bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of amyotrophic lateral sclerosis and exposure to particulate matter: A case-control study
Authors: Filippini T , Mandrioli J , Malagoli C , Cherubini A , Maffeis G , Vinceti M
Published: October 2020

Background

Amyotrophic lateral sclerosis (ALS) is fatal neurodegenerative disease with still unknown etiology. Some environmental and occupational risk factors have been proposed, including air pollution, as suggested by recent studies. We carried out a case-control study in order to assess ALS risk due to environmental exposure to particulate matter ≤10 µm (PM10).

Methods

We recruited ALS patients referred to the Modena Neurology Unit between 1994-2015 and a reference group sampled from the population of Modena province. Using a geographical information system-based dispersion model, we estimated outdoor air PM10 levels at the geocoded subjects' addresses of residence at the time of diagnosis. We computed odds ratio (OR) and 95% confidence interval (CI) of ALS according to increasing PM10 exposure, using an unconditional logistic regression model adjusted for age and sex.

Results

For the study 132 participants (52 cases/80 controls), mean of annual average and maximum PM10 levels were 5.2 and 38.6 µg/m3, respectively. Using fixed cutpoints at 5, 10 and 20 of average annual PM10 levels, compared with subjects <5 µg/m3, we did not find an excess ALS risk associated with PM10 exposure, since OR was 0.87 (95%CI 0.39-1.96), 0.94 (0.24-3.70), and 0.87 (0.05-15.01) at 5-10, 10-20 and ≥20 µg/m3, respectively. When using maximum annual PM10 levels, we found an excess ALS risk for subjects exposed at 10-20 µg/m3 (OR = 4.27, 0.69-26.51) compared with exposure below 10 µg/m3. However, risk decreased with further exposure increase at 20-50 (OR = 1.49, 0.39-5.75), and ≥50 µg/m3 (OR = 1.16, 0.98-4.82).

Conclusions

Our findings do not suggest that PM10 exposure is associated with ALS risk, even at the high levels of exposure characterizing a Northern Italy province. However, the statistically imprecise increased risks associated with maximum annual exposure levels suggest the need of further investigations.

Key messages

Outdoor particulate matter exposure seems not associated risk of amyotrophic lateral sclerosis. Only exposure to high concentrations of particulate matter might increase risk of amyotrophic lateral sclerosis.
Adherence to medication among Tunisian adults with type 2 diabetes
Authors: Amara A , Ghammem R , Zammit N , BenFredj S , Maatoug J , Ghanam H
Published: October 2020

Introduction

Diabetes mellitus is a growing public health concern. Despite compelling evidence about the effectiveness of medications, studies have indicated that less than 50% of patients achieved therapeutic targets. The aim of this study was to assess the adherence to type 2 diabetes mellitus treatment and its determinants.

Methods

A cross-sectional study was conducted between April and June 2017 in the Endocrinology and internal medicine departments of Farhat Hached University Hospital in Sousse, Tunisia. A convenient sample of patients who fulfilled the eligibility criteria was recruited. A pre-tested questionnaire was used to gather information. This was followed by assessing patients' adherence to diabetes medications using the eight-item Morisky Medication Adherence Scale (MMAS-8).

Results

A total of 330 patients with Type 2 Diabetes Mellitus participated in this study. The mean ±SD age of patients was 58.96±10.3 with female predominance (60.3%). More than half of participants were with high cardiovascular risk. In most cases (70.6 %), participants were moderate adherent. Results showed that patients become non-adherent as the disease gets older (p = 0.001). In addition patients with health insurance were significantly more adherent comparing to those who did not have it (p = 0.01). Regarding self-care practices and other metabolic risk factors' effects, our data revealed that exercising 30 minutes below than 5 times in week and poor self-management of diet were associated with low adherence (p < 10-3). On the other hand, patients who have started insulin therapy were less adherent than those who had not yet (0.01). Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent, with respective percentage of 39.1% and 37.5%.

Conclusions

This study provides insights into the determinants of non-adherence, ultimately guiding the effective interventions through development of structured long-term policies not yet implemented.

Key messages

In most cases (70.6 %), participants were moderate adherent. Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent.
Effectiveness of mud-therapy in rheumatic and dermatologic diseases: a systematic review
Authors: Mingrone V M , Paduano S , Venturelli F , Marchesi I , Valeriani F , Bassi M C , Borella P , Bargellini A
Published: October 2020

Background

Thermal mud therapy alone or in combination with thermal water baths is widely used in clinical practice for the management of rheumatic and dermatologic diseases in many countries. Despite its long history and tradition, its biological action and its clinical effectiveness are still not clear. The aim of this systematic review is to synthetize the current evidence on the mud therapy effects on pain, function and quality of life in patients with rheumatic and dermatologic diseases.

