bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescription of physical activity: expectations of patients consulting in primary care in Yvelines
Authors: Astruc A , Kanso C , Blanchard J C
Published: October 2020

Background

Since 2016, French law has allowed general practitioners to prescribe adapted physical activity (APA) to patients with long-term health conditions. Studies have demonstrated that physicians are interested in this practice but very few have surveyed patient expectations.

Objective

The objective of this work was to study patients' expectations regarding the prescription of APA.

Materials and Methods

This is a quantitative descriptive study treating data obtained from a survey carried out in general practice offices in the department of Yvelines between June and September 2019. The inclusion criteria for patients were: above 18 years old and present in the waiting room.

Results

252 patients were surveyed in 9 doctors' offices. We received 90 % of responses. Prescription of APA is a good idea for 95,2 % of patients, 80,2 % were motivated to join an APA program and 67,4 % thought that prescription of APA would increase their motivation. The main constraints to physical activity practice were lack of time (59,9 %) and lack of motivation (31,7 %). The main practices that would help patients to better adhere to an APA program were group sessions supervised by a professional (64,7 %) pursued by a follow up with their doctor (41,7 %). 53,2 % of patients considered that it would be important to monitor their physical activity through a connected device. Factors independently associated with the motivation to participate in the APA program were a female gender (p < 0,01), a bachelor's degree (p = 0,01), a general opinion that prescription of physical activity is a good idea (p < 0,01).

Conclusions

Our results revealed an enthusiasm with patients for APA prescription, which is interesting for the promotion of PA in general medicine.

Key messages

Our results revealed an enthusiasm with patients for prescription of physical activity. Prescribing physical activity to patients seems to be an innovative way to promote physical activity.
Theory to practice: How the City of Utrecht develops a Health and Equity in all Policies approach
Authors: Weber M , Droomers M
Published: October 2020

Introduction

We witness an increase in Health in All Policies approaches worldwide. In Utrecht this inter-sectoral and multi-level governance approach is strong since several years. Utrecht has made progress in linking spatial challenges with social challenges, aiming for healthy urban living for all. An example is social renovation, in which social housing corporations combine physical renovation with social programs in Overvecht, the most socio-economically deprived neighbourhood in Utrecht. The project addresses social determinants of health, such as income, education and employment, and subsequently improvement of health of the residents.

Methods

In April 2020, social renovation of an apartment building of around 180 households will start. During the exploration phase, community workers carry out door-to-door visits. This forms the basis for community development activities and provides the possibility to refer residents directly to professional assistance. After one year, the actual renovation starts. Following, new residents are purposely selected and assigned to the newly renovated flats that have been vacated during the process.

Results

Impact of the social renovation process on health and health determinants will be evaluated. The door-to-door visits are used to interview the residents about their wellbeing, stress, mental and physical health condition, sense of mastery, financial problems, perceived safety, and social and physical living environment. Interviews will be repeated during the community development phase (after six months), and just before the start of the physical renovation (after one year).

Discussion

Social renovation aims to contribute to and preferably improve residents' personal living conditions and social living environment, instead of just improving their housing conditions. Lessons learned from this process will inspire replication and upscaling in other neighbourhoods.
Tackling antimicrobial resistance in the community
Authors: Tonkie-Crine S , Abel L , Van Hecke O , Wang K , Butler C
Published: October 2020

Antibiotic prescription is a major driver of antibiotic resistance. The majority of antibiotic prescribing occurs in community care settings, often for respiratory infections. A substantial proportion of prescriptions are issued not according to guidelines, particularly for acute respiratory infections which can be self-limiting. Prescribers in these settings need support to prescribe antibiotics more prudently. Patients and the public also need support to manage infections which are self-limiting. This presentation presents a summary of how antimicrobial stewardship (AMS) activities are being used in community settings. Firstly, types of community-level interventions are discussed, including those aimed at clinicians, patients and the public. Next, we assess interventions based on their effectiveness at reducing antibiotic prescriptions or use and their cost-effectiveness. Finally, we discuss directions for future research and consider how the research to date could influence policy.
25.K. Workshop: Unleashing the power of large routinely collected data for the benefit of public health
Authors:   Organised by: EHESP (France),   Chair persons: Olivier Grimaud - France, Alastair Leyland - UK
Published: October 2020

As for many other scientific domains, public health is nowadays contemplating the opportunities of using but also the challenges of mastering large routinely collected data ('big data') in order to generate knowledge, and to inform and evaluate decisions and policies. In a wide perspective, “public health relevant big data” extends from the “omics” to social network postings.

