bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental hazards in the preconception period
Authors: Vilcins D
Published: October 2020

Environmental risk factors are ubiquitous, and a growing body of evidence has shown exposure to many environmental hazards is associated with poorer health outcomes. Environmental hazards are linked to human health across the life span, with maternal exposure to a wide range of environmental hazards, such as air pollution, endocrine disrupting chemicals, pesticides and heavy metals, associated with neonatal outcomes and longer-term child health. There is a small body of evidence emerging that suggests maternal and paternal exposure to environmental hazards in the preconception period may be associated with negative health outcomes of resulting children. Understanding the environmental and occupational exposures most pertinent to preconception care allows care givers to provide advice on limiting exposure, which in turn improves the odds of protecting the long-term health of the child. This presentation will provide an overview of the current evidence from the environmental health research. Workshop participants will have the opportunity to discuss pathways of reducing exposure to the environmental health risks most pertinent to the preconception period.
The impact of smoking on deaths and disease in the face of population ageing: the example of Germany
Authors: Mons U
Published: October 2020

Background

Despite weak tobacco control, smoking in Germany has steadily declined over the last 25 years. As policymakers expect that this trend will reflect in a declining associated public health burden, I sought to quantify trends in smoking-attributable mortality (SAM) and smoking-attributable cancer incidence (SACI) and to explore the impact of population ageing.

Methods

Smoking and mortality statistics from 1992 to 2017 were obtained from the German Statistical Office, from which SAM was calculated separately for each cause of death causally associated with smoking. Cancer incidence data from 1999 to 2016 was obtained from the German Cancer Registry, and SACI was calculated separately for each cancer site causally associated with smoking. The impact of population ageing was explored by comparing crude and age-standardized SAM and SACI, respectively. To estimate the impact of population ageing on future SAM and SACI, a forward projection until 2035 was modelled.

Results

Preliminary results suggest that total SAM and SACI only slightly declined over time, while stronger decreases were seen in age-adjusted SAM and SACI. Differences between crude and age-standardized SAM and SACI seem to be particularly striking in men. The forward projection of SAM and SACI suggests that population ageing will lead to further steady increases within the next two decades in both sexes.

Conclusions

Results indicate that past decreases in SAM and SACI due to declines in smoking were largely compensated by population ageing. In the next two decades, population ageing will lead to a steady increase in SAM and SACI. Only by taking determined immediate action with a comprehensive set of evidence-based tobacco control polices could significant inroads into reducing the smoking-associated disease burden be achieved. Also, given still significant smoking rates in middle and old age, there is tremendous potential to curb the associated public health burden by intensifying cessation programs.

Key messages

Contrary to common expectations among policymakers, the smoking-attributable public health burden will strongly increase in the next decades. Determined immediate policy action is required to halt or attenuate these trends.
Resilience factors associated with physical function in vulnerable older adults from four countries
Authors: Pennington J T , Sentell T L , Vafaei A , Camara S M , Belanger E , Pirkle C
Published: October 2020

Background

Adverse childhood experiences (ACEs) include an array of maltreatment and they have been shown to confer higher risks of early mobility loss and ultimately disablement in older ages. This study aims to identify resilience factors associated with physical function in a diverse sample of older adults (65-74 years) from the 2012 International Mobility in Aging Study (IMIAS) who reported ACEs.

Methods

2002 participants were recruited from Kingston, Ontario; St. Hyacinthe, Quebec; Tirana, Albania; Manizales, Colombia; and Natal, Brazil. Economic ACEs were classified by self-report of at least one-poor childhood economic status, childhood hunger, parental unemployment-before the age of 15 years. The Short Physical Performance Battery was used to measure physical function; a score of < 8 was considered poor. Associations between hypothesized resilience factors (education, social support, expressed gender roles) and physical function were identified via bivariate analysis and logistic regression; after adjusting for sex, age, and sample site.

Results

Nearly half (46%) the participants reported economic ACES. High levels of education (OR 0.39; CI: 0.22-0.66) and social support from family (OR: 0.52; CI: 0.36-0.76), partners (OR: 0.47; CI: 0.29-0.74), and friends (OR: 0.59; CI: 0.38-0.92), as well as masculine (OR:0.49; CI: 0.29-0.83) and androgynous (0.48; CI: 0.30-0.77) gender roles, protected against poor physical function for those reporting childhood economic ACEs.

Conclusions

Despite encountering economic ACEs, those who achieved high relative levels of education, greater levels of support, as well as those characterized by masculine or androgynous gender roles, were more likely to maintain good physical performance in older ages compared to those with low education, no social support, and those classified as undifferentiated gender roles. Findings highlight critical points of intervention for those who experienced ACES.

