bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting mental health literacy in schools
Authors: Fretian A , Kirchhoff S , Graf P , Bauer U
Published: October 2020

Background

Adolescence is the most suitable time for health promotion and prevention programs regarding mental illness to start. Given that, about half of the mental illnesses will develop by the age of 14, addressing this issue early in the life course is a particular public health goal in Europe. Mental health literacy is considered a key determinant of good mental health, as it comprises adequate knowledge positive attitudes towards mental health and help-seeking behavior. School-based interventions aimed at increasing mental health literacy are a promising method to reach most young people, at least in countries were school attendance is mandatory. The goal of our project is to evaluate a mental health school program, adapted from a Curriculum originating in Canada, in regard to its ability to increase the mental health literacy of adolescents and young adults within the German school setting.

Methods

Data is currently being collected within the school setting from adolescents and young adults attending regular secondary schools and vocational schools in Germany at three different time points: (T0) before the intervention, (T1) afterwards and (T2) 2-3 months later. A control group will be questioned as well. Data collection takes place between February and December 2020.

Results

Till October 2020 a sample size of about 200 to 400 participants will be reached. It is expected that the intervention group will have a significantly higher increase in mental health literacy, more positive attitudes towards help-seeking and a decrease in stigmatizing attitudes towards mental illness compared to the control group.

Conclusions

It is expected that, the mental health Curriculum will show to be an effective way of promoting the mental health literacy of young people attending different school forms in Germany. A national wide implementation might be a promising public health measure for fostering good mental health and mental health literacy in adolescents and young people.
Teacher Mental Health Literacy: Results from a State-wide Survey in Schools
Authors: Bauer U , Okan O , Faulbaum F
Published: October 2020

Background

Teachers have an important role to play in context of mental health literacy (MHL) promotion of school-aged children. Their MHL is seen as the counterpart of student`s health literacy. Especially vulnerable schoolchildren such as those affected by adverse life events (e.g. parental mental health problems) can benefit from programs. In addition, the whole school environment has impact on school mental health promotion. Yet, only little evidence is available on teachers MHL in Europe. The aim is to provide evidence from a state-wide survey on the state of MHL of teachers in Germany.

Methods

Based on semi-structured interviews with school teachers from all school types in one federal state, including primary and secondary schools, a MHL online questionnaire was developed. The survey was conducted in in 2017 in N = 2500 teachers in Germany. Descriptive and regression analyse have been performed.

Results

Teachers feel considerable uncertainties when working with children affected by adversities related to parental mental health problems. Dealing with the social family background seems hard. Teachers state that they don`t feel comfortable when aiming at mental health promotion of affected children or children in general. Data also show that they may tend to make misjudgements, and that they are not sufficiently trained to address mental health issues in the classrooms. Regression models show that the degree and quality of teaching mental health is affected by differences across school forms, satisfaction with and engagement of school principals in mental health action, learned strategies to respond to parents, and experienced stress, burden and exposure during their work.

Conclusions

Increasing teacher MHL and the environmental capacities and responsiveness towards school mental health promotion should be an important capacity building strategy. Policy support for school mental health promotion is a critical means to sustain effective whole-school approaches.
Lifecourse-varying exposure to structural stigma, minority stress reactions, and mental health among sexual minority male migrants
Authors: van der Star A , Bränström R , Pachankis J
Published: October 2020

Background

Increasing evidence suggests that structural stigma (e.g., discriminatory laws, policies, and population attitudes) can give rise to minority stress reactions (i.e., rejection sensitivity, internalized homophobia, and identity concealment) to compromise sexual minorities' mental health. Yet, many sexual minorities encounter divergent structural-stigma contexts over the life course, with potentially important implications for their experience of minority stress reactions and mental health. We take advantage of sexual minority male migrants' lifecourse-varying exposures to structural stigma contexts to examine this possibility.

Methods

A sample of 247 sexual minority men who had migrated from 71 countries to the low-structural-stigma context of Sweden completed a survey regarding migration experiences, minority stress reactions, and mental health. This survey was linked to objective indices of structural stigma present in these men's countries of origin, diverse in terms of structural stigma.

Results

Country-of-origin structural stigma was significantly associated with poor mental health and this association was mediated by rejection sensitivity and internalized homophobia, but only among those who arrived to Sweden at an older age and more recently.