In this workshop we will concentrate on electronic health records and medical claims data (hereafter referred to as eHRs) which are increasingly being used in public health research and practice. Depending of the national and historical contexts, eHRs encompass details pertaining not only to hospital admissions but also to deaths and infectious diseases registrations, prescriptions and contacts with health services. As a result, eHRs datasets are both long (ie, vast number of records) and wide (i.e., vast amount of information per record). Although the usual public health and epidemiological concepts of inference and causation are still relevant for the analysis of big health data and interpretation of their results, a new set of methodological approaches is also necessary to tackle them. These include for instance quasi-experimental/natural experimental analysis, data mining and machine learning. Recent reviews have demonstrated that these data science terms have corresponding concepts in public health research. This workshop will discuss the use of large routinely collected data in public health with a specific focus on eHRs. The objectives are: to understand the specificity of eHRs in the wider domain of big data; to discuss the challenges imposed when using such data (e.g., data heterogeneity, fragmentation, handling, access, privacy), to discuss how the analysis of big data can assist public health researchers, evaluators and policy-makers; to discuss their advantages and limitations; to outline the methodological, legal and ethical challenges that this entails. Following a brief introduction, the workshop will continue with 5 presentations drawing from a variety of national contexts. The spectrum will spread from countries where eHRs and data linkage have been applied for some years (e.g., Finland, Singapore), to others where development are more recent (France) or even being initiated (Brazil). Together, the presentations will address issues related to the development of big data set, access and training of users and implementation in public health research and practice. The remaining time will be dedicated to interaction with the audience and conclusion.

Key messages

Access and use of big data in the context of public health practice and research is spreading fast. The challenges ahead consist of maintaining and securing vast amount of heterogeneous health and related data, and in building the capacity to analyse them using old and new analytical approaches.
French Health big data experience: The evolution of the national health insurance information system
Authors: Le Meur N , Gao F
Published: October 2020

The French national health insurance information system created in 1999 is one of the largest global data warehouse of medico-administrative data, covering nearly 66 million inhabitants and containing more than 160 billion records, including all outpatient health expenditures. Recent legislation has enlarged the scope of information and access to the data warehouse. Initially created to reimburse patients, the national health insurance data warehouse has developed into a powerful tool for conducting public health research.

Public health researchers and epidemiologists have long studied population health determinants, including access to and impact of health care interventions, through hypothesis driven investigations based on experimental (randomized controlled trials) or quasi-experimental designs (e.g. cohort or case control studies). In such studies, efforts are centred on data validity rather than scope or volume. Nowadays the availability of medical claims and electronic health records (eHR) allows users not only to address similar research questions at no or little cost for data collection, but also to extend the scope of research questions to the analysis of care pathways, the evaluation of public health policies, the impact of interventions in real-life conditions.

Striding away from the conventional hypothesis driven research paradigm, public health researchers have started exploring the power of applying data mining approaches on eHR. As demonstrated in the omics revolution, data driven approaches are discovery-generating tools with explanatory and predictive power. Could data mining methods applied to eHR deliver similar breakthroughs in Health Services Research? What new knowledge and tools must the public health research community acquire to embrace this new research paradigm? These are the issues that we will discuss, with illustrations, during this presentation.
The national strategy for suicide prevention in the Netherlands: on the road to zero suicides
Authors: Franx G
Published: October 2020

Background

In the Netherlands, 1829 persons (11.6/100.000) ended their life by suicide in 2018. Two out of three suicides concern men, most of them in the age group of 50-55. Suicide amongst youth is rising, especially amongst youngsters between 10-25. Around 40 persons a day, predominantly young and female, are treated in Dutch hospitals after having attempted suicide. Only 40% of those who die by suicide have been in touch with healthcare professionals. These figures made the Dutch government to put in place a national strategy for suicide prevention.

Methods

This strategy follows the WHO's guidance and covers a range of measures in public health as well as in the health care sector. Its implementation is coordinated by “113 Suicide prevention”, the national centre of expertise on suicide prevention in the Netherlands.

Results

A broad package of measures is being implemented simultaneously, targeting the entire population as well as specific vulnerable groups, such as youngsters, persons with LGBT related issues and persons with mental health needs. We initiated several collective preventive measures, such as media guidelines for safe reporting, a public awareness campaign against stigma, reduction of access to deadly means or places; selective prevention initiatives, e.g. training over 3400 of gatekeepers to detect and address suicidal thoughts with desperate persons; and indicated suicide prevention strategies including screening, treatment and follow up of patients with suicidal behaviour in general practice or mental health hospitals. In this presentation the different components of the Dutch strategy for suicide prevention will be described more in detail, and experiences and first results of the different components will be addressed.