Key messages

These findings imply that the associated negative physical health outcomes of ACEs can be delayed or eliminated via exposure to certain protective factors. Economic ACE exposure may be unavoidable, but there are resilience factors that could be promoted to foster the better health across the life course.
The Impact of early retirement, nation-related and personal characteristics on cognitive decline
Authors: Carmel S , Tur-Sinai A
Published: October 2020

Background

The increasing prevalence of cognitive decline (CD) in old age has become a global challenge. Our study aims to enhance understanding of this phenomenon by evaluating longitudinal effects of personal and national determinants on memory decline (MD) among European retirees.

Methods

We used data from two interviews collected in 12 European (EU) countries and in Israel by SHARE - a multidisciplinary, cross-national bank of survey data. Our sample included 11,930 retirees aged 50+ who were interviewed at baseline (T1) and again four years later (T2). MD was evaluated by the change in the recalled number of words at T2 compared to those remembered at T1. Ten words were presented at each interview and participants were asked to repeat them, first immediately and again after a few minutes (maximum 20 words). The scale for evaluation of change over time ranged from -20 to + 20.

Results

Except for gender, all of our explanatory variables had a significant effect on MD including age, education, health/function status, depressive symptoms, early retirement, active lifestyle and EU-countries divided into four geographical regions. Decline over time in physical and mental health variables had an additional significant negative effect on memory.

Conclusions

These findings lead us to suggest focusing on what we know and are able to change in order to postpone MD. In addition to promotion of national policies to prolong years of education and participation in the workforce, we recommend introducing programs that encourage people to postpone retirement, and adjusting workplace conditions in order to enable older persons to continue contributing to the workforce. We also suggest promoting an active lifestyle among older adults, especially in Mediterranean and eastern European nations by implementing health and active leisure education programs.

Key messages

Declines in health and functioning negatively affect memory, while education and active lifestyle have a protective effect. Moreover, early retirement has a similar negative effect on memory change in each of the studied EU-regions even when controlling for all of the personal and behavioral factors.
Legal and human rights-based approaches to healthy diets and sustainable food systems
Authors: Patterson D W , Buse K , Magnusson R , Toebes B C A
Published: October 2020

Issue

Malnutrition in all its forms poses daunting challenges to global health and development. The agriculture sector is a significant contributor to global warming. COVID-19 has pushed many people into poverty, including food poverty. A radical rethink of business models, food systems, civil society involvement, and national and international governance is required to address the interlinked crises of COVID-19, obesity, undernutrition, and climate change. International human rights law, institutions and mechanisms provide important opportunities for norm setting, advocacy and accountability. Yet these pathways are under-utilised by both governments and civil society.

Description

The global AIDS response demonstrated the power of a human rights-based approach. United Nations' HIV/AIDS and Human Rights Guidelines greatly influenced the global consensus for effective, evidence-based approaches. The Guidelines also informed resolutions of the UN General Assembly and its Human Rights Council, contributing to more affordable medicines, an unprecedented increase in people on treatment, less stigmatising health services, the empowerment of marginalised groups, and the institutionalisation of norms, including “no one left behind.” Human rights-based approaches have also been successfully utilised in tobacco control.

Results

In 2019, 180 experts from 38 countries published an open call on WHO and the UN Office of the High Commissioner for Human Rights (OHCHR) to initiate an inclusive process to develop guidelines on human rights, healthy diets and sustainable food systems. Most signatories were from the health and development sectors, demonstrating the increasingly broad interest in using human rights mechanisms to address global health challenges.

Lessons

Opportunities exist to transform food systems and create healthier food environments and a healthier planet by clarifying existing international obligations to progressively realise the right to food and the right to health.

Key messages

Market forces, alone, are failing to deliver healthy diets and sustainable food systems. International legal frameworks and accountability mechanisms provide opportunities for engagement and action. Human rights guidelines can help mobilize multisectoral action, strengthen State and private sector accountability, and deepen community engagement in the urgent task of achieving Agenda 2030.
Television marketing of food and beverage targeted to children, Italy
Authors: Gianfredi V , Rabica F , Dallagiacoma G , Fatigoni C , Moretti M , Nucci D
Published: October 2020

Aim

According to the World Health Organization (WHO), 40 million children aged < 5 and 131 million of children aged 5-9 are overweight or obese. Growing evidence is focusing on the association between number of hours spent watching television (TV) and children's food behaviour. Our aim was to assess the amount of TV food marketing targeted to Italian children, and to qualitatively analyse the ads.

