bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of family psychoeducation and access to information on illness negative perceptions: a study on French families of persons experiencing schizophrenia
Authors: Villani M
Published: November 2019

Background

A better understanding of schizophrenia, a chronic disease often leading to heavy negative consequences both on users and families, has been shown to reduce those difficulties. Studies recommend family psychoeducation, as this structured educative intervention reduces parents’ depressive symptoms, enhances family mood, and decreases risks of relapse for users. Our objective is to assess whether family psychoeducation and access to information has an effect on close relatives’ illness negative perceptions.

Methods

Our sample consists in 27 close relatives of persons with schizophrenia. We used a semi-structured interview assessing access to psycho-education and information about illness and diagnosis. We also used the Brief Illness Perception Questionnaire, which explores various illness negative perceptions, as well as probable causes of the illness.

Results

A better access to diagnosis for families is associated with a shorter perceived probable illness duration (p=.044). Family psychoeducation programs, followed by 38,5% of close relatives, reduces their perception of the frequency of user’s present symptoms (p=.029). This could be caused by a better understanding of real symptoms, or by an enhancement of family mood. Also, family psychoeducation has an effect on causal attributions: 50% of close relatives with access to family psychoeducation believed in a substance abuse causality, opposed to 12,5% of the others (p=.036).

Conclusions

Family psychoeducation could help allowing a shift in causal attributions and more generally enhancing family reaction to the disease, which, in turn, can have an impact on the user’s recovery process. Thus, this intervention deserves more attention and should be more systematically proposed to French families, alongside with an easier access to information.
Neighborhood walkability related to knee and low back pain for older people: A multilevel analysis
Authors: Okabe D , Tsuji T , Hanazato M , Asada N , Kondo K
Published: November 2019

Background

Previous research has linked built environments to physical activity. However, the association between built environments and musculoskeletal pain is unknown. This study aimed to investigate the effects of neighborhood walkability as a built environment on the knee and low back pain for older people.

Methods

Data were from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independent people from aged 65 and older. A cross-sectional multilevel analysis was performed on 22,892 subjects in 792 neighborhoods. We used neighborhood walkability as regional level residents’ perception of access to parks and sidewalks and fresh food stores and difficulty in walking due to slopes and stairs and population density. Knee and low back pain which restrict daily life within the past year were our objective variables.

Results

The prevalence of knee pain was 26.2 %, and that of low back pain was 29.3 %. Neighborhood walkability was positively associated with knee and low back pain after adjusting for individual confounders and mediators such as physical activity, a quarter increased perception of access to parks and sidewalks decreased the prevalence of knee pain (PR: 0.85, 95% CI: 0.77-0.94), a quarter increased perception of access to fresh food store decreased the prevalence of knee and low back pain (PR: 0.90, 95% CI: 0.84-0.96, PR: 0.92, 95% CI: 0.86-0.98), a quarter increased population density decreased the prevalence of knee and low back pain (PR: 0.95; 95% CI: 0.93-0.98, PR: 0.96; 95% CI: 0.94-0.98). This trend remains after adjusting the population density, and higher difficulty in walking due to slopes and stairs is newly significant to knee pain (PR: 1.09; 95% CI: 1.01-1.18).

Conclusions

Some of the neighborhood walkability has a protective relation to the knee and low back pain for older people. Longitudinal and intervention studies of the built environment for musculoskeletal pain are required.

Key messages

To our knowledge, this is the first study to discover that neighborhood walkability has a protective relation to knee and low back pain considering various adjustments in a large-scale survey. Improvement of built environments could potentially reduce musculoskeletal pain. In the future, not only individual factors but also environmental determinants of pain should be studied.
The European FOOD programme (Fighting Obesity through Offer and Demand)
Authors: Leaute R , Bertrand N
Published: November 2019

Designated by the WHO as one of the greatest public health challenge of our century, obesity in 2018 is still responsible for 1 in 5 deaths in different parts of Europe. A balanced diet is therefore essential for European citizens’ health. Moreover, as employees spend a significant amount of their waking hours at work, it is a designated place to convey health promotion messages and improve the workers’ eating behavior. The FOOD programme contributes to this objective by promoting healthy eating habits during the working day towards two complementary target groups: workers and restaurants, making the healthy choice more obvious and more accessible.

The FOOD programme is a public-private consortium gathering representatives of Public Health Authorities, Nutritionists and Universities around the lead partner and coordinator Edenred in Austria, Belgium, Czech Republic, France, Spain, Italy, Portugal, Romania, and Slovakia. To meet its objectives, the Consortium followed a five-step methodology with a strong evaluation, enabling a qualitative and adapted set of actions. After a phase of analysis of the needs, communication tools were created to provide practical advice and recommendations to encourage healthy eating habits among the workers and restaurants.

