthening Community Based Care to minimize health inequalities
Authors:   Organised by: Mig-HealthCare consortium Chair persons: Pania Karnaki - Greece, Allan Krasnik - EUPHA (MIG)
Published: November 2019

Over the past few years, a large number of refugees, migrants and asylum seekers have reached the south-eastern points of entry of the EU, challenging health and social systems of bordering countries with a spillover effect to the rest of the EU. Refugees, asylum seekers and migrants are at higher risk of poverty and social exclusion compared to the local populations, while the different vulnerable groups face diverse barriers when accessing health services. In many cases they do not receive appropriate health and social care that best meets their needs. Furthermore, in the EU MS, different practices apply to health and social care delivery for migrants/refugees. Research has shown the importance of community-based models to improve health care access of vulnerable migrants and refugees. Such models include elements of good communication, cultural awareness, sensitivity and respect for the diverse cultural and ethnic backgrounds by community health care staff as well health education and primary healthcare services.

Mig-HealthCare - strengthening Community Based Care to minimize health inequalities and improve the integration of vulnerable migrants and refugees into local communities, is a 3-year project, launched in 2017, with the financial support of the European Commission. It is implemented by a consortium of 14 partners among them universities, national authorities and NGOs from ten countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees, support their inclusion and participation in European communities and reduce health inequalities. The project’s specific objectives are: Describe the current physical and mental health profile of vulnerable migrants and refugees including needs, expectations and capacities of service providers.Develop a roadmap and toolbox for the implementation of community based care models, following an assessment of existing health services and best practices.Train community service providers on appropriate delivery of health care models for vulnerable migrants and refugees.Pilot test and evaluate community based care models which emphasize prevention, physical and mental health promotion and integration.

The project results are presented on behalf of the Mig-HealthCare consortium.

Key messages

The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees. The Mig-HealthCare project focuses on developing a roadmap to facilitate the effective implementation of community care models.
Survey on the physical and mental health among migrants and refugees in ten European countries
Authors: Karnaki P , Zota D , Riza E , Gil-Salmerón A , Durá-Ferrandis E , Tsiampalis T , Linos A
Published: November 2019

This study discusses the main findings of the quantitative research conducted within the Mig-HealthCare consortium countries to explore the physical and mental health of migrants and refugees. The study population is defined as migrants/refugees who have been residing in Europe, for at least 6 months and up to 5 years. In order to be able to capture the recent migration flow, the analysis was based on 1169 questionnaires collected in 10 EU-Member States, answered by adult migrants residing less than 5 years in the specific country.

A total of 29% of migrants stated that their health is poor or fair. Overall, 56.9% of migrants needed health care services during the last 6 months, however approximately one in four did not have access to them. The most frequent problems were long waiting times, not being able to organize an appointment, not knowing where to go, lack of communication and long distances. The most frequent chronic health problem migrants/refugees face is caries and headaches/migraines, followed by psychological disease and sleep disorders. Approximately one in three women have been pregnant since entering the current EU country, whereas one in four have had a miscarriage or abortion and 21.5% are currently pregnant.

Summing up, most of the migrants face common medical problems such as bad teeth, headaches and psychological problems. However long waiting times, not knowing where to go and lack of communication are barriers to accessing healthcare. The fact that the immunization status of migrants/refugees is unclear, a significant number suffer from serious chronic diseases and the limited breast and cervical cancer screening of female migrants/refugees pose serious threats to their health and important challenges for the health services of Europe.
Predictions concerning the use of health care services in Europe by migrants/refugees and the Mig-HealthCare Roadmap & Toolbox
Authors: Zota D , Karnaki P , Gil-Salmerón A , Garcés-Ferrer J , Riza E , Linos A
Published: November 2019

Based on the multiple levels of research conducted within the project the consortium developed a roadmap & toolbox which includes the following categories: Continuity of information, Language Culture & Communication, Mental Health, Vaccinations, Maternal/child health, Health promotion, Oral health/Dental Care and NCDs while the Toolbox contains tools on these categories in different languages. The roadmap & toolbox is accessible through the project website. In addition, different scenarios, giving a comprehensive picture of the foreseen situation and the evidence-based policies and actions needed to maximize the effective delivery and sensitivity in the service of care to culturally diverse population groups were developed focusing on mental health, chronic disease management and oral health. Refugees and migrants tend to have a higher prevalence of mental distress compared to non-refugees. For the challenge of lack of recording mental health of migrants/refugees, improving the collaboration between ‘migrant-specific’ organizations is needed. Health care systems in Europe will have to accommodate the high demand for health care services for chronic conditions among migrants/refugees in the coming years. Implications such as the impact of poverty, level of health literacy and/or the cultural adaption of the measures need to be considered when planning to address future trends related to non-communicable diseases including diabetes among migrants/refugees. The provision of oral care presents great variability across the European countries, but in most cases, it is characterized by high cost and restricted range of services if offered within the state health systems. Migrants /refugees will not be able to meet the high cost of private dental care. Local community interventions have been proven very effective.
The equity impact of a universal child health promotion programme
Authors: Pulkki-Brännström A M , Lindkvist M , Eurenius E , Häggström J , Ivarsson A , Sampaio F , Feldman I
Published: November 2019