Methods

PubMed/Medline, Embase, and Cochrane Library were searched for articles about the comparative effectiveness of mud therapy alone or combined with other therapies on pain, function and quality of life in adults with rheumatic or dermatological diseases without any restrictions of severity. Studies were searched up to 15 October 2019. We included randomized and non-randomized trials and comparative cohort studies, as well as non-comparative case series and case reports only for safety outcomes. The following outcomes were considered: pain assessed by validated scales or through painkillers drugs consumption, function (i.e. muscle tone, joint motility and stiffness) assessed by validated scores, quality of life and autonomy assessed by validated scales and adverse events. Laboratory inflammation parameters were investigated as secondary outcomes.

Results

A total of 2,455 articles were retrieved through database search, remaining 1,914 records after duplicates removed. The selection by title and abstract led to include 140 studies for full-text evaluation. The screening of full-text is still being carried out. The majority of 140 records assess the effects of mud therapy in patients with osteoarthritis (51 articles), osteoarthrosis (12) and psoriasis (10).

Conclusions

Our results will provide a synthesis of the current evidence on the mud therapy effectiveness, useful to evaluate its inclusion within clinical protocols for the treatment of rheumatic and dermatologic diseases.

Key messages

The majority of studies report the treatment with mud for rheumatic diseases. The synthesis of the evidence is useful to evaluate the mud therapy as treatment for rheumatic and dermatologic diseases.
Functional disability in Brazilian octogenarians: data from the 2013 National Health Survey
Authors: Stolses Bergamo Francisco P M , de Assumpção D , Silva Arbex Borim F , Gomes de Macedo Bacurau A , Pita Ruiz A M , Liberalesso Neri A
Published: October 2020

Background

The impairment of function capacity implies a greater risk of biological and social vulnerability, increasing the demand for healthcare services and caregivers.

Objective

Estimate the prevalence of functional disability in the performance of basic and instrumental activities of daily living (BADL and IADL) among long-lived Brazilians (≥80 years) according to sociodemographic characteristics and self-rated health.

Methods

A cross-sectional study was conducted with data from seniors who participated in the 2013 National Health Survey (n = 1498). Functional disability was defined as difficulty performing at least one of the six BADL or five IADL. Independent associations were determined using Poisson multiple regression analysis, with the calculation of prevalence ratios and 95% confidence intervals adjusted for chronic diseases.

Results

Mean age was 84.8 years (CI95%: 84.5-85.1); 59% were women; 62% were self-declared white; and 63% had no private health insurance. The prevalence of functional disability in BADL and IADL was 33.8% (CI95%: 30.6-37.2) and 66.4% (CI95%: 62.5-70.2), respectively. Only 17.7% participated in organized social activities and only 15.5% rated their health as poor/very poor. Regarding BADL, greater disability was found among those ≥85 years of age, among men and those who rated their health as poor (p < 0.05). Regarding IADL, greater disability was found among those ≥85 years of age, those without a conjugal life, illiterate individuals and those who rated their health as poor (p < 0.05).

Conclusions

Approximately 1/3 and 2/3 of long-lived Brazilian exhibited restricted skills for maintaining their autonomy and independence regarding the performance of BADL and IADL, respectively. The present findings underscore the importance of family and social support networks to assist older adults in the performance of basic and instrumental activities of daily living as well as activities related to mobility.

Key messages

The impairment of function capacity increases the demand for healthcare services and caregivers. Approximately 1/3 and 2/3 of long-lived Brazilians have functional disability regarding the performance of basic and instrumental activities of daily living, respectively.
Is haze control effective? A research based on regional public perception differences
Authors: Li Y , Chen Y Y
Published: October 2020

Background

Beijing-Tianjin-Hebei region (BTHR) is a world-class city group in China. However, haze severity of BTHR ranked in the top in China, 2014. As haze has certain impact on people's physical and psychological health, government has taken various measures to actively manage it in recent years. We try to answer the question: From public perception, whether haze control in BTHR has achieved a little success?

Methods

According to region and gender, we select four groups as respondents: BTHR and non-BTHR men, BTHR and non-BTHR women. We investigate their perception towards haze related issues. After collecting 400 anonymous questionnaires, we use clustering by fast search and find of density peaks (CFSFDP) algorithm to divide the investigated population into different clusters that represent different perception situations. Then, we test whether the frequency of each group divided into four clusters was consistent with the overall distribution frequency by fitting test.

