bluuebunny/crossref_metadata_2025 huggingface dataset:
Automated surveillance of orthopaedic implants: a systematic review
Authors: Dhalluin T , Fakhiri S , Herbert J , Bouzillé G , Cuggia M , Guillon L
Published: October 2020

Introduction

More than 200,000 orthopaedic implants are implanted each year in France. Automating the data collection of device-related patient outcomes in orthopaedics is a challenge to improve device monitoring and though orthopaedic practices. The goal of this study was to assess the existing models of automated surveillance of medical devices in orthopaedics, by performing a systematic review.

Methods

The research equation contained the following MeSH terms from PubMed [Arthroplasty, Replacement], combined with [Patient Generated Health Data], [Public Reporting of Healthcare Data], [Medical Records Systems, Computerized], or [Data Warehousing]. Articles were extracted among peer-reviewed journal, in English. Titles and abstracts of selected articles were double-blind reviewed to include the articles in the study according to the following criteria: data obtained automatically, without duplicate data entry by caregivers or review of medical records one by one. For each study, we recorded: device location, targeted population, population size, methods and objectives.

Results

From the 54 articles identified through PubMed, 23 articles met the inclusion criteria after review of titles and abstracts 18 considered surveillance of knee devices and 13 hip devices. Monitoring of other joint prosthesis was practically absent. The aims of the analyses primarily concerned postoperative complications and length of stay, but the objectives were widely various.

Discussion

There were few studies using electronic medical records or clinical data warehouses to monitor devices in orthopaedics. The majority of the included studies were performed on claim databases. An information bias about data collection methods was frequently identified in the abstracts. The literature review highlighted the potential uses of health data in joint replacement and the current underuse of the medical records and/or data warehouse in orthopaedic surveillance.

Key messages

There were few studies using automated surveillance to monitor devices in orthopaedics. The aims of automated surveillance concerned postoperative complications and length of stay.
Developing a smartphone app with UK migrants for UK migrants: lessons learned from focus group work
Authors: Burns R , Hugenholtz G C G , Kirkby V , Elsay N , Aldridge R W
Published: October 2020

Background

In 2018, 14% of people living in the UK were born abroad, yet we have a limited understanding of the broader determinants of their health. To address this knowledge gap, the Health on the MovE (HOME) smartphone application (app) study was conceived. Through app-based surveys, the study will examine how risk factors for health and well-being are distributed among migrants and how these vary over time since migration to the UK. There is a lack of research addressing the development of apps for longitudinal data collection in the general population - and we did not find any in migrant groups.

Methods

To better inform the design of the HOME app study, three workshops were held in 2018 and 2019, involving both migrants and App development experts. We used a semi-structured interview schedule focused on five themes: smartphones, apps and research, HOME app wireframe (screen-by-screen review of the app), types of surveys and survey schedules, resource section content, and participant engagement strategies. The participants were purposively sampled to reflect the migrant population arriving in the UK from non-EU countries.

Results

Migrants reported high smartphone use and were positive about the app design and app-based research. Concerns around privacy and data protection were highlighted and limits were suggested for the frequency of surveys and the number of questions used. Mental health was identified as a key topic for research. Participants requested the inclusion of resources concerning asylum claim procedures and immigrant and labour laws. Migrants advised that study recruitment material should clearly state the purpose and scope of the research and requested regular feedback on study outcomes.

Conclusions

The workshops provided important feedback and facilitated the co-production of the HOME app. Overall findings suggest that the study would be both acceptable to the migrant population and feasible for real-time data collection.

Key messages

The process identified potential barriers to the acceptability and feasibility of an app-based study for real-time data collection in the UK migrant population. Organising workshops with migrants allowed for an iterative process of co-production of the HOME app. Their critical comments resulted in subsequent changes to the app design and study methodology.
Assessment of needs and barriers to healthcare care in Arab Palestinian mothers in East Jerusalem
Authors: Karjawlly M , Agbaria N , Nubani Husseini M , Zwas D
Published: October 2020

Background

Arab Women in East Jerusalem often have limited education and low socioeconomic status (SES) and are therefore at risk of low health literacy. Most health literature is poorly translated into Arabic from other languages, leading to unintentional misrepresentation and content gaps. These materials are often culturally inappropriate and full of medical jargon that is incomprehensible to the layperson. Although studies have explored the needs of Arab communities in Israel, none have focused specifically on Arab women in East Jerusalem. The aim of this study is to assess the needs and barriers to health care as related to health literacy in Arab Palestinian women in East Jerusalem.