Methods

The 5 most viewed TV channels were selected and recorded for 20 days (non-consecutive, both week and week-end days) and analysed through the WHO's tool to asses food -beverage multimedia marketing targeted to children. The analysed exposure variables were: type of product, viewing time, channel's target and broadcasting company (for all types of ads), duration of each food ad, type of programme, and target of the advertised product (only for food and beverage). Power of persuasion variables were assessed only for food marketing. Lastly, for each food product showed, the food category and if it was a core vs non-core product was assessed. Differences between groups were assessed using the chi-square test and t-test.

Results

During 320 hours of broadcasting TV, a total of 9,069 ads were identified, (51.7 hours). Food products were the second most frequently advertised (19.4%). On average, 5.4 food ads were displayed during non-peak viewing time/hour (6 during peak). The time slot of 3 pm had the highest rate of food ads (23.8%). Channels targeted to the general public had a higher rate of food ads compared to channels targeted to children (p = 0.000). Private channels transmitted a higher number of food ads compared to public channels (p = 0.000). Humour was the most frequently persuasive technique used in food ads and in ads targeted to whole population (14.3%).

Conclusions

Children usually watch TV programs that have a high rate of food ads, mainly promoting unhealthy products with captivating techniques. Legislators should advocate for a healthier food marketing.

Key messages

Children are exposed to a high amount of TV food commercials daily. Food marketing should be strictly regulated in accordance with the WHO Nutrient Profile model.
The Epidemiology and Burden of Cardiometabolic Risk factors in a Young Emirati Population
Authors: Mezhal F , Ahmed L , Jabari A , Alzaabi T , Alblooshi M , Alhosani A , Ali R
Published: October 2020

Introduction

The United Arab Emirates (UAE) has experienced a rapid growth in economy. This growth was paralleled with a drastic rise in non-communicable diseases (NCDs); primarily cardiovascular disease, which accounts for 40% of mortality in UAE. These NCDs are caused by the accumulation of cardiometabolic risk factors (CRFs) such as obesity, dysglycemia, dyslipidemia, hypertension and central obesity. The CRFs are associated with other factors including sociodemography, physical inactivity, tobacco use, and heredity.

Objective

The objective is to investigate the burden of CRFs and their interrelationship, and to estimate the association with other determinants like sociodemographic status, lifestyle and family history.

Methods

Data was drawn from the UAE Healthy Future Study participants aged 18 to 40. Demographic and health data was collected by questionnaires. Measurements, blood pressure, and blood samples were collected. CRFs were analyzed by age and gender.

Results

A total of 5,126 eligible participants were included in the analysis. The age-adjusted prevalence rates were 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. Obesity had the strongest relationship with other metabolic factors. Education, employment, smoking and family history had associations with some metabolic markers. Forty percent had ≥2 risk factors. The burden of ≥ 2 CRFs was affected by age (OR 1.1), having lower education (OR 1.37) and having a family history (OR 1.44).

Conclusions

CRFs are highly prevalent in young adults in the UAE. These risk factors are accumulating and are affected by multiple determinants. Obesity is highly associated with having other CRFs simultaneously. This should be taken into account in the design of target-group-specific prevention of NCD development. Further research is needed to investigate how the clustering manifests in young adults to prevent the early rise of NCDs in the UAE.

Key messages

Cardiovascular disease and associated risk factors are highly prevalent in the young population (18-40) of the UAE. The clustering of cardiometabolic risk factors occurs early in young people in UAE.
Patient-reported outcomes in patients undergoing elective arthroplasty: the PaRIS-IOR study
Authors: Golinelli D , Rosa S , Rucci P , Tedesco D , Grassi A , Amabile M , Cosentino M , Maietti E , Zaffagnini S , Fantini M P
Published: October 2020

Background

The number of hip and knee arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched the PaRIS Initiative for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the Initiative (PaRIS-IOR study), because it hosts the Registry of Orthopedic Prosthetic Implants (RIPO). The objective of PaRIS-IOR study is to investigate the characteristics and temporal trend of PROMs in relation to the type of surgical intervention and patient profile. Here we report the preliminary results of the first study year.

Methods

The PaRIS-IOR is a prospective, single site, cohort study started on January 1st 2019 that consists of the administration of Euro Quality 5 Dimensions (EQ-5D), Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score Physical function Short-form (HOOS-PS, KOOS-PS) questionnaires to patients on the list for elective arthroplasty. Questionnaires data are linked with those routinely collected by the RIPO and regional administrative data, in order to track patients' medical history.