Since 2009, 380 communication tools have reached 6,9 million employees and 521,000 restaurants. In addition, as part of the annual evaluation, barometers are being conducted towards employees and restaurants in order to collect their habits and perception of healthy eating during the working day. Since 2012, 82,600 workers and 7,700 restaurants answered the questionnaires. Return from the target groups confirms a change of perception in the last years as almost half of employees choose a restaurant based on healthy options. On their side, restaurants state a regular increase in the demand for healthy meals and reckon that they could learn more about healthy eating.

Key messages

Creating healthier eating patterns during the working day. Making the healthy choice the easy choice.
Could chips and nuts be vector of food-borne outbreaks during happy hour?
Authors: Gori F , Cuccaro C , Santamaria M , Cardaci R , Burgassi S , Battaglia M A , Messina G
Published: November 2019

Background

A Greater tendency to eat meals outside the home has led to an increase in the attendance of restaurants, cafes, and fast food. That is one of the reasons why the global interest in handling food has risen over the years. The aim of this study is to understand the level of microbial contamination in the food that is served along happy hour in cafe.

Methods

This cross sectional pilot study was performed from April to May 2018 in the city of Siena, central Italy (<60000 citizens). Ten cafes were randomly selected. Samples of peanuts and potatoes were obtained in three different moments, at the beginning (T0), in the middle (T1), at the end (T2) of happy hours events. Collection of the samples was obtained using sterile kit and laboratory analysis was conducted in the University lab. The samples were located on selective medium and the growth of microbial pathogens were checked at 24 and 48 hours. The tested microorganisms were Enterococci, Staphylococci, Coliforms bacteria, Molds, and Yeasts. The statistical analyses were conducted using the Wilcoxon test using Stata 12.

Results

A significant Yeasts contamination appeared only on chips at T0, while within T0 and T1 we found a significant increase of Enterococci, Staphylococci, and Yeasts (p < 0.05) both in peanuts and chips. Comparing T1 and T2 only Yeasts showed significant growth in potatoes (p = 0.04). Between T0 and T2 we also found the growth of Coliforms bacteria in peanuts (p = 0.03).

Conclusions

We showed an increase in the microbial load associated with food handling, mostly of Enterococci. Long exposure time increased the likelihood of contamination and the possibility to exceed the dose for the occurrence of good outbreak. It is likely that offering small portions of handling food would reduce the manipulation by participants and the risk of food-borne outbreaks.

Key messages

Define the most frequent microrganisms could be associated with backed food and evaluate which one of these can exceed the dose for the occurrence of disease in long time. Reflect on the likelihood that the risk of food-borne outbreak caused by manipulation of happy hour participants, may result in an increase in hospital admissions.
4.N. Workshop: Health workforce coordination and agency across sectors, organisations and professions
Authors:   Organised by: EUPHA (HWR), EUPHA (HSR) Chair persons: Ellen Kuhlmann - EUPHA (HWR), Viola Burau - Denmark
Published: November 2019

Background

An increase in chronic illness and multimorbidity together with ‘ageing societies’ and demand for long-term care have created growing need for integrated care and improved coordination of services. However, health systems largely failed to respond to changing needs. Education and training of health professionals are still organised ‘in silos’; connections between health and social care and other groups providing relevant services are usually absent; and fragmentation of care according to specialisation remains the dominant organising principle of healthcare services. In this situation there is an urgent need for change to build skills and competencies, use health human resources more effectively and rearrange care according to population needs and preventative approaches.

Objectives

This workshop brings together research from different national and European research projects positioned at the interface of healthcare services and workforce development. The major aim is to foster the building of bridges across professions, organisations and sectors. The workshop seeks to explore the benefits and novel insights gained from comprehensive efforts to strengthen coordination and integrated models of care and how this may foster agency of the health professions as well as the implementation of new models of care that strengthen health promotion. The findings illustrate that capacity for innovating health systems can be improved through coordination and the crucial role of health professions in these transformations. Health professionals may act as facilitators of integrated work and care arrangements. Strengthening professional agency and coordination across sectors, organisations and professional groups embodies new opportunities for innovating health service provision and health workforce development. These transformations, in turn, may foster people-centred healthcare services.

Key messages

Building bridges between sectors, organisations and professions is a key to people-centred care. Coordination improves health workforce agency and service capacity to respond to population needs.
Intersectoral coordination and diabetes prevention: building capacity through professional agency
Authors: Burau V , Hillersdal L , Timm A , Maindal H T
Published: November 2019

Background

Intersectoral coordination of disease prevention is highly complex. The case of women who develop diabetes during pregnancy (GDM) is a case in point: intersectoral coordination mainly concerns diabetes prevention and thus stretches over the life course of women and their families. Our study aims to analyse how health professions through their day-to-day practice contribute to the creation, maintenance and transformation of intersectoral coordination of diabetes prevention over the life course; and how contexts at systems/organisational influences such processes.

