bluuebunny/crossref_metadata_2025 huggingface dataset:
Can incorporating behaviour change principles make clinical practice guidelines and health policies more impactful in change public health?
Authors: Bacon S
Published: October 2020

Background

We now live in world of ever-increasing amounts of evidence and information. In spite of the use of high-quality methods to synthesise this information, clinical practice guidelines and health policies often fail to impact public health. Canada has started to develop a series of guidelines and policies which have incorporated a behaviour change perspective into their development to fast track their implementability and their impact on public health. For example, the Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR)'s new Cardiovascular Rehabilitation Guidelines are being built using key integrated knowledge translation and behaviour change theories to develop recommendations which not only target the what to do but, who, and how this needs to be done. Another example is Canada's new Food Guide, which is unique in the fact that it has taken a behaviour-oriented perspective, rather than a macro and micronutrient path. Both of these examples leverage basic behaviour change principles to get multiple stakeholders to increase their uptake and usage of these knowledge products.

Results

Both the CACPR guidelines and the Food Guide are still relatively new, so their uptake and impact is not currently measurable. However, there is a monitoring plan which will evaluate these aspects. That being said, there is some evidence that both of these products have been well received by their respective communities.

Conclusions

Taking a behaviour change perspective in the development and delivery of guidelines and policy, especially health policy, has the potential to positively engage more stakeholders in the process, and fast track their impact on public's health. Ultimately, more evidence is needed to define the optimal way to do this.
Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study
Authors: Barrett P M , McCarthy F P , Evans M , Kublickas M , Perry I J , Stenvinkel P , Khashan A S , Kublickiene K
Published: October 2020

Background

Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype.

Methods

Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded.

Results

The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD.

Conclusions

Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery.

Key messages

Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.
Economic evaluations of public health interventions for physical activity and diet: systematic review
Authors: Gebreslassie M , Sampaio F , Nystrand C , Ssegonja R , Feldman I
Published: October 2020

Background

Physical inactivity and unhealthy dietary habits are associated with an increased disease and economic burden. Despite the prevalence of different public health programs, decision-makers encounter a multitude of challenges in prioritizing interventions for optimal resource allocation. The aim of this systematic review, therefore, was to identify economic evaluations of public health interventions targeting physical activity and healthy diet, and assess the quality and transferability of the findings to the Swedish context.

Methods

A search of published economic evaluations was conducted through electronic databases including PubMed, Web of Science, PsycINFO, National Health Service Economic Evaluation Databases (NHS EED) and the Health Technology Assessment Database (HTA). An additional search was done using references of relevant systematic reviews and, websites of relevant organizations were checked to find grey literature. Quality and transferability of the economic evaluations were appraised using a quality assessment tool developed by the Swedish Agency for Health Technology Assessment.

Preliminary Results

Thirty-two economic evaluations of 178 interventions were included; thirteen studies targeting physical activity, thirteen targeting healthy diet and six targeting both. The interventions varied in terms of their content, setting, mode of delivery and target populations. A majority of the economic evaluations reported that the interventions were likely to be cost-effective; however, considerable variations in the methodological and reporting qualities were observed. Only half of the economic evaluations were rated to have a high probability of transferring to the Swedish context.

Conclusions

Most of the interventions were reported to be cost-effective. However, a variation in quality and transferability of the available evidence to the Swedish context were observed.

Key messages

Public health interventions targeting physical activity and dietary habits have a high potential to be cost-effective. Decision makers should consider transferability and suitability of findings of economic evaluation from a different context to a decision problem at hand.
Designing for Growth and Development – A co-designed course for homeless people
Authors: Kroll T , Frazer K
Published: October 2020

Background

In many developed countries, homelessness remains an intractable challenge for intersectoral policies. People who are homeless struggle with a myriad of problems. They frequently experience stigmatisation and social marginalisation. Physical and mental health may be severely compromised, and it could be challenging to retain a sense of personal agency.

Objectives.

To co-design a personal and organisational development training course, in collaboration with clients and staff of a homeless service provider. To ensure that homeless individuals develop strategies and supports to help them navigate complex life circumstances. 6 three-hour workshops, informed by design-thinking. Each workshop session was co-designed (2 clients of a homeless charity, one staff member of staff, and two academics) in Ireland. Workshops followed the design cycle, starting with empathy exercises, then moved to define specific life challenges related to homelessness. Solution-focused ideation sessions followed. The team proceeded then to build a testable 'prototype'.