Results

The study population consists of 1,413 patients. Patients undergoing knee arthroplasty (n = 393) were older (68.4 vs 60.2 years; p < 0.001), and had a higher prevalence of obesity (41.6 vs 22.6%; p < 0.001) than patients undergoing hip arthroplasty (n = 1020). Female and obese patients reported a worse perceived health status both in the EQ-5D (p < 0.001) and in the HOOS-PS and KOOS-PS (p < 0.001). Among patients who underwent knee surgery, the younger ones reported a poorer perceived health in the general and the specific questionnaires.

Conclusions

The PaRIS-IOR study has potential important implications in targeting the factors affecting patient-reported functional outcomes and quality of life after joint arthroplasty.

Key messages

The PaRIS-IOR study underscores the poorer perception of health status in female and obese patients undergoing arthroplasty and in younger patients undergoing knee surgery. The routine adoption of PROMs may support surgeons in the management of patients undergoing hip and knee arthroplasty and policy-makers in improving healthcare quality in orthopedics.
Understanding public health providers’ preferences for interventions against informal payment in Tanzania: a discrete choice experiment
Authors: Binyaruka P
Published: October 2020

Background

Informal payments are regressive. They can limit the access to quality healthcare, particularly of the most vulnerable, and are potentially catastrophic. Little is known in terms of providers' preferences for interventions.

Methods

We conducted a cross-sectional discrete choice experiment (DCE) among 432 health providers from 42 public health facilities (hospitals and health centres) in seven districts from Pwani region and five districts from Dar es Salaam region. The DCE attributes were derived from a scoping literature review, qualitative interview from 27 key informants from three districts, and through workshop with health providers, managers and policy makers. The final DCE survey tool included 12 unlabeled choice sets, each describing two hypothetical jobs that varied across six attributes: mode of payment, supervision at facility, opportunity for private practice, awareness and monitoring, measures against informal payment, and incentive payment for lack informal payment in the past 6 months. Multinomial logit and mixed multinomial logit methods were used to estimate preferences for the attributes.

Results

All attribute-levels, apart from supervision at the facility level, were significantly influencing health providers' choice decisions for job type (p < 0.001). The most preferred attributes were measures for awareness creation and monitoring -i.e. preferences were significantly higher for facility with noticeboard (coefficient 0.39, 95% CI 0.29 -0.48 ), followed by provision of receipts (0.34, 0.24 -0.44) and presence of hotline number for reporting corrupt practices (0.26, 0.17 -0.35). Opportunity for private practice was significantly preferred (0.38, 0.31-045) and job preference increases as salary top-up increases (0.06, 0.05-0.7). The less preferred attributes were cash payment for healthcare (-0.27, -0.35- -0.19) and disciplinary measures at the district (-0.15, -0.23 - -0.07) or facility level (-0.10, -0.17- -0.03).
Influence of social-cultural factors and gender on health workforce absenteeism: a qualitative study from Nigeria
Authors: Omwujekwe O
Published: October 2020

Background

Absenteeism is widespread across the Nigerian health sector among all cadres of providers. Little is known about the health worker incentives and drivers of absenteeism among staff working in primary health care settings in rural areas in Enugu State.

Methods

We focused on six primary care centers in rural and urban regions in Enugu State, south-east Nigeria. We conducted in-depth interviews and focus group discussions with 70 respondents living nearby: comprising 12 frontline health workers, 12 healthcare managers, 6 Health Facility Committee leaders and 40 service users. We used thematic data analysis, drawing on conceptualisations of culture and gender.

Results

Socio-cultural causes of absenteeism included gender roles (caregiving responsibilities, home keeping, child bearing issues, etc.), marital status, attending to social events and cultural ceremonies. Consequently, women were more likely to be absent than men, given traditional roles (e.g. home keeping, caregiving, farming) and child bearing. Male absenteeism reflected a need to generate additional income through dual practice and other jobs. Sanctions against those absent was similar for men and women. Individual health workers who were connected to politically powerful individuals “godmothers” or “godfathers” were able to use these connections to improve their placements and protect themselves from potential sanction.

Conclusions

Effective strategies to tackle absenteeism will require socio-economic and these factors to be taken into account when addressing health systems and structural factors. Long-term change also requires addressing the power imbalances that give rise to these conditions, something that is likely to be especially challenging.
Towards the development of a national Mental Health Surveillance System in Germany
Authors: Mauz E , Peitz D P , Kersjes C K , Hoelling H H , Thom J T
Published: October 2020

Background

On behalf of the federal ministry of health the Robert Koch Institute as the German public health institute is currently developing a concept for a national Mental Health Surveillance (MHS). This surveillance should systematically gather, process and analyze primary and secondary data, thus integrating different data sources to comprehensively inform about mental health trends in the population. To do so, selected mental health indicators should be reported on a regular basis to detect changes over time and reveal need for public health measures.