Methods

The study draws on organisational studies of professions and focuses on the mechanisms underlying the making of intersectoral coordination. As part of a pilot study, we conducted a review of the international literature on intersectoral coordination of public health, a review of national policy documents, and a secondary analysis of interviews conducted as part of the development of the Face-it intervention.

Results

The organisation of GDM diabetes prevention in Denmark emerges as fragmented. Care pathways are divided between different phases, types of services, sectors and health professions. There are additional variations among municipalities. Formal (intersectoral) coordination is also limited to vulnerable women and their families. GDM diabetes prevention involves a broad range of professions; professional agency in GDM diabetes prevention is dispersed. Clinical specialists in hospitals show the strongest interest, rooted in healthcare knowledge on prevention. General practitioners have a similar knowledge base, but consider prevention less central. The same applies to health visitors and midwives, whose knowledge base also includes social care.

Conclusions

Individual professions have a strong capacity for intersectoral agency. Strengthening this capacity requires alignment across professions and adaptation to specific contexts.
Interprofessional collaboration in health promotion: changing tasks as leverage for innovation
Authors: Ledderer L , Christensen M , Burau V
Published: November 2019

Background

Increasing demand for interprofessional collaboration calls for change in organisational practice and interactions of professionals. Health promotion is a particularly interesting area for observing these changes, because it involves professionals with different disciplinary backgrounds usually also working in different sectors. In Denmark new health promotion strategies in organisations were introduced to engage professionals in new tasks and establish interprofessional ways of working. Our research aimed to explore how these strategies impact in professional practices, using a cookery project for children as a case study, which involved care assistants and school teachers.

Methods

A qualitative case study was conducted to investigate how care assistants from a nursing home and school teachers implemented a cookery project in a Danish school; the focus was on joint care and teaching situations among the two professions and their users. Our data consisted of documents, participatory observations, and interviews with professionals; a sociological institutional framework was applied to analyse the data.

Results

Institutional changes and the demand for joint care and teaching activities in the cooking project fostered new interprofessional collaboration. Three themes of new professional activities emerged: 1) ‘interplay’ related to making different generations collaborate on the tasks involved in the cookery session, 2) ‘care’ concerned with caregiving activities, and 3) ‘learning” focused on schooling on healthy food and cooking. The activities were related to traditional and new roles in professional practices of both groups.

Conclusions

Changes in professional practices evolved in an informal manner from new tasks and ‘lived’ experiences in the cookery project. The specific practical tasks of health promotion offer an important leverage for future interprofessional collaborations.
Building bridges: Sustainable Urban Health in Hamburg, 2018
Authors: Fehr R , Trojan A , Hornberg C
Published: November 2019

Issue

With most humans, globally, now living in cities, “Urban Health” receives increasing attention. For sustainably securing and promoting human health in the urban setting, a multitude of urban systems, fierce dynamics, and systemic interactions need to be considered. The goal is to provide an integrative view of Sustainable Urban Health (SUH), i.e. capturing the “forest” instead of merely the “trees”. How is this possible, and what insights can be derived? A theory-based SUH approach, starting out from the Human ecology perspective, provides a framework which is compatible with WHO’s Healthy Cities approach.

Methods

Methods used include literature searches and managed cooperation, proceeding from a model exercise (published paper) to a full-scale book publication, thus building bridges across disciplines and societal sectors.

Results

As for results, there is a comprehensive account of Hamburg SUH, including history, health status, governance, health care, rehabilitation, prevention and health promotion, “health in all policies” (e.g. economics, housing, mobility), and current integrative community projects. 100 authors delivered c.70 contributions. Activities around “health” are shown to constitute a remarkable element of urban culture, with room for improvement, e.g. concerning quality assurance on a systems level; more focus on sustainability (incl. environmental impact and overall future-proofing); and safeguarding relevant sources as a “collective memory”. To take the issue forward in civic society, one venerable Hamburg NGO (founded in 1765) now established a SUH working group.

Conclusions

The intensity and diversity as well as certain catch-up needs of SUH in a European metropolis are demonstrated. This “no regrets” approach meets with interest also in civic society. Once it is applied in multiple cities, innovative concepts and efforts can be compared easily, and get locally adjusted, for further strengthening SUH.

Key messages

Sustainable Urban Health (SUH), based on Human ecology, is an integrative “no regrets” approach and can cooperatively be applied anywhere, informing and guiding professionals and civic society. Even where activities around “health” constitute a remarkable element of urban culture, there is room for improvement, e.g. quality assurance on systems level, and more focus on sustainability.
Differences in attitudes of medical and dental students about e-professionalism on social media
Authors: Vukusic Rukavina T , Relic D , Marelic M , Machala Poplasen L , Viskic J , Jokic D , Sedak K
Published: November 2019

Background

Since the use of social media (SM) has increased among health professionals, it is necessary to explore students’ use of SM. Aim of this study was to recognize the patterns of SM use and difference in attitudes about e-professionalism on SM among medical and dental students.