Results

The team jointly developed a high degree of creative confidence and shared responsibility for different sessions. The team developed a 'peer-support programme' as a tangible output. Academic team members gained deep insights into the lived experience of homelessness; client members deployed skills and experiences and gained renewed confidence in their abilities. The homeless charity proceeds with testing the 'peer-support' programme prototype.

Conclusions

We expect the Access and Life-Long learning programme at the university will offer the programme as a credit-bearing course. Its acceptability and usability will be tested.

Key messages

Homeless individuals can be meaningfully involved in designing services that empower them to navigate complex systems. Design thinking yields personal and organisational benefits.
Natural course of smoking cessation and predictors of quitting in young adulthood
Authors: Kalubi J , Dugas E N , Wellman R J , Sylvestre M P , O'Loughlin J
Published: October 2020

Background

Young adulthood is characterized by major life changes that can promote or inhibit cigarette smoking. Gaps in knowledge on the natural course of, and factors associated with quitting impede progress in designing effective cessation interventions targeting this age group. We describe the natural course of cessation among students who smoked cigarettes in their last year of high school and we identify predictors of quit status at age 30.

Methods

Data were drawn from an ongoing investigation of 1294 grade 7 students age 12-13 recruited in 1999-2000 in 10 high schools in Montreal, Canada. Using data collected at ages 17, 20, 24 and 30, grade 11 cigarette smokers were categorized as quitters or current smokers at age 30.

Results

Among 245 grade 11 smokers, 48% (55% of females; 33% of males) had quit by age 30. Among 106 quitters with complete data, 27% were consistently abstinent during young adulthood, 33% were intermittently abstinent and 40% were abstinent at age 30 only. Smokers at age 30 had higher impulsivity scores in grade 11 than quitters and were more likely to report nicotine dependence symptoms and have family members who smoked. Quitters rated self-control and social influences as more important reasons to quit than smokers. Although 85% of smokers wanted to quit, only 45% had used a cessation strategy in the past year.

Conclusions

Adolescents likely to be smokers at age 30 are identifiable in high school. Cessation assistance must be offered early in high school to provide adolescents with opportunities to quit before smoking becomes intractable.

Key messages

Among grade 11 smokers, 27% were consistently abstinent in young adulthood, 33% were intermittently abstinent, and 40% were abstinent at age 30 only. Cessation programs are needed early in high school to prevent intractable smoking.
IQOS point-of-sale marketing strategies at a time of legislation transition in Israel
Authors: Bar Zeev Y , Berg C , Abroms L C , Levine H
Published: October 2020

Background

Heated tobacco products (HTP), such as Philip Morris IQOS, have penetrated the global tobacco market. Currently the only HTP on the market in Israel, IQOS was introduced in 2016. The device is sold in specialty stores and online; while the heat sticks (HEETS) are sold at traditional retailers. In 01/2019 a ban on advertisements in all media (excluding print media) and at the point-of-sale (POS) went into effect. In 01/2020, a POS display ban and plain packaging went into effect. Understanding the POS marketing strategies at a time of regulatory transition could aid regulatory efforts in other countries.

Methods

Observations were conducted in 80 retailers carrying HEETS in 4 large Israeli cities in 12/2019, before the POS display ban and plain packaging went into effect. Data were collected using an adapted version of the Standardized Tobacco Assessment for Retail Settings, which assessed store characteristics, product offerings, pricing, promotional strategies, and placement.

Results

All retailers sold cigarettes; 51% carried also electronic cigarettes. Only one retailer carried the IQOS device. HEETS packages were visible to customers in 47% of retailers. Over 60% carried at least 3 HEETS different flavours (out of 5 available). In all but one retailer, HEETS were sold at higher prices than cigarettes, on average 21% more expensive. Posted ads were uncommon. In 14.5% of retailers, a special IQOS product display cast was prominent. Additionally, 25% of retailers placed cigarettes and 14% placed HEETS near youth-oriented merchandise.

Conclusions

This study provides insights into IQOS marketing strategies during a period of regulatory transition. Findings suggest that IQOS-specific promotions were not common, but a proportion of retailers highlighted IQOS via displays and/or proximity to youth-oriented merchandise. Moreover, IQOS may be promoted to higher socio-economic status populations, as indicated by pricing and possibly by availability of products.

