bluuebunny/crossref_metadata_2025 huggingface dataset:
Life course trajectories of weight status and risk of type 2 diabetes
Authors: Yacaman-Mendez D , Tyrnelius P , Gudjonsdottir H , Ponce de leon A , Trolle-Lagerros Y , Lager A
Published: October 2020

Background

Overweight and obesity are risk factors for type 2 diabetes (T2D) with a cumulative effect. However, individuals experience important variation throughout life. We aimed to identify life-course trajectories of changes in weight categories among men and women and their association with T2D.

Methods

4,820 women and 3,128 men participants of the Stockholm Diabetes Preventive Program (1992-2017) provided self-reported weight status at age 7 and 18, BMI 10 and 5 years before the study and measured BMI at baseline. Exposure was categorized as low weight, normal weight and high weight. Diagnosis of T2D was assessed with an oral glucose tolerance tests (OGTT) or taken from inpatient and outpatient registries. The life course trajectories were estimated using latent group mixture models, risk of T2D and population attributable fractions with Poisson regression.

Results

We found five trajectories in women and men: stable normal (44.8%, 34.2%), low increasing (17.4%, 18.7%), high in early adulthood (18.6%, 27.8%), high in late adulthood (14.7%, 14.5%), and stable high (4.5%, 4.5%). Compared to stable normal, the risk of T2D was higher in the low increasing (RR: 1.4 (95%CI: 1.0-2.0), RR:1.54(95%CI: 1.0-2.2)), high in early adulthood ((RR: 2.79 (95%CI: 2.1-3.7), RR: 2.8 (95%CI: 2.0-3.6)), high in late adulthood ((RR: 1.6 (95%CI: 1.1-2.2), RR: 1.6 (95%CI: 1.1-2.3)) and stable high groups ((RR: 2.9 (95%CI: 1.9-4.3), RR: 2.7 (95%CI 1.8-4.0)), and 48.2% (95% CI: 36.3% - 57.8%) of the cases of T2D in women and 41.2% (95%CI: 27.4% - 52.3%) in men could have been avoided if participants had been in the stable normal group. PAF was higher for the high in early adulthood group -25.5% (19%-31%) and (27.2% (19%-35%)-.

Conclusions

We identified five life course trajectories of changes in weight status. Risk of T2D was greater in the stable high and high in early adulthood groups but the proportion of T2D cases that can be attributed to the high in early adulthood group was greater.

Key messages

Different life-course trajectories of high body weight are associated to the risk of diabetes in late adulthood. The largest proportion of cases of T2D can be attributed to weight gain in early adulthood.
Pediatric metabolic syndrome definitions impact prevalence and socioeconomic gradients
Authors: Lepe A , de Kroon M L A , de Winter A F , Reijneveld S A
Published: October 2020

Background

The choice of pediatric metabolic syndrome (MetS) definition influences prevalence estimates, but further implications, especially on the association with socioeconomic status (SES), are not well-known. This hampers a synthesis of the evidence to help guide the relevant stakeholders. For this reason, we aim to assess the impact of alternative definitions on the prevalence of MetS, the children that are identified, and the association between SES and MetS.

Methods

Data were used from the Lifelines Cohort Study, a prospective multigenerational cohort in the Netherlands. At baseline 9,754 children participated, of which 5,085 (52.1%) were included in the longitudinal analyses. We computed the prevalence of MetS according to five published definitions and measured the observed positive agreement between pairs of definitions, indicating the proportion of agreement across the average number of MetS cases. Logistic regression was used to assess the association between SES and MetS. All models were adjusted for age and sex; the longitudinal models were also adjusted for baseline MetS status.

Results

The prevalence rates of MetS varied between definitions (0.7-3.0% at baseline), but positive agreement between MetS definitions was generally fair to good ranging from 0.34 (95% confidence interval (CI) 0.28; 0.41) to 0.66 (95%CI 0.58; 0.75) at baseline. At both assessments, we found an inverse association between baseline SES and MetS, which ranged from 0.81 (95%CI 0.70; 0.93) to 0.92 (95%CI 0.86; 0.98) per definition in the longitudinal analyses with a mean follow-up (SD) of 3.0 (0.75) years.

Conclusions

Alternative definitions of MetS lead to differing prevalence estimates, and they agreed on 50% of the average number of cases of MetS. The alternative definitions also lead to similar socioeconomic gradients; regardless of which definition was used we concluded low SES was a risk factor for developing MetS.