Results

Questionnaires are automatically divided into four clusters by CFSFDP. The results of test (p > 0.1) show that the four groups are consistent (no significant difference) with overall clustering. Overall average score for “public perception to haze control” is 2.974 (full-score is 5.000), belonging to middle and upper level.

Conclusions

The cluster results show that there is no significant difference in the perception of haze control effect among four groups. Therefore, for the public in BTHR, there is no significant difference in their recognition of haze control compared with that in other regions, and the overall scores are all at the middle and upper levels. From public perception, effect of haze control in BTHR is in line with that in other regions.

Key messages

Using clustering algorithm and statistical test to identify the difference of public perception of haze control. From the perspective of public perception, haze control in BTHR has achieved initial results.
The long-term burden of war injuries in LMICs: Case of the Lebanese War of 2006
Authors: Kobeissi E , Menassa M , Honein-AbouHaidar G , Abdul Khalek R , Chaya B , Elamine A , Abu-Sittah G , El Achi N
Published: October 2020

Background

Armed conflict is a major cause of disability and mortality, particularly in LMICs. July 12, 2006 marks the start of a 33-day war in Lebanon which resulted in at least 1191 deaths and 4409 injured, the vast majority of whom were civilians. Little is known about the consequences of war-injuries inflicted on civilians. The AUB arm of the NIHR PrOTeCT Group aims to identify 1) war-injury characteristics associated with high burden of care 2) the long-term socioeconomic burden and 3) the quality of life of the injured civilians and their access to healthcare and medicine under conditions of war.

Methods

This study employs a mixed-method research design by reviewing medical records of patients admitted to hospitals in Lebanon between July 12th and August 15th, 2006, conducting interviews with patients, and administering the EQ5D5L questionnaire to understand the burden of injuries and the quality of life of patients 13 years after injury. Qualitative and quantitative data analysis methods will be used.

Preliminary Results

25 interviews have been conducted so far. Injured civilians were mostly males, average age 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The emerging themes include description of the 1-scene and type of injury; 2-referral process from the injury site to the hospital; 3-the types of services received; and 4-the financial and non-financial long-term impact. They described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living.

Conclusions

These preliminary results show that civilians injured during the July 2006 war are experiencing physical and psychological sequelae; thus, more services need to be offered to civilians injured during war.

Key messages

Physical impairments related to war injuries influenced the quality of life of study participants. Affordable or free rehabilitation services need to be offered to civilians injured during war.
The spirit of Vienna: health strategies in managing the world drug problem
Authors: Morais D , Silva M
Published: October 2020

Health sciences have always had a lot of influence in the formulation of drug policies. However, the international system for the control of illicit drugs is distant from the World Health Organization, for example. It was in the name of health and well-being protection that the Single Narcotics Convention (1961) established a ban on drugs as a rule, with the exception of medical and scientific uses. But it was also in the name of a health category, Harm Reduction, that the so-called Vienna consensus began to break in 2009: it is about the global bipolarization around drug policy, locating member states in two groups.

Taking strategy as a means designed to achieve a purpose, which updates the position of agents in the International Drug Control System and which operates the renunciation of the other (FOUCAULT, 2001), we ask: what, in the last decade, was their strategy groups of countries in managing the global drug problem? To answer this question, an ethnography of events and documents was carried out, in addition to semi-structured interviews and participant observation. The field research was the 62nd Ministerial Segment of the UN Commission on Narcotic Drugs (Vienna, 2019), when the last 10 years of drug policy were evaluated and the next decade was planned.

Following the Brazilian resolution, created in partnership with Norway, entitled “Promoting measures to prevent transmission of HIV for women who use drugs, including by improving access to post-exposure prophylaxis”, it was possible to observe the effort to maintain that space as a place where health has no voice. Categories such as 'women who use drugs' and 'emergency contraceptives' have been the subject of controversy among diplomats, who have backed down to maintain the already weakened consensus.

It is concluded that health is historically used as a strategy for the prohibition of substances, but it can be a tool for changing the paradigm if observed as an instrument in dispute and based on Harm Reduction

Key messages

Health is the strategy to legitimize drug prohibition, but it can also be the protagonist of the paradigm shift in drug policy if it is anchored in harm reduction. There is an effort to keep the UN's international illicit drug control system out of the health field.
Patient and Public Involvement in health research: evidence on the practice of participant selection
Authors: Lander J , Dierks M L
Published: October 2020

Background

Research on Patient and Public Involvement (PPI) largely focusses on its aims and methods. Aspects regarding who participates in PPI are largely overlooked, though they may impact considerably on the planning, process and outcomes: who exactly are 'patients and public' in PPI? How are participants selected and why? Are and should participants be representative? Our objective was to explore respective practices and perceptions to inform future PPI.