Methods

A purposive process was used to recruit mothers aged 25-50 whose children attended East Jerusalem schools. We conducted 4 focus groups (FG) in three different East Jerusalem regions. These groups were audio-recorded, transcribed, and analyzed using systematic text condensation.

Results

The Arab Palestinian women in our FGs reported difficulty communicating with doctors and understanding their instructions. Language barriers played a role, as reports were written in Hebrew or English. The women also reported an inability to interpret their blood test results and access medical information, as well as a lack of knowledge for their screening needs. They reported not knowing how to get their medical complaints addressed or what their medical rights were. They also complained of inconsistent medical staffing, which made establishing a relationship with their doctor difficult.

Conclusions

FGs provided a deeper understanding of this community's health literacy needs, including communication power dynamics and the need for culturally appropriate and effective community-based interventions. FGs also identified potential intervention methods tailored to the community and understand their barriers to HL. This study informed a pioneering community-based HL intervention for Arab women.

Key messages

To our knowledge, this is the first study assessing the specific needs and barriers to health care health literacy among Palestinian Arab mothers in East Jerusalem. This study will inform us of community-based culturally appropriate interventions for this community.
Health Communication for medical students: Progress and Challenges in Public Health
Authors: Faria de Moura Villela E
Published: October 2020

Introduction

Health communication has gained space in medical debates, especially in the public health, since the quality of the communication process, until the context of the patient-physician relationship. The recently inaugurated Medicine courses in Brazil recognize the importance of this interface in the training of medical professionals since the first semester.

Methods

A questionnaire prepared by professors was applied to medical students from a Brazilian Midwest public university to evaluate their prior knowledge acquired of health communication. Fourteen questions previously prepared were subdivided into three categories. The category chosen for the presentation of these data were: The importance of the study of health communication for Medicine and Public Health.

Results

Sixty students were interviewed, and 78% of participants assessed the health communication as very important for the medical sciences. 47% say that within the university, this communication is good; 30% consider regular and only 18% feel great. 96% of the students believe that education is the most important factor in determining the quality of health communication process, even when compared with age variables and internet access. The importance of the study of communication to the doctor-patient relationship was considered beneficial, and 74% classified it as essential.

Conclusions

Thus, we noted that most respondents recognize the importance of health communication in their own training and doctor's relationship with the community. However, it is detected the existence of communication failures in the Brazilian health services, which shows the need for medical training to develop innovative and effective communication strategies in public health. The importance of the study of communication to the patient-physician relationship was considered beneficial, and classified as essential, for medical formation, which reflects in the Brazilian health care system.

Key messages

Communication failures in the Brazilian health services need attention: it's necessary to develop effective communication strategies in public health. The importance of health communication is recognized in students training and doctor's relationship with the community.
New organizational model to foster good practice. Central venous access management in cancer patients
Authors: Mastrandrea G , Cangialosi F , Notarangelo P , Chetta G , Graps E A
Published: October 2020

Issue

Central Venous Access positioning is a common practice in cancer patients, however improper devices' management lead to complications and multiple accesses to hospital services, increasing costs. Assessment and certification of Central Venous Access insertion site at hospital so as proper dressing at home, are required; patient empowerment in management of complex technologies is desirable to improve outcomes.

Problem Description

To tackle the abovementioned issues, PICC project was drawn up in joint action between the Strategic Health and Social care Agency and the Research Institute on Cancer in Puglia. The aim is to pilot an organisational model for central venous access positioning and remote monitoring barely technology driven and based on safe storage of outcomes pictures, patient/care-givers empowerment, integrated care approach. A sistematic review of good practices for Central Venous Access management was conducted in june 2019; besides an analysis of medical devices public procurement procedures was performed at national scale; a survey was edited to probe the existence of diverse organisational models to insert and manage Central Venous Access.

Results

Very preliminary data are avalaible. Procurement analysis showed: around 15 companies of Central Venous Access and related medical devices' producers; a spread of Central Venous Access location medical devices/supply of services based on few firms (including consumables). The analysis helps to identify the “least common multiple” in technologic equipment to support Central Venous Access management to develop a standard and applicable model, not driven by a conditioning “starting choice” (catheter selection, tip location, dressings).

Lessons

A standard Central Venous Access management certification procedure can be realized regardless of potential technology driven approach. A Central Venous Access remote monitoring model based on images and empowered patients can allow daily review fostering integrated care.