Key messages

Evidence regarding different definitions of metabolic syndrome in children can be combined because the agreement among definitions is generally fair to good. As low socioeconomic status is a consistent risk factor for developing metabolic syndrome, preventive interventions should preferentially target children from low socioeconomic backgrounds.
Time trends of risk and protective factors for non-communicable diseases in São Paulo City 2006-2017
Authors: Siqueira Borges R S , Seoane Leal C H , Sipukow Sciama D , Gaspareto N , D'Elia Nunes R P
Published: October 2020

Background

Non-Communicable Diseases (NCD) were responsible for approximately 73% of mortality in São Paulo, Brazil in 2017, in addition to a high burden of disease, costs for the Health System and a lower quality of life. Monitoring the main risk and protection factors for NCD is essential to transform information into action and support public health promotion policies.

Methods

This is a time trend analysis (2006 - 2017) with data from VIGITEL - Brazilian Surveillance System of Risk and Protective Factors for NCD through Telephone Interviews with adults (≥ 18 years), carried out annually since 2006. Data from the adult population of the city of São Paulo were selected for the following risk and protection factors: obesity, regular consumption of fruits and vegetables, leisure-time physical activity, alcohol abuse and tobacco smoking. The annual percentual change (APC) were estimated by Prais Winstein regression, using Stata 14.

Results

In the period of 2006 to 2017, the prevalence of obesity increased from 11.3% to 18.5% (APC 4.84; CI 3.56-6.16). In relation to regular consumption of fruits and vegetables and leisure-time physical activity, the prevalence increased from 26.8% to 35.5 % (APC 2.03; IC 0,87-3,21) and 27.5% to 29.9% (APC 3,08; IC 1.12-5.08), respectively. Regarding smoking, the prevalence decreased from 18.8% to 14.2% (APC-3.83; IC-5,64- -1.98). However, alcohol abuse increased from 12.0% to 17.4% (APC 2.5; IC 1.42-3.58).

Conclusions

The analysis showed some advances, such as reducing smoking, increasing regular consumption of fruits and vegetables and leisure-time physical activity. On the other hand, there was a significant increase in obesity and alcohol abuse. It is worth remembering that these risk and protection factors can be modified and are related to the Social Determinants of Health that influence lifestyle, so intersectoral population strategies are necessary to face them, as well as public policies that promote healthier environments.

Key messages

Monitoring the main risk and protective factors for Non-Communicable Diseases is essential to implement and to support public health promotion policies and programs. This analysis showed some advances, such as reducing smoking, increasing regular consumption of fruits and vegetables. On the other hand, there was a significant increase in obesity and alcohol abuse.
Implementing mhGAP training to strengthen mental health in primary health care centers in Brazil
Authors: Mendonca J M T , Freire A A , Rewa T , Zorzi D , Monteiro C N , Palacio D C , Borges L M , Marcolino F F , Bonfim D
Published: October 2020

Introduction

Although it is already known that 14% of the global disease burden is attributed to Mental, neurological and substance use disorders, three quarters of people affected by mental disorders in low-income countries do not access treatment. Launched by WHO in 2008, the mhGAP Intervention Guide is a simple technical tool based on scientific evidence which facilitates the management of priority mental health conditions, using protocols for clinical decision in the PHC centers.

Objective

This work aims to describe the methodology of training the primary care staff and specialized mental health workers from São Paulo, Brazil, in the mhGAP Intervention Guide.

Methods

The training was designed in three steps. In the first step, mhGAP Training of Trainers and Supervisors (ToTS) capacitated 76 trainers. In the second a working group (WG) responsible for planning the replication for 100% of the technical staff of 13 PHC centers and 3 mental health community services was formed. The WG defined that the trainers should attend in two alignment moments to guarantee uniformity. And the third stage is the replication, divided in nine groups with forty participants, throughout the year 2020.

Results

The training promotes the exchange of experiences between the participants, who share their personal experiences, enriching the discussions. They also approximate the relationship between PHC and Mental Health services, as well as favors the interdisciplinary and collaborative practice. The PHC workers are more aware of their responsibility in mental health care and feel more empowered. As a challenge, the PHC professionals showed insecurity and reluctance to give the training.

Conclusions

The training provides evidence-based tools for the assessment and integrated management of priority mental disorders by PHC professionals.