Methods

To build up a national MHS, a conceptual framework and a core indicator set were established according to a two-stage procedure: 1) scoping review to collect a broad range of indicators in the field of public mental health on a population based level, 2) consensus among public mental health experts and stakeholders by an iterative Delphi process which considered quantitative and qualitative information.

Results

Drawing on theoretical foundation, an action-guiding conceptual framework with basic action goals referring to mental health promotion and prevention, mental health determinants, mental health status as well as mental health care and burden of mental disorders was developed. Within the consensus process, the 184 indicators resulting from the scoping review could be reduced to a parsimonious core indicator set.

Conclusions

The contribution shows background, method and first results of developing a German MHS. Next, the feasibility of the hereby presented core indicator set will be tested by identifying and closing data gaps. In the long run, the MHS should be integrated in a broader surveillance of non-communicable diseases. It should serve as a reliable database for epidemiological as well as health care research and evidence-based policy advice on public health measures to protect and strengthen mental health in the population.
20.E. Round table: Health tourist and health promotion: introducing the European Charter for Sustainable Health Tourism
Authors:   Organised by: EUPHA Health promotion section, PROMIS, Sicilian Health Government, CEFPAS,   Chair persons: Luís Saboga-Nunes - EUPHA-HP, Roberta Arnone - Italy
Published: October 2020

The goal of this workshop is to bring health tourism (HT) to the public health perspective, raise awareness for viable HT in the context of the Sustainable Development Goals (SDG), while introducing the “European Charter for Sustainable Health Tourism”!

Mobility and the EU open market, have incremented a new trend in the European global economy, based in HT. In 2017 of the general tourism in the EU28, 5% was due to HT. It is expected that this share will increase in the near future. The concept of HT needs to be refurbished since it does not represent only medical tourism (that is the object of an increasing set of regulations among member states) but it includes also wellbeing and wellness (e.g with spa and quality of life tourism) that is not scrutinized by treaties, international or even national regulatory agencies. Citizens, therefore, play a major role in the marked demand of HT, either by being active actors in the procurement of services or commodities (Prosumers), or by being passive consumers (Passumers) of a strategic market not always aligned with well-being and quality of life. Therefore, the need for a “European Charter for Sustainable Health Tourism” is a set of references to increase health literacy about HT and its real impact in public health. Moreover, the aim of this workshop is to study opportunities, offer examples and discuss on how to develop, evolve and improve health promotion practices by actions taken at the HT setting. First we want to invite the audience to discuss HT from the salutogenesis perspective; In a second moment an interregional point of view of the Silver Economy will frame the conceptual framework on HT; a third presentation will look at a particular case of HT and public health and the added value of multilateralism; from here the participants will be invited to consider the particular case of Health and Wellness tourism in Sicily; the final presenters will look at HT in the perspective of the Reference Sites Collaborative Network. This workshop will use interactive methodologies of participation so that the audience will be actively involved in the discussion and wants to offer a forum for public health researchers, practitioners and policy-makers interested in HT and methodological insights and will allow discussing results, facilitate exchange, and support further synergies between countries.

Key messages

The goal of this workshop is to raise awareness for sustainable health tourism in the context of the SDG, by proposing the adoption of the first “European Charter for Sustainable Health Tourism”. Explore how in European Countries (study cases) health tourism answers health promotion principles for a more sustainable society.
Health tourism and public health in the perspective of the Reference Sites Collaborative Network (RSCN)
Authors: Illario M , Bousquet J
Published: October 2020

Background

In the EU tourism strategy 'Europe, the first tourist destination in the world: a new political framework for tourism in Europe', accessibility of tourism services is highlighted. In this context Health Tourism (HT) deserves special attention. Sensitize interested parties in HT to generate greater know-how on the demand and profiles of travelers with specific needs and evaluate the economic impact of the age-friendly and patient-friendly HT, are today pressing issues. Older adults (an important market share) require adaptation of services. Tourists with reduced mobility (recently estimated at 127 million people), disabilities or suffering from chronic illnesses, have needs that must be integrated into the provision of HT services. Assessment of these needs is a mandate in order to tailor HT to public health concerns. The Reference Sites Collaborative Network (RSCN) of the European Innovation Partnership on Active and Healthy Ageing aims to assess HT offer accessible to older adults and citizens with special health needs and reference successful examples in order to create awareness towards a comprehensive HT agenda in Europe.

Methods

A survey has been set up, aimed at assessing the experiences in the RSCN, where innovations (eHealth, telecare, integrated care, independent living etc) are scanned regarding effectiveness, accessibility, efficiency and sustainability.