Conclusions

Prolonged exposure to high levels of structural stigma can give rise to stressful cognitive, affective, and behavioral patterns to jeopardize sexual minority men's mental health; yet, these consequences of structural stigma may wane with increased duration of exposure to more supportive structural contexts.
The risks of public health partnerships with the food and beverage industry
Authors: McKe M
Published: October 2020

Martin McKee will question whether the private sector can be trusted to act as partners in addressing global health issues such as the NCD pandemic, and present evidence that suggests health actors should proceed with caution when considering the industry as potential bedfellows. He will argue that the known actions of many commercial organisations impose an obligation on those seeking to engage with public health bodies to demonstrate absolute transparency, while the public health bodies have an obligation to understand the ways in which commercial organisations seek to shape the dominant narrative and capture regulatory processes.
Climate-smart health care: the power of health care action on air pollution and climate change
Authors: Wang J
Published: October 2020

If one sector is indisputably at the frontline of climate change and air pollution, bearing the costs of increased diseases and more frequent extreme weather events, it is health care. At the same time, the health care sector is a significant contributor to air pollution and climate change, driving an increase in the diseases it is trying to treat. It is not only health care organizations that will be impacted by these dual environmental health menaces, but every individual who relies on their services. The health sector has an opportunity to not only prevent further damage from the air pollution and climate crises, but also to improve health outcomes by decarbonizing, building climate resilience, and amplifying the message around the interdependency between climate change and human health. We will present a framework, co-developed by WHO and Health Care Without Harm, for climate-resilient, sustainable health facilities. We will also highlight the power of health care strategies to tackle air pollution and climate change, exploring examples from India, the United States, Europe, and other regions. The discussion will focus around our findings that health care is one of the most important actors that can drive widespread sustainable solutions and incentivize positive health outcomes globally. The health sector can also play a critical role in advocating for a healthy environment by using its voice and its economic clout to reduce its own climate footprint while becoming a community anchor for sustainability and a leader in the global climate movement. We conclude that when health care is speaking, people listen; when health care acts, markets respond; when health care improves, people's lives are impacted; and we have a framework for scaling this impact around the world.
A critical refection on the enablers of transformative health promotion action
Authors: Barry M
Published: October 2020

The goal of ensuring that all human beings can have healthy lives and can maximise their health potential calls for concerted action on health promotion as an integral component of modern health systems and public policy. In addressing current health and global challenges, there is an urgent need to move beyond the rhetoric of health promotion towards concrete action and strengthening the capacity of countries to implement health promotion at a political, policy and service delivery level. This presentation reviews progress to date and critically considers the enabling mechanisms and system requirements for transformative health promotion actions that can improve the capacity of health and social systems to improve population health and wellbeing, reduce health inequities, and realise the ambitions of the SDGs and the right to health for all. Drawing on a recent report prepared for the European Commission, this presentation discusses what actions are needed to strengthen health promoting policies, research and practices that support a whole-of-government and whole-of-society approach. This presentation makes the case for investing in transformative actions for improved health and wellbeing. Health promotion needs to be placed at the centre of the health policy and sustainable development agenda in order to enhance the resilience of health systems, improve health equity, and make health promotion practices and actions integral to the global health and wellbeing agenda.
Strengthening health promotion research
Authors: Potvin L
Published: October 2020

Neither the Ottawa Charter nor any other WHO Conference declarations mention research and its role as a driver of health promotion practice. As a result, health promotion is often perceived as a discourse based on principles and values, an ideology that lacks scientific rigour. Despite this lack of recognition in health promotion documents, there is a burgeoning research domain that labels itself health promotion. The growing number of journals that publish empirical studies related to health promotion, the growing number of research training programs with a subspeciality in health promotion, and the growing number of research infrastructure (research chairs, research centres, institutes and so on) are all sure signs of a thriving research enterprise. However, these are institutionally disparate and dispersed in various disciplinary such as: education, public health, psychology and others. Up to now, health promotion research has followed what one could call “potluck” a development model. In this model, interested individuals come with their own piece of empirical study, anchored in their disciplinary perspective, and the study is labelled health promotion essentially because they have decided to label it this way. As a result, the field of health promotion research also appears as disparate, wherein various and even contradictory epistemological and ethical perspectives are present.

In this presentation, we will argue that health promotion as a practice and as policy systems would benefit from a stronger and more unified field of health promotion research, to the extent that research creates knowledge based on these practices and policy systems. Using a sustainability framework, we will show how research reinforces the conditions for the sustainability of health promotion practice and systems and we will propose some methodological and ethical principles with the potential to strengthen the positive and mutual benefits of health promotion research and practice.
6.F. Round table: What is the evidence for and against price transparency in pharmaceutical pricing and procurement?
Authors:   Organised by: European Observatory Chair person: Dimitra Panteli - Germany
Published: October 2020

Although the potential for price transparency in pharmaceutical systems has been widely debated, there has been less discussion of the empirical basis to inform policymaking in this area. The lack of price transparency is viewed as one of the biggest barriers to joint pharmaceutical procurement, an initiative that has the potential to drive down pharmaceutical prices by pooling the purchasing power of smaller populations and thus improve the affordability of medicines. However, critics of the call for increased transparency in pharmaceutical pricing argue that such policies would lead to price inflation, particularly for countries with lower ability to pay or limited negotiating power.