Background

We aimed to evaluate whether the Salut Programme, a universal child health promotion intervention, aimed to strengthen healthy lifestyles in northern Sweden, had any effect on income-related inequalities in positive birth outcomes for children and on healthcare use for children and their mothers.

Methods

Mother’s residence and child’s date of birth determined whether the child and the mother belonged to the control group (areas that received care-as-usual) or the intervention group (areas with the intervention implemented from 2005), during the pre-measure period (children born 2002-2004) and the post-measure period (children born 2006-2008). The sum of parents’ taxable income was used for socioeconomic ranking. We computed the standard concentration index for six binary indicators of positive birth outcomes, and for inpatient and day patient care for children and mothers during the two years after delivery. Using a difference-in-difference approach, we assessed whether the extent of inequality changed over time between areas.

Results

Income-related inequalities in child health status at birth and in child healthcare use were absent, except that full-term pregnancies were concentrated among the poor at pre-measure in the intervention group. However, mothers’ healthcare use was significantly pro-poor in the control group. The extent of inequality changed between pre- and post-measure periods for two outcomes: the pro-poor concentration of full-term pregnancies in the intervention group at pre-measure disappeared at post-measure; and an increase in pro-poor concentration of normal birth weight in the control group was not matched by a similar increase in the intervention group. Inequalities in healthcare use did not change significantly.

Conclusions

Birth outcomes and child healthcare use seemed to be equitably distributed. However, the results raise concerns whether the intervention may have reduced the pro-poor concentration of positive birth outcomes.

Key messages

There are concerns that participation in universal health promotion programmes differs by socioeconomic status, although few public health interventions have been evaluated from an equity perspective. Birth outcomes and child healthcare use in Northern Sweden seemed to be equitably distributed across different socioeconomic groups.
Prevalence of non-adequate health literacy in Europe: a systematic review and meta-analysis
Authors: Baccolini V , Di Paolo C , Salerno C , Rosso A , Prencipe G P , Isonne C , Marzuillo C , De Vito C , Villari P , Romano F
Published: November 2019

Background

Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of non-adequate HL (NAHL) in European countries and outline the main needs for interventions.

Methods

The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified meta-analyses were carried out. We also performed a meta-regression analysis to test the association between variables and NAHL.

Results

In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients.

Conclusions

Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed.

Key messages

Despite several variations, a significant proportion of European population has non-adequate health literacy. Targeted public health strategies of intervention are crucial to address this deficit.
Transitional care models for chronic patients: preliminary results from an umbrella review
Authors: Riccardi M T , Cicconi M , Ricciardi W , Gianino M M , Damiani G
Published: November 2019

Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients

Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p < 0.05 was deemed as statistically significant)

124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs.

Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform.

Key messages

The patient transfer supervision from one care setting to another is necessary for continuity of care, but there is no robust evidence about the better performance of transitional care models. Systematically reviewed transitional care models has been shown be more cost saving, with a moderate impact on hospital readmission or emergency department visits rates.
Clinicians’ decision making about Parkinson’s treatment plans using self-report vs digital data
Authors: Timotijevic L , Rusconi P , Hodgkins C , Egan B M , Banks A
Published: November 2019

Background

An mHealth-based support systems promise to deliver objective data about the patient’s healthcare status to the clinician in a timely manner but at the same time, risks increasing ‘technical uncertainty”, by increasing the amount of available information, but not necessarily its utility in making medical decisions.The study aim was to investigate clinicians’ decision making about treatment and care plans based on the relative utility of subjective (reported by a person with Parkinson’s Disease, PwP) or objective (digital health) information.

Methodology

Clinicians completed an online questionnaire with 15 vignettes describing patient cases of PwP where information type (subjective, objective, subjective and objective) and symptoms / signs were manipulated whilst disease stage, duration and patient demographics were kept constant. Dependent variables were the likelihood of changing the care plan and the confidence in the decision. We also recorded the willingness to rely on subjective or objective information.