Methods

A cross-sectional study was carried out in the School of Medicine University of Zagreb and the School of Dental Medicine University of Zagreb in academic year 2018/2019. Data were collected using online questionnaires. Data were analysed by descriptive statistics.

Results

A total of 698 responses were received, 411 from second and fifth year medical students (RR 69%), and 287 from first to sixth year dental students (RR 68%). Facebook was the most commonly used SM platform (99%), followed by Instagram (81%) and YouTube (72%). Dental students significantly more accepted friend requests from patients (28% vs 6%, P < 0.001), sent friend requests to patients (5% vs 1%, P = 0.002) and significantly more plan to use SM in interaction with patients (39% vs 16%, P < 0.001). Attitudes regarding what should be considered as unprofessional online behaviour significantly differed regarding posting patient photographs (90% medical vs 61% dental students, P < 0.001), posting interactions with unidentifiable patients (42% medical vs 23% dental students, P < 0.001) and inappropriate language use (72% medical vs 83% dental students, P < 0.001). Students would find useful existence of guidelines about e-professionalism (84% medical vs 90% dental students, P = 0.016).

Conclusions

Results showed that dental students are more open to communicating with patients using SM. Results showed difference in attitudes among medical and dental students what constitutes unprofessional behaviour on SM. Results indicate the need to develop guidelines for students regarding e-professionalism.

Key messages

The difference exists in attitudes among medical and dental students what constitutes unprofessional behaviour on SM. There is a need to develop guidelines for students regarding e-professionalism.
Does Sense make sense? Mixed methods study of a Dutch sexual health program
Authors: Joosten R , Jochems L , Wijsen C , Heijman T , Timen A
Published: November 2019

In the Netherlands, the Sense program addresses several key elements of sexual health for young people <25 year. This program offers free consultations at the PHS concerning STI, contraceptives, pregnancy or sexuality. The performance of this program has not been studied yet. This mixed methods study investigates facilitators and barriers of a Sense consultation from the perspective of clients and health care professionals (HCP) and investigates the outcome of the consultation at three points in time. Semi-structured interviews were conducted after consultation among 16 clients and 6 HCP. Questionnaires were collected directly after consultation and at 3, 6 and 12 months after consultation. Two cohorts were recruited; clients with STI consultation only and clients with questions related to sexuality, contraception and pregnancy (Sense consultation, SC). Satisfaction of the consultation and applicability of the given advice was measured. In the follow up presence of STI, pregnancy, sexual problem and contraceptive use was measured. A minority of the interviewed clients were familiar with Sense, highly valued the expertise of the HCP and the open atmosphere during the consultation. Reasons for visiting Sense included expertise, more anonymity and feeling more comfortable than at the GP. The questionnaire after consultation was returned by 144 STI clients and 32 SC clients. Both type of consultation were highly valued and advice was easily applicable. The follow up cohort included 97 STI clients and 23 SC clients. Response rate of the 3- and 6 month-questionnaires was 61%. Results of the full one year follow-up are expected in September 2019. Study results provide evidence for a highly valued Sense program, by both clients and HCP. Sense is a platform to discuss STI, contraception and sexuality in an open atmosphere, though familiarity with Sense is low. A major conclusion is that an STI consultation provides the opportunity to address questions related to sexuality.

Key messages

The Sense program is highly valued by young people, and yet the program is not widely known among young people. There is need for more publicity to the program to enable more young people to use this program and to improve the sexual health care of young Dutch people.
Gender-specific health literacy of individuals with a migrant background: A mixed-method approach
Authors: Aldin A , Chakraverty D , Baumeister A , Monsef I , Jakob T , Seven ÜS , Anapa G , Kalbe E , Woopen C , Skoetz N
Published: November 2019

Background

The project “Gender-specific health literacy in individuals with a migrant background (GLIM)” (German Federal Ministry of Education and Research; 01GL1723) aims to provide a comprehensive overview of international research and evidence on aspects of gender and migration related to health literacy. It encompasses primary and secondary research using a mixed-methods approach.

Methods

In a first step, we systematically review the available quantitative and qualitative evidence: in the first quantitative review, we meta-analyse the evidence on gender differences in health literacy of migrants. The second quantitative review assesses the effectiveness of interventions for improving health literacy in female and male migrants. The third review summarises qualitative evidence to assess factors associated with gender and migration that may play a role in the design, delivery, and effectiveness of such interventions. In a second step, we conduct primary research by performing focus group discussions (FGDs) with health care providers who regularly work with different migrant groups in order to explore their perspectives on the challenges and needs of migrants in the German health care system.