Given the widespread use of negotiated confidential discounts granted to different payers by manufacturers and the pervasiveness of international reference pricing as a policy mechanism for determining pharmaceutical prices, transparency policies would not only affect countries directly implementing them. As a result, policy-makers are often reluctant and unsure about how to proceed; this became readily apparent in the discussions around the Transparency Resolution at the World Health Assembly in May 2019. A concise overview of the evidence on the consequences of transparency policies is lacking.

This panel draws on a wide-ranging literature review that sought to answer the following key research questions: Is there empirical evidence that examines the effect of price transparency on price development (within countries implementing the policy as well as other countries)

In the area of pharmaceuticals? Regarding other types of healthcare goods and services? Regarding products from other industries?

What insights can we learn from the available evidence and how transferrable is evidence from other healthcare dimensions or other industries to the issue of price transparency for pharmaceuticals?

In this workshop we will bring together researchers to discuss the type of evidence available the extent to which it is empirically grounded. The workshop aims to address this issue and highlight evidence gaps for and against price transparency policies. Each panellist will talk for a maximum of 10 minutes presenting insights from their work; audience members will be actively invited to share their insights and reflections.

Key messages

The debate on price transparency in pharmaceutical systems needs to advance by looking at the full range of evidence available. Highlighting evidence gaps can endorse real world experiments to test theoretical arguments.
“I won’t sleep tonight”: professional emotions related with family violence against child in Brazil
Authors: Mourão A M , Noronha C V N
Published: October 2020

Background

Interpersonal violence is a diverse cultural phenomenon. Worldwide, 300 million children aged 2 to 4 years has experienced violent discipline by their caregivers. In Brazil, Family Health Strategy (ESF) and Extended Family Health Core (NASF) are essential public policies of primary health care in Unified Health System (SUS). Emotions are extended psychological dimensions; however, society gets influence the way to express it. As a matter of fact, they cannot be an isolated case of contextual social interactions. This research aims to identify and discuss emotions that arises at health professional area which supports children victims of family violence.

Methods

Qualitative, descriptive research collecting data from observation, diary notes and interviews. Authorized by Human Research Ethics Committee of Federal University of Bahia. Held with 7 ESF teams and 1 NASF team, between November 2017 and June 2018, in Salvador-Bahia-Brazil. Empirical data were analysed through thematic analysis with ATLAS.ti 8.0.

Results

The code group 'subjectivity' grouped 2 codes: 'fear' and 'emotions'. The code 'fear' appeared in co-occurrence with 17 other codes, mostly: reception, reporting, avoiding case; and received 21 quotations. This topic stood out about nurses check notes, home visitors, psychologist and social worker, supporting their care needs. Fear appeared strongly related to those people who are “involved” with drug trafficking and avoiding of “getting into cases”. The code 'emotions' had 35 quotations and in co-occurrence with 11 other codes: suspicion, monitoring, referral, among others. Participants cited different emotions produced in these cases: revolt, sadness, anger, pain, despair, indignation, compassion.

Conclusions

Health professionals, both ESF and NASF teams were affected by family violence against children. The results suggest the necessity of a professional multidisciplinary supervision to improve child care.

Key messages

For managers: suggestion implementing systematic supervision with multidisciplinary team practicing primary health care services. For professionals: suggestion including the family violence topic to discuss in group, meetings and educational activities.
Infection prevention and control and antimicrobial stewardship in European long-term care, 2016-2017
Authors: Kinross P , Latour K , Ricchizzi E , Kärki T , Suetens C
Published: October 2020

Background

Europe's population is ageing. Long-term care facilities (LTCFs) for this vulnerable population are often relatively homelike with low staff-to-resident ratios. In 2016-2017, ECDC coordinated its third point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European long-term care facilities (LTCFs). It included collection of data on structure and process indicators (SPIs) of infection prevention and control (IPC) and antimicrobial stewardship, to support countries' identification of national and local interventions in LTCFs.

Methods

In each country, national contacts recruited a convenience sample of LTCFs. National/LTCF PPS teams used a standard protocol that included case definition algorithms (adapted US CDC/SHEA definitions) applied to each resident with signs/symptoms of infection on the PPS day, and questions for LTCF staff on SPIs of IPC and antimicrobial stewardship activities. Denominators indicate the number of responses available for analysis.