Methods

We conducted a systematic database search to select published PPI in medical and health research. Authors of included publications (n = 315) were addressed via an electronic survey, closed and open responses were assessed using descriptive statistics and thematic content evaluation.

Results

Respondents (40%) reported to have recruited a broad spectrum of participants, often including more than one specific group (56%), e.g. publics with and without topic-wise experience. There were only little differences with respect to selecting participants for different involvement aims and using different recruiting methods. Representativeness was often seen as a crucial recruiting objective (71%), while many considered achieving it (very) difficult (69%). They identified significant respective challenges and desired more guidance on various aspects of planning and conducting PPI (56%).

Conclusions

Recruiting PPI participants and handling representativeness are controversial and are associated with various obstacles. While few prior studies addressed single related aspects using debates and theory, our results add a more comprehensive and empirical perspective, particularly regarding the (real) relevance of representativeness.

Key messages

Study authors need to be more systematic and reasonable in selecting PPI participants and in deciding about the need for representativeness. PPI-guidelines should concretize the most relevant steps for planning and conducting participant selection, so that the practice of PPI can be regarded sound and meaningful.
Analysis of the local health-enhancing physical activity policies in the French Riviera
Authors: Racine A N , Garbarino J M , Massiera B , Vuillemin A
Published: October 2020

Background

Policy is one of the levers to initiate structural and environmental changes to foster health-enhancing physical activity (HEPA) promotion. However, little is known about local evidence to support governments in their policies to promote HEPA. This study aims to analyze the local HEPA policies development in French mid-size cities.

Methods

Mid-size cities from 2 counties of the French South Region were targeted (n = 17). In each city, a local HEPA policy analysis tool, CAPLA-Santé, was administered to key informants heading the departments of sport, health and social. CAPLA-Santé is a local policy analysis tool adapted from the national HEPA policy analysis tool (HEPA PAT version 2) developed by the World Health Organization. Data were collected through semi-structured interviews and documents analysis.

Results

A total of 10 mid-size cities were volunteered to participate. Key informants from sport (n = 10), health (n = 5) and social (n = 6) departments were interviewed. Several written HEPA policies were formalized in 6 cities, 4 of them based their policies on scientific evidences or a national policy. These policies (n = 14), were mainly from the sport (n = 8) and the health sectors (n = 4). Some cities had a department head to ensure cross-sectoral collaboration (n = 3). Key informants reported that the support of national policies, the commitment of elected officials and an important local stakeholders' network could facilitate the HEPA promotion; whereas lack of intersectoral collaboration and resources could be a limitation.

Conclusions

The results help to better understand the local HEPA policies, highlighting some barriers, facilitators and perspectives. These findings could be valuable to scale up the HEPA promotion at the local level.

Key messages

Local policymakers had difficulties to adopt an intersectoral and global approaches in HEPA promotion. Using local HEPA policy analysis tool can provide evidence to support policymakers.
Norwegian parents' views on nutrition policy measures and responsibility
Authors: Roos G
Published: October 2020

Background

Norwegian nutrition policy has during the last 50 years shifted from a focus on state concerns over the common good and social welfare towards increased individual responsibility and a focus on active consumers who make conscious choices. This paper investigates division of responsibility between the state and individuals by analysing parents' views on nutrition policy measures and responsibility for healthy eating.

Methods

In 2019, Norwegian parents with children aged 1-16 years (N = 1085; 59% women and 41% men), completed a web-based survey on children's food and clothing consumption. The questionnaire included questions about individual and state responsibility for healthy eating and nutrition policy measures.

Results

Preliminary results indicate that there is consensus among parents that health is an individual responsibility (75%), whereas simultaneously 30% indicated that the state should not interfere with people's eating. Among nutrition policy measures parents agree that the state should use food price regulation to support healthy eating (71%) and 94% agree that there should be lower prices (VAT) on fruits and vegetables. The majority of parents (65%) think that marketing of unhealthy food to children should be banned, and that the packed lunch should be replaced by a school meal, while the opinions around keyhole labelling are somewhat more varied (46% agree that the keyhole label makes choosing healthy food easier). Further analysis in relation to background (education, income etc.) and food consumption are planned.