Key messages

Understanding IQOS marketing strategies at point-of-sale is critical to inform regulatory measures globally. IQOS marketing strategies in Israel at the point-of-sale suggest that IQOS is promoted to higher socio-economic status populations.
Exploring depressive symptoms among LGBT+ medical students: an Italian multicentre survey
Authors: Lo Moro G , Bert F , Gualano M R , Leombruni P , Siliquini R ,   PRIMES Collaborating Group
Published: October 2020

Background

Sexual minorities are high-risk populations for mental issues. Recently, attention on medical students (MS) is growing as they might be at higher risk of depression, but few studies focused on mental health of LGBT+ minorities among MS. Our main aims were to investigate depressive symptoms (DS) among LGBT+ MS, compared with non-LGBT+ MS and explore DS predictors.

Methods

A multicentre cross-sectional survey was performed in 12 Medical Schools (Italy, 2018). The questionnaire included sociodemographic items and psychometric tests. The Beck Depression Inventory II was completed by 325 LGBT+ MS and by 2048 non-LGBT+. Chi-squared tests and multivariable logistic regressions were run (significance level: p < 0.05).

Results

Females consisted of 61.5% of the sample, with no differences between the two groups (p = 0.075). DS were reported by 42.5% of LGBT+ MS and 27.4% of non-LGBT+ MS (p < 0.001). Overall, LGBT+ MS took more stimulants (p = 0.001), psychiatric drugs (p < 0.001) and were more frequently seen by psychologists/psychiatrists (p < 0.001). Also, they reported worse family cohesion (p < 0.001) and relationships with classmates (p = 0.018). Considering only non-depressed MS, it was confirmed that LGBT+ MS had higher frequencies of psychiatric drugs consumption (p = 0.036), psychologists/psychiatrists follow up (p = 0.003), poor family cohesion (p = 0.003), poor classmate relationships (p = 0.003). DS predictors were comparable between the two groups, except for age and female gender that were risk factors only in non-LGBT+ MS.

Conclusions

Depression is a great public health issue; it is essential to dedicate efforts targeted to youths at high concern. LGBT+ people confirmed to have an increased DS risk compared to their peers also in a high-risk population like the MS one. Results of non-depressed LGBT+ MS showed a higher necessity of care and a bad living environment, highlighting the need of specific preventive and supportive interventions to bolster sexual minorities.
Strengthening health promotion practice
Authors: Van Den Broucke S
Published: October 2020

Health services in most developed countries were developed to meet the needs of a demand-led health care, and focus mostly on treatment, cure and care. This system is challenged by the growing burden of non-communicable diseases, increased multi-morbidity, newly emerging communicable diseases, and increasing anti-microbial resistance. At the same time, widening health inequalities pose an additional threat to health systems that do not give enough attention to the factors that produce health. To address these challenges, it is necessary to reorient health services towards more preventive, people-centred and community-based approaches, with a more prominent role for health promotion, integrated within the wider health system. This shift of focus requires the strengthening of health workforce capacities to effectively implement health promotion. Whereas a competent health workforce has always been considered a key condition for the delivery of effective health services, the nature of the necessary 'competencies' is being redefined in the light of the current changes of the health system. Within the diversifying primary care and public health workforce, new skills and tasks must be added to existing professional roles, new professional profiles emerge, and collaborations between professions become more important.

This presentation will consider the place of health promotion workforce development within the broader context of public health and health promotion capacity building systems targeting a diversifying primary care and public health workforce. Drawing on recent reviews it will provide an overview of existing capacity development systems in primary and secondary prevention and health promotion, and consider possibilities for integration and implementation of capacity systems within and across disciplinary boundaries.
Healthcare employee's personality traits and service quality: Do team relationships matter?
Authors: Gur A , Weimann Saks D , Stavi L
Published: October 2020

Background

Employee personality is an important factor that affects healthcare service delivery. It appears from the literature that customers perceive employees with personality traits of conscientiousness and agreeableness as more reliable and empathetic and therefore will rank higher service quality. Relationships between team members also affect the perception of service quality. The research examined whether healthcare employees' personality traits (conscientiousness and agreeableness) are related to their perception of service quality, mediated by the quality of team relationships (trust among team members, peer support, and participation in decision-making).

Methods

First, 35 nurses (Israeli college students completing their BA) were asked to rate 22 items based on the Big Five Personality Traits, that most influence employee relationships. The two prominent personality traits were conscientiousness and agreeableness. Next, 174 self-administered questionnaires were completed by nurses who are college students completing their BA (72% return rate). The questionnaire examined personality traits (conscientiousness and agreeableness), service quality, and employee relationships (trust among team members, peer support, and participation in decision-making).

Results

The mediation model was significant [F(4, 169)=35.03, p < 0.001, R Square=0.45]. However, only trust among team members was found as a mediator between employee personality and perceptions of service quality.