Key messages

Patients’ proper training, even in complex technologies usage, can increase self awareness and empowerment and promote compliance to innovative organizational models. Collaboration among patients – caregivers and professionals, set up of a dynamic pictures store to record Central Venous Access management procedures can improve oucomes avoiding added costs.
The effect of organizational arrangements on people with type 2 diabetes and foot ulcers in Scotland
Authors: Meza-Torres B , Cunningham S , Leese G , de Lusignan S , Carinci F
Published: October 2020

Background

A recent meta-analysis showed that specific organizational arrangements may decrease the risk of lower extremity amputations among subjects with type 2 diabetes (T2D) affected by foot ulcers (DFU). We aim to translate these results into algorithms to extract cohorts from routine data from the Scottish Diabetes Register (SCI-Diabetes). We used models to estimate the actual effectiveness of different practices and discuss transferability of the approach to other contexts e.g. the English database of general practitioners.

Methods

A multidisciplinary team mapped the Scottish database to the outputs of meta-analysis, adopting the standard set for diabetes of the International Consortium for Health Outcomes Measurement. Algorithms extracted a standardized retrospective cohort for 2016-2019. Records up to 5 years before first entry into the cohort were used for case-mix. Proportional hazards were used for multivariate modelling. Results were expressed in terms of hazard ratios with 95% confidence intervals.

Results

In 2016-2019, a total of 275,386 adults with T2D were registered in SCI-diabetes. Among them, 1,843 (0.66%) had an amputation, of which 777(42%) had a previous DFU diagnosis. We applied the criteria derived from meta-analysis and the definitions of the diabetes standard set to calculate columns included in the case-mix for predictive modelling. The refinement of multivariate models is still in progress and all adjusted hazard ratios will be included in the revised version of this abstract to be presented at the Conference.

Conclusions

Epidemiological evidence on diabetes care can be directly translated into algorithms for extracting dynamic cohorts from high quality diabetes registers. Results can be generalised to different types of national databases, adjusting for the heterogeneous dataset structures.

Key messages

Sets of criteria and definitions adopted for the conduction of meta-analyses can be translated into algorithms to extract cohorts and test models of real-world evidence from routine national databases. The Scottish Diabetes Register was successfully used to confirm the effectiveness of organizational arrangements in diabetes in normal practice.
Design of a mechanism for access to various sources of data on health of workers
Authors: Kundurdzhiev T , Stoycheva M , Tzacheva N , Velikov S , Hristova L
Published: October 2020

The study is based on the National Science Program 'eHealth in Bulgaria (e-Health)', funded by the Ministry of Education and Science. Partnership Contract No. D-01-200/16.11.2018

Issue

Comprehensive occupational health records can be put into practice by linking multiple clinical applications, all of which need to be tailored to the requirements of specific conditions and specifications.

Description of the Problem

Sharing health records between distributed entities and meaningful analysis of these records requires the use of a systematic approach regarding clinical (semantic) data structures. These data should be based on a single Reference Model so that the equivalent clinical information is correctly and uniquely presented.

Results

Two reference models (Archetypes) related to occupational health record have been created, respectively one for the health of the working people and one for the working environment and working conditions. The models are based on openEHR. The freely available Archetype editor software was used to create the archetype. The model and hierarchical structure of the occupational health record are constructed using the XML standard.

Lessons

Archetypes are effective pre-coordinated combinations of hierarchies that are coordinated across the subject area to ensure semantic interoperability, consistency and data quality. The use of standardized archetypes provides an interoperable way of presenting and sharing data between different types of information systems and the specifications used.

Key messages

The use of standardized archetypes provides an interoperable way of presenting and sharing data. Shared data is between different types of information systems and specifications used.
Threats to public interest journalism: A call to action to public health
Authors: Williams M , Sweet M , Finlay S , Mohamed J , Armstrong R , McInerney M
Published: October 2020

Public interest journalism is an important determinant of health, due to its roles in accountability and holding power to account, empowering communities, and contributing to health literacy. The capacity of public interest journalism to contribute to planetary health and health equity, as well as healthier people, societies, and systems of governance is under attack. Reasons include the collapse of the underpinning business model, the market power of digital platforms, neoliberalism, the rise of authoritarianism, and attacks on press freedom and safety. This paper presents an ecological analysis of the upstream determinants of a healthy and sustainable public interest journalism sector, which is informed by Aboriginal ways of knowing, being and doing, and a decolonising methodology. It also presents a case study of innovation in health-related public interest journalism in Australia, and includes clear calls to action for public health practitioners, researchers and advocates, as well as wider policy making.

Key messages

Public interest journalism is an important determinant of health. Threats to public interest journalism are a threat to public health. Collaborations strengthen public interest journalism: this presentation provides an example.
Integration of eMental health technologies into traditional community-based interventions
Authors: Turmaine K , Picot Ngo C , Le Jeannic A , Roelandt J L , Chevreul K , Dumas A
Published: October 2020

Background

Very little research has been conducted to appraise the merits of including municipalities and their local health providers in the promotion of digital health programmes. While more and more municipalities have locally implemented a health strategic plan and have focused on building local network of professionals, how do the latter react to the implementation of innovative e-mental health community-based programmes?