Conclusions

The relevance of the Dutch national strategy is related to the broad package of measures implemented simultaneously in many domains of society, but closely monitoring and evaluating the effect stays challenging.
Suicide prevention in Slovenia in the context of public health
Authors: Roškar S , Vinke M
Published: October 2020

Background

Suicide mortality in Slovenia has decreased with 30% in the last two decades, from 28,25 per 100,000 in 2003 to 17,08 per 100,000 in 2018. Nevertheless, the country's suicide rate remains markedly above the EU average. Only from March 2018, Slovenia has a National Strategy for Mental Health 2018-2028, with one of the priority areas being suicide prevention and a strategic goal of decreasing suicide mortality by 15% in the next 10 years.

Methods

Specific objectives are aimed at (i) raising of mental health awareness and literacy, particularly in relation to suicide, (ii) early identification of people at risk, (iii) access to help and mental health provision for people at risk of suicide, (iv) reduction in alcohol use, (v) restriction of access to the means of suicide.

Results

Many of suicide prevention initiatives in Slovenia are being implemented on the local, regional, and national level. They include universal and targeted approaches such as collaboration with different gatekeepers (e.g. general practitioners, first responders, school workers, media), screening programs for at risk individuals at the primary health care level (e.g. PHQ-9), network of psychological counselling services, etc. Two interventions will be presented in more detail, namely (i) collaboration with media representatives on responsible reporting on suicide (a 'pre-post' comparison of reporting revealed statistically significant improvement in 6 out of 10 guidelines) and (ii) a population screening for depression and referral program for individuals aged > 35.

Conclusions

The aforementioned decrease in suicide mortality, timely coincides with the launch of multiple preventative activities. Even though further sound research is necessary to confirm a statistically significant relationship between the observed decrease and these preventive initiatives, it is probable that these actions contribute to the stagnation (and even decline) in the suicide rate in our country.
Practical lessons learnt from the worldwide implementation of 115 community-based interventions for suicidal prevention
Authors: Hegerl U
Published: October 2020

Background

Depression and other psychiatric disorders are the main cause for suicidal behaviour. The community based 4-level-intervention concept adapted by the “European Alliance against Depression” (www.EAAD.net) has been found to have preventive effects not only on depression but also on suicidal behavior in several but not all controlled studies. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric care givers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and their relatives (level 4).

Methods

This 4-level intervention has in the meanwhile been implemented in more than 115 regions worldwide. A systematic assessment of the practical experiences, as well as a systematic process analysis and an implementation research were performed.

Results

Important findings of this research are: i) the relevance of a strong bottom-up element in the implementation process, ii) the synergistic and catalytic effects generated by becoming simultaneously active at the four different intervention levels, and iii) the crucial advantage of combining the partly overlapping topics of depression and prevention of suicidal behaviour. The latter approach is highly relevant having in mind the unclear risk-benefit-balance of anti-suicidal public campaigns, which are likely to result in a lowering of the threshold by normalization of suicidal behavior. More detailed information on these findings will be presented.

Conclusions

Systematic research on the on-going community based 4-level intervention program can add useful insights in suicide prevention strategies.
25.M. Workshop: Improving migration health information systems: Task-Force for facilitating action
Authors:   Organised by: University of Pecs (Hungary),   Chair persons: Kayvan Bozorgmehr - Germany, István Szilárd - Hungary
Published: October 2020

Health information systems have not kept up with the demands and needs created by the sharp rise in human mobility over the past three decades. Most health information systems operate in national silos, and fail to provide a fully accurate, reliable and timely picture of the health and health care situation of a world on the move. As such, health needs of a large number of international migrants go unrecognized, and health systems fail to produce the evidence required for migrant-sensitive service planning, monitoring and public health action. The generation of such essential evidence relies on the inclusion of migrant health in health information systems in a consistent, comparable and ethically acceptable manner. A high-level consensus conference in Pecs (October 2019) noted the need for greater harmonisation and international cooperation on migrant health information systems, including data collection, analysis and dissemination. Taking the status quo of health information systems as a starting point, the workshop aims to present steps towards health system reforms which make information systems more sensitive and responsive to the health needs of increasingly mobile human populations. To this end, the workshop brings together researchers, policy makers and health professionals from different fields and institutions, to share existing knowledge, and by jointly exploring the following questions: What measures can we take to facilitate the harmonisation of migrant health indicators and data collection methods to ensure cross-border comparability, compatibility and completeness of data?How can we effectively improve international cooperation and governance of data management in order to share and transfer data for reasonable analysis, advocacy, and action?How can we initiate health systems reforms towards the above aims, considering that health systems are complex adaptive social constructs which are often resistant to change and not linear?What ethical and data protection considerations must be made when collecting, analysing and sharing migrant health data?How can build the required human resource capacities?