Key messages

The mhGAP Intervention Guide training strengths the relationship between Primary Care and Mental Health services and improves Mental Health treatment access. The training improves integrated management of priority mental disorders by PHC professionals.
Interaction between physical activity and polygenic risk score for type-2 diabetes in older Americans
Authors: Wu Y Y , Thompson M D , Youkhana F , Pirkle C M
Published: October 2020

Background

Genetics plays an important role in the development of type-2 diabetes (T2D). Polygenic risk scores (PRS) are increasingly used to quantify genetic risk of T2D in epidemiological studies. These scores, when integrated into analyses of modifiable lifestyle factors, may improve understanding of T2D etiology, as the strength of association with T2D and some lifestyle or demographic factors may vary according to genetic predisposition.

Methods

We examined PRS-lifestyle factor interactions on T2D with data from the United States Health and Retirement Study (HRS), a prospective longitudinal cohort of older adults (≥50 at baseline). HRS contains nationally representative samples of Black and White Americans with pre-calculated PRS for T2D (N = 14,001). Covariates included sex, education, BMI, smoking, alcohol, and physical activity. Predicted prevalence and incidence of T2D were calculated with logistic regression models. Nonparametric bootstrap method was performed to calculate differences in T2D prevalence and incidence by PRS percentiles and interaction variables.

Results

Significant interaction (p_interaction=0.0096) was detected between PRS and physical activity among Whites only. In those with the lowest decile of PRS, T2D prevalence was similar (∼10%) for those reporting no physical activity compared to low or moderate activity. In those with the top decile of PRS, lower T2D prevalence (17%, 95%CI:14.8,19.6) was observed among those with moderate compared to no activity (24%, 95%CI:20.4,27.5). Incident T2D in Whites followed a similar pattern (p_interaction=0.0194). Among Black participants, no significant interaction with any lifestyle variables was detected.

Conclusions

Interaction of different genetic risk profiles with lifestyle factors may inform understanding of why certain inventions are more or less effective in different groups of people, potentially improving clinical and prevention interventions.

Key messages

Protection conferred by physical activity on T2D varied by underlying genetic risk. Gene-environment interaction studies provide insights on why lifestyle factors vary in their associations with T2D.
Factors associated with short term transitions in frailty status in the population ≥ 50 years of age
Authors: Van der Heyden J , Braekman E , Demarest S , De Ridder K
Published: October 2020

Background

Frailty is a clinical state that increases an individual's vulnerability and leads to chronic and complex medical needs in the older population. Transition to frailty is a dynamic and reversible process. Therefore, identification of determinants of transitions between frailty states is important for preventive action. This study assesses correlates of short time transitions in frailty states in the non-institutionalized population aged ≥ 50 years in Belgium.

Methods

404 respondents of the Belgian health interview survey 2018 belonging to the target age group participated in a subsequent health examination survey (average time lapse 53 days). At both time points frailty was assessed with the SHARE frailty instrument classifying respondents as robust, prefrail or frail according to Fried's phenotype. Physical, biomedical, mental, social and demographic determinants of transitions in frailty status were explored through relative risk ratios (RRR) from a backward stepwise multinomial regression analysis.

Results

Both upward and downward transitions occurred in 21% of the respondents. Transitions were more frequent in women. Being obese (RRR 1.93; 95%CI 1.02-3.67) and being unsatisfied with social contacts (RRR 4.35; 95%CI 1.59-11.86) were significantly associated with a transition to a less favorable frailty status. Activity limitations (RRR 0.30; 95%CI 0.13-0.68) and a high serum total/HDL-cholesterol ratio (RRR 0.19; 95%CI 0.04-0.79) were inversely associated with an improvement of the frailty status. No significant associations were found with age, education level, multimorbidity, mental health, quality of life, smoking, physical activity, hyperglycemia, hypertension and increased C-reactive protein.

Conclusions

Preventive action to delay or reverse the transition towards frailty should start from 50 years onwards and include nutritional advise, actions that facilitate people to participate in activities and initiatives to improve social networks of people.

Key messages

Obesity and a high serum total/HDL-cholesterol ratio are risk factors for developing frailty. Investing in a good social network and an environment which facilitates participation in activities is important to delay or reverse the evolution towards frailty.
Physical activity promotion of elderly people as a complex intervention: supportive toolbox
Authors: Tillmann J , Vonstein C , Rossmann C , Halbach S , Acet S , Schmidt N , Langosch C , De Bock F
Published: October 2020

Issue

In EU countries, almost 20% of the population is aged 65 or older. This longer life expectancy offers many opportunities but health risks as well. Health promotion measures like physical activity are of central importance but only a small proportion of the elderly meets the minimum level of physical activity recommended by the WHO. The project “Ageing in balance” investigates how a complex intervention to promote physical activity in older people can be implemented and facilitated by making practical tools centrally available.