Methods

In 2018, 42 French municipalities volunteered to promote StopBlues, a digital health tool aimed at preventing mental distress and suicide. In each municipality, a local delegate was responsible for the promotion of the tool. Using observations, questionnaires and interviews with the delegates, we analysed how the promotion of StopBlues® was conducted in each setting. 2/3 of these municipalities started the promotion directly, and in 2019, a second wave of municipalities launched the promotion with a stronger support from the research team backed by the French World Health Organization Collaborating Centre for Research and Training in Mental Health (WHOCC).

Results

The use of digital technology in the implementation of a mental health programme received a mixed reception from the local health professionals because of its innovative aspect. 2/3 of the delegates declared that they were struggling to create a stronger network of local partners including private medical practioners. 63% of the respondents stated that their municipalities got involved in the programme for networking purposes.

Conclusions

Digital technologies have initiated a paradigm shift in the way community-based health programmes are set up but need to strengthen their territorial anchorage in order to be accepted and used at the local level.

Key messages

Digital technology can be a strong lever against health inequities but its effectiveness has to be studied carefully. Digital technolgy has to be implemented in local settings with the collaboration of local actors in order to be accepted and used.
Remote orthopaedic consultations for primary care patients by a large-scale telemedicine service
Authors: Silva L B , Gouvea K A A , Oliveira C R A , Percope M A , Ribeiro A L P , Oliveira J A Q , Marcolino M S
Published: October 2020

Backgrounds

Telemedicine was implemented in Brazil to support primary care practitioners. As orthopedic complaints are frequent in primary health care (PHC), this study aimed to analyze the profile of orthopedic teleconsultations requested by PHC health professionals.

Methods

This observational, transversal study analyzed consecutive orthopedic teleconsultations from March/17 to July/19. Teleconsultations were classified as: character (educational or assistance), focus of the doubt (diagnosis, treatment or rehabilitation) and the location of involvement (muscle, bone, joint). Sex of the patients, professional category of the professionals who requested and the ones who responded teleconsultations, and Human Development Indexes (HDI) of the cities were accessed.

Results

Throughout the study, 415 teleconsultations were accessed from 112 municipalities with an HDI average of 0.651. The professionals who requested most of the teleconsultations were nurses (47%) and physicians (35%) and the ones who answered were mostly internal medicine physicians (61%) and orthopedists (34%). Most doubts were related to assistance of a specific patient (66%). Of those, the majority were female (59%). In 68% of the teleconsultations, there was a request for assistance in patient treatment, 38% for diagnosis and 25% for rehabilitation. Doubts were more often related to bones (46%) and joints (24%). Of those who specified the complaint, 17% were about general pain,14% low back pain and 4% fracture. The main subspecialties were spine (23%), foot (19%) and knee (11%). In 9% of cases, there was an indication for referral for in-person orthopaedic consultation.

Conclusions

Teleconsultation helps to identify the most frequent doubts in PHC. Most of those were solved in PHC with no need for referral, what evidenced the great potential of using teleconsultations in clinical practice, as a useful tool to qualify the referral to the specialist.

Key messages

Importance of telehealth tools for a public health system, especially for a country where the distance is a barrier to access healthcare services. Teleconsultation have been proven to be an effective strategy to qualify the referral to the specialist.
Knowledge of heat waves and practice of protective measures against it in a rural West African
Authors: Gobir A , Aliyu A , Abubakar A , Ibrahim J , Esekhaigbe C , Joshua A , Adagba K , Muhammed S
Published: October 2020

Background

Heat wave has a direct linkage to global climate change and is associated with increased morbidity and mortality. Between March and May 2019, Nigeria experienced severe heat waves. Understanding heat waves provides an opportunity for individuals to proactively take measures to prevent its negative health impacts. However, illiteracy levels in rural Sub-Saharan Africa are higher than in urban areas.This study was therefore conducted to assess knowledge of heat waves and practice of protective measures against it in an affected rural community of Nigeria.

Methods

A cross-sectional, community based descriptive study conducted among household heads in Nasarawan Buhari, a rural agrarian community in Nigeria. An interviewer-administered questionnaire was used to collect data from 104 household heads, selected using systematic random sampling technique. Data was analyzed using SPSS (version 20).