Results

To date, we identified 163 relevant references after screening of 17,932 references, for all reviews combined. Various health literacy interventions and measurement tools exist and require critical evaluation. The FGDs yielded hints to factors that a) influence gender differences in the health literacy of migrants (e.g. masculinity norms preventing Mediterranean men from consulting psychotherapists) or b) limit systemic health literacy (e.g. lack of translators).

Conclusions

Results from the FGDs can provide insights into the processes underlying the results of the reviews. However, despite increasing research, summarising the available evidence is highly challenging, as there are no universal definitions of the key concepts health literacy and migrant background.

Key messages

This is an interdisciplinary project, combining quantitative and qualitative evidence to provide maximum value to health policy and decision-making for the health care and health literacy of migrants. Research on gender-, and migration-specific aspects of health literacy is of great importance for the development and delivery of effective interventions for improving migrants’ health literacy.
Cardiovascular hospitalisation before and during the financial crisis among occupations in Taiwan
Authors: Chang Y
Published: November 2019

Background

Cardiovascular diseases (CVD) were related to financial stress. Little was known about the effects of financial crisis on cardiovascular health by occupations. This study examined CVD hospitalisations before and during the 2008 financial crisis among five occupational groups in Taiwan.

Methods

Data were collected from the Taiwan Survey on Hypertension, Hyperglycemia and Hyperlipidaemia 2007, including 4,673 participants aged 20 and above, categorized into five types of occupations, i.e., professional & manager (PM), office clerk & administrative staff (OA), skilled work (SW), unskilled worker (UW) and non-worker (NW). We abstracted their CVD hospitalisation records in the three years before (September 2005 to August 2008) and during the 2008 financial crisis (September 2008 to August 2011) from the National Health Insurance Research Database. Using incidence rate ratios (IRRs), we compared CVD hospitalisation of the first, second, third year from September 2008 to the three-year average before September 2008 for five occupational groups. Random effect negative binomial models were performed to estimate IRRs.

Results

After adjusting for covariates including age, sex, education, smoking, alcohol drinking, exercise and body mass index, there was an increase of CVD hospitalisation incidence for NW in the first year of the financial crisis (IRR=1.46, 95% Confidence Interval [95% CI]=1.19-1.77); in the second year, SW had a raised risk of CVD hospitalisation (IRR= 2.71, 95% CI = 1.59-4.60). For all occupational groups, the incidence rates of CVD hospitalisation reached the peak in the third year (PM: IRR=2.68, 95% CI = 1.05-6.83; OA: IRR=2.70, 95% CI = 1.18-6.19; SW: IRR=5.13, 95% CI = 2.89-9.09; UW: IRR=2.12, 95% CI = 1.02-4.41; NW: IRR=1.85, 95% CI = 1.18-2.67).

Conclusions

CVD hospitalisation of all occupations were affected by the financial crisis; when non-workers were the early victims, skilled workers may be the most vulnerable in the 2008 financial crisis.

Key messages

This study investigated the effects of the 2008 financial crisis on cardiovascular disease hospitalization by five occupational types in Taiwan. All occupations, particularly skilled workers, were affected by the financial crisis.
Socioeconomic Inequalities in Cardiovascular Risk Factors in Turkey, 2008-2016
Authors: Erkoyun E , Mackenbach J P
Published: November 2019

Background

This study aims to investigate the magnitude of occupational class (OC) and educational inequalities in cardiovascular risk factors in Turkey from 2008 to 2016.

Methods

We used the Turkey Health Survey, a bi-annual health interview survey among a representative sample of the Turkish population. We calculated the age-standardized prevalence of four cardiovascular risk factors (obesity, overweight, hypertension, diabetes and smoking) by OC and education, and summarized inequalities with the Relative Index of Inequality (RII) and Slope Index of Inequality (SII). To determine whether the RII/SII changed over time we estimated a regression model with an interaction term between survey year and OC/education.

Results

We found different patterns for men and women. Among men, smoking was the only risk factor with a higher prevalence in both lower OC and education groups (RII = 1.18 (95% CI: 1.08-1.28) and 1.40 (1.26-1.55), respectively). Obesity, overweight and diabetes was higher among higher OC (e.g., for overweight RII = 0.83, 95% CI 0.76-0.90) whereas obesity was higher among lower educated (RII = 1.32, (95% CI: 1.08-1.61)) and no inequalities were found for hypertension by socioeconomic status. However, among women, all risk factors except smoking had a higher prevalence in lower OC and education groups (e.g., for overweight RII = 1.14 (1.06-1.24) and 2.98 (2.71-3.29), respectively), whereas for smoking we found a higher prevalence in higher socioeconomic groups (RII for OC = 0.77 (95% CI: 0.65-0.90 and for education = 0.36 (0.29-0.44)). Significant interactions with survey year were only found in a few cases, mainly pointing to emergence or widening of inequalities to the disadvantage of lower socioeconomic groups.