Conclusions

Healthy eating is considered a personal responsibility by Norwegian parents. They support nutrition policy measures and especially agree that the state should use price regulation to endorse healthy eating.

Key messages

Consumer views on nutrition policy measures should be taken into account. Norwegian parents support state regulation, especially food price regulation measures.
Political analysis of the neonatal screening for severe combined immunodeficiency - Curitiba, Brazil
Authors: Lima D R L , Goiozo P F I , Sanches A , De Carvalho E , Carvalho H A , Silva C L
Published: October 2020

Severe Combined Immunodeficiency (SCID) is the most aggressive form of primary immunodeficiencies, being able to death within 2 years after birth. In the USA, the screening found that the incidence of SCID was double that previously stipulated, before screening. Israel, Taiwan, Spain and others European countries are also testing for SCID. The long-term survival of patients diagnosed and treated before 4 months of life reaches 94%. Brazil does not perform neonatal screening for SCID through the Public Health System (SUS), numbers are unknown and under-diagnosed, even the treatment for SCID is funded by SUS. Analyze the political dimensions of the bill that aims to implement neonatal screening for SCID in Curitiba, Brazil. Participatory research was carried out between March - October 2019 and, bibliographic research on policy analysis in the context of emerging countries, to understand the criteria are taken into account for the political agenda, the influence of interest groups and the influence of the political arena in the implementation of a public policy through policy analysis. The project is pending in the municipal legislature of Curitiba and faces issues related to the financing of the implementation - a wide range of dependent variables act in the construction of a public policy. Its materialization, although important for public health, must consider real possibilities of implementation. In parallel, independent of the bill, a screening pilot project is under preparation by doctors, academics, and civil society. Brazil has a feasible technique that can be implemented on a large scale for neonatal SCID screening. However, although strongly recommended by the medical community, the implementation of this policy can be unviable by political and financial issues.

Key messages

The implementation of a public policy involves decisions between institutions, rules of the game and political forces. Early diagnosis may reduce treatment costs, requiring public policies for SCID.
A critical discourse analysis of health in Swedish integration policies
Authors: Svanholm S , Viitasara E , Carlerby H
Published: October 2020

Background

Previous research has indicated that migrants risk facing inequities both internationally and in Sweden; integration policies are therefore important to study. How health is described in policies affects how health interventions are approached. A discourse analysis offers a way of understanding how health is framed within the integration policies of the Establishment Program. The aim was to critically analyse the health discourses used in Swedish and European Union (EU) integration policies.

Methods

A critical discourse analysis, inspired by Fairclough, was performed on integration policies related to Sweden, on local, regional, national and the EU level. The policies of the Establishment Program, which focuses on newly arrived migrants (refugees, persons of subsidiary protection and their relatives who arrived through family reunification), were chosen for the analysis, and 17 documents were analysed in total.

Results

The analysis of the documents showed that although no definition of health was presented, health discourses were expressed in the form of the medicalization of health and the individualization of health. This not only by the terminology used, but also in how the healthcare sector was considered responsible for any health related issue and how individual health behaviours were of focus in interventions to promote health.

Conclusions

A pathogenic approach to health was visible in the policies and individual disease prevention was the main health focus. The results showed similarities to previous research highlighting how a particular understanding of health in a neoliberal context is formed.

Key messages

Health as a resource is missing in the integration policy documents. Viewing health as an individual quality puts the responsibility of promoting health on the individual.
Public health policy and medical unionism in the context of collapse of Brazilian democracy
Authors: Guimarães-Teixeira E , Delgado P , Machado M H , Camargo A
Published: October 2020

Issue

This is a report about an editorial initiative to contribute to the debate on the crisis of trade unionism and public health in Brazil.

Description of the Problem

The Rio de Janeiro Doctors Union (SinMed-RJ), the first trade union of liberal professionals in Brazil, began its activities in 1927 and has completed nine decades. It kept present in the political life, in the process of drafting labor laws, subjected to the brutal intervention of security agencies during the military dictatorship, and in the street struggle for democratizing access to health in the 1980s. It is yet part of the history of the struggles for the re-democratization of the country and the construction of a universal public health policy. Together with The Brazilian Center for Health Studies (Cebes) it fights for the construction and consolidation of the Unified Health System (SUS) and the achievements of the 1988 Citizen Constitution, actions that had a major impact on the trade union and on public health.

Results

In 2017, the government that emerged from the 2016 judicial-parliamentary coup, made changes to labor legislation, destroying the legal framework for the defense of work and discontinuing the financial of trade unions. In 2019, we were witnessing the struggle of combative and socially based unions for the survival of their entities. The SinMed-RJ promoted debates on the role of the media in deconstructing democracy and the precariousness of medical work, while actively supporting the struggle of doctors in defense of their rights.