Key messages

Evidence based development of ‘migrant sensitive health care system’ requires specific, consistent and comparable health data Health systems harmonization on the field of migration requires supportive policy, guidance, infrastructure and trained human resources
Availability and integration of health data on refugee and migrants in health information systems
Authors: Bozorgmehr K , Jahn R , Biddle L , Rohleder S , Puthopparambil S
Published: October 2020

This presentation discusses the findings of a Health Evidence Network synthesis report on availability and integration of refugee and migrant health data in health information systems in the WHO European Region. Based on an analysis of 41 full-text studies and 696 abstracts, the report found that refugee and migrant health data were available in less than half of the Region's Member States, and that data availability and integration, data collection systems, as well as indicators on migration varied markedly between states. From these findings, the report derived key policy considerations regarding the strengthening and harmonization of migrant health data collection, as well as governance and monitoring of health information systems.
Aim and purpose of Consensus Conference follow up Task-Force
Authors: Szilárd I
Published: October 2020

Background

Experts of the high-level Consensus Conference (Pécs, 7-8 October 2019) agreed that there is a need for greater harmonisation and international cooperation on migrant health information systems. In order to facilitate the realization of this goal the formation of a multi-stakeholder scientific task force (TF) was proposed.

Objectives

The Consensus Conference Follow up Task-Force is an informal, voluntary scientific body, aiming to assist and facilitate the realization of the Statement of the Conference. More specifically: Calling the attention about the needfor reliable, migrants/migration related health, public health and occupational health data;for the harmonisation of the migrants/migration related health information systems;for the establishment of international cooperation;Design and work out unified definitions and technical guidance on taxonomy and methodologies of data collection;Facilitate and assist both individual researchers' and teams' endowers for the international harmonisation of target group variables and indicators in order to ensure comparability of data;Call the attention for and initiate the establishment of a European level migrant health database, and provide scientific and technical assistance for its realization.

Results

The WHO Collaborating Centre at the University of Pécs Medical School (UPMS) has offered to coordinate this initiative, worked out the Terms of Reference (ToR) of this new body and asked the leading international organizations and individual experts to participate in the work of this innovative endower. WHO, IOM, ECDC and the European Union Agency for Fundamental Rights has appointed delegates and twelve experts joint to the initiative. On 11 February an internet-based conference was organized where participants approved the ToR and with consensus Prof. Dr. Kayvan Bozorgmehr has been elected for president. UPMS runs its secretariat. The work plan of the TF will be presented during the conference.
Regulations and fiscal policies
Authors: Neveux M , Allais O
Published: October 2020

The food environments in which people develop their dietary behaviour and make their food choices have significant influence on what they purchase and, in turn, what they eat. Food prices, food labelling and food marketing are one of the determinants of food choices. They influence, to a certain degree, what and how much food people buy, and policies based on these determinants have been effective in promoting desirable dietary changes. However, these assessments of dietary changes have been exclusively conducted at the adult level, and not at children level. What are the impacts of such policies on children's overall diet? Do these effects substantially differ between European countries? To answer these outstanding questions, the work package will conduct a contextual review looking at (i) fiscal policies (food and non-alcoholic beverages), (ii) the regulation of food labelling and (iii) the regulation of the marketing of food products to children.
Evaluation of a digital health gamification platform with older adults: An observational cohort study with a pre-test/post-test design
Authors: Hurmuz M , Jansen-Kosterink S M , van Velsen L
Published: October 2020

Background

Older adults are usually less physically active than younger adults. Physical inactivity can lead to frailty, which can increase the possibility of being admitted in a hospital and, being functional limited. To handle frailty Stranded is developed. Within this platform the user will be shipwrecked and has to build a boat to leave an uninhibited island. The user can leave the island by executing physical exercises and playing cognitive games. The primary aim focussed on differences in quality of life and perceived health status after using Stranded (TRL7). The secondary aim focussed on the usability of and user experience with Stranded. This study was conducted within the FRAIL-project (Eurostars-2 10.824).

Methods

An observational cohort study with a pre-test/post-test design was carried out. The pre-test measurements were performed before the use of Stranded, and the post-test measurements after using it for four weeks. The study population consisted of older adults, 55 years of age or older and each subject signed an informed consent form.

Results

One hundred and eleven older adults were included in this study (64.9% female and 35.1% male) and 91 participants started using Stranded. In total, 59 subjects dropped out. Two health variables significantly increased (n = 52), the subjects' perceived health state on a visual analogue scale and the subjects' quality of life viewed from the positive health perspective. Stranded's usability scored an average of 61.3 (SD = 21.6). The average scores on the user experience domains were all between 3.3 and 3.9 on a 7-point scale. The subjects did not have a strong negative or positive opinion about these domains.