Results

Although experiences are available, they are still fragmented and could take advantage of networking at local, national and international levels to exploit HT full potential. Several gaps have been identified, that can be strengthened by investments (e.g. infrastructure, training).

Conclusions

The HT sector provides opportunities arising from the improvement of health services to residents that could strengthen a personalized service offer targeting tourists increasing sustainability of such services.
Dental care in Europe: financing, coverage and provision
Authors: Winkelmann J , Henschke C , Scarpetti S , Panteli D
Published: October 2020

Background

In Europe, countries have adopted very different approaches to providing publicly subsidized dental insurance coverage. However, little attention has been paid on these variations in the coverage, financing and provision of oral health care and its implications. This cross-country Health Systems in Transition (HiT) Review aims to fill this gap in the field of comparison of oral health systems.

Methods

The comparative HiT draws on multiple data sources. It builds on detailed country information from national HiTs and other international sources (MISSOC, OECD/OBS country profiles). International databases (Eurostat, OECD, EHIS, EU-SILC) are used as main sources to compare available oral health related indicators. National and international policy documents and information by country experts complement this information. The HiT covers all EU members states and countries belonging to the EU's single market (UK, Iceland, Norway, Switzerland).

Results

In almost all countries, dental care is funded to a greater extent by private patient payments than other health care sectors. Overall, contribution of voluntary health insurances (VHI) to dental spending is low, while out-of-pocket spending is substantial in many countries leading to high levels of unmet needs for dental care for financial reasons, mainly for poor households. Comparison of coverage reveals that most countries commit to a minimum scope of basic dental care (emergency care, children), but there is large variation in terms of restriction of service packages ranging from countries with very limited, partial to comprehensive coverage.

Conclusions

Dental care has become a priority for European policy makers as countries extend statutory dental care coverage recognising the importance of prevention of oral diseases. However, there remain wide variations in the level of coverage resulting in differences of likelihood of dental care use.
Comparing dental care coverage for older adults in eight jurisdictions
Authors: Allin S , Farmer J , Quiñonez C , Peckham A , Marchildon G , Panteli D , Henschke C , Fattore G , Lamloum D
Published: October 2020

Background

Oral health is an important component of general health and healthy aging, yet financial protection for the costs of oral health care is often limited.

Methods

We systematically compare dental care coverage in Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We populated data collection templates to provide detailed and comparable descriptions of dental care coverage in 8 jurisdictions.

Results

Overall there were four general types of coverage models: 1) deep public coverage for a small subset of the population based on strict eligibility criteria jurisdictions: Canada, Australia and Italy; 2) universal but shallow coverage of the population, combined with deeper coverage for a sub-set of the population meeting eligibility criteria: England, France, Sweden; 3) universal, and predominantly deep coverage for the whole population: Germany; and 4) shallow coverage available to some subgroups of the population in the United States.

Conclusions

While age, specifically turning 65, is an important consideration in the design of public coverage in Canada, Australia and the United States, many jurisdictions do not consider age as an eligibility criterion for public coverage. Yet all jurisdictions we include, except Sweden, provide differential coverage for those who meet a specific low-income threshold. Due to the limited availability of comparable data within and across jurisdictions, further research would benefit from standardized data collection initiatives for oral health measures.

Key message

Given the important role oral health plays in promoting healthy aging, the limited public coverage of oral health within statutory health systems warrants policy and research attention.
HIV test and knowledge of U=U: insights from MSM living in Portugal and participating in EMIS 2017
Authors: Costa J P , Meireles P , Aguiar A , Schmidt A J , Barros H
Published: October 2020

Recently, it became clear that undetectable equals untransmittable (U=U), stressing the importance of engaging in medical care and adhering to antiretroviral therapy. HIV testing and counselling (HTC) are offered in different settings and can be an opportunity to inform people. We aimed to understand if HIV testing history, including recency, place and, result, was associated with U=U knowledge.

We used data from 2242 MSM living in Portugal participating in EMIS 2017 that answered if they already knew that “A person with HIV who is on effective treatment (called 'undetectable viral load') cannot pass their virus to someone else during sex”, opting of 5 possible answers, dichotomized in “I already knew” vs. any other option. Regarding HIV testing history, participants were categorized as follows:1. HIV positive; 2. HIV negative and last test ≤12 months in a community setting; 3. HIV negative and last test ≤12 months in a medical setting, and 4. never tested for HIV or last test >12 months or tested in other settings (reference). Logistic regression models were fitted to estimate crude and city size and education-adjusted associations.