Description of the problem

A complex intervention following the steps of an ideal-typical process and combining behavioural and structural preventive approaches is implemented in several model regions in Germany over three years (2019-2021). As a service at the federal level, a toolbox comprising tools for needs assessment, interventions and information on physical activity, project management, legal issues and financing is built up to support the work of local decision-makers. It's evaluated how setting approaches to promote physical activity for elderly people can be successful, which supporting and impeding factors exist and how the process can be supported by a flexible toolbox provided at federal level.

Results

Socioeconomically deprived model regions (rural, town, city) were recruited and started to raise awareness and to perform needs assessment. Building of local steering committees and implementing interventions are the next steps. Currently the toolbox contains systematically identified instruments for needs assessment, an intervention database with a newly developed evidence ranking system and several information modules.

Lessons

Facilitating promotion of physical activity in the elderly is important as prioritization and resources at local level are often limited. Making the implementation of setting approaches successful and providing the potentially most promising support from federal level is still pioneering work.

Key messages

The effort is to build up a flexible support system for local stakeholders to promote physical activity in elderly people. It is evaluated how a complex behavioural and structural prevention effort for elderly people can be implemented.
Creating health enabling environments in large, complex and competitive food systems
Authors: Dancey J a n e , Brimblecombe Julie
Published: October 2020

Australia's largest university, Monash, is a complex food system, with >70 000 students, 17000 staff, 50 food outlets, a supermarket and >100 vending machines. Analysis of this food system in 2016 identified poor availability of healthy food and prompted the university to implement a local healthy eating framework, the Victorian Government's Healthy Choices Guidelines (HCGs). Australians consume a diet low in plant foods and high in discretionary foods: 67% of adults are overweight or obese. Our food environment is large, complex and competitive and akin to a shopping mall or small town and our findings are broadly applicable to these settings. In 2016 Monash commenced implementation of HCGs which classify foods using a traffic light system: Green (best choice), Amber (choose carefully) and Red (limit). To create health enabling environments, the guidelines recommend ≥50% Green and <20% Red foods.

Three key strategies are explored: 1) Retail food healthiness assessments, 2) Vending changes and 3) Retail food healthiness labelling. Multiple implementation challenges arose in food retail.

In 2016, we conducted retail food healthiness assessments using HCGs. These assessments indicated the Monash food retail environment was 19% Green, 26% Amber and 55% Red. HCG vending was successfully implemented in 2017 using a commercial tender process. Healthy retail labelling was implemented with 32 retailers in 2018; the cost and complexities associated with menu assessments, retailer education and labelling fidelity present enormous challenges.

Local frameworks do not scale up in large, complex, competitive retail systems. Success with vending contracts indicates change to food retail may occur with contract clauses. Implementing change in established food retail is problematic.

Implementation challenges in large, complex, competitive retail settings require further exploration. Contract clauses show promise for implementing and sustaining change in complex food systems.

Key messages

Large, complex, competitive retail settings present challenges for food system change. Leasing clauses show promise for changes to large, complex, competitive, retail food systems.
The impact of economic sanctions on health and health systems in low- and middle-income countries
Authors: Suhrcke M , Pinna Pintor M , Hamelmann C
Published: October 2020

Background

Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs.

Methods

We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments.

Results

Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions.

Conclusions

Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority.

Key messages

The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.
Socioeconomic differences in incident metabolic syndrome in adults: the mediation of health behaviors
Authors: Hoveling L A , Liefbroer A C , Bültmann U , Smidt N
Published: October 2020

Introduction

The incidence of metabolic syndrome (MetS) strongly varies by socioeconomic status (SES). Health behaviors could be one of the mechanisms explaining the SES-MetS relationship, but little is known about their mediating role. This study aims to longitudinally asses the association between SES measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviors, including physical activity, smoking, alcohol drinking and diet quality.

Methods

A subsample of the adult Lifelines Cohort Study, including 85,910 participants without MetS at baseline was used. MetS was measured at the second assessment (follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SES, health behaviors and incident MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviors explaining the associations between SES and incident MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SES measures and follow-up time.