Conclusions

Employee personality characterized by conscientiousness and agreeableness encourages trust-based employee relationship, which in turn positively affect the quality of service provided. Healthcare organizations should consider this in their human resources policies and procedures, in order to improve healthcare services.

Key messages

Employee's personality traits are relevant to healthcare service quality. Nurturing trust among healthcare employees may result in improved healthcare services.
Health surveillance indicators: what is available in European data sets for policy evaluation?
Authors: Stanley I , Hebstreit A , Murrin C
Published: October 2020

Background

Policy actions targeting diets and physical activity have been proposed as mechanisms for the prevention and control NCDs in Europe. While these actions have the potential to improve health at a population level, the impact of these policies in Europe is currently unknown. The aim of this study, as part of the wider Policy Evaluation Network, is to catalogue the data available for policy evaluation in Europe to inform the development of surveillance instruments. The catalogues will also provide an opportunity for key stakeholders to view the available EU indicators that can be employed to evaluate policies which influence diet, physical activity and sedentary behaviour.

Methods

A suite of key indicators was agreed by over 30 EU experts and PEN members in a workshop in September 2019. Variables in existing EU monitoring systems were suggested by workshop participants as measures for each key indicator. The mapping process involved an evaluation of how suitable the suggested variables were as measures for the indicators. This was done using a Likert scale (matched, somewhat matched, less matched, not matched).

Results

Diet (n = 72) and physical activity and sedentary behaviour (n = 65) related indicators, across all levels of the socio-ecological model were selected for the mapping process. 72% of diet indicators and 86% of physical activity and sedentary behaviour indicators were matched to at least one variable in an existing EU monitoring system. The majority of indicator-measure pairs were categorised as 'matched' on the Likert scale.

Conclusions

While there are gaps in the measurement of policy level indicators in domains such as inequality, funding and resources and governance, the majority of key policy indicators were mapped to measures in existing systems.Therefore, much of the evidence for evaluation of policies is readily available in Europe.

Key messages

By mapping the key indicators to variables in existing pan-European monitoring and surveillance systems we aim to document the data currently available for policy evaluation. The catalogue of mapped indicators will provide a tool for key stakeholders to aid in the evaluation and development of policies influencing diets, physical activity and sedentary behaviour in Europe.
The challenges of the outbreak: the Italian COVID-19 integrated surveillance system
Authors: Pezzotti P , Punzo O , Bella A , Del Manso M , Urdiales A M , Fabiani M , Ciervo A , Andrianou X , Riccardo F , Stefanelli P
Published: October 2020

Background

In Italy, the National surveillance of all SARS-CoV-2 laboratory-confirmed cases was established on 27 February 2020, building on a previously existing laboratory network focused on suspected and confirmed COVID-19 severe respiratory infections.

Methods

The integrated epidemiological and microbiological surveillance systematically collects and analyzes information on all SARS-CoV-2 confirmed cases. Regional reference laboratories analyze samples, inform Local Health Authorities of the results and coordinate data flow between cases, hospitals and GPs. Regions provide data through a web interface connected to a dedicated IT platform or by sending a dataset. The Infectious Diseases Department at Istituto Superiore di Sanità processes and analyzes data, producing reports on a daily and weekly basis, as well as indicator analyses based on the monitoring of “phase 2” (post-lockdown). Moreover, mathematical models are constructed daily on these data.

Results

Since the beginning of the epidemic, the surveillance system recorded 238.901 COVID-19 cases and 33.369 deaths on 19-6. Main challenges were the coordination of different actors, hampered by the decentralization of health to the Regions, and data interpretation due to the delay in the detection of cases and deaths. Besides the COVID-19 surveillance, we planned ad hoc studies and periodic surveys: health care workers, long term care facilities, clusters and red zones, health system resilience monitoring.

Conclusions

COVID-19 surveillance is an essential tool to inform the public about the epidemic trend and provide support to public health response. We urge upon all relevant stakeholders a reflection on important issues such as defining ethical boundaries for data scavenging during emergencies, how existing laws on data protection could affect record linkage among different existing datasets to assess diseases and other variables for correlation, or which ethical approaches on open data would apply to our setting.