Results

A majority of the respondents were males (79.8%) and most of them (89.4%) had poor knowledge of heat waves. Farming occupation was significantly associated with knowledge of heat waves (P = 0.025). Awareness of measures needed to protect against the negative health impacts of heat waves was also poor. Hence fluid intake and cold showers were the only protective measures used by majority of respondents to reduce effect of the extreme heat.

Conclusions

Both knowledge of heat waves and practice of protective measures against it were poor among respondents. A health education intervention on heat waves and how to prevent its negative health impacts was conducted in the community.

Key messages

Due to poor knowledge of heat waves and its negative health effects, practice of protective measures against it was poor among respondents. There is need for more public health response to address this rural public health challenge.
Examination of daily water consumption behaviors of individuals living in a semi-rural area
Authors: Ozyazgan A A , Deniz S , Pehlivan E
Published: October 2020

Background

The aim of this study is to investigate water consumption behaviors and related factors in the summer period of the population over the age of 15 who apply to family health centers in the semi-rural region.

Methods

The universe of this cross-sectional study consisted of adult patients who applied to community health centers of a region in Malatya. A questionnaire was applied to random 303 individuals about sociodemographic information and water and other fluid consumption and water use behavior.And also Chrobach alpha coefficient of 0.83, the validity adopted in Turkey Likert type consisting of 16 questions Water Consumption Behavior Scale-16 (WCBS) was used for data collection. Scale score height is considered good. In the analysis of the data; Mann Whitney-U and Kruskal-Wallis tests were used. P < 0.05 was chosen as the level of error.

Results

49.8% of the participants were male and 64.4% were married. The median daily drinking water consumption of the individuals was 2000 ml (320 ml-1000 ml) and the median daily liquid consumption was 3300 ml (718ml-17001ml). There was no significant difference between age groups, marital status and education level and daily water and other fluid consumptions (p > 0,05). 48.8% of individuals stated that they saved water and the most important reason for this was the high level of water consumption prices.In our study, there was no significant difference between gender, place of residence and number of households and total WCBS scale score.(p > 0,05). But the married individuals' scale score were significantly higher than the single individuals (p < 0,05)

Conclusions

Water and fluid consumption of individuals are at moderate levels in the region. Marital status was most important factor influencing the water consumption behaviors has been found in this study.When the most important factors in saving water are examined, the high price water bills were noteworthy.

Key messages

In order to ensure correct water consumption the society should be informed, the necessary sensitivity should be performed to behavioral change and measures should be taken. Adequate daily water consumption is required to protect the health of individuals.
“Place standard” depicts social gradient in the neighbourhood environment in Cyprus
Authors: Middleton N , Kleopa D , Kouta C , Kaifa S , Photiou G , Panayioutou A
Published: October 2020

Background

Census data, GIS, surveys and audits are used to profile “place”, each with shortcomings. There are several “neighbourhood environment” tools, including the “Place Standard” a policy and advocacy tool developed in Scotland. “Place” is not a strong feature in the public health agenda in Cyprus.

Methods

In an internet survey under the auspices of the Cyprus Healthy Cities Office, participants rated 14 features of their neighborhood environment. Exploratory factor, cluster and regression analysis were used to explore the dimensionality of the concept, neighborhood profiles and differences according to individual and area-level characteristics.

Results

With the exception of safety (M = 4.4, SD = 1.7 on a 1: large to 7: little improvement), 492 participants (mean age 42, 50% residents for >10 years) from 266 postcodes (33% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control”. A clear dimensionality of Built, Physical, Social and Service environment supports the construct validity of the tool. People who rated their neighbourhood lower on a social position ladder were consistently more likely to rate all contextual neighrbourhood features less favourably. The social gradient was evident according to both individual sociodemographic characteristics and census-based area measures of built (e.g. pre-2001 housing) and socio-economic disadvantage (e.g. single-parent households) and appeared stronger in terms of the built (e.g. moving around) than the social environment (social contact, identity and belonging).

Conclusions

The “place standard” shows good metric properties and can be used as a public health research, and practice tool to profile the variability and document the inequity in the neighbourhood health environment as well as to support and enhance citizens' participation in the dialogue, which they generally rate lowest.

Key messages

The “Place Standard” offers a framework and a tool to profile the neighbourhood environment in research and public health practice. Generally unfavourable rating of health-related neighbourhood environment with evidence of social gradient across all features with larger differences in built environment.
Heat waves and mortality: developing a local prediction model based on two kinds of heat waves
Authors: dos P , Luís Santos , Nunes C
Published: October 2020

Background

Heat waves (HW) will tend to have a higher impact on mortality due to climate change. The aim of this study was to develop a tailored model to predict local mortality associated to HW.