Conclusions

Inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, but if current trends continue similar inequalities will emerge in the near future.

Key messages

In Turkey, in men obesity, overweight and diabetes are concentrated among higher occupational classes, obesity is concentrated among lower education groups and lower socioeconomic groups smoke more. In Turkey, in women obesity, overweight, hypertension and diabetes are concentrated among lower socioeconomic groups however higher socioeconomic groups smoke more.
The achievements of the ToREACH project and next steps
Authors: Montante S
Published: November 2019

Putting in practice the Strategic Research Agenda of TO REACH within a European platform for learning and collaboration requires the engagement with a wide range of stakeholders both at national and European level. The TO-REACH project is itself a first step towards establishing such a partnership and cooperation approach, involving policymakers, funders, researchers and other stakeholders from across the European Union. A shared European approach to health services and policy research will contribute to addressing the challenges described in the previous presentations by putting in place the governance and framework conditions needed to support the necessary research across the region and beyond.

Coriine Alberti

Contact: corinne.alberti@urc-eco.fr

Matthias Wismar

Contact: wismarm@obs.who.int
Clinical and policy contexts for cancer care: Evidence from Denmark, Ireland and Ontario (Canada)
Authors: Morris M , Landon S , McKee M , Nolte E
Published: November 2019

Background

We know there are large differences in cancer survival between countries. We know much less about why they exist and persist. In the International Cancer Benchmarking Partnership, we are seeking to understand the influences on patient journey in different countries. In this study we explore how health system factors impact on cancer care in Denmark, Ireland, and Ontario (Canada) to identify common themes, national specificities, and messages for other health care providers.

Methods

We systematically analysed (i) cancer policy and strategy documents from the three jurisdictions, published between 1995-2014 (n = 20) and (ii) interviews with key informants representing government, health services providers, professional bodies and patient organisations (n = 25). We thematically analysed both datasets using NVivo.

Results

Five themes emerged from the document review and were confirmed by interview: governance, quality assurance, service delivery, infrastructure and workforce. All three jurisdictions introduced a designated organisation to lead, monitor and, in Ontario, fund cancer services. Reducing wait times was prioritized, with the expansion of diagnostic capacity from the 2000s, for example. Concentrating services into fewer specialist centres was widely viewed as crucial for improving survival for some cancers. Yet policy intent was not always successfully realised on the ground, with lack of sustained investment, organisational barriers or logistical challenges impeding implementation. Jurisdictions face particular challenges maintaining and upgrading infrastructure and equipment, and recruiting and retaining critical staff, specifically in radiology and primary care.

Conclusions

Cancer care is complex and understanding the interrelationships between factors acting at different levels of the health system is important to improve outcomes. Continued investment in infrastructure and people will be essential.

Key messages

Countries face common challenges in creating health systems that optimise cancer outcomes. Sustained investment in equipment and human resources will be critical to optimise cancer care and survival.
Workshop: Health workforce meets HSR: Tackling regional inequalities in health service provision
Authors:   Organised by: EUPHA (HSR), EUPHA (HWR) Chair persons: Judith de Jong - EUPHA (HSR), Ellen Kuhlmann - EUPHA (HWR)
Published: November 2019

Background

Many countries across Europe are facing considerable challenges in providing accessible and high quality care regardless of where people live. A major element is the difficulty that countries face to attract and retain health care professionals to work in remote and rural areas. This applies to primary care services as well as to hospital care, and to the care provided by physicians and other health professionals, including nurses. A widely shared question is therefore how to safeguard access to health care in rural areas and to solve recruitment and retention problems in such regions, both of medical and nursing staff. The workshop will build on last year’s joint workshop of the Sections on HSR and HWR that ended with questions related to how to organize accessible and equitable health services including the workforces required to do so.

Objectives

This workshop will provide a snapshot of studies from across the European region, with a particular focus on differences between rural and urban health care practices and the types of solutions being used to reduce regional disparities in provision of care. This often refers to retention and recruitment strategies, but the session will also address other types of solutions in the organization of care that can help ensure accessible care, including in vulnerable regions and settings. Tackling this challenge will therefore require a joint approach, tapping into experience from health workforce research as well as wider health services research, bringing together research into the organization and management of healthcare and into the health human resources providing this care, operated from different angles and being informed by different research traditions and data sources. Based on statements, we will discuss the topic of how to organize accessible and equitable health services including the workforces required to do so after the presentations.