Results

3,052 LTCFs in 24 EU/EEA countries were recruited, with 102,301 residents included. The prevalence of HAIs (residents with ≥1 HAI) was 3.7%. Although 1,524/1,623 (94%) LTFS had a hand hygiene (HH) protocol, only 1,046/1,585 (66%) LTCFs had organised ≥1 HH training session for care professionals during the previous year. 1,185/1,561 (76%) LTCFs reported IPC training of nursing and paramedical staff. Only 340/1,639 (21%) of LTCFs reported training on appropriate prescribing and 493/1,623 (30%) LTCFs had provided feedback to GPs on antimicrobial consumption. On the PPS day, annual antimicrobial consumption data were available to only 530/1,623 (32%) LTCFs.

Conclusions

Even in LTCFs with the capacity to perform this PPS, IPC training was non-ubiquitous and antimicrobial stewardship activities, including training, were rarely reported. ECDC encourages EU/EEA countries to recruit LTCFs to participate in future PPSs, to allow them to benchmark HAI rates and practices.

Key messages

The prevalence of healthcare-associated infections in European long-term care facilities (LTCFs) highlights their requirement for infection prevention and control (IPC) and antimicrobial stewardship. This multi-national point prevalence survey (PPS) indicates that European countries can consider reinforcing IPC, antimicrobial stewardship practices and participation in PPSs in LTCFs.
Ethnic differences in incidence and mortality of stroke in Denmark
Authors: Mkoma G F , Johnsen S P , Iversen H K , Andersen G , Nørredam M L
Published: October 2020

Background

Stroke is a leading cause of disability and mortality worldwide. However, studies on incidence and mortality of stroke hereof among ethnic minorities compared with local born are still limited.

Methods

We conducted a Danish nationwide register-based cohort study between 2004 and 2018. All cases of first ever stroke aged 18-95 years were included. Country of birth was used to construct ethnic groups. Age standardized incidence rate ratio (IRR) of stroke stratified by country of birth and sex were estimated with the Danish born as a reference group. Ethnic minorities were grouped as Western and Non-western for mortality hazard ratio (HR) estimates.

Results

In overall, ethnic minorities had a higher risk of stroke compared with Danish born. Particularly, the IRR of all stroke was estimated to be 8.3 times higher among Polish men compared to Danish born men (IRR, 8.32; 95% CI, 6.89-10.05). Compared with Danish born women, Pakistan women had the highest risk of all stroke (IRR, 2.89; 95% CI, 2.46-3.39). By contrast, Swedish women had reduced risk of hemorrhagic stroke (IRR, 0.40; 95% CI, 0.18-0.89) and Norwegian women had reduced risk of ischemic stroke (IRR, 0.87; 95% CI, 0.72-1.06). Compared with Danish born men, all-cause 1-year mortality hazard for Non-western men was (HR, 1.61; 95% CI, 1.13-2.29) while for Western men was (HR, 1.07; 95% CI, 0.90-1.29) among ischemic stroke patients. Among hemorrhagic stroke patients, 1-year mortality hazard for Non-western men was (HR, 0.75; 95% CI, 0.39-1.47) whereas Western men had (HR, 1.48; 95% CI, 1.04-2.10). Among women, we observed reduced all cause 1-year mortality hazard in Non-western (HR, 0.32; 95% CI, 0.13-0.80) for hemorrhagic stroke whereas no difference in mortality hazard was observed for ischemic stroke.

Conclusions

Incidence and post stroke mortality appear to vary among ethnic minorities in comparison to Danish born. It may depend on the type of stroke and sex.

Key messages

The study contributes knowledge in migration and health. With good quality registers, we are in unique position to establish findings in Denmark, which has a growing migrant population.
Assessment of the impact of the European food industry on obesity and population nutrition
Authors: Van Dam I , Allais O , Vandevijvere S
Published: October 2020

Background

Our food environment is becoming increasingly dominated by ultra-processed foods and big industry players often escape accountability through self-regulation and vague commitments.

Methods

Applying the 'Business Impact Assessment' (BIA-Obesity), as proposed by INFORMAS, the commitments and performance of the biggest companies among packaged food and non-alcoholic beverage manufacturers, quick-service restaurants and supermarkets were assessed at a European level and in Belgium as a case study. The tool consists of six different domains comprising the corporate nutrition strategy, food formulation, labelling, marketing, accessibility of (un)healthy products and relationships with other organisations.

