bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards an EU sustainable health information infrastructure. Integrating technical and political views and interest
Authors: Padrón-Monedero A , Sarmiento-Suárez S , Gómez-García T , Ortiz-Pinto M , Pérez-Gómez B , Fernández-Navarro P , Galán I , Noguer I
Published: October 2020

Background

Health information systems (HIS) play a key role in providing information for decision-making. Europe lacks of an integrated HIS on non-communicable diseases (NCD) and Health Systems Performance (HSP) able to compare health problems across countries. NCDs are the main contributor to the EU-burden of disease, including the highest mortality rates. There is a general agreement among public health policy makers and researchers on the need of an integrated EU health information (HI) infrastructure to monitor risk factors, NCD and HSP. Such infrastructure would provide common inputs for public health and research to prioritize health policies. However, there is no EU-EEA consensus on how to go forward with this initiative.

Methods

The Information for Action (InfAct) project is aimed at establishing a sustainable HI infrastructure on HIS and HSP by cataloging resources, experience, research capacities and expertise into a 'one-stop shop'. Significant political will is needed to support and systematically feed a functional and permanent governance structure. InfAct provides a ground for Member States to discuss and generate consensus through two main boards: 1) Technical Dialogues (TD), composed by national experts, to discuss scientific aspects, feasibility and added value; and 2) Assembly of Members (AoM) where political representatives from Ministries of Health and Research provide the framework of political acceptance and guarantee of implementation and future development.

Results

Both boards reveal different interests and concerns. The AoM rather focused on resources and necessary political decisions based on expected returns. The TD focused on feasibility aspects and new adaptations required from current systems. The feedback provided by both boards is key to develop a sustainable EU-HIS infrastructure.

Conclusions

The TD and the AoM are key forums to provide feedback, guidance and advocacy to build a sustainable EU-HIS infrastructure
14.M. Workshop: Health policy responses to the European “refugee crisis”
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Bernd Rechel - European Observatory
Published: October 2020

This workshop explores how health systems in Europe have responded to the so-called “refugee crisis” in 2015 and what lessons can be drawn for the future. Based on contributions to a Special Issue of Health Policy, it offers a platform for sharing examples from across Europe, facilitating cross-country learning.

Although the arrival of large numbers of new migrants in Europe in 2015 was often portrayed as a crisis or a threat and has exposed a lack of preparedness and responsiveness in many countries, many things have worked well in the reception of and provision for newly arriving migrants. There have been instructive case studies and sometimes things worked well without further ado and for this reason went unnoticed. While the exact dynamics of future migratory movements are difficult to predict and depend on sometimes questionable “deals with the devil” at the EU's outside borders, refugees will continue to come to Europe and health systems have to be prepared to respond to their needs.

This workshop aims to build on recent experience and inform current debates on how health systems can best respond. It provides examples from three European countries (Austria, Germany and Finland) that have been at the forefront of receiving migrants. The first presentation, on Finland, recalls how this country received one of the highest numbers of refugees per capita and how its parallel system of health services coped with this influx. The second presentation, using the example of one federal state in Germany, illustrates that there is sometimes considerable scope for action at the local level and provides examples of how this scope can best be used. The third presentation explores how mental health needs of refugees develop in the asylum process. It argues that for more cooperation on this issue and the existence of low threshold services. A final presentation, on Austria, illustrates the needs of undocumented migrants in Vienna. It argues that non-governmental organizations (NGOs) play a crucial role in providing accessible health services and that they can also help in public health surveillance and data collection.

The workshop will provide opportunity for the audience to comment on and discuss presentations and to consider current policy options in Europe to better address the health needs of newly arrived migrants. It will also ask what barriers exist that existing good practices are not being taken up. The workshop will be of interest to public health researchers, practitioners and policy-makers working on migration-related issues across Europe.

Key messages

The workshop provides a forum for discussing European responses to the 2015 “refugee crisis”. It explores health policy options at the European and national level.
Governance of health services for asylum-seekers in Finland
Authors: Tuomisto K , Tiittala P , Keskimäki I , Helve O
Published: October 2020

Background

In 2015 Finland received the 4th highest number of asylum-seekers in Europe per capita, exceeding numbers of any previous year by ten times. Health services to them are provided in a parallel system with entitlements similar to most Western European countries. Our study explored the governance of this system following a right to health approach, along three dimensions: formal recognition of the right to health, standards, and coordination mechanisms.