Key messages

A strong and adequately funded public health system in place allows an efficient response in times of epidemics both in terms of data collection and public health response, policy and decisions. COVID-19 epidemic showed us all the limits of a regionalized health system which was not entirely coordinated between periphery and central institutions.
Describing Intimate partner violence against ever-partnered women in Europe and perpetrator’s characteristics. Results from the Violence against women EU-wide survey
Authors: Barbier A , Chariot P , Lefèvre T
Published: October 2020

Available data on intimate partner violence (IPV) are derived from asynchronous and heterogeneous studies. Definition of IPV varies, is often partial, and only a limited number of potential determinants are considered. The Violence against women survey collected data consistently and simultaneously on all dimensions of IPV. Women were also asked about the perpetrator's characteristics. The present study aims to describe prevalence of physical, sexual and psychological IPV against European women, and reported perpetrator's characteristics. Face-to-face interviews were conducted with randomly selected women aged between 18 and 74, by the European Union Agency for Fundamental Rights.

IPV was defined by a positive answer to at least one question about violence perpetrated by current or ex-partner. Among the 40357 ever-partnered women, lifetime prevalence of overall IPV was 51.7% (95%CI 51.2-52.2). Prevalence of physical, sexual and psychological IPV were respectively 20.0% (19.6-20.4), 8.4% (8.2-8.7) and 48.5% (48.1-49.0). Partners' or ex-partners characteristics associated with IPV perpetration included: lower education level, unemployment or staying at home, earning less than the woman, a relationship lasting between 1 to 10 years, high frequency of drunkenness, and perpetration of other type of violence.

Lifetime prevalence of IPV in EU is high and likely to be underestimated. Specific trajectories and profiles of perpetrators should be characterized to ground the interventions. The risk of underreporting violence should be addressed as it jeopardizes the efficacy of interventions for prevention. They may be undifferentiated and differentiated, targeted and time-sensitive, respectively dedicated to general audience and high-risk populations.
The effect of Sexual violence on women’s suicide risk. A mediation analysis based on the nationally-representative 2017 French Health Barometer survey
Authors: El-Khoury F ,   - Equipe baromètre Santé
Published: October 2020

Objectives

The experience of sexual violence has been associated with a host of mental health problems, especially among women. However, data on this association from a large sample of general population is surprisingly limited. Also, no study quantifies sex-differences in the effect of sexual victimization on suicide risk.

Methods

The French “Health Barometer” (Baromètre Santé) is a cross-sectional phone survey, which recruited a nationally representative sample of French adults aged 18 to 75 years in 2017 (n = 25319). Data were weighted to be representative of the French adult population. The Experience and timing of lifetime physical sexual violence, as well as suicide risk were measured for all participants. We conducted adjusted mediation analyses, using the counterfactual approach, to evaluate the contribution that lifetime sexual victimisation has in the association between sex and suicide risk.

Results

The median age for the first experience of sexual violence was 12. Women were around five times more likely to report lifetime sexual violence compared to men (9.1% vs 1.9%), and were more at risk of any suicidal ideation (Ora =1.20 (95%CI: 1.07-1.36)) and suicidal imagery (Ora=1.39 (95%CI: 1.20 -1.61)). We estimated that 47% of the increased risk of suicidal ideation in the preceding year women have compared to men is mediated by lifetime sexual assault. Lifetime sexual assault also explained 39% of the association between sex and having imagery of suicide.

Discussion

Our findings reiterate the importance of the prevention of sexual violence and an adequate care for sexual assault victims, especially women, in public health and mental health policies and initiatives.
Reshuffling community prevention and care: a new model for healthy ageing
Authors: Liotta G
Published: October 2020

Europe is facing a unprecedented change of the population structure due to demographic transition, that makes the European countries a laboratory for implementing policies aimed at healthy ageing. However, there is a paucity of evidence-based interventions, except for the ones focussed on changing individuals' life style, the main ones being nutrition, physical activities, smoking and drinking. Even in the case of life habits, there are no structured interventions, while health promotion activities are mainly entrusted to the GPs, who are responsible for communicating the needed changes of behaviours to the patients they meet. The increase of chronic diseases prevalence claims for rethinking this approach in order to set up structured prevention activities to mitigate the impact of diseases on functional decline.