Results

Preliminary results for Belgian companies based on publicly available information show a median score of < 30% and a maximum score of < 60% for comprehensiveness, specificity and transparency of commitments. Hardly any commitments are in place to increase accessibility to healthier products. Even though several commitments are made regarding advertisement towards children below 12 years, on average 36% of sales is for products not-permitted to be marketed to children (WHO) and 71% for products that are ultra-processed (NOVA). Throughout Europe, companies selling ultra-processed foods on average generate 85% (77%-90%) of their sales from ultra-processed foods of which 50% (35%-74%) is not-permitted to be marketed to children.

Conclusions

Even though many commitments are made, they are not sufficiently specific or comprehensive and do not link well with performance. To reach the goals set out by the Sustainable Development goals and to improve the food environment it is crucial to ensure that commitments don't get lost in translation, but are strengthened and transformed into results.

Key messages

Food industry players make several nutrition and health related commitments, but these don’t always translate into performance. The BIA-tool clearly distinguishes between the comprehensiveness, specificity and transparency of nutrition related commitments made by the food industry.
Low system quality and job strain hamper information system benefits in nursing
Authors: Gluschkoff K , Kaipio J , Hyppönen H , Vehko T , Karhe L , Lääveri T , Kaihlanen A , Saranto K , Heponiemi T
Published: October 2020

Background

Health information systems (HIS) have been widely adopted in nursing to increase the efficiency and safety of patient care. Previous studies have shown that low HIS quality is a barrier to obtaining such benefits from HIS use. The association between HIS quality and HIS benefits has not, however, been studied taking into account the characteristics of the work environment, such as job strain. This study examined the joint associations of HIS quality and job strain with the perceived patient care-related benefits of HIS use in nursing.

Methods

Cross-sectional survey data of 2707 Finnish registered nurses were used to examine the associations of two indicators of HIS quality (ease of use and technical quality) and job strain with the benefits of HIS use. Missing data were addressed with multiple imputation and linear regression was used to examine the associations. All analyses were adjusted for age, gender, and employment sector.

Results

Together with the covariates, HIS quality explained 14% to 20% of the variance in the perceived benefits of HIS use. The additional variance explained by job strain was only 1%. HIS quality in terms of ease of use interacted with job strain in predicting HIS benefits. Nurses who found HIS difficult to use and experienced high job strain reported the lowest benefits from HIS use. By contrast, nurses who found HIS easy to use considered HIS beneficial for improving patient care even if they experienced high job strain.

Conclusions

The results suggest that healthcare organizations should focus on ensuring good HIS quality to improve patient care through HIS use in nursing. Exposure to job strain may intensify the association between low HIS quality and lower patient care-related benefits from HIS use. HIS with good quality seem to improve patient care even in a high-strain work environment.

Key messages

Nurses who work with low-quality health information systems and experience job strain perceive the systems least beneficial for improving patient care. High-quality information systems, by contrast, are perceived to improve patient care even in a high-strain work environment.
A regional approach to climate and health adaptation in the Middle East
Authors: Negev M , Shaheen M , Hochman A , Khreis H , Levine H , Salah I , Alpert P , Georgiades P , Davidovitch N , Jaghbir M
Published: October 2020

Background

The Middle East (ME) is expected to be influenced by climate changes that will significantly affect human health. An increase in temperature and in the intensity, length and frequency of heat waves, alongside a decrease in precipitation, have been observed, and longer summers and shorter winters are expected. Population growth intensifies the stress on water and the ecosystem in an already sensitive region. Moreover, political conflicts intensify the vulnerability of the region's population and prevent cross-border collaboration and knowledge transfer. The aims of this talk are to: 1) present climate scenarios and potential health risks for the ME; and 2) present a regional inter-disciplinary collaboration that focuses on climate and health research.

Methods

To prioritize regional research directions, a group of climatologists and public health researchers from the ME and Europe convened in an expert workshop, which included a process of consensus-building regarding research priorities and potential collaboration.

Results

Associated health risks are mainly increases in morbidity and mortality due to heatwaves, and increases in potentially deadly vector- water- air- and food-borne diseases such as chikungunya, yellow fever and dengue fever, due to expansion of invasive species of mosquitoes. There are wide economic and infrastructure gaps among the region's countries, entailing different levels of preparedness. Countries also face multiple intra- and inter-country political conflicts and instability which further weaken their ability to adapt at the regional level. However, climate change has regional impacts which should be understood and mitigated at that level. Research priorities include spatio-temporal research on heat and health outcomes; regional surveillance of infectious diseases; and preparedness of health systems and pathways for collaboration among health agencies in the midst of a political conflict with an emphasis on vulnerable populations.