Methods

We were involved in the Finnish policy response as medical specialists on refugee health at the National Institute for Health and Welfare, as physicians within the Finnish Immigration Service and as senior medical officer at the Ministry of Social Affairs and Health. We also conducted a review of academic and grey literature.

Results

Prior to the “refugee crisis” in 2015, Finland was considered to have a functioning system for providing health services to asylum-seekers. However, the arrival of many new asylum-seekers in 2015-2016 exposed many weaknesses in the governance of the system. We identified three major obstacles in the governance system for health services for asylum-seekers: 1) ineffective and reactive national level coordination and stewardship; 2) inadequate legislative and supervisory frameworks; and 3) discrepancies between constitutional rights to health, legal entitlements to services and available guidance.

Conclusions

In view of the governance weaknesses related to the parallel system for asylum-seekers, we recommend removing the parallel system and integrating health services for asylum-seekers into the national health system.
Shaping access to health care for refugees at the local level in Germany
Authors: Rolke K , Wenner J , Razum O
Published: October 2020

Background

In Germany, the federal states and even the municipalities have considerable scope for shaping implementation of national health policies for newly arrived refugees, including in the way they organize access to health services. We analysed how gatekeepers can shape access to health care at the local level, exploring access models in six municipalities in the federal state of North Rhine-Westphalia.

Methods

We assessed the implementation of local access models and the consequences for access for refugees. Our study covered three municipalities with a health care voucher model and three with an electronic health card model. We combined data from official reports and from 21 semi-structured interviews with gatekeepers.

Results

Our research illustrates how gatekeepers at the local level can shape and facilitate access to health care for refugees, irrespective of the access model chosen. Larger municipalities are more likely to implement an electronic health card model. Gatekeepers report that costs, workload and control are the major aspects underlying the choice of model in municipalities. Access plays only a minor role, although some gatekeepers claim that the electronic health card model can improve access.

Conclusions

National health policies can support gatekeepers in their role as facilitators, such as through financial incentives or a minimum amount of bureaucracy. They can also allow newly arrived refugees to become members of the statutory health insurance system, which would relieve social welfare offices and general practitioners (GPs) from their role of gatekeepers.
Responding to COVID19 in France
Authors: Charpak Y
Published: October 2020

While it is hard to predict what will have happened by the time of the conference, this round table will be tightly templated and coordinated. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened in order to draw comparative lessons about public health politics and governance.
The European Union’s response to COVID19
Authors: de Ruijter A
Published: October 2020

While it is hard to predict what will have happened by the time of the conference, this round table will be tightly templated and coordinated. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened in order to draw comparative lessons about public health politics and governance.
Pensions reforms: what does policy needs from science
Authors: Treu T
Published: October 2020

Key note from the former Italian Minister of Labour and Social Security
FAO/WHO GIFT platform - hands on
Authors: Ferreira de Sousa R , Padula de Quadros V , Balcerzak A , Bevere T
Published: October 2020

The FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT) is a novel open-access online platform hosted by FAO and supported by WHO. FAO/WHO GIFT is aimed at increasing the quality, availability and use of individual quantitative food consumption (IQFC) data in low- and middle-income countries (LMIC) to enable evidence-based decision-making and policy development for better nutrition and food safety. The platform is developed in synergy with other global initiatives working with food consumption data (e.g. Intake, Global Dietary Database, FAO/WHO FOSCOLLAB).

The main objective of the session is to give the opportunity to participants to apply the knowledge gained over the previous sessions.

Participants will be divided in small groups to do hands-on exercises using the features of the platform. Participants will learn how to identify existing IQFC surveys worldwide using the FAO/WHO GIFT inventory map. Participants will also explore the potential of the Indicators section of the platform according to the needs of different fields of work (food consumption, food safety and nutrition). Expert users will learn how to download dietary microdata and how to take advantage of other data sources using the same food classification and description system - FoodEx2.

The workshop will close with a brainstorm session on how the FAO/WHO GIFT platform can be improved to support participants work.
Tobacco control’s effects on social inequalities in smoking: Moving towards a health equity approach
Authors: Lapalme J
Published: October 2020

Population-level public health policies aim to improve health for the entire population. Yet, in doing so, they may unintentionally neglect vulnerable populations' specific needs, which may perpetuate social inequalities in health. As an example, tobacco control policies (e.g. media campaigns, smoke-free places, tax increases, and tobacco product regulation) have been found to significantly reduce overall smoking prevalence in many high-income countries. However, social inequalities in smoking have been increasing, with smoking prevalence being higher, notably for those of low socio-economic status (SES). Low SES individuals start smoking at younger ages, smoke more cigarettes per day, have lower cessation rates, and are exposed to more second-hand smoke than higher SES individuals. These social inequalities in smoking translate into social inequalities in health such that low SES groups carry a disproportionately heavier burden of smoking-related illnesses.