Conclusions

The average quality of life increased slightly. It is hard to find an appropriate population to investigate the effects of these innovations, because of not willing to include too frail older adults for whom participating could be intensive. The usability was perceived as acceptable.
HESRi potential for action
Authors: Brown C
Published: October 2020

Resolution on Health Equity (EUR/RC69/R5) puts equity, gender equality, human rights and social determinants as high priority for action of all 53 WHO EURO Member States (MS) and partners. The resolution was unanimously adopted following a year of extensive consultation and dialogue with MS and partners: NGOs, scientific community, professional associations and UN and bilateral agencies. WHO scientific leadership role in health equity in EURO was key to success as it brought forward innovations in health equity analysis and solutions which were also presented and debated at the high-level regional conference. Together with member states WHO is now developing Health Equity Solutions Platform to connect innovative life policy sites with the latest available evidence and practical tools to accelerate development of solutions. New narrative, set of tools and innovative methodology in data analysis were taken up globally, represent a model for the global report on health inequities and feed into global strategy on social determinants of health.
HESRi country impact and uptake in Slovenia
Authors: Gabrijelčič Blenkus M
Published: October 2020

Equity and solidarity are strongly embedded in Slovene society from the second half of the 20th century on. Questions, exploring equity issues date in 1964, as a part of the Slovene Public Opinion (SPO) Survey. Slovenia is reporting on health equity and wellbeing in three strands. The first one is regular Human Development Report, based on Slovene Development Strategy since 2007, delegated partially to Institute of Economic Research (IER). Second one is regular Inequalities in Health Report, led by National Institute of Public Health (NIPH), and based on the National Health Strategy, since 2011. The third one is regular Poverty Report, led by Institute of Social Protection (ISP), based on the decision of the Parliamentarian Commission for Health and Social Affairs in 2013.

NIPH comprehensively reported on Inequalities in Health in 2011, at that time based on direct measures of socio-economic status (SES) like education, or indirect measures or indexes (as development index or deprivation index of the municipality). In the second, 2018 report, several developments enabled for reporting health equity gap based on the individual SES status and first few cases of policy influences on equity status were described. In line with the WHO Rio SDH declaration 2011, in the third Health Equity Report, planned for 2021, further shift is foreseen and focus will be given to the policies influencing the equity gaps.

For the 2021 Health Equity Report for Slovenia, three national key institutions (NIJZ, IER and ISP) decided to work together, based on the established multisectoral competences. WHO HESRi was developed and launched in best possible timing for the Slovene national initiative, to provide the international support, insights and facilitate further national development. Slovene priorities will be defined according to the national interests, Slovene presidency to EU in 2021 and Country Specific Recommendations in the frame of the European Semester.
Migrants and refugees’ children’s role in promoting the family health literacy in second language courses
Authors: Harsch S , Bittlingmayer U
Published: October 2020

Background

Recent research on health literacy (HL) stresses the importance of the social context for children's HL, especially among vulnerable groups such as migrants and refugees. However, reaching migrant is difficult, so experts recommend adult second language courses (SLC) as promising settings to promote HL of migrants and their families. Yet, empirical evidence of promoting family health literacy (FHL) in SLC is scarce. The project SCURA, funded by the German Federal Ministry of Education and Research, therefore aimed at exploring how FHL is addressed in SCL and to develop an FHL promoting intervention.

Methods

We conducted a mixed-method study, including a scoping study on empirical evidence of HL in SLC (N = 17), analyses of international curricula (N = 22) and of German textbooks (N = 24), participant observation in two SLC (100 hours), expert interviews (N = 15) triangulated the findings and conceptualized an FHL intervention.

Results

Whereas health is a preferred topic in SLC because it is interesting, and engaging and included in the standard SLC curricula, FHL is rarely targeted and not defined. Qualitative data reveal a vast scope of FHL related occasions offering possibilities to improve parents' health knowledge, communication skills and health literacy. Based on the results, we developed and implemented a multi-modal diversity sensitive FHL program, integrated into SCL, that targets

parents' and children's physical, mental and social health topics, promotes FHL, and empowers migrant families to make good health decisions within their new context.