Lessons

Cebes and SinMed-RJ met against the privatization health, an important agenda of debate and action. From 2019, there had been a growing increase in measures to deconstruct public policies and labor protection, breaking the social legitimacy of state institutions, retracting the democratic space, deepening inequality and unemployment. This agenda is urgent to be widely debated for the whole society of a country in crisis.

Key messages

The major impact of this work was to include the public health challenges of Brazil in the agenda of the trade union, and to fight to rescue the democracy in Brazil. The major impact was to work with other institution on health studies and publish a special number of a free publication in honor of nine decades of the first union of liberal professional in Brazil.
Times of change in complex environments - Evaluating hospital co-payments in Palestine refugee camps
Authors: Valente de Almeida S V , Ghattas H , Paolucci G , Seita A
Published: October 2020

We measure the impact introducing a of 10% co-payment component on hospitalisation costs for Palestine refugees from Lebanon in public and private hospitals. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand and supply for healthcare.

The data was collected by the United Nations Relief and Works Agency for Palestine Refugees in the Near East and include episode level information from all public, private and Red Crescent Hospitals in Lebanon, between April 2016 and October 2017. This is a complete population episode level dataset with information from before and after the policy change. We use multinomial logit, negative binomial and linear models to estimate the policy impact on demand by type of hospital, average length of stay and treatment costs for the patient and the provider.

After the new policy was implemented patients were 18% more likely to choose a (free-of-charge) PRCS hospital for secondary care, instead of a Private or Public hospital, where the co-payment was introduced. This impact was stronger for episodes with longer stays, which are also the more severe and more expensive cases. Average length of stay decreased in general for all hospitals and we could not find a statistically significant impact on costs for the provider nor the patient.

We find evidence that the introduction of co-payments is hospital costs led to a shift in demand, but it is not clear to what extent the hospitals receiving this demand shift were prepared for having more patients than before, also because these are typically of less quality then the others. Regarding costs, there is no evidence that the provider managed to contain costs with the new policy, as the demand adapted to the changes. Our findings provide important information on hospitalisation expenses and the consequences of a policy change from a lessons learned perspective that should be taken into account for future policy decision making.

Key messages

We show that in a context of poverty, the introduction of payment for specific hospital types can be efficient for shifting demand, but has doubtable impact on costs containment for the provider. The co-payment policy can have a negative impact on patients' health since after its implementation demand increased at free-of-charge hospitals, which typically have less resources to treat patients.
Family caregiving in an aging society: Key policy questions
Authors: Vinarski H , Halperin D
Published: October 2020

An aging population, attended by an increase in chronic diseases and disability, together with decrements in health among the elderly, require considerable health care resources being expended on long-term care needs in the home environment at the community level. Increase in life expectancy, and more substantially, the disproportionate increment within the very oldest age groups and in the number of elderly whose activities are limited by some sort of physical or cognitive disability have significantly increased family care needs. Such demographic shift and socioeconomic changes throughout the developed world are making elderly care an increasingly important public policy issue. Particularly, one of the principal foci of policy makers should be supporting and nurturing family care. This paper focuses on the case of Israel. Like many industrialized countries, Israel faces the challenge of caring for a growing number of vulnerable older people while advancing adequate policies to support both elderly and their informal caregivers. Currently, the demands for family caregivers has increased drastically, and, studies predict that the personal, social, and economic costs of caregiving, which have risen dramatically over the last three decades, will only continue to increase. This paper focuses on the extent to which current legislation supports primary informal caregivers in Israel. A review of the legislation and benefits has indicated that the aid supplied is limited mainly because their application is relevant only in extreme cases where the elderly need constant supervision or care in institutions. Their contribution to most elderly and their families is only partial. The rights afforded to the informal caregivers are relatively few, are limited and are all concentrated in the domain of occupational support, and this also in a restricted manner.

Key message

Family caregiving in an aging society: Key policy questions.
More harm than good? Building a framework to identify adverse effects of public health interventions
Authors: Stratil J , Oliver K , von Philipsborn P , Movsisyan A , Rehfuess E A
Published: October 2020

Background

While the importance of adverse events of medical interventions is widely recognized, adverse effects of public health interventions remain a neglected topic. This project aims to develop a framework to guide researchers and decision-makers to systematically reflect on and identify potential adverse effects of public health interventions.