Based on data from a critical discourse analysis of tobacco control policy in Quebec, Canada, as well as from a literature review of vulnerable populations' experiences with tobacco control policies, this presentation will: 1) illustrate ways in which tobacco control policies may be increasing social inequalities in smoking, including the absence of vulnerable populations who smoke from policy planning, smoking denormalization's unintended stigmatizing effects, and targeting behaviours rather than the 'causes of the cause' in policy; 2) provide ideas for future population-level policies based on a health equity approach, which includes integrating vulnerable population's voices in policy design, prioritizing vulnerable populations and health equity in policy, and shifting attention towards policies addressing social inequalities in access to social determinants (e.g. education, income, employment security, safe, clean, and affordable housing) to improve health rather than targeting behaviours, such as smoking.
Equality versus equity: Barriers to health care access for Indigenous populations in Canada
Authors: Tremblay M
Published: October 2020

Canada's universal and publicly funded health-care system aims to promote universal and equitable access to care based on the needs of individuals, rather than on their capacity to pay for these services. Despite these principles, some groups, such as Indigenous peoples, experience significant and persistent social inequalities in health compared to the general population. This situation results from the continuing impacts of colonialism, which has an undeniable influence on social determinants of health, including access to care. This is surprising for many health professionals because it contradicts the democratic ideals of justice and equality that underlie the health-care system, as well as the rhetoric of their professional practice which asserts that 'everyone is treated the same'.

Based on literature and on research findings, this presentation will demonstrate several ways in which a universal and homogeneous approach to health-care can contribute to creating social inequalities in health for Indigenous populations. First, health professionals tend to favor socially and culturally neutral practice, which can hinder the recognition of the influence of historical and socio-cultural factors on patients' health. This kind of practice may encourage a distorted reading of patients' issues and can lead to inappropriate responses. Second, a homogenous approach to care refers by default to health-care models and practices that are rooted in values and perspectives of the dominant culture, which contributes to the provision of culturally unsafe care for Indigenous patients. Finally, this type of approach overlooks the critical and specific needs of vulnerable groups, who often require more than the general population to achieve the same results. We will conclude by outlining some potential solutions, mainly how cultural safety as a transformative approach to care allows health professionals to better consider the needs and cultural identity of Indigenous patients.
Community outreach workers: Perceived practices and impacts on families and young children
Authors: Roy M , Lavoie-Trudeau E , Benkhalti M , Couturier Y , Lane J , Clapperton I , Roy M A , Bibeau L , Ouellette M , Camden C
Published: October 2020

Background

Community outreach workers support individuals accessing healthcare and other services that could be useful to respond to their needs. Even though community outreach workers have been working in the province of Quebec (Canada) for the past 40 years, their practice is poorly documented and evaluated, especially with respect to young children aged 0 to 5 years. This study aimed to document the practice of community outreach workers and its perceived impacts among children and families.

Methods

A qualitative methodology with a descriptive research design was used. We performed a content analysis on 55 scientific and grey literature documents, 24 individual interviews, and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners.

Results

Our analysis reveals three main themes: 1) characteristics of the population served, 2) concrete actions performed by community outreach workers, and 3) perceived impacts of community outreach on families and children. Community outreach workers were perceived as essential to reach families with vulnerable circumstances and children with special needs. With respect to concrete actions, community outreach workers were reported to tailor their interventions to respond in different but complementary ways to the healthcare system. Perceived impacts included increased access for children and families to appropriate services, decreased social isolation, increased empowerment (especially with respect to parental abilities), increased social capital of families, and confidence towards the healthcare system. Results showed that community outreach workers helped to reduce inequalities in health

Conclusions

Community outreach work help the healthcare system to fulfill its legal mandate to protect citizen and increase health and well-being. It is crucial that such type of proximity approaches be not only encouraged but also sustained.