The median (P25; P75) age of participants was 34 (25; 43) years. No significant statistical association was found with age or current occupation. Those with more years of education and living in a big or very big city were more likely to know that U=U (aOR:1.55; 95%CI:1.20-1.99 and aOR:1.26; 95%CI:1.04-1.53, respectively). Considering HIV testing history and diagnosis, men with diagnosed HIV (aOR:6.33; 95%CI:4.50-8.90), those who had the last test in community setting (aOR:2.44; 95%CI:1.87-3.17) and those who had the last test in a medical setting (aOR: 1.57; 95%CI:1.26-1.95) were more aware of U=U than those not tested in the last 12 months.

Our results suggest that there is a gradient of U=U knowledge associated with HIV testing history among MSM. Efforts should focus on improving counselling about U=U at all HIV testing settings.

Key messages

The knowledge of U=U seems to be associated with the place, recency and result of the last HIV test. Counselling should focus on the best evidence available at all HIV testing settings, to inform and empower the individuals.
Advocating for Front-line Health Advocates- A Scoping Review of Health Advocacy Pedagogy
Authors: Somaroo H , Naidoo S
Published: October 2020

Background

Health advocacy (HA) is a core competency of transformed, socially- and contextually-responsive, 21st century medical graduates though remains challenging for medical educators, including in South Africa. The optimal delivery of HA education has been vulnerable to vague definitions, lacking distinct or measurable dimensions, varied judgement, and poor prioritization in curricula which balance competing interests. We aimed to clarify HA definitions and explore current practices of HA pedagogy.

Methods

A step wise, scoping review approach was adopted, for evidence on HA and HA pedagogy. This included electronic database searches of published literature, and internet searches for non-journal publications, from 2000 to 2020 and limited to reports published in English. Websites of relevant regulatory bodies and professional organizations were also explored. Inductive thematic analysis was used to analyze the data.

Results

Sixty-four total articles and documents were included. Majority emerged from North America, the field of health education, and medical disciplines of family medicine, internal medicine, and pediatrics. HA compels graduates to be change agents and activists, at both the individual and community levels, and to promote equitable access to quality healthcare. It is increasingly associated with social accountability, consideration of the social determinants of health, and progression from advocating with, rather than for, individuals and populations. Various curricular approaches were evident, including didactic and experiential learning, and longitudinal and integrated designs.

Conclusions

Although HA is a core competency for medical graduates in South Africa, there is little evidence related to HA pedagogy in the country and the African continent. Despite distinct variability in current instructional approaches, there is potential for consolidation, contextual relevance, enhanced HA pedagogy, and improved HA competencies.

Key messages

HA is a core medical graduates’ competency but HA education is often sub-optimally engaged with and delivered. Enhanced, contextually relevant HA pedagogy could empower medical graduates to be better health advocates and more confident change agents for patients and communities they serve.
The gethnic approach for explaining the search for health information on social media
Authors: Rosenberg D , Mano R , Mesch G
Published: October 2020

Gender and ethnic inequalities in searching for health information have been studied extensively in the context of the internet as a whole, but rarely with respect to social media. Moreover, locality size has rarely been considered as a determinant in the search for health information. Furthermore, little attention has been paid to differences between searching for health information in general and for information on specific health issues. This study proposes a gethnic diversification approach to understand these phenomena. This approach maintains that the triple disadvantage of belonging simultaneously to three disadvantaged groups is translated into an advantage with respect to the probability of searching for health information online. The sample consisted of social media users in Israel (N = 803). The study's outcomes variables were general types of health information (medical vs. non-medical) and searching for specific health issues. The results of logistic regression analyses provide support for the gethnic diversification approach. These results imply that disadvantaged minorities residing in small localities (but also in large ones) use social media to search for health information to a greater extent than their counterparts from larger localities and than members of the advantaged group in order to compensate for their restricted amount of health-related social capital. This finding signals a major need for accessible and quality health services in small localities where many disadvantaged minority groups reside.

Key messages

Minority women residing in small localities should be treaten as a special group by the public health officials. More resources should be invested in developing health services in localities populated by minorities.
Knowledge at palm of hand: supported self-management and audiovisual content School of Patients DF
Authors: Cubas-Rolim E , Yung F R , Gripp M R , Oliveira C L A , Marques L A , Fagundes M C , Souza B V , Ribeiro L , Faria-Tostes E , Santana F
Published: October 2020

Background

The region of practice of the School of Patients DF is vulnerable at health literacy and income. Audiovisual information is strategic in primary care for its great power of reach and information retention.

Objectives

Since 2016 videos of health education have been produced, initially technical on the Planification for hypertension and diabetes. After the focus switched to popular health education, aiming at improving communication between health professionals and patients on chronic diseases and health promotion, including testimonials. The is potential for video exhibition in qualified waiting rooms and forwarding in social network.