Key messages

Workforce policies should focus on retaining primary care workforce in rural areas and integrated policies should attract new primary care practices. Both in primary care and hospital care new solutions are being sought which should help resolve regional differences in access to care and attractiveness for the health workforce.
Regional shortages in a small country: how to provide the right care in the right place?
Authors: Hansen J , Batenburg R , Vis E , Van der Velden L
Published: November 2019

Background

The Netherlands, though being a relatively small and densely populated country, is faced with a similar challenge as other countries in terms of regional differences in access to care and attractiveness for care workers to build their careers. Both in primary care and hospital care new solutions are being sought which should help resolve these growing difficulties.

Methods

We conducted a literature review, survey and registry analysis, and held interviews with key stakeholders.

Results

Substantial differences exist between regions in the supply of both primary care and hospital care doctors. Particular and less populated regions appear to be hit in multiple ways, both with an extra ageing population requiring more care as well as by limited attractiveness for both primary care and hospital care workers. Solutions being used so far are mostly initiated by individual health care settings, such as strategic personnel management, redistribution of tasks and campaigns to increase the inflow of staff. Increasingly, solutions are also being explored at regional level, including a growing emphasis on regional collaboration, both in providing the right care in the right place as well as in terms of joint recruitment strategies. Still, such approaches only have a limited effect as a result of which new approaches are needed.

Conclusions

Strategies to improve the attractiveness of particular regions are now often fragmented, both between types of professions and sectors and different regions. In addition, innovative and new solutions appear to be hampered by vested interests of stakeholders. If new solutions are to be developed it is key that stakeholders are willing to compromise, be it when it comes to the autonomy of health care professionals and their associations and to the financial commitments required from government and insurer side.
Relationship between sleep patterns and multimorbidity in the Canadian Longitudinal Study on Aging
Authors: Nicholson K , Rodrigues R , Anderson K , Wilk P , Guaiana G , Stranges S
Published: November 2019

Background

Sleep difficulties are an unmet public health problem, affecting large segments of the population around the world. Poor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes like multiple chronic diseases (multimorbidity) and reduced longevity.

Methods

A cross-sectional analysis of the Canadian Longitudinal Study on Aging (CLSA), a national health survey of community-dwelling adults and older adults. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short: <6 hours, normal: 6-8 hours, long: >8 hours) and sleep quality (dissatisfied/very dissatisfied, neutral, satisfied/very satisfied). To capture multimorbidity, a primary definition was operationalized with 17 chronic conditions, whereas a secondary definition was operationalized with 9 chronic conditions to capture both the primary care and public health perspective.

Results

In our sample, 50.9% were female (average age: 62.7 years) and 49.1% were male (average age: 63.2 years). The majority reported a normal sleep duration and approximately half reported being either satisfied or very satisfied with sleep quality. About 70% were living with multimorbidity using the primary care definition (females: 71.7%; males 64.3%), while about 30% were living with multimorbidity using the public health definition (females: 34.8%; males: 28.9%). The adjusted analyses indicated the odds of multimorbidity increased for those who reported short or long sleep duration, as well as dissatisfaction with sleep quality, across age groups and both females and males.

Conclusions

Disrupted sleep may be an additional behavioural risk factor for a number of chronic diseases, in the context of aging populations. It is necessary to understand the potential impact of sleep on the risk of multimorbidity, and this research will build knowledge in this important area.

Key messages

This research will utilize a national health survey to examine and report the characteristics of sleep quality and sleep duration among approximately 30,000 community-dwelling adults in Canada. This research will explore relationships between sleep duration, sleep quality and multimorbidity (controlling for confounding factors) among community-dwelling adults in Canada.
Difference in access to health care for newly arrived refugees in Germany: a natural quasi-experiment
Authors: Wenner J , Rolke K , Razum O
Published: November 2019

Background

Providing quantitative evidence on structural access barriers to health care for newly arrived refugees constitutes a challenge due to a lack of suitable data. The coexistence of two different local access models in Germany allows for a comparative analysis of the association between access policies and realized access. Our study compares these two models to establish whether they lead to differences in access to care among refugees.

Methods

Municipalities in Germany’s largest federal state of North Rhine-Westphalia (NRW) have implemented different access models to which refugees are quasi-randomly assigned. We recruited 6 municipalities of which 3 decided to implement the health care voucher (HcV) model and 3 the electronic health card model (eHC) in a natural quasi-experimental study design. Analyses were based on claims data collected from the welfare offices or the statutory health insurance. We compared standardized incidence rates (SIR) based on 3 indicators: emergency service, ambulatory sensitive hospitalization and use of specialized care.

Results

We included data on health care use of all recently assigned refugees in the 6 municipalities over a period of 7 quarters (2016/17). The average quarterly sample size is n = 9,077 which corresponds to 6.5% of the population of recently assigned refugees in NRW at that time. We find differences in realized access between the models. For emergency care, the SIR differ significantly between municipalities using the HcV model (SIR:1.88; 95%-CI: 1.62-2.18) and eHC model (SIR:1.33; 95%-CI: 1.14-1.55).