Conclusions

Currently, standard SLC rarely target FHL in the curriculum, but FHL topics are informally discussed. Hence, training teachers to use the upcoming FHL topics to teach the second language is a win-win-solution for it achieves both aims: increasing HL and language skills.
NCDs, gender, intersectionality and the World Health Organization
Authors: Somerville C
Published: October 2020

Claire Somerville, PhD (Gender Centre, Graduate Institute of International and Development Studies, Geneva) will present research that investigates how gender and intersectionality analysis of NCDs is integrated into different levels of health policy and programming and within country level health systems and services by the World Health Organization (WHO). The research is the first of its kind and is based on a WHO document analysis and key informant interviews with key representatives working on issues of gender and NCDs within WHO. The findings of Somerville's investigation reveal how gender and its intersections is understood and mainstreamed at all three organizational levels of the WHO (headquarters (HQ), regions, and country level offices) and what the key impediments are not only in terms of mainstreaming a more relational and intersectional understanding of gender in general, but specifically in relation to NCDs.
Tailored intervention with peer-to-peer as a tool to promote childhood vaccination in migrants
Authors: Jama A , Godoy-Ramirez K , Byström E , Burström B , Roth A , Lindstrand A , Kulane A
Published: October 2020

Background

A tailored intervention about childhood vaccination in Stockholm, Sweden, has focused on different activities with the aim to improve vaccination confidence and in particular Measles, Mumps and Rubella (MMR) vaccination coverage. The intervention included provided peer education focusing on vaccination information, the vaccine-preventable diseases, child development and communication skills in Somali and Swedish language and for the peers to further inform other parents in their communities.

Aim

This study aims to explore peers’ experiences of the interventions and their role to promote vaccination confidence.

Methods

This study follows a qualitative methodology with in-depth interviews and the data collection is ongoing. The study participants consist of seven peers who participated in the program. The interviews aimed to explore how the peers used the training in real life. All interviews conducted were tape-recorded and transcribed verbatim in order to facilitate deep content analysis. The analysis followed a content analysis, by first coding the data and then developing categories and emerging themes.

Results

Preliminary findings show that peers expressed the importance of having a training that equipped them with knowledge and confidence to discuss fact-based information with hesitant parents. The peers shared that after the training they had several opportunities to talk about childhood vaccinations in particular MMR vaccination with other parents. Some peers took an active role in reaching other parents by utilising the film and the cards to facilitate their dialogue. Other also acknowledged that when they could not answer a specific question, they encouraged the parents to address the query with the child health clinic nurses.

Conclusions

The use of a peer-to-peer concept to increase vaccination confidence provides additional forums for parents to dialogue about their concerns and receive correct vaccination information.

Key messages

Tailored interventions in close collaboration with communities are crucial for sustainable improvements of vaccination acceptance and coverage. The peer-to-peer concept provides a new arena to reach vaccination hesitant parents and can complement the communication on vaccination from health care provides.
Physical activity and body weight of breast cancer survivors – VICAN national survey
Authors: Rey D , Touzani R , Monet A , Bendiane M K , Bouhnik A D , Mancini J
Published: October 2020

Background

Cancer recurrence and poor quality of life are major challenges of the growing population of breast cancer (BC) survivors. International guidelines encourage survivors to engage in regular physical activity (PA) and to maintain a healthy body weight (BW), as both have a proven benefit on survival. Our aims were (1) to describe PA and BW 5 years after a BC diagnosis and (2) to define the predictors of long-term engagement in healthy lifestyle, in a representative sample of French survivors.

Methods

The French National VICAN surveys were implemented in 2012 and 2015 among cancer survivors. This analysis focused on 723 women with BC, without progression at 5 years, and who participated in both surveys. The questionnaires dealt with several topics including socioeconomic status, treatments and side effects, psychometric scales and lifestyle habits.

Results

Five years after diagnosis, 26% of women reported regular PA, 61% occasional PA and 14% no PA. Moreover, 27% reported a weight gain ≥5kg, and 10% a weight loss ≥5kg. Half of the women had decreased or stopped PA since diagnosis. In logistic regression, long-term regular PA was associated with better mental quality of life (aOR=1.04; 1.01-1.07), no depression (aOR=3.42; 1.21-9.65), higher Post Traumatic Growth Inventory score (aOR=1.02; 1.01-1.04), normal arm mobility (aOR=3.7; 1.6-8.4) and healthy and stable BW since diagnosis (aOR=4.47; 1.61-12.37). Weight gain ≥5kg was associated with younger age (aOR=0.96; 0.93-0.99), higher BW at diagnosis (aOR=1.02; 1.01-1.04), and lymphedema 5 years after diagnosis (aOR=1.69; 1.02-2.83).

Conclusions

For BC survivors, mental well-being is essential for successful long-term investment in healthy habits. More psychological and dietary support, and a better management of sequelae are needed in this population.