Results

There are videos from diabetes, hypertension, obesity to dengue, pre-natal care and other APS themes, which follow printed orientation with pertinent links. There are graduate and post-graduate studies in course for optimizing audio-visual content for support and capacitation of the family caregivers, especially regarding the facilitated visual model of prescription (“Illustrated Prescription”). Data until 2020-January: YOUTUBE 3146 views, 118,6 hours of exhibition, 50 videos. FACEBOOK page with a reach of 369.248 views. INSTAGRAM 10.119 followers, 193 posts, 37.800 likes and 1003 commentaries.

Conclusions

Modifications in lifestyle and adherence to medication are fundamental for treatment, and videos are promising for health promotion and selfcare capacitation. There is potential for reducing the hierarchy barriers (testimonials). The shared construction of knowledge and its dissemination makes the patient active part in community diffusion of information.

Key messages

Health professionals have a vital role as educators, including for social online networks. Patients have a protagonist role in their treatment, as well as multipliers of knowledge at their community.
Personal cell phones among children: attitudes of parents of primary school pupils
Authors: Austys D , Sprudzanaitė A , Arlauskas R , Stukas R
Published: October 2020

Background

A large number of primary school children have personal smartphones which enable them to communicate with lots of people and use social networks. However, social networking should not be accessible to primary school pupils due to existing age restrictions. Studies show that cell phones can be used to send offensive or sexual content to children or by them. This might have long-term effects on child's mental health and even provoke suicidal thoughts. While parents are able to control many aspects of children's life, we aimed to disclose parental attitudes towards use of mobile phones among children.

Methods

A total number of 619 parents of primary school children from middle-sized town of Lithuania participated in this study. Parents anonymously expressed their opinion to questions about personal cell phones usage among children. Distribution of participants was assessed according to social and demographic characteristics.

Results

Most of the respondents (79.8%) indicated that use of mobile phones might be harmful to children's health, 56.0% indicated that their children use social networks and every second child was registered by their parents (49.5%). Minority of the respondents (8.1%) thought that children (including children from other families) receive messages from strangers and communicate with them (2.1%). Similarly, very few of the respondents thought that children receive offensive (15.0%) or sexual (4.8%) content. Younger and lower educated parents registered their children to social networks more frequently (p-value less than 0.05). Lower educated parents more frequently indicated that offensive or sexual content can reach children via smartphones (p-value less than 0.05).

Conclusions

Majority of parents of primary school children thought that cell phones might be harmful to children's health but most of them did not pay attention to threats such as communication with strangers or transmission of sexual content.

Key messages

Only minority of parents of primary school children indicated communication with strangers or transmission of sexual content as threats induced by use of smartphones among children. Regardless that lower educated parents indicated awareness of content-related threats to children more frequently they registered their children to social networks more frequently as well.
Digital health and digital information in the context of big data. An ethical insight on interests
Authors: Mirchev M , Kerekovska A
Published: October 2020

Background

Health data is the key link between the prospects we face in improving health services and the context of current information reality. In the field of public health, the sheer scale of data collecting, digitalization and use is already raising questions related to the ethical norms among different stakeholders. The fact that it is personal data at stake, confronts at least two views: the individual versus the public interest. The more we ease the process of health data aggregation and use, the more risks of possible harms we face. So, whose interest is a priority?

Aim

To consider if it is possible to balance the conflicting interests of individuals and society in the digital health era by advocating for mutual compromises and rational argumentation.

Methods

Ethical, documental and historical research.

Results

The amount of digital health related personal data transforms both opportunities for improved healthcare and research, and possible uncertainties related to improper use, harms, abuses, injustice. This nourishes individuals' doubts and potentially restricts the public interest by putting limits on future use of data. A balance between the confronting interests is needed. Granting ownership rights over data requires entirely new legal frame, since property rights hardly encompass the unique nature of information. Moreover, data is a valuable artefact, and ownership could provoke further commercialization. On the other hand, it is virtually impossible to put a separating line between commercial and ideal use of health data for care improvements and science. Our focus should be on the ideal use and essentially on insuring individual's privacy and confidentiality, but not at the expense of public benefits and scientific progress.

Conclusions

Health information is a powerful tool, and its utilization suggests compromises, which are possible if rational argumentation and support is provided to individuals with the aim to overcome the existing discrepancies.

Key messages

The appearance of digital health fully represents the dynamic information reality in which constructing a balance between different stakeholder’s interests is vital and not impossible to achieve. Healthcare prospects depend on our individual responsibility and willing to share as we have the data and the means to use and secure it, and we have the duty to do it.