Key messages

Inter-sectoral and inter-disciplinary work is a known requirement for tackling climate change challenges. Structural changes are needed at both the local and regional levels to fulfill this vision. Political conflicts in the Middle East weaken the ability to adapt to climate change in a vulnerable region.
Impact of ambient temperature on mental health in Bern, Switzerland: a time-series study
Authors: Bundo M , de Schrijver E , Federspiel A , Luterbacher J , Franco O H , Müller T , Vicedo-Cabrera A M
Published: October 2020

Background

Previous studies suggest that people with mental disorders are more vulnerable to increased ambient temperatures (AT). In Switzerland, neuropsychiatric diseases contribute up to 35.1% of the total burden of disease. This burden could possibly increase in the future under current climate change scenarios, if no appropriate public health measures were implemented. However, there is lack of evidence on the impact of AT on mental health in Switzerland.

Objective

This study aimed to investigate the short-term association between AT and mental health hospitalizations in Bern, Switzerland.

Methods

From 1973 to 2010, we collected individual data on daily hospitalizations for mental disorders (71,931) from the University Hospital of Psychiatry and Psychotherapy in Bern. We used population-weighted daily mean AT for the canton of Bern derived from the 2.2-km gridded weather data provided by MeteoSwiss. We applied conditional Poisson regression with distributed lag linear models to assess the association and to account for delayed effects up to 3 days after the exposure. We conducted stratified analysis and by age, sex and diagnosis.

Results

The overall risk of hospitalizations increased linearly by 3.0% (95% CI: 0.0%, 6.0%) for every 10C°C-increase in mean daily AT. No differences in risk estimates were found across sex (3.0% in males (95% CI: 0%, 7.0%) and 4.0% in females (95% CI: 0%, 8.0%)) and age groups (≥ 45 years old: 4.0% (95% CI: 0%, 9.0%) and <45 years old: 3.0% (95% CI 0%, 7%)). Larger association estimates were found for schizophrenia (10.0%; 95% CI 4%, 16%), while no association was found for substance abuse (0.0%; 95% CI -7.0%, 6.0%).

Conclusions

Our preliminary findings suggest that increasing AT are associated with an increased risk in hospitalizations due to mental disorders in Bern. Specific public health policies should be urgently implemented in order to protect this vulnerable population sub-group from the challenges of climate change.

Key messages

Increased ambient temperatures are associated with an increased risk in hospitalizations due to mental health disorders. Specific health policies should be implement to protect mental health patients from the challenges of climate change.
Reducing inequalities in child health: a case study in an English local authority
Authors: Fairbrother H , Holding E , Powell K , Griffin N , Wistow J , Summerbell C
Published: October 2020

Background

Many health outcomes for children and young people in England, UK remain poor compared to international peers, with persistent inequalities across the country. Our study sought to understand, from the perspectives of local stakeholders, the key factors affecting the development and implementation of policy to improve child health and reduce inequalities.

Methods

We carried out a detailed case study in an English local authority area. Our fieldwork comprised: documentary review of local policies, observation of key strategic and operational meetings and semi-structured interviews with local stakeholders. We followed Jessop's (2016) approach in using specific policy areas and policies (mental health, obesity and the early years) as 'entry points' to understand the local context.

Results

First, and most importantly, there was an overriding consensus that local action to reduce inequalities in child health is hampered by a persistent unequal distribution of the social determinants of health. Second, local stakeholders highlighted the damaging impact of austerity measures and poverty in the UK, which, they argued, had impacted most upon the most vulnerable. Third, while national policies often provided a framework and incentive for local action, there was an emphasis on the importance of local knowledge and place-based approaches, developed through close work with communities.

Conclusions

Our study highlights the need for progressive policies to begin to reduce the uneven distribution of the social determinants of health to enable local stakeholders to make progress in tackling inequalities in child health. It emphasises the futility of funding national policies to improve child health and reduce inequalities in the context of greatly reduced budgets for local authorities. National policy should also facilitate the mobilisation of context specific knowledge, produced in conjunction with community members.

Key messages

Our work evidences the pressing need to address structural inequalities and adequately resource and facilitate work to reduce inequalities at a local level. National policy should facilitate the mobilisation of context specific knowledge, produced in conjunction with community members.
The Imola Active Breaks study: a new strategy in child public health to reduce sedentary
Authors: Masini A , Marini S , Gori D , Montalti M , Lanari M , Ceciliani A , Stagni R , Bisi M C , Tessari A , Dallolio L
Published: October 2020

Background

Physical inactivity is worldwide considered one of the biggest public health problems of the 21st century. WHO recommended in children, at least 60 minute of Moderate Vigorous Physical activity (MVPA) per day, but low percentages comply with guidelines. Considering that children spend many hours at school, classroom is the ideal setting to increase their PA. Active Breaks (AB) are a 5-15-minute bouts of PA led by the teachers during academic lessons. The aim of the Imola AB study is to implement a 1-year intervention based on AB (10min/3per-day) in primary school as a new strategy to reduce inactivity. We present the baseline results.