Based on the available data some elements to rethink community care and prevention can be identified. Bio-psycho-social frailty represents a synthetic indicator of the risk of negative events like the worsening of functional status, hospitalization, institutionalization and death, far more effective than single diseases or comorbidities or even than disabilities. The assessment of frailty should be pursued through a pro-active approach in order to fill the gap of the lack of awareness about frailty which is common. This approach should be reserved to the population with the highest risk of negative events, namely the over-75 one. At side of already well-known interventions on physical activities and malnutrition other risk factors for negative events such as social isolation or polypharmacotherapy should be considered. The increased frequency of heat waves should also be at the basis of yearly intervention able to reduce the risk of death and hospitalization, always associated to climate stressors. A schedule of prevention intervention should be formally structured in order to put the basis for a better aging in Europe as a model for other continents.
Monitoring changes in the organization of Dutch long-term care and their effects on the mental health and wellbeing of people with dementia
Authors: van der Roest H , Prins M , van Erp J , Hartstra E , van der Schot A
Published: October 2020

Background

The 'Living Arrangements for People with Dementia (LAFD)' monitor-study aims to provide insight into effects of changes in the organization of Dutch long-term care for people with dementia. The objective of this study is to evaluate changes over time in the level of cognitive impairment, the frequency and severity of behavioral symptoms, and quality of life of residents with dementia, and changes in staffing levels. The study allows for detection of trends and developments that are relevant for the quality of nursing home care.

Methods

The LAFD-study is a repeated cross-sectional study. Since 2008, assessments have been conducted in participating nursing homes every two year. Up to 2020, five assessments have been completed. The number of participating nursing homes over time ranged from 47 to 144 and a sample of one third of residents was included in the study. Data collection was performed by care professionals. Cognitive impairment was assessed with the Cognitive Performance Scale, frequency and severity of behavioral symptoms were assessed with the Neuropsychiatric Inventory; quality of life was assessed with de Qualidem. Per nursing home, the amount of direct provided care was inventoried.

Results

Assessments up to 2017/2018 showed an improvement in cognitive functioning and quality of life in Dutch nursing homes. The amount of behavioral problems did not change, as did the amount of direct care. However, the level of professional caregivers increased slightly. In the last assessment, 53 nursing homes participated, and 668 residents were included. The fast majority of participants was over 80 years of age (67.1%) and 68.5% were female. The data are currently being further analyzed and presented at the conference.

Conclusions

There is a trend of improvement in cognitive functioning and quality of life up to 2018. The most recent assessment will indicate whether these positive trends continue.
Mapping refugees and migrants’ access to health care in Tunisia
Authors: Arfa C
Published: October 2020

Objectives of the study carried out under the request of the Office of Family Planning and population are collecting data on refugees and migrants, assessing their social and health needs, mapping health care providers and formulating recommendations to ensure equitable and affordable access to quality health services. The methodology has combined qualitative and quantitative research and focus group discussion scattered over the country, NGOs, ministries, and desk review.

Results shown several gaps in relation to access to health care by refugees and migrants including: NGOs provide 55% of servicesVulnerability is increased by lack of official documents for residency and work permitLack of response of public and private providersCultural and linguistic barriersXenophobic and racist attitudes of both population and health care providers

Based on gap analysis and inputs from several focus groups several recommendations were made to improve access of refugees and migrants to quality health care including the need: to fill the legal vacuum on refuge and migrationto establish an independent public authority on migrationto establish with support from civil society organizations a space for dialogue and communication with refugees and migrantsto improve health system responsiveness to refugees and migrants.

As the issue of migrant's access to quality health care is multi-dimensional there is a need to establish inter sectoral task force involving concerned line ministries (i.e health, interior, migration, social affairs, etc..) national and international civil society organizations and concerned United Nations agencies.

The objectives of the paper are to: Map the social, economic and health conditions of refugees and migrants in TunisiaTo assess gaps of health services access of refugees and migrantsTo advocate a right base approach to health of refugees and migrants in Tunisia.
Implementing Health Literacy Intelligence during COVI-19 outbreak
Authors: Leiras G , Arriaga M , Gaspar R , Raposo B , Domingos S
Published: October 2020

Background

During events that involve health risks, people may feel the need personal and social resources to cope with the demands posed by event. Depending on their individual characteristics, people may perceive their resources as sufficient or as insufficient to face the situation. Risk perception analysis was conducted in Portugal during the COVID-19 outbreak, to develop communication strategies, customized to the changing needs, helping people make informed decisions.

Methods

Citizens messages on social networks of 3 official information sources, and 8 media sources were analyzed between 26th January and 5th March 2020. A sample of comments to publications related to COVID-19 were analyzed in 4-days periods and categorized. A qualitative theory-driven thematic analysis was carried out based on two global categories: Demands and Resources. From this analysis, the threat level ratio (Demands/Resources) was calculated.