Methods

We conducted a mixed-method systematic review of theoretical and conceptual publications on adverse events of public health interventions to develop a preliminary framework employing best-fit framework synthesis. We used the WHO-INTEGRATE framework as a starting point for the synthesis, a multidimensional evidence-to-decision framework developed for complex interventions in complex systems.

Results

The framework includes two interlinked parts: The first maps domains in which potential adverse events might arise. Drawing on the WHO-INTEGRATE framework, these domains include aspects related to health, but also domains related to societal, economic, and environmental implications. The second part maps general mechanisms through which public health interventions can lead to adverse effects (e.g. reactive behaviour change, increase of labelling and stigmatization, and exposure to environmental risk-factors).

Conclusions

The framework will be advanced in the second phase of the project through empirical studies of harmful effects in public health interventions, which we will identify through an overview of systematic reviews. Adverse effects of public health interventions are currently not sufficiently considered in research and practice. Taking them into account is essential for informed decision-making and establishing appropriate countermeasures. Our framework could be a valuable asset for researchers and policy makers in developing, implementing and evaluating public health interventions.

Key messages

Awareness of the adverse effects of public health interventions is essential for informed decision-making and establishing countermeasures. This framework supports researchers and decision-makers in systematically reflecting on and identifying adverse events when developing, piloting, implementing or evaluating public health interventions.
Profile of incarcerated women in the interior of Brazil and the challenge of education in prison
Authors: Faquim J , Macedo J , Oliveira J , Machado S , Ivancko G , Costa K , Alves M , Oliveira T
Published: October 2020

According to the Ministry of Justice and Public Security, Brazil is fourth in the world position in relation to the absolute size of female prison population, with 42.000 women deprived of freedom (2016), behind the United States, China and Russia. Around 50% are young (< 29 years old), 62% are black and 66% have not yet attended high school. This study aimed to characterize the profile of women incarcerated in a penitentiary in the interior of Brazil, through the survey of sociodemographic data, education, health, legal and life expectations. This is a descriptive and exploratory study conducted with 68 women (20 to 67 years old) in 2019 and 2020. Most women declared themselves black or brown (56%), incomplete elementary school (42%), have work experience (73%). Around 69% reported needing health treatment and 76% have already used psychoactive substances including alcohol, cigarettes, marijuana, cocaine or crack. The main reasons that led to the arrest were drug trafficking (54%) and theft (26%) and the majority (53%) are repeat offenders in prison system. Regarding the biggest dream of life, the main answers were related to family life (44%), having a job (26%) and access to education (20%). With these results, an extension project was proposed to offer a professional qualification in vegetable gardens, aromatic and medicinal plants for women prisoners. In addition to professional qualification, the project is dedicated to promoting debates on map of life, ethics, human relations, citizenship, gender, women's rights and health, quality of life, body and verbal expression, digital inclusion, food and nutrition security, entrepreneurship, cooperativism, solidary economy, rights and duties of the worker, aiming at better employment conditions. This research contributed to articulate actions between university and society, empower women through access to education and allowed the work team to develop competencies related to collaborative work and interdisciplinarity.

Key messages

This study aimed to characterize the profile of women incarcerated in a penitentiary in Brazil, through the survey of sociodemographic data, education, health, legal and life expectations. This research contributed to articulate actions between university-society, empower incarcerated women through access to education and allowed the work team collaborative and interdisciplinarity work.
#CroakeyGO: Walking as an act of journalism to engage not distance the public in health reporting
Authors: Williams M , Sweet M , Armstrong R , McInerney M , Ward M
Published: October 2020

Health as it is reported in mainstream media is narrow and communities are often excluded, despite being where the experience of health occurs. A wide range of research indicates that it is through narratives of community members that media and health messages are best conveyed, and community members now have a range of platforms for quickly conveying information to each other and the media. However, there have been surprisingly few innovations for journalists to use this material, or to better connect with the public and report more accurately about health.

Our experience across several journalism projects demonstrates how quickly and deeply health content can be developed in collaboration with communities. One example is #CroakeyGO - an innovation in public interest journalism that gathers, walks and talks with community members together at a defined time and location about health-related matters.

#CroakeyGO brings together diverse voices from local communities - people who might otherwise not connect. This stimulates discussion about health issues beyond the individual, including system- and environmental-level issues that impact local lives. #CroakeyGO also means respecting Indigenous peoples' connection to Country on which we walk and reflecting on intergenerational inequities and solutions Indigenous knowledges offer.