Key messages

For breast cancer survivors, mental well-being is essential for successful long-term investment in healthy habits. More psychological and dietary support, and better sequelae management are needed to help breast cancer survivors to persist in healthy lifestyle.
A health inequality impact assessment of leveling down overweight and obesity
Authors: Bender A , Sørensen J , Diderichsen F
Published: October 2020

Background

Social differences in the proportion of overweight and obesity have increased in recent decades. Health impact assessments provide population-level valuations of changes in disease prevalence related to scenarios with different risk factors levels. These scenarios can be focused on reducing overweight and obesity among people with low socioeconomic position.

Methods

This study included the projected population of Copenhagen, Denmark in year 2040 (n = 742,130). Using the DYNAMO-HIA tool we conducted a health inequality impact assessment. Future prevented disease prevalence (IHD, diabetes, stroke, and multi-morbidity) and change in life expectancy related to an equalized scenario were estimated in a scenario where the prevalence of overweight/obesity (OWOB) in the group of people with short and medium educational attainment was reduced to the levels of people with long education.

Results

A higher proportion of people with short and medium education were OWOB than among people with long education and they had higher prevalence of cardiometabolic diseases. The diabetes prevalence among people with short education was reduced by 8-10% for men and 12-13% for women and life expectancy with diabetes decreased by one year in the group of women with short education. No notable effect of the equalized OWOB was seen regarding life expectancy with and prevalence of stroke and IHD.

Conclusions

Reaching the low prevalence of OWOB observed among people with high educational level, will reduce future cardiometabolic disease, increase life expectancy and meanwhile reduce the social inequality in health. These findings can serve as relevant references points for public health planners.

Key messages

This study is the first to combine advanced mathematical modelling and population data to assess changes in health from reducing socioeconomic inequality in obesity and overweight. These results propose valuable reference values for outcome assessments of interventions on inequalities in health.
Leisure-time physical activity among adults in Estonia 2000 − 2016
Authors: Pärna K , Mikk M
Published: October 2020

Background

Leisure-time physical activity (LTPA) can be an effective tool in the prevention and treatment of the majority of noncommunicable diseases, which are the leading cause of death worldwide. Therefore, the knowledge on the level and trends of LTPA is an important task for the public health sector and enables identification of adults at high risk of hypokinetic diseases. The aim of this study was to describe LTPA trend among adults in Estonia in 2000-2016 and to analyze the association between LTPA and sociodemographic, -economic, health- and work-related factors, and risk behaviours.

Methods

This study was based on 25 − 64-year-old adults (n = 16,903) of the postal cross-sectional surveys of Health Behaviour among Estonian Adult Population in 2000-2016. For data analysis, LTPA was divided into two categories: physically active (at least 2 − 3 times per week) and physically inactive (less than 2 times a week). Chi-square test was used to analyze changes in prevalence trend of LTPA over the study period. Logistic regression analysis was used to test associations between LTPA and different factors.

Results

The prevalence of LTPA increased from 26.2% to 42.6% among men (p < 0.001) and from 28.0% to 43.6% among women (p < 0.001) in Estonia in 2000-2016. Odds to be physically active during leisure time was significantly associated with marital status, education, income, economic activity, self-rated health, body mass index and smoking status among men and women. Compared to adults with basic education, men and women with higher education had higher odds (OR = 1.61, 95% CI 1.30 − 2.01; OR = 1.36, 95% CI 1.10 − 1.68, respectively) to be physically active. LTPA was associated with age among men and with nationality and alcohol use among women only.

Conclusions

Based on the study results, health promotion activities should be addressed in particular to the adults with lower LTPA paying attention to the factors associated with LTPA.

Key messages

LTPA increased significantly among men and women in Estonia in 2000 − 2016 being higher among women than men. Health promotion activities should be addressed in particular to the adults with lower LTPA paying attention to the different factors associated with LTPA.
The association between psychological distress in mid-life and hospital-based multimorbidity
Authors: Johnston M , Black C , Mercer S W
Published: October 2020

Background

Mental ill-health is common with significant impact on individuals and services. Using healthcare records to identify poor mental health missed individuals who do not seek healthcare treatment. A screening questionnaire (General Health Questionnaire (GHQ)) can detect psychological distress. However, before considering implementing such a screening tool, we need to understand if it detects those at high risk of experiencing poorer outcomes. Hospital-based multimorbidity is a rising healthcare challenge. The aim was to assess the prevalence of psychological distress in mid-life and its influence on hospital-based multimorbidity by older age in the Aberdeen Children of the 1950s (ACONF) cohort.