Results

A total of 8,251 comments were analysed in 10 periods of 4 days of data collection, from 26th January to 5th March. The threat level ratio increased during the first 15 days of analysis, having its maximum (6.80) in the period between the 7th and 14th of February, mostly associated with the perceived danger associated with the lack of airports arrivals control from China. After the announcement of the first confirmed case of COVID-19 in a Portuguese citizen outside Portugal, on 23rd February, the risk perception increased 1,4% compared to the previous period of analysis. On the contrary, after announcing the first confirmed case in Portugal, on the 1st March, the risk perception decreased 1,6%, which is inferred to be associated with a shift in the media discourse and to the use of humour.

Conclusions

Awareness of risks is a necessary condition for people to adhere to the necessary recommendations to mitigate the crisis. During an epidemic, an effective communication strategy can become an opportunity to promote health literacy.

Key messages

Risk perception is essential to define effective communication strategies to promote health literacy and best practices among targeted populations. effective communication strategies customized to people’s needs and priorities help people making informed decisions during a public health emergency.
Organisational barriers to accessing vaccination services: a literature overview focusing on underserved populations in Europe
Authors: Jansen D
Published: October 2020

Background

Immunization and equitable access to immunization are core components of the right to health (WHO). Although more and more children in the WHO European Region are being vaccinated against measles than ever before, coverage gaps even persist within countries. As a result, specific, underserved populations are left unprotected, resulting in a record number of these populations affected by the virus in 2018. Aim of this presentation is 1) to explore barriers that underserved populations might encounter and 2) share good examples of organisation of vaccination services for underserved populations.

Methods

Literature searches have been conducted in a variety of databases, using different search terms. Published studies in English that explores 1) barriers in the organization of care; 2) successful interventions related to the organization of care, in (expected) low vaccination uptake populations will be included. The databases will extend beyond the medical literature to include social science literature. The literature search included peer reviewed international academic literature and government reports dating from 2010 to 2019.

Results

In this presentation the results of the literature review will be presented: what barriers in the organization of care are experienced by populations that have low vaccination uptake? And what evidence does the literature present concerning the organisation of care that lead to a sufficient to high uptake of vaccination in populations where you would not expect this?

Conclusions

the results of the literature review will provide a useful and valuable overview of barriers and facilitators of accessing vaccination services of (expected) low uptake populations in Europe. Since access, as a key dimension of organisation of care, is still the main factor hindering vaccine uptake it is important to learn lessons not only from poor practices but also from good practices.
Narrative medicine in the cancer care: implementation and impact
Authors: Scardoni A , Cenci C , Sancini S , Moro M , Signorelli C , Odone A
Published: October 2020

Issue

National and international health authorities have described Narrative-based medicine (NBM) in clinical practice as a fundamental tool for acquiring, understanding and integrating the different points of view of those involved in the disease and its treatment, promoting more effective and appropriate care.

Description of the problem

The use of NBM is part of the strategic project to improve patient-engagement in San Raffaele Hospital in Milan. Its implementation started, using the 'DNM-Digital Narrative Medicine' web-based platform, with the pilot prostate cancer path in March 2019.

Results

A 10-item questionnaire was sent to all 47 patients and 45 doctors involved, to evaluate: benefits perceived by the care team in terms of communication support, personalization of therapy, observation of cognitive elements not otherwise evident; benefits perceived by the patient (support, communication, self-management, identification of emotional, relational, social elements of daily life); patient and medical staff opinions in terms of compliance, accessibility, ease of use. The overall rating was 4.3/5 for doctors and 4.2/5 for patients. Patients valued the most the platform supporting them in the decision on what treatment to undergo (4.8/5), for the doctor the platform has been important in considering unknown aspects of the patient and understanding the patient's point of view (4.4/5). Patients, more than doctors, perceived platform usability positively. 43% of the patients who decided not to participate reported to prefer a direct approach with the doctor.

Lessons

The oncologic field represents an optimal setting for the implementation of methods aimed at strengthening communication and relationship of care. NBM offers the possibility of exploring elements as adherence to treatment, perception of illness, socio-psychological impact, sometimes missed during the visit, enhancing the conversation between patient and care team and stimulating the co-construction of care.

Key messages

NBM has proven to be a useful tool and a good communication channel in the oncologic setting. The NBM platform demonstrated good acceptability and ease of use by doctors and patients.
Evaluating quantitative methods for intercategorical-intersectionality research: a simulation study
Authors: Mahendran M , Bauer G , Lizotte D , Zhu Y
Published: October 2020

Introduction

This study evaluated seven quantitative methods for their predictive accuracy for intersectionally defined subgroups, via a simulation study. The methods were single-level regression with interaction terms, cross-classification, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA), and four decision tree

Methods

classification and regression trees (CART), conditional inference trees, chi-square automatic interaction detector, and random forest. Also evaluated was how well methods identified variables relevant to the outcome. An example analysis will be presented using data from the U.S. National Health and Nutritional Examination Survey.