Results

Clinicians were equally likely to change the care plan and were equally confident in their decision when receiving information from self-reports or the digital health devices’ outcomes. The likelihood for change increased when both information sources provided consistent information. However, inconsistent information from both sources did lead to more conservative decision making, that is, clinicians were more reluctant to change the care plan.

Conclusions

Clinicians consider digital health information equally as useful and trustworthy as patients’ self-reports for their care plan decisions. This finding corroborates the potential utility of wearable technology and mobile devices for symptoms’ monitoring. Facilitating clinician’s feedback on situations where subjective and objective sources provide conflicting information is an important consideration for the development and improvement of clinical decision support systems (DSS).

Key messages

It would be important to identify conditions and mechanisms that could give rise to this conflicting information and the impact that that could have on patient care. Guidelines (e.g., more frequent appointments to monitor the situation) could then be put in place to deal with these situations.
A Developmentally Appropriate Patient Education during Transition
Authors: Gagnayre R G , Lombrail P L
Published: November 2019

Introduction

Patient education is recommended to improve transition from pediatric to adult care for young people living with chronic conditions. But a consensus has not been reached regarding a particular model. Our study aims to understand how to implement a Developmentally Appropriate Patient Education during Transition (DAPET), which would revolve around the young people’s psychosocial development.

Methods

Three focus groups were organized with healthcare providers and two focus groups took place with the parents of young people with chronic conditions. We relied on Activity Theory to explore practices and to identify obstacles, as well as recognize which resources were available to implement a DAPET.

Results

Six themes were identitified via the thematic analysis. In summary, healthcare providers agreed on the need to engage in an educational approach centered on the psychosocial development of young people during transition. They did, however, highlight a lack of competencies in adolescent and young adult medicine and a lack of available resources to meet these goals. The parents wanted to redefine their role with healthcare providers in order to apprehend transition to adult care and to allow their children to develop self-management skills.

Conclusions

Healthcare providers and parents considered the implementation of a DAPET to be acceptable and even advisable. However, this program’s feasibility was questioned due to the perceived shortfalls of the hospital system as it currently stands and the ways in which an educational approach would be applied. An enabling environment is therefore required to facilitate the educational initiatives of healthcare providers and to encourage the participation of parents. The means and modalities for achieving this are discussed.

Key messages

Patient Education during transition from pediatric to adult care need to be developmentally appropriate. Healthcare providers need en enabling environment to carry on a developmentally appropriate approach during transition.
Multimodal Surveillance of HAI in an Intensive Care Unit of a Large Teaching Hospital
Authors: Migliara G , Di Paolo C , Barbato D , Baccolini V , Salerno C , Nardi A , Cottarelli A , Marzuillo C , De Giusti M , Villari P
Published: November 2019

Background

Healthcare associated Infections (HAIs) represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients in intensive care units (ICU). Surveillance systems are recommended to gather data in order to elaborate and evaluate intervention to reduce HAIs risk. Here we describe results of the multimodal surveillance system implemented in the ICU of a large teaching hospital in Rome from April 2016 to October 2018.

Methods

The surveillance system integrated four different approaches: i) active surveillance focused on inpatients; ii) environmental microbiological surveillance; iii) surveillance focused on isolated microorganisms; iv) behavioral surveillance of the healthcare personnel. The system included the molecular genotyping of bacterial isolates through the pulsed field gel electrophoresis (PFGE). Moreover, an intervention to improve personnel adherence to hand hygiene (HH) guidelines was conducted.

Results

Overall, 773 patients were included in the surveillance. The global incidence rate of the device related HAIs was 14.1 (95%CI: 12.2-16.3) per 1000 patient day. Monthly device related HAIs incidence rate showed a decreasing, from 26.9 per 1000 patient day in October 2016, to 4.9 in September 2018. The most common bacterial isolate was K. pneumoniae (20.7%), the 94.0% of which were multidrug-resistant. A total of 305 environmental bacterial isolates were retrieved and the most frequent was A. baumannii (27.2%), that was always multidrug-resistant. Genotyping showed a limited number of major PFGE patters in clinical and environmental isolates. Behavioral compliance to HH guidelines improved after the educational intervention.

Conclusions

The data showed an overall slight decrease over time of the adjusted risk HAIs rates. Through the integration of information gathered from the four approaches, the application of this model returns a precise and detailed view of the infectious risk and of the microbial ecology of the ICU.

Key messages

Multimodal surveillance systems are effective to monitor HAI incidence and to determine the infectious risk. Genotyping techniques allows to characterize and link the clinical and environmental isolates.