Key messages

Community outreach workers adapt their practices to act in a complementary way to the healthcare system. Community outreach workers help to reduce inequalities in health.
Tuberculosis: where and how fast are stone quarry workers infected?
Authors: Carvalho Sousa S , Magalhães Alves C , Santos S , Marques F , Duarte R , Gonçalves G , Carvalho C
Published: October 2020

Background

In 2018 an annual tuberculosis (TB) screening program targeting stone quarry workers was implemented in two municipalities in Northern Portugal. These have been hotspots for TB (76 and 59 cases per 100 000 population per year in 2012-2016, well above the 18 cases per 100 000 population observed in Portugal in 2016), with 30% of active TB cases occurring among stone quarry workers. Screening in this setting is recommended by the World Health Organization, as exposure to silica and silicosis increase the risk of TB. Occupational health services, TB outpatient centers, the hospital, a laboratory, primary health care and public health services work closely together with employers, employees, municipal council and the community promoting meetings and continuous training.

Screening activities included a symptom questionnaire, chest X-ray and sputum exam; and, after exclusion of active TB, interferon-gamma release assay (IGRA) for latent tuberculosis infection (LTBI). Preventive treatment was offered.

Objective

Assess annual rate of TB infection

Methods

Workers without history of TB/LTBI were IGRA tested in 2018, and retested in 2019. Annual rate of infection was calculated as the proportion of workers IGRA negative in 2018 becoming positive in 2019.

Results

In 2018-2019, 274 workers were screened yearly. In 2018, 22 were diagnosed with LTBI and 26 had previous history of TB/LTBI. Out of 226 IGRA negative workers in 2018, 19 tested positive in 2019 (8.4% annual rate of infection). These individuals were not identified as close contacts of any new TB case and no cases of active TB were reported in their stone quarries. Some active TB cases were regular customers of specific bars.

Conclusions

Active transmission of TB seems to be occurring among stone quarry workers. Workers that converted from IGRA negative to positive had no co-workers with active TB in the study period, suggesting they could have been infected away from the workplace, possibly in community public places.

Key messages

Stone quarry workers in a high-risk TB sub-region were infected at an 8.4% annual rate, and could have been infected in community public places such as bars. Besides screening close contacts and at workplace, more efforts should be made identifying social contacts of active TB cases.
Experiences of humanitarian assistance programs with corporate funding
Authors: Makhoul J , Nasser F , El-Amine Z , Nakkash R
Published: October 2020

Background

Dwindling governmental funding for widespread natural disasters and armed conflicts have attracted corporate funding for humanitarian assistance. Although such funding has allowed expansion of humanitarian programs and capacity building, evaluations of such partnerships are rare and focus only on management aspects, without attention to possible influences on the organizations themselves and the populations they serve. Given the well-established conflicts of interest of corporations and their adverse influence on public health, an assessment of industry funding to humanitarian assistance is necessary to identify potential violations and harms.

Methods

The research explores the experiences and views of a sample of humanitarian agencies in Lebanon which serve refugee populations about corporate funding and influences on their programs. In-depth interviews with international and local humanitarian agency representatives in Lebanon were conducted and analyzed by thematic analysis.

Results

Findings indicate perceived advantages with financial assistance, flexible agendas and mutual learning. Meanwhile, challenges fall in project coordination, implementation, and the lack of attention of the private sector to the work ethics with vulnerable populations. Also, this collaboration could impact refugees positively or negatively depending on the type of corporations, their branding and how they are perceived by the populations served. Organizations trust that their processes of detection and reporting are an impervious firewall against conflicts of interest.

Conclusions

Corporate power expressed through funding to humanitarian agencies may influence the decision making and the implementation of the programs for humanitarian assistance. The study highlights the need for critical thinking about corporate funding, and creating opportunities for discussion about this issue for humanitarian agencies.

Key messages

Industry conflicts of interest on public health are well-established, but understudied in humanitarian assistance programs. Corporate funding for humanitarian assistance may hide potential conflicts of interest for the corporation.
The CUORE project cardiovascular risk assessment in primary care: the ongoing experience in Italy
Authors: Palmieri L , Vannucchi S , Lo Noce C , Di Lonardo A , Unim B , Grisetti T , Meduri C , Donfrancesco C
Published: October 2020

Background

Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO).

Aim

To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population.

Methods

Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples.

Results

Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR < 3%); 9.9% of M, 0.4% of W were at high risk (CR ≥ 20%); 26% of M, 16% of W were current smokers; 13% of M, 10% of W were diabetic; 33% of hypertensive M, 35% of hypertensive W were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14% of M, 7% of W). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (0.2-0.7 mmHg), total cholesterol by 4.1 mg/dl (3.0-5.2 mg/dl), smokers prevalence by 3.1% (2.3%-4.0%); HDL-cholesterol increased in W by 0.3 mg/dl (0.1-0.5 mg/dl).