Methods

In this ecological study, daily temperature and daily mortality were collected from May to October of 1980 to 2017 in Coimbra, Portugal. Two definitions of HW were used: more than two consecutive days of maximum temperature (MaxT) or minimum temperature (MinT) above percentile 95 for the periods in question. Attributable general mortalities with 13 and 30 lag days were calculated and then converted to attributable general mortality rates adjusted to the resident population. Bivariate and multivariate analyses with SPSS statistics were performed with the following independent variables for each HW: MaxT, diurnal temperature variation (DTV), mean of the mean daily temperatures, month, ageing index (AI), ordinal number of the HW for that year (ONHW), duration, overlapping of another HW and existence of a public health contingency plan.

Results

The multivariate analyses returned a R2=0,19 for the MaxT model (MaxTM) for both 13 and 30 lag days and a R2=0,51 for the MinT model (MinTM) with 13 lag days and R2=0,45 for 30 lag days. DTV was the only variable with statistical significance in the MaxTM (p < 0,023; β = 0,44 for 13 lag days and p < 0,024; β = 0,43 for 30 lag days). In the MinTM model two variables had statistical significance: AI (p < 0,008; β = 1,72 for 13 lag days and p < 0,037; β = 0,44 for 30 lag days) and ONHW (p < 0,038; β= -0,44 for 30 lag days).

Conclusions

MaxTM and MinTM had different predictability potentials with different statistical significant independent variables. This may mean HW defined by MaxT have impact in a distinct way from HW defined by MinT. Further development of these models that include acclimatization indexes and causes of mortality may help local public health services to create more efficient, selective contingency plans.

Key messages

Minimum and maximum temperature defined heat waves may impact mortality differently. Local heat wave/mortality models may contribute to more efficient, selective contingency plans than regional models.
Health in cities: Getting out and about as we age
Authors: Ma T , Ivers R , de Leeuw E , Clapham K , Kobel C
Published: October 2020

Transportation influences health through its effects on people's access to goods, services, and life chance opportunities; social interactions; physical activity levels; air pollution exposures; and road injury risks. Given the ageing of populations, it is essential that decisions about land use and transportation systems are appropriate to meet the mobility needs of older people and support healthy ageing. Not all transportation options, however, may be accessible to older people. Factors that affect accessibility relate to the spatial and physical characteristics of places, personal and social contexts of individuals, and rules and norms underpinning planning and policy making.

This research aimed to understand how different parts and processes of urban systems interact to influence transportation options for older people. Using the Greater Sydney area as a case, we drew on key informant interviews and public policy documents to identify the considerations that inform planning and policy making as they pertain to the nature of cities and the opportunities of older people to get out and about. We compared and integrated these findings with peer-reviewed literature of similar urban growth areas.

Our analysis mapped the factors of the human-urban system that are central to enabling transportation mobility for older people, articulated their interrelationships, and identified the actors that influence them. Our results point to the involvement of actors from the public health, community development, transportation, and urban planning sectors at multiple levels of government. Each of these actors operate within their own remit to influence a part of the urban system relevant to older people's transportation, such as the zoning of land, the approval of housing developments, and the location of bus stops. However, these individual actions are constrained by others in the system. We interpret this complexity with a governance lens.

Key messages

Efforts to promote mobility in old age should move beyond ‘single solutions to single issues’ approaches toward those that reflect the complexity of cities and the ways that people move within them. For sustained realization of desired outcomes, age-friendly initiatives cannot occur in isolation, but rather must take into account the behaviours and dynamics of the urban system.
Developing urban resilience in Haifa: preparedness to climate change in health and welfare agencies
Authors: Negev M , Levine H , Zohar T , Nouman H , Zohar M , Paz S
Published: October 2020

Background

Extreme climate events (wildfires, floods, heatwaves, cold spells) are becoming more frequent in the Mediterranean, but adaptation levels in the health and welfare sectors remain low. The city of Haifa in northern Israel is prone to both war and extreme climate events. Focusing on Haifa, we aim to 1) examine local officials' risk perceptions of different extreme events, 2) compare preparedness to war vs. climate events, and 3) conduct a spatial analysis of climate and health vulnerabilities.

Methods

Mixed-Methods: a qualitative component including 30 in-depth interviews with local government health and welfare officials, and a qualitative component that includes mapping vulnerability indicators such as socio-economic status, recipients of welfare allowances, and temperature, focusing on urban heat islands.