Methods

Quasi-experimental pre-post study in 6-10aged primary school children, in Imola(Italy).We evaluated PA level with Actigraph accelerometers: time (in minutes) spent in MVPA Weekly and Daily (W-MVPA; D-MVPA) and Weekly Sedentary behaviours (W-SB).

Results

We recruited 152 children: N = 110 in Active Breaks experimental group (AB) and N = 42 in control group (CG). Actigraph's analysis showed that 42,5% of children in the ABG vs 31.0% in the CG reach the WHO recommendation (p=ns). We investigated baseline differences between groups using ANOVA dividing children by grade. In 3-4 grades: W-MVPA (AB = 318.3±15.5 vs CG = 310.4±98.0 p = 0.78); D-MVPA (AB = 53.0±20.3 vs CG = 51.8±16.3 p = 0.79);W-SB (AB = 6,687.5±375.3 vs CG = 6,754.7±281.0 p = 0.45). In 1grade: W-MVPA (AB = 376.1±127.9 vs CG = 300.3±120.0 p = 0.02); D-MVPA (AB = 62.7±21.3 vs CG = 50.0±20.0 p = 0.02); W-SB (AB = 6,436.0±496.0 vs CG = 6,373.3 ±1,532.0 p = 0.7).

Conclusions

Only the 39.2% of the total sample met the 60-minute/day of MVPA recommended. We found no significant baseline differences in PA level measured by Actigraph between CG and AB, excepted in 1 grade. The intervention implemented in the Imola AB study could be a good strategy to reduce sedentary in children and reach the WHO recommendation, thus contributing to the aims of the new Global Action Plan on PA 2018-2030.

Key messages

Less than 50% reach the WHO recommendations of PA. AB implemented in the Imola Study could be a public health school-based strategy to reduce sedentary and increase healthy behavior in children. Active breaks (AB) are emerging as a good strategy to increase the PA level, reducing the time in sedentary habits.
Promotion of water consumption in elementary schools: evaluation of the 'H2NOE Water Schools' program
Authors: Griebler U , Titscher V , Affengruber L
Published: October 2020

Background

Children often do not drink enough water. Consumption of water is associated with several health benefits, including prevention of overweight and reduction of dental caries. Drinking water can also improve children's attention and memory and sufficient water intake is important especially during the school day. A pilot programme to increase the tap water consumption of elementary school children started in 2018 - the “H2NOE Water Schools” in Lower Austria programme. The intervention schools received a free water bottle for each child, an information workshop for teachers and teaching materials.

Methods

In an intervention study with a control group in a before-and-after design we examined whether the “H2NOE water school” can lead to a change in the drinking behaviour of the pupils. All children of the 3rd grade in the 22 intervention schools (IG) and 32 control schools (CG) were surveyed using a paper-pencil questionnaire in autumn 2018 and in June 2019. We used multi-level analyses taking into account clusters at class level to analyse the beverage consumption data.

Results

In total, data of 1242 students were available at baseline and 1164 students at the end of the intervention. The consumption of tap water per day improved in both groups in a similar way: in the IG from 4.1 glasses (95% CI 3.8-4.3) to 4.7 (4.5-5.0) and in the CG from 3.1 glasses (95% CI 2.9-3.4) to 3.9 (3.6-4.2). Soft drink consumption remained stable in both groups, but juice consumption decreased in the IG compared to the CG.

Conclusions

The children in the intervention schools drank more tap water after 1 school year with the intervention than at the beginning. However, this was also evident in the control schools. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects in these schools. The different seasons of the measurement (autumn and early summer) could have an influence on the results.

Key messages

A school-based intervention providing free water bottles improved the water consumption of elementary school children. The mere measurement of beverage consumption in the control schools also resulted in increased water consumption.
Effects of neoliberal rationality on Brazilian Public Health System recent policies and discourses
Authors: Sater De Andrade H , Resende Carvalho S , Freitas de Oliveira C , Ravelli Cabrini D
Published: October 2020

Background

We analyzed the increasing penetration of neoliberal rationality in recent changes of Brazilian Public Health. We seek to observe if these different discourses and organizational changes represent a lack of accountability for public power and put in risk universal access through a paradoxical defense of equity principle.

Methods

We performed a discourse analysis of 8 technical documents published by the Ministry of Health from 2016 to 2019 as well as different 5 interviews made with and 6 articles signed by its minister and secretaries. This period comprehends an interim government formed after a controversial impeachment process and the new Ministry staff named after Bolsonaro's election.