To date we have published more than 40 articles from #CroakeyGO events around metropolitan and regional Australia. We have collaboratively produced social media and other editorial content with community members and stimulated enduring networks for health planning, advocacy and research. #CroakeyGO reinforces that improving health in a community requires more than just additional services, and that transformations in journalism can facilitate and support rather than hinder collective action.

Key messages

Innovations in journalism are required and possible to improve health reporting. Communities are willing to engage in health reporting.
How to tackle the growing problem of type 2 diabetes in the European Union?
Authors: Mahrouseh N M , Njuguna D W , Varga O A
Published: October 2020

Background

There is an alerting increase in the population affected by type 2 diabetes mellitus (T2DM) in the European Union (EU) with significant socioeconomic burden. According to an estimation by the International Diabetes Federation, by 2030, the total number of diabetic patients will be 38 million in EU. The “screen and treat” strategies that predominantly applied in policies to prevent T2DM have not achieved significant success, as reported by a large systematic review and meta-analysis published in 2017. Although the member states of the EU have almost full responsibilities for actions in the field of health, the EU has to tackle non-communicable diseases by targeting health determinants and lifestyle mostly through non-binding policies. The goal of this work is to review the T2DM prevention policies in the EU and compare with tobacco policies, from a legal perspective.

Methods

Following the systematic search and screening of policies from EUR-lex, a content analysis was carried out by using MonQcle as publicly available legal text document analysis platform, by two coders. The search was limited for regulations, directives and white papers.

Results

Our data collection consisted of 19 documents including 10 regulations, 6 directives and 3 white papers with relevance to T2DM, covering the following topics: health infrastructure and services, informational policies, economic policies, environmental policies, command and control and social policies. The identified policies covered the time frame of 1972 to 2020. Diabetes was targeted as part of non-communicable diseases. None of the policies was legally binding addressing T2DM directly which is in sharp contrast to the tobacco control policies in the EU.

Conclusions

T2DM, in fact, is largely preventable. EU institutions should consider to reframe T2DM prevention strategies and consider applying a wide range of population-level legislative and innovative actions to prevent T2DM e.g. taxes on unhealthy food products.

Key messages

T2DM is a largely preventable disease, effective legal tools should be created and applied matching the scale of such public health problem. T2DM policies of the EU may be subject to change due to additional value of actions taken by the EU compared to that could have been achieved by member states alone.
Prospective associations of four nutrient profiles with weigh gain, overweight and obesity risk
Authors: Egnell M , Neal B , Ni Mhurchu C , Rayner M , Jones A , Seconda L , Touvier M , Kesse-Guyot E , Hercberg S , Julia C
Published: October 2020

Background

Nutrient Profiling Systems (NPSs), including the UK Food Standards Agency NPS and its variants are used to classify foods according to their nutritional composition for nutrition policies. The prospective validity of these NPSs requires however further investigation. The study investigates the associations of the original Food Standards Agency (FSA)-NPS and three variants - the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC), the Health Star Rating (HSR) system NPS and the French NPS (HCSP-NPS) -, which are used as a basis for nutrition policies, with weight status.

Methods

Dietary indices based on each of the four investigated NPSs applied at the food level were computed at the individual level to characterize the diet quality of 71,178 French individuals from the NutriNet-Santé cohort. Associations of these Dietary Indices (DIs) (as tertiles) with weight gain were assessed using multivariable mixed models, and with overweight and obesity risks using multivariable Cox models.

Results

For the four NPSs, participants with a lower diet nutritional quality were more likely to have an increase in body mass index over time (median follow-up of 3.14 ± 2.76 years, beta coefficients positive, all p ≤ 0.0001), and an increased risk of overweight (HRT3vs.T1=1.27 [1.17-1.37] for the HCSP-DI, followed by the original FSA-DI with HRT3vs.T1=1.18 [1.09-1.28], the NPSC-DI with HRT3vs.T1=1.14 [1.06-1.24] and the HSR-DI, HRT3vs.T1=1.12 [1.04-1.21]). Whilst differences were small, the HCSP-DI appeared to show significantly greater association with risk of overweight compared to other NPS.

Conclusions

Less healthy diets defined using the Food Standards Agency-NPS and related systems were all associated with weight gain and overweight risk. Demonstrating this association with health outcomes is an important indicator of one validity dimension of NPSs and supports their use in public policies for the prevention of diet-related chronic diseases.

Key messages

Nutrient profile models of foods and beverages allow capturing the nutritional quality of diets and are prospectively associated with weight gain and obesity. The French NPS which underpins the front-of-pack Nutri-Score appeared to have a small but significant higher performance.