Results

The city of Haifa developed a comprehensive resilience policy for war and wildfire. However, there is no awareness or preparedness for other climate events that have not yet been experienced. Similarly, hospitals are prepared for emergencies, but not for extreme climate events. There are no national budget or guidelines for climate adaptation at the city level or in hospitals. Correspondingly, risk perceptions of climate change among health and welfare officials remain low. At the city level, social and climatic vulnerabilities are correlated, so that downtown neighborhoods are characterized by poorer socio-economic, health and welfare conditions, and higher summer temperatures.

Conclusions

Haifa has good preparedness for events that had been experienced in the past. While emergency preparedness provides a good infrastructure for climate change preparedness, awareness and adaptation to the unique aspects of climate change preparations are needed, including reference to related spatial dimensions. Identifying the gaps between preparedness to various emergency events, can contribute to better climate change preparedness at the local level.

Key messages

In the city of Haifa, emergency preparedness exists but is not extended to extreme climate events, and awareness to health risks of climate change remains low in the health and welfare agencies. Learning from emergency preparedness to wars, wildfires and earthquakes may contribute to enhancing preparedness to extreme climate events at the local level.
Understanding national barriers to climate change adaptation for public health - a global survey
Authors: Marcus H , Hanna E
Published: October 2020

Background

Climate change has introduced a series of unprecedented threats to human health, ranging from rising food and water insecurity to deteriorating air quality, novel disease outbreaks, and intensifying natural disasters. The Paris Agreement pushes countries to develop adaptation plans that will protect human health from the worst impacts of climate change -a process referred to as climate change adaptation (CCA). Yet despite international pressure and escalating health threats, vast shortcomings persist in national CCA for public health progress. Thus, we investigated the major governance constraints underlying these trends.

Methods

A mixed-methods online survey was distributed to representatives of national public health associations and societies of 82 member countries under the World Federation of Public Health Associations.

Results

9 of the 11 respondent countries (82%) affirmed the existence of a national CCA plan that includes an explicit public health focus. All respondees listed governance challenges in developing and operationalising their national CCA agenda. The major identified barriers to CCA for public health progress were lack of inter-government policy coordination and insufficient political will to mobilize human and non-human resources in support of public health-oriented adaptation efforts.

Conclusions

Climate change-driven amplification of global health risks necessitates that all nations generate clear CCA plans to protect human health. Our findings assist by highlighting the need for new platforms for organizational collaboration/networked governance and enhanced forums for CCA agenda-setting and ambition-raising. Such forms of enriched knowledge may facilitate decision-making amongst key public health stakeholders and global institutions for how best to align climate advocacy and country-wide support initiatives with cross-cutting national needs and constraints.

Key messages

Climate change-driven amplification of global health risks necessitates that all nations generate clear climate change adaptation plans to protect human health. New platforms for organizational collaboration/networked governance and enhanced forums for adaptation agenda-setting and ambition-raising may significantly bolster public health adaptation progress.
Lifestyle habits among a sample of middle school adolescents in Tunisia
Authors: Ben Fredj M , Dhouib W , Kacem M , Bennasrallah C , Dhouib W , Zemni I , Bannour R , Trimech F , Belguith Sriha A
Published: October 2020

Introduction

Adolescent health is a major global concern today. In fact, adolescence is the period of life where different risky behaviors can take hold and is therefore the best prevention phase to guarantee healthy lifestule in adulthood. We aimed to assess the lifestyle of middle school adolescents and to highlight the main behaviors such as the eating habits, the physical activity and the personal hygiene.

Methods

We carried out a cross sectional study among a sample of adolescents from December 2017 to January 2018 and we involved two middle school schools in the region of Monastir in Tunisia. The questionnaire GSHS (the Global school-based student health survey) was used.

Results

In total, 802 participants were enrolled with a mean age of 13.6 ±1.9 years, ranged from 11 to 16 years old. Females represented 51.9% of the study population. More than one third of the students (36%) reported rarely or never eating breakfast with a significant difference in girls more than in boys (62.8% vs 37.2%, p < 10-3). Almost half of students (46.2%) reported drinking sugary sodas at least once a day and 86.3% of them reported consuming fast food more than two times per week. In addition, 59.4% of middle school students reported eating fruit more than twice a day and 24.3% eating vegetables at least three times a day. Regarding physical activity, our results showed that 24.4% of middle school students were physically active (1 hour minimum during the day) every day for the last 7 days, boys more than girls (56.5% vs 43.5%, p = 0.02). In addition, 39.7% of students declared they sit at least three hours a day. As for personal hygiene, our study found that 9.3% of students never, or rarely, washed or brushed their teeth; boys more than girls (69.3% vs 30.7%, p = <0.001).

Conclusions

Our results provide additional evidence on the need to combat sedentary lifestyle and encourage healthy nutrition and physical activity among adolescents.