Conclusions

Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process.

Key messages

The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.
Cut-off values of surrogate indices of insulin resistance as risk predictors for metabolic syndrome
Authors: Pikó P , Fiatal S z , Kósa Z s , Sándor J , Ádány R
Published: October 2020

Background

The metabolic syndrome (MS) based on insulin resistance (IR) is a cluster of conditions indicating an increased risk of cardiometabolic diseases. This study aimed to define valid cut-off values for surrogate measures for IR to predicting the risk for the development of MS in the Hungarian general (HG) and Roma (HR) populations.

Methods

This study included 397 HG and 368 HR subjects aged 20-64 years from a complex health survey in 2018/2019. Four surrogate measures, namely the homeostasis model assessment-IR (HOMA-IR), McAuley index (McA), TG to HDL-cholesterol ratio (TG/HDL-C) and TG and glucose index (TyG) were calculated for all participants. The cut-off values were determined as the value with the highest Youden index (YI) on the basis of results obtained by receiver operating characteristic (ROC) curve analysis for the development of MS on separate and combined populations.

Results

Since no significant difference could be detected between the results obtained on separate populations, cut-off values defined on the combined one are proposed to use for risk prediction. The area under the ROC curve was 0.753 (95%CI: 0.718-0.787) for HOMA-IR, 0.827 (95%CI: 0.797-0.856) for McA, 0.843 (95%CI: 0.814-0.872) for TG/HDL-C ratio and 0.862 (95%CI: 0.835-0.889) for TyG. The cut-off value was 2.32 (sensitivity (sens.) 70.9%; specificity (spec.) 69.0%; YI: 0.399) for HOMA-IR, 5.989 (sens. 69.7%; spec. 82.7%; YI: 0.524) for McA, 1.274 (sens. 73.4; spec. 84.3%; YI: 0.574) for TG/HDL-C ratio and 4.694 (sens. 77.2%; spec. 84.3%; YI: 0.615) for TyG. Concerning the fact, that the TyG has the best indicative power for predicting IR to the estimation of MS risk in both populations the IR/MS prevalence was defined by using TyG and found to be as high as 42.3% and 40.5% in the HG and HR populations, respectively.

Conclusions

Based on our results the TyG index could be a useful supplementary method for identifying individuals at risk for MS.

Key messages

The optimal cut-off points’ four surrogate indices of insulin resistance for the prediction of metabolic syndrome did not differ significantly between the Hungarian general and Roma populations. The triglyceride and glucose index proved to be the strongest predictor for the risk of metabolic syndrome in the Hungarian general and Roma populations.
Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort
Authors: Guerrero Fernández de Alba I , Gimeno-Miguel A , Poblador Plou B , Bliek Bueno K , Carmona Pirez J , Rodriguez-Blázquez C , Forjaz M J , Prados-Torres A
Published: October 2020

Background

Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes.

Methods

Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities.

Results

Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23).

Conclusions

The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes.

Key messages

Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.
Trends of polypharmacy among older adults with schizophrenia in Quebec, Canada between 2000 and 2017
Authors: Lunghi C , Rochette L , Ouali A , Sirois C
Published: October 2020

Background

Schizophrenia is a severe psychiatric disorder associated with an increased risk of type 2 diabetes, dyslipidemia and obesity. As adults with schizophrenia age, they become at high risk for multimorbidity and polypharmacy. However, little is known about the trends in total medications use within this population. The objective of this study was to draw a portrait of polypharmacy among Quebec older adults with schizophrenia from 2000 to 2017.

Methods

This population-based cohort study used the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medications use, according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia. We calculated the total number of medications used by every individual in each year under study, and the age- and sex-standardized proportion of individuals with polypharmacy (10+ medications, 15+, and 20+). We further identified the clinical and socio-demographic factors associated with polypharmacy using Poisson regression models with robust variance estimation.

Results

From 2000 to 2017, the prevalence of total medications used increased across all age groups, with a median of 8 medications consumed in 2000-2001, which rose to 11 in 2016-2017. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased over time: 5+: 76.6% to 89.3%; 10+ drugs: 36.9% to 62.2%; 15+: 13.3% to 34.4%; 20+: 3.9% to 14.4%. In the multivariate regression, the only clinically significant factor associated with polypharmacy was the high number of diseases (e.g., 5+: RR = 1.29; 95% IC:1.44-1.53).