Methods

Prospective cohort study using ACONF. GHQ-4 was measured in mid-life from questionnaire. Multimorbidity (2 or more co-existing conditions) was measured using linked hospital records in older age (15 years after the questionnaire). The relationship between psychological distress (GHQ-4 score of 1 or more) and multimorbidity was assessed using logistic regression with adjustment for key life-course variables.

Results

Of 5,839 individuals (48% male, mean age 48), psychological distress prevalence was 20% and was associated with being female, lower childhood cognition, lower educational attainment, lower adult social class, unemployment, higher adult body mass index, smoking and alcohol misuse. In comparison to the asymptomatic reference group, the odds ratio for multimorbidity in older age in those with psychological distress was 2.2 (95% CI 1.8-2.7) in the unadjusted model. In the adjusted model this was 1.4 (95% CI 1.1-1.8).

Conclusions

1 in 5 individuals in the general population in mid-life had psychological distress. This was associated with hospital-based multimorbidity by older age. Intervening early could reduce costs to both individuals and healthcare services. The next step is research of the cost-effectiveness of population screening for psychological distress.

Key messages

Psychological distress in mid-life is associated with hospital-based multimorbidity by older age. Screening for psychological distress early in life should be explored as an intervention to reduce costs to individuals and healthcare services.
Loneliness, social isolation and healthcare utilisation in the general population
Authors: Christiansen J , Pedersen S S , Andersen C M , Qualter P , Lund R , Lasgaard M
Published: October 2020

Background

The present prospective cohort study investigated the association of loneliness and social isolation with healthcare utilisation in the general population over time. We also investigated the synergistic effect of loneliness and social isolation on healthcare utilisation.

Methods

Data from the 2013 Danish “How are you?' survey (n = 29,472) were combined with individual-level register data from the National Danish Patient Registry and the Danish National Health Service Registry in a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics, chronic disease, and healthcare utilisation during the follow-up period.

Results

Loneliness was significantly associated with number of GP visits (incident-rate ratio (IRR) = 1.06, 95% confidence interval (CI) [1.01, 1.13]), emergency admissions (IRR = 1.19, 95% CI [1.03, 1.37]) and number of hospital admission days (IRR = 1.32, 95% CI [1.08, 1.62]). No significant associations were found between social isolation and healthcare utilisation with one minor exception, in which social isolation was associated with less planned admissions (IRR = .88, 95% CI [.78, .99]). Finally, loneliness and social isolation demonstrated a synergistic effect on number of visits to the GP (IRR = .87, 95% CI [.78, .98]) and number of hospital admission days (IRR = .67, 95% CI [.45, .98]).

Conclusions

Our findings suggest that loneliness is a risk factor for primary and secondary healthcare utilisation, independently of social isolation, baseline demographics, chronic disease, and healthcare utilisation during the follow-up period.

Key messages

Loneliness is an independent risk factor for healthcare utilisation in the general population. Social isolation is not associated with healthcare utilisation in the general population.
Future Health Scenarios at the global level
Authors: Goren E
Published: October 2020

Understanding potential patterns in future population levels is critical to anticipating and planning for changing age structures, resource and health care needs, and environmental and economic landscapes. Forecasting future population under prospective policy scenarios is an invaluable tool to investigate the potential consequences of today's policy decisions as they unfold over time. Future Health Scenarios (FHS) at the Institute for Health Metrics and Evaluation (IHME) produces future population forecasts under reference and alternative policy scenarios modelled as a function of fertility, migration, and cause-specific mortality rates. In this workshop, we will introduce FHS's forecasting methodology framework that also includes forecasting of cause-specific non-fatal health loss, including years lived with disability (YLD), DALYs and healthy life expectancy. We will discuss challenges and solutions to forecasting using statistical models as a function of drivers of health, and highlight forecasting results publicly available in IHME's viz tools.
A ‘futures’ approach towards the wellbeing of future generations in Wales and beyond
Authors: Azam S
Published: October 2020

'Futures' is a way of thinking about future uncertainty. It is not about predicting the future but is about developing alternative futures or scenarios and using them to inform how best to move towards the preferred future. This approach has been explored and applied to Wales, the UK, which has the Well-being of Future Generations (Wales) Act 2015. This Act has been globally recognised as a unique sustainable development legislation, putting Wales at the forefront of creating a different future for generations to come. Whilst most public bodies have always had responsibilities in delivering a range of services to support health and wellbeing, one of the key innovative requirements of the Act is the focus on the 'future', which by definition requires new and different approaches. This in turn means new tools, new skills and a new and different mind-set in which planners, commissioners, policy makers and service providers need to take a long-term view to addressing health and well-being. The presentation will explore the various approaches, methods and tools for 'futures' thinking and how this innovative agenda is progressing in Wales.