Conclusions

Local decisions regarding the organization of access to health care are associated with differences in realized access to health care of refugees in NRW. The implementation of the eHC model may contribute to a decrease of emergency service. Further analyses should attempt to reduce a possible (self-)selection bias of municipalities which might have led to an underestimation of the difference between models.

Key messages

The organization of health care for newly arrived refugees on the local level is decisive for their access to care. Local policy makers may use their scope for action to remove access barriers for newly arrived refugees.
Health of asylum seeker children in Finland: a total population health examination survey (TERTTU)
Authors: Skogberg N , Koponen P , Lilja E , Mustonen K-L , Garoff F , Ahmed A , Castaneda A E
Published: November 2019

Background

There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe, especially children and adolescents. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to inform evidence-based policy-making and development of services.

Methods

A sample of all first-time asylum applicants was drawn from the Finnish Immigration Services electronic asylum database. Data on 303 children aged 0-17 years was gathered with a standardised health examination (including a dental assessment for 7-17 year-olds) and face-to-face-interview including the Minimum European Health Module and somatic and behavioural symptoms over the past 30 days. Guardians of 0-12 year-olds were interviewed, 13-17 year-olds responded themselves. Participation rate was 72%.

Results

62% (95% CI 49,4-73,0) of 13-17 year-olds have had their growth and development monitored compared with 91% (95% CI 83,6-95,6) of 7-12 year-old and 86% (95% CI 79,4-91,0) of 0-6 year-olds. Long-standing health problems were more common among 13-17 year-olds (28%, 95% CI 18,2-39,7) and 7-12 year-olds (25%, 95% CI 16,8-34,2) compared 0-6 year-olds (13%, 95% CI 8,2-19,5). Sleep disturbances were more common among 13-17 year-olds (35%, 95% CI 24,2-47,4) and 7-12 year-olds (28%, 95% CI 19,6-37,5) than 2-6 year-olds (18%, 95% CI 11,3-26,7). Approximately fifth of children aged 7-17 years and slightly more than tenth of younger children had fears and anxieties. Signs of dental caries were found in 46% (95% CI 35,4-55,9) of 7-12 year-olds and in 23% (95% CI 14,1-35,1) of 13-17 year-olds.

Conclusions

Timely and accurate assessment of healthcare needs is crucial to support and improve the health and wellbeing of children and adolescents. Survey data will be used for developing the national initial health assessment protocol for asylum seeking children and adolescents.

Key messages

The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seeking adults, adolescents and children in Europe, allowing for examining family units. Health information on asylum seeking children and adolescents in Finland, is relevant for service development, also for other European countries.
The impact of Internet use on mental wellbeing and health behaviours among persons with disability
Authors: Szulc K , Duplaga M
Published: November 2019

Background

Disability is frequently related to the digital divide. However, the Internet may be also an opportunity for many people with disabilities, especially for those who suffer from difficulties in involving in social activities. For some of them, it is also a tool for undertaking professional tasks. The aim of the study was the assessment of the impact of the Internet on selected aspects of psychological wellbeing and undertaking health behaviours in persons with disabilities.

Methods

From the data set of the biannual Social Diagnosis survey, data of respondents confirming the status of disability were extracted. They were used for the development of multivariate logistic regression models for self-assessment of life, the prevalence of suicidal thoughts, feeling lonely, the use of psychological support and health behaviours. The impact of Internet usage was adjusted for sociodemographic variables. Weights provided by the study team were used in the analysis.

Results

The responses from 3231 respondents were used in the analysis. There were 33.1% of Internet users in the study group. Respondents with a mild disability made 25.3%, with moderate 39.4%, with severe 24.2%, and without an established degree of disability 11.1%. Logistic regression modelling revealed that Internet users more frequently assessed their lives as happy (odds ratio, 95% confidence interval (OR, 95%CI): 1.40, 1.13-1.75) and undertook some form of physical activity (2.32, 1.84-2.91). They also less frequently excessively consumed alcohol (0.51, 0.33-0.80). No relation was found for experiencing loneliness (0.89, 0.71-1.12), suicidal thoughts (0.998, 0.77-1.29), receiving psychological care (0.84, 0.62-1.14) and smoking (0.83, 0.66-1.04).

Conclusions

Although persons with disabilities suffer from digital divide, Internet use may exert a beneficial impact on their wellbeing and favour more beneficial health behaviours.

Key messages

Internet access and use among persons with disabilities may be an opportunity for improved wellbeing. Persons with disabilities who are Internet users assess their lives as more happy and demonstrate more favourable health behaviours.