Conclusions

This study shows a noticeable increase in polypharmacy exposure of older adults with schizophrenia, raising concerns about the growing risks for adverse effects and drug interactions with antipsychotic treatments.

Key messages

Polypharmacy has constantly grown in the last two decades. Further research is needed to better understand outcomes of polypharmacy among older individuals with schizophrenia.
The effect of levothyroxine therapy on depressive symptoms in adults with subclinical hypothyroidism
Authors: Wildisen L , Del Giovane C , Feller M , Moutzouri E , Mooijaart S , Poortvliet R , Du Puy R , Peeters R , Gussekloo J , Rodondi N
Published: October 2020

Background

Levothyroxine is one of the most commonly prescribed drugs. A common reason for levothyroxine treatment on patients with subclinical hypothyroidism are depressive symptoms. A meta-analysis of four RCTs (n = 278) found no benefit of levothyroxine therapy on depressive symptoms. However, the confidence interval does not exclude a small clinical benefit. We aim to assess the effect of levothyroxine therapy for depressive symptoms in patients with subclinical hypothyroidism using data from a RCT with more than 400 adults.

Methods

The TRUST trial was a double-blind, randomized, placebo-controlled trial involving adults aged ≥65y with subclinical hypothyroidism (elevated TSH levels (4.6-19.9 mU/L) and free thyroxine within the reference range). The outcome was depressive symptoms after 12 months based on the Geriatric Depression Scale (GDS-15), a 15-item questionnaire (range: 0 to 15, higher scores indicate more depressive symptoms, minimal clinical important difference: 2). The multivariable linear regression model was adjusted for levothyroxine starting dose, sex, site, and GDS-15 baseline score.

Results

425 Swiss and Dutch adults with subclinical hypothyroidism were randomised (mean age 75y, 56% female). The mean (SD) TSH was 6.6 (2.1) mU/L at baseline and after 12 months decreased to 3.8 (2.3) mU/L in the levothyroxine group vs 5.9 (2.7) mU/L in the placebo group. At baseline, the mean GDS-15 score was 1.3 (1.9) in the levothyroxine group and 1.0 (1.6) in the placebo group. The mean GDS-15 score at 12 months was 1.4 (2.1) in the levothyroxine and 1.1 (1.7) in the placebo group with an adjusted between-group difference of 0.2 for levothyroxine vs. placebo (95% CI:-0.1 to 0.5; p = 0.29).

Conclusions

In this by far largest RCT on the topic, levothyroxine therapy did not confer a benefit for depressive symptoms. Consequently, our results do not support the practice of prescribing levothyroxine for depressive symptoms when they co-occur with subclinical hypothyroidism.

Key messages

Levothyroxine has no benefit on depressive symptoms in patients with subclinical hypothyroidism. Levothyroxine prescription to patients with subclinical hypothyroidism and depressive symptoms should be reconsidered.
Depression and physical multimorbidity during the adulthood. Cross-sectional associations
Authors: Arias de la Torre J , Ronaldson A , Valderas J M , JAlonso  , Prina M , Hatch S , Rayner L , Pickles A , Hotopf M , ADregan
Published: October 2020

Introduction

The prevalence of depression and physical multimorbidity (pMM) might vary over the life course in a non-random fashion. The aims of our study were to: 1) assess the prevalence of depression and pMM over the life course; and 2) estimate changes in their pattern of association at different ages.

Methods

Data from 13,736 participants aged 26, 30, 34, 38, 42 and 46 years old of the British Child Study cohort was used. Individuals with information on current self-reported depression were selected as study sample. pMM (yes/no) caseness was defined as the coexistence of 2 or more self-reported physical conditions (e.g. asthma, diabetes, epilepsy). The prevalence of depression and pMM was calculated for each wave. To assess their relationship, prevalence ratios (PR) adjusted by gender, socioeconomic (e.g. educational level) and health-related variables (e.g. BMI and smoking status) and their 95% Confidence Intervals (95%CI) were obtained at each wave from multivariable Poisson models.