Key messages

Understanding the health needs and concerns of young people contribute to implement effective health programs. Interventions in young people should act on various aspects of the lifestyle to ensure an optimal effect.
Factors associated with abandonment of exclusive breastfeeding in Veracruz, Mexico
Authors: Alemán Pérez I A , Cervantes Gómez K C , Cosgalla González R I , Tapia Pulido E A , Villegas Domínguez J E , Falcón Correa S G , Landa Santibañez G E
Published: October 2020

Background

Exclusive breastfeeding is a fundamental part in the development of the newborn, however, 40% of babies worldwide receive this form of feeding, while in Mexico we comply with breastfeeding in 14.4% although currently the services of health participating in social security promote exclusive breastfeeding promotion strategies. Research question: What are the factors associated with the abandonment of exclusive breastfeeding in mothers assigned to social security health services in Veracruz, Mexico?

Methods

A cross-sectional, analytical, observational and prospective study was conducted between December 2019 and March 2020. Women who had had children older than 6 months, attached to the Mexican Social Security Institute were included, excluding those who could not breastfeed due to medical indications. A non-probabilistic sampling was obtained. The results were collected and analyzed with the SPSS Statistic® program. We calculted Chi-square test and odds ratios and 95% confidence interval.

Results

176 patients were included, obtaining a prevalence of exclusive breastfeeding of 45.25%. The factors that facilitate the abandonment of breastfeeding were “not producing enough milk” (OR 4.6 IC95% 2.2-9.4) and other personal or family beliefs, both with p < 0.05. The association between abandonment of exclusive breastfeeding and marital status, occupation, family type, number of children, previous history of breastfeeding, pregnancy planning, prenatal consultations, pregnancy termination form, receiving information on breastfeeding by health personnel during their postpartum stay in the hospital, attending breastfeeding training and main source of information on breastfeeding, without being significant for any of these factors.

Conclusions

The factors associated with the abandonment of exclusive breastfeeding are the beliefs of the mother along with those of her family, overcoming the educational actions of the health system and the social conditions of the mother.

Key messages

The educational strategies of the health system should be evaluated, since according to the results it has not yet been possible to sensitize patients about the importance of exclusive breastfeeding. Research on this topic should continue as exclusive breastfeeding brings benefits to the health of the mother, the child and the family as it is also a support for the economy.
Sociodemographic determinants of disability in patients with schizophrenia (Bulgaria, 2018-2019)
Authors: Veleva I , Yankulovska S , Velikova K , Valkova M , Grancharova G
Published: October 2020

Background

Schizophrenia is an increasing public health problem. Despite its low prevalence and mortality, it causes significant disability and has enormous health, social, and economic burden for patients, families, society and health systems worldwide. The aim was to assess the impact of some sociodemographic determinants on disability in patients with paranoid schizophrenia (PS).

Methods

The study includes 108 patients in Psychiatric Clinic at Pleven University Hospital: 66 males and 42 females, mean age 38.9±10.0, duration of disease 12.8±8.2 years; mean onset of disease - 24 years (Me = 25 and Mo = 22). The study was approved by Ethical Committee. The disease burden was assessed by Positive and Negative Syndrome Scale (Ð ANSS), and level of disability - by 36-item WHO Disability Assessment Schedule 2.0. Four variables (gender, age, education, type of employment) were chosen and their impact on disability was assessed by one-way ANOVA (F-test), Tukey's NDS test, two-sided t-test, Pierson r. Data processing was performed by IBM SPSS v.24.

Results

The most severe deficits were observed in “getting along with people” (61.34±25.77),”life-activities-household” (55.74±23.45), “participation in society” (53.13±19.12), “understanding and communicating” (41.67±17.67). Age at disease onset and its duration showed weak positive correlation. In most domains, males had higher deficits (р=0.0001). Age had an impact only on “getting around” (r = 0.41;p=0.0001) and “self-care” (r = 0.260;p=0.007). Significant differences (F (2,104)=7.565, p < 0.01) were found between groups by education level and occupation (employed/students, unemployed and disabled) - F (3,103)=16.734; p<0.001.

Conclusions

Sociodemographic factors play a major role for different function domains deficits in PS patients. Most pronounced is the impact of education and occupation. Patients with higher education and those engaged in study or work demonstrate better social functioning than less educated and disabled people.

Key messages

Education is an important protective factor for disability. Lower educational level decreases competitiveness in workforce market, both in general population and in patients with schizophrenia. Sociodemographic determinants should be considered in planning appropriate preventive and rehabilitation activities to stimulate better social functioning and adaptation of PS patients.