Results

We studied different perspectives of neoliberalism that have been seeking for the last years to untangle the concept of neoliberalism. Inspired by Foucault's thoughts, neoliberalism is understood here beyond as a complex transformation of government paradigms that produces very narrow models of individual freedom and subjectivity and that considers private entrepreneurship as naturally superior to state actions commonly described as inefficient and costly. Often justified by a literature characterized as scientific, we understand that recent Brazilian Public Health formulations have been emphasizing equity to the detriment of universality and overestimating public-private partnerships and private management logic as positive solution for public policies and a prioritization of healthy lifestyle and risk management based on individual and moral autonomy over the role of the State of intervention on health social determinants.

Conclusions

Recent public speeches and technical documents of Public Health in Brazil at the federal level have been influenced by a neoliberal rationality. These changes require more accurate methods to unravel neoliberalism meanings and practices and preserve hard-won social rights during the re-democratization of Brazil.

Key messages

Neoliberal rationality of recent Brazilian Public Health discourses represents a lack of accountability for public power and a risk to health universal access. These changes require more accurate methods to unravel neoliberalism meanings and practices and preserve hard-won social rights of our public health system during the re-democratization of Brazil.
Out-of-pocket funding of medical services among older adults
Authors: Tur-Sinai A
Published: October 2020

Background

The current composition of Israeli private funding is inconsistent with the principles of the State Health Insurance Law. According with the aging process, this study identifies and investigates the predictors of out-of-pocket (hereinafter- OOP) funding of medical care and healthcare among the 50+ population. Its three objectives are to profile the healthcare services for which older adults pay out of pocket, profile the older adults who pay OOP for medical services and detect changes over the years, and identify predictors of private healthcare service funding by older adults.

Methods

The study is based on the SHARE-Israel database. Relating to longitudinal information yielded by the SHARE-Israel, it sheds light on the characteristics of those who reported having paid OOP for medical services.

Results

A large majority of the 50+ population in Israel that consumes healthcare services is asked to pay for them out of pocket. Their average age is sixty-seven. Possession of supplemental health insurance coverage, state of health and changes in it, and economic resources are found to have the strongest effect on the probability of OOP funding. The motive of financial and/or social support that older adults receive from and/or give to their immediate surroundings makes it more likely that they will pay OOP for healthcare services. The decision on whether to pay out of pocket in advanced age is positively dependent on age but negatively dependent on level of education. The probability of OOP funding varies between Jews and Arabs and between non-immigrant Jews and recent-immigrant Jews from the former Soviet Union.

Conclusions

The share of OOP funding of healthcare in older adult households' total annual income is trending upward. The funding of older adult healthcare services in Israel is marked by inequality. Furthermore, economic motives are central in determining whether older adults' out-of-pocket expenditure on healthcare services will stabilize over time.

Key messages

The funding of older adult healthcare services in Israel is marked by inequality. Economic motives are central in determining whether older adults’ out-of-pocket expenditure on healthcare services will stabilize over time.
Introduction
Authors: Rae M
Published: October 2020

Introduction - A leader of leaders: History of the Faculty of Public Health, its work in developing a mature established public health system and systems leaders in changing times.
Case for rethinking system leadership and its development in public health
Authors: Smith T
Published: October 2020

Background

There is growing recognition of the importance of leadership in Public Health (PH) practice, and the need to embed it into the education and training of PH professionals. However the theoretical discourse within leadership research has changed significantly and there is recognition that previous conceptualisations of leadership, and our ways of developing it may be flawed, and need to be changed in practice.

Objectives

This presentation will discuss development of leadership theory, and system leadership. In particular it will highlight how System Leadership differs from previous understandings of leadership and the implications of this for ph practitioners and those charged with developing system leadership capacity within public health.

Body of the session

Leadership in organisations is mostly focused on current/anticipated internal challenges (strategy, performance management, staff engagement, etc.). Leaders are generally developed via individual leader development rather than a focus developing Leadership capacity across organisations/systems. Within PH it is increasingly realised that single organisations can no longer respond effectively to the “wicked” issues they face. They do not possess sufficient know-how to address the complex and multi-dimensional problems faced, so leadership models based on a single hierarchical organisation are not sustainable. There is a need to work collectively in an ecosystem-based approach (not an ego-based system). System Leadership development requires that participants are actively engaged in real attempts to improve PH System. Development requires that underlying values are made explicit, explored and diversity embraced. The emphasis will be on supporting learners in the doing rather than critiquing or talking about it.

Conclusions

There is need to appreciate fully the nature of systems leadership, together with implications for PH practice and the development of system leadership capacity throughout the PH workforce.