Results

Prevalence of depression varied with age (10.0% at age 26, 7.8% at age 38 and 18.3% at age 46) as did prevalence of pMM (37% at age 26, 15.6% at age 34, and 20.2% at age 46). A non-linear trend in the prevalence both of depression and pMM was observed with a decrease from age 26 to age 38 (34 for pMM) followed by a consistent increment to age 46. In all ages depression was significantly associated with pMM the magnitude ranging from PR: 1.52 (95%CI 1.41-1.65) at age 26 to PR: 1.96 (95%CI 1.72-2.23) at age 38.

Conclusions

There is consistent association between the prevalence of depression and pMM over different ages during adulthood. The non-linear pattern suggests differences in the type of conditions contributing to pMM at different ages (non-chronic in young adulthood vs chronic from middle adulthood). Further research on clusters and trajectories of different conditions over life course might be valuable to understand the association between depression and pMM.

Key messages

There is consistent association between the prevalence of depression and pMM over different ages during adulthood. They could be differences in the type of conditions contributing to depression related pMM at different ages (non-chronic in young adulthood vs chronic from middle adulthood).
Effect of group treatment on physical inactivity among Syrian refugees. Randomized controlled trial
Authors: Hasha W , Fadnes L T , Igland J , Strømme E M , Younes J H , Kumar B , Diaz E
Published: October 2020

Background

Refugees in Norway show low levels of physical activity, and have relatively high prevalence of pain disorders and post-traumatic symptoms. Physical inactivity can be both a cause of and a consequence of physical and mental symptoms. In CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), two group interventions, one based on physiotherapy and body awareness (PAAI) and the other on Teaching Recovery Techniques (TRT), were developed to treat patients with pain disorders and/or post-traumatic symptoms.

Objective

As a secondary outcome of study, we assessed the effect of these group interventions on physical inactivity.

Methods

We conducted a randomized controlled trial testing two group interventions. Syrian adults ≥16 years with pain and/or post-traumatic symptoms were randomized to either intervention group or control group. Effect of the intervention was measured after 8 (PAAI) and 6 (TRT) weeks, as relative risk (RR) with 95% confidence intervals for being inactive for intervention versus control groups, using log-binomial regression with adjustment for baseline inactivity and type of intervention (PAAI or TRT).

Results

177 Syrian refugees were recruited between July 2018-September 2019. 88 were randomized to the intervention group and 89 to the control group. Mean age was 35 years (SD 11) and 38% were women. Inactivity at recruitment was reported by 126 (71%) participants. The follow-up questionnaire was completed at 6/8 weeks by 116 (66%) participants. At that point, 39% in the intervention group were inactive as compared to 56% in the control group. RR for inactivity for the intervention group adjusted for inactivity at baseline was 0.68 (0.47-0.99) and remained 0.68 (0.48-0.99) when further adjusting for type of intervention (PAAI vs TRT).

Conclusions

PAAI and TRT group interventions reduced inactivity among refugees by 32%. Effect on physical inactivity was similar between PAAI and TRT interventions.

Key messages

Public health care should be aware of physical inactivity, especially in relation to pain disorders and post-traumatic symptoms among refugees. Group treatment interventions succeeded to encourage refugees to increase their physical activity.
No ordinary leaders - Analysing female-headed households in Palestine refugee camps
Authors: Valente de Almeida S , Ghattas H , Pita Barros P
Published: October 2020

We explore the potential impacts of being a female head of household (FH) or a family member in a female-headed household (MFH) in terms of budget expenditures and socio-economic determinants. Female household leaders in Palestine Refugee Camps find themselves with more barriers to provide the basic needs to their families. However, there is yet no analysis on the different household typologies, nor whether these translate into differences in healthcare spending and well-being outcomes.

We perform a cross section analysis using two-part models (probit and glm) to understand correlations between household composition and spending decisions, as well as healthcare indicators. The data are from AUB Socioeconomic Surveys from 2010 and 2015 with household and individual level information.

Our preliminary results follow the evidence in the literature and show that expenditure in healthcare as a percentage of total spending is 2.3%*** higher in 2010 and 3.3%*** in 2015 in female headed households. This difference is higher in families headed by widows or single women. Comparing 2010 to 2015 female-headed households are better off financially and belonging to these families is a significant determinant of receiving remittances from family abroad or in Lebanon and being self-employed.

Our results suggest that family remittances for female-headed households, heads of households having their own business and better budget management may be helping these families to cope with financial distress. These families are also target of special social support, but further research is needed to understand whether this support should target the gender of the household head or a more specific issue, that might be common to most of these households, but not the female leadership itself.