Methods

The simulated datasets varied by outcome variable type (binary and continuous), input variable types, sample size, and size and direction of the effects. Accuracy was evaluated using mean squared error or mean absolute percentage error. The secondary outcome was evaluated via significance and confidence interval coverage of regression terms and variable selection of the machine learning methods.

Results

Predictive accuracy improved with increasing sample size for all methods except CART. At small sample sizes random forest and MAIHDA generally created the most precise predictions. Variable selection consistently faced a high type 1 error for CTree and CHAID. While performing well for prediction, variable selection by random forest and confidence interval coverage and power of MAIHDA main effects coefficients were suboptimal.

Discussion

From this study emerge recommendations for applying methods in quantitative intersectionality. Different methodologies are optimal for different purposes, for example while random forest and MAIHDA performed well for prediction, they were less reliable for variable identification. In our discussion, we will work through how to select, apply, and interpret methodologies to achieve analytic goals that align with intersectionality theory.
Prevalence of suicidal behaviour and violence among young people
Authors: Jakubauskiene M , Lindert J
Published: October 2020

Background

Violence and suicidal behaviour among young people is an enormous public mental health issue in Europe and worldwide leading to poor mental health outcomes, increased use of healthcare services and loss of life. Specifically, vulnerable are young people especially in societies were prevalence of violence and suicide rates are considerably high.

Public mental health of young people in Lithuania is of a great concern due high prevalence of various determinants resulting in poor public mental health outcomes and high suicide rates. This study aimed to identify the prevalence of violence and suicidal behaviour as well as use of health care services among 15-29 years of age young population in Lithuania.

Methods

A cross sectional survey involving 1007 respondents aged 15-29 years in Lithuania was conducted in 2016. Descriptive statistics and logistic regression were applied.

Results

39.7% (95% CI: 34.3-45.2) of young people in Lithuania referred to have suicidal behaviour during the last 12 months, 39.5% (95% CI: 34.1-44.9) of respondents had suicidal ideations, 13.4% (95% CI: 9.7-17.1) - made plans for suicide and 2.1% (95% CI: 0.6-3.7) attempted to commit suicide during the last 12 months. Prevalence of suicide risk was very similar in both gender groups. 27.5% of young people reported experience of psychological violence, 7.26% - physical violence and 4.3% - sexual harassment within the last year. Experienced violence increases risk of suicidal behaviour from 1.85 times in case of psychological violence to 3.79 time in case of physical violence. Young adults who had suicidal behaviour and experienced violence tend to call emergency medical services and were hospitalized more often.

Conclusions

Experienced physical, psychological and sexual violence is related to higher risk of suicidal behaviour. Suicide prevention strategies should consider violence prevention and vigilance of health care system to address suicidal behaviour.
Canada’s health system: struggling to modernize a half-century old system
Authors: Allin S , Marchildon G , Merkur S
Published: October 2020

Canada receives worldwide attention for its single-payer and single-tier universal health coverage system, with hospital, diagnostic and primary care services free of user fees. The level of health spending and overall population health outcomes are comparable to other high-income countries such as France and Australia, but compared to the US Canada spends half as much on health care and achieves significantly better health outcomes. Nevertheless, it faces several challenges. One is providing financial access to other services. Pharmaceutical coverage is uneven and less generous than in comparable countries globally. Access to dental care, not covered for the general population, is challenging for the roughly one-third of the population lacking supplemental coverage, which nearly always is obtained through the workplace. The 2016 Commonwealth Fund international population surveys of 11 countries found that 41% of Canadians said they skipped dental care/check-ups in the past year due to costs - second highest among after the US. A second challenge is waiting for services. Canada shows the longest waits for specialist and surgical services. The third is stasis regarding adapting to changes in medicine and service delivery to improve quality and address major gaps in health across sub-populations such as Indigenous peoples. Innovations such as managed care and pay-for-performance lag behind most countries. Reform efforts aim to address fragmented care across providers, increase coverage, and reduce pharmaceutical costs. There are efforts to strengthen primary care, better coordinate across sectors, and reduce costly specialized care. There has also been increasing momentum to address financial barriers to accessing prescription drugs and containing pharmaceutical costs through a national “pharmacare” plan.