Key messages

Female-headed households are related to higher household budget spending on healthcare, are more likely to receive remittances from abroad and most of female heads of households are self-employed. We contribute to the discussion on whether special social support should target specifically female headed households or other specific poverty related issues.
Racial differences in mammographic density in Brazil: implications for mammographic screening
Authors: Gabrielli L , Ghaderi S , Almeida M C C , Goes E , Gnoatto C , Almeida L , Menezes G M S , dos-Santos-Silva I , Aquino E M L
Published: October 2020

Background

Mammographic density (MD)-the amount of radio-dense fibroglandular tissue seen on a mammogram - is a stronger biomarker of susceptibility to breast cancer and a major determinant of the sensitivity of mammographic screening. This study examined for the first time racial differences in MD in Brazil.

Methods

555 women (215 from the Longitudinal Study of Adult Health - ELSA-Brasil and 340 users of the Unified Health System - SUS) in Bahia were enrolled into the study. Participants completed an interview, had their heights and weights measured, and underwent a 2-view (cranio-caudal (CC) and medio-lateral-oblique (MLO)) digital mammography of each breast. MD was measured on the left MLO image using the semi-automated Cumulus software, and expressed as the percentage (PMD) of the breast area occupied by fibroglandular tissue. Linear regression models were fitted to assess ethnicity-PMD associations adjusting for age at mammography, body mass index (BMI) and reading batch (minimally-adjusted) and further for socio-economic and reproductive variables.

Results

The study population comprised 95 White (W), 270 Brown-mixed (Bm) and 169 Black (B) women, with a mean age at mammography of 58 (SD = 5.4) years. 63% W, 69% Bm and 49% B women had low educational level; 24% W, 47% Bm and 31% B women had ≥4 children. Minimally-adjusted analysis showed that relative to W women, PMD was 23% (1.23; 95% CI 1.04-1.45) higher in Bm and 4% (1.04; 0.89-1.21) higher in B; however, further adjustment for socio-economic and reproductive variables attenuated the racial differences (fully-adjusted model: 16% (1.16; 0.96-1.40) and 9% (1.09; 0.92-1.29) for Bm and B, respectively.

Conclusions

The racial differences in PMD were mainly accounted by ethnic differences in socio-economic and reproductive-related factors.

Implications Further studies should examine whether racial differences in PMD in Brazil lead to racial differences in false negative and interval cancer rates of mammographic screening.

Key messages

In Brazil, ethnic differences in socio-economic and reproductive-related factors are responsible for racial differences in mammographic density. More research is needed to address racial differences in breast cancer risk in Brazil.
Do social inequalities in smoking differ by immigration status in young adults?
Authors: Kalubi J , Tchouaga Z , Ghenadenik A , O'Loughlin J , Frohlich K L
Published: October 2020

Background

Tobacco use accounts for half the difference in life expectancy across groups of low and high socioeconomic status. The objective was to assess whether social inequalities in smoking in Canada-born young adults are also apparent among same-age immigrants, a group often viewed as disadvantaged and vulnerable to multiple health issues.

Methods

Data were drawn from the Interdisciplinary Study of Inequalities in Smoking, a longitudinal investigation of social inequalities in smoking in Montreal, Canada. The sample included 2,077 young adults age 18-25 (56.6% female; 18.9% immigrants). Immigrants had been in Canada 11.6 (SD 6.4) years on average. The association between level of education and current smoking was examined separately in immigrants and non-immigrants in multivariate logistic regression analyses controlling for covariates.

Results

Twenty percent of immigrants were current smokers compared to 24% of non-immigrants. In immigrants, relative to those who were university-educated, the adjusted odds ratio (OR) (95% confidence interval) for current smoking was 1.2 (0.6, 2.3) among those with pre-university or vocational training, and 1.5 (0.7, 2.9) among those with high school education only. In non-immigrants, the adjusted ORs were 1.9 (1.4, 2.5) among those with pre-university or vocational training and 4.0 (2.9, 5.5) among those with high school education.

Conclusions

Despite a mean of over 10 years in Canada, young adults who immigrated to Canada did not manifest the strong social gradient in smoking apparent in non-immigrants. Identification of factors that protect immigrants from manifesting marked social inequalities in smoking could inform the development of smoking preventive intervention sensitive to social inequalities in smoking.

Key messages

A social gradient in smoking apparent in Canada-born young adults was not observed in same-age immigrants. Factors that protect immigrants against social inequalities in smoking should be identified.