Results

Education (OR 0.92, 99% CI: 0.91-0.94) and occupational prestige (OR 0.94, 99% CI: 0.91-0.97) were inversely associated with MetS. Income was not associated with MetS. Health behaviors explained only partly (13.8%) the association between education and MetS, with smoking as the strongest mediating factor (8.6%). Health behaviors played a minor role (2.7%) in explaining occupational MetS differences, with physical activity as the strongest suppressing factor (-10.4%).

Conclusions

Individuals with more years of education or a higher occupational prestige showed a decreased risk of developing MetS. This was mainly because of non-smoking, less often excessive alcohol drinking and a higher diet quality; however, they were more often physically inactive.

Key messages

Education and occupational prestige are inversely associated with MetS incidence. Health behaviors explain a small part of the SES – MetS incidence pathway, with smoking as the largest contributor.
Can school-based, health behavioural interventions tackle health inequities in childhood?
Authors: Bosma H , Oosterhoff M , Vermeiren A P , Willeboordse M , Joore M A , van Schayck O C P
Published: October 2020

Background

To improve the health situation of children in primary school, many school-based interventions that are aimed at changing health behaviours, are being set up. Prior to knowing the (long-term) effectiveness of such intervention, we set out to examine whether there is room for such interventions to also tackle the health gap between children from high and low socioeconomic backgrounds.

Methods

Data from the Dutch quasi-experimental Health Primary School of the Future were used. All children from eight primary schools were included in the period 2015-2019. In the first cross-sectional phase, we studied whether there were socioeconomic differences in various health outcomes (e.g. body mass index) and whether these were smaller in children in the oldest groups (highest classes). In a two-year longitudinal approach, it was studied how socioeconomic differences in health outcomes developed in two years time and whether health behaviours could “explain” any socioeconomic differences in the outcomes. Linear and logistic regression analyses were used, including multilevel variants thereof, as well as mediation analyses.

Results

Both the cross-sectional and longitudinal analyses indicated substantial and consistent socioeconomic differences in various health outcomes. The socioeconomic differences in health appeared stronger in the oldest children (highest classes). Due to only small socioeconomic differences in health behaviours, such behaviours did not mediate the socioeconomic differences in the children's health outcomes.

Conclusions

The findings indicate substantial socioeconomic differences in health in primary school. That being longer at school did not attenuate the socioeconomic differences in health and that health behaviours did not mediate the socioeconomic differences in health suggests that there might not be much room for school-based, health behaviour interventions to easily tackle socioeconomic differences in health in childhood.

Key messages

We found substantial socioeconomic differences in child health in the Netherlands. But we found only little evidence that primary school-based, health behavioural interventions will easily tackle socioeconomic differences in child health.
Frequency and patient attributes associated with ED visits within 30 days after discharge
Authors: Salgado R , Moita B , Lopes S
Published: October 2020

Background

About 20%-25% of patients return to the emergency department (ED) within 30 days after inpatient discharge. This outcome is relevant since it may signal failures in inpatient care and care transitions. However, literature on the topic is still scarce. Our study aims to describe frequency and patient attributes associated with ED visits within 30 days (30d) of inpatient discharge in one public Portuguese hospital.

Methods

The study included adult patients discharged in 2016. Admissions of deceased or transferred patients were excluded. The rate of 30d ED visits after discharge was computed for selected patient (gender and age) and admission attributes [urgent, Major Diagnostic Category (MDC)]. Number of days from discharge to ED visit was determined. Logistic regression was used to compute crude and age-gender adjusted odds-ratios (cOR, aOR) for each selected admission attribute.

Results

From the 21744 admissions included (median age: 58y; 40% male), for 5058 there was at least one ED visit within 30d after discharge (23%). The majority of ED visits were triaged urgent (n = 2286; 45%) or very urgent (n = 1499; 30%). Time to first ED visit was, on average, 11 days. The risk of ED visit was increased among men (cOR = 1.180; 95% confidence interval - 95%CI: 1.103-1.262) and patients aged 75 or older (cOR = 1.704; 95%CI: 1.557-1.866). After controlling for gender and age differences, admissions with mental diseases (aOR = 1.807; 95%CI: 1.452-2.247), respiratory diseases (aOR = 1.786; 95%CI: 1.535-2.078), endocrine diseases (aOR = 1.758; 95%CI: 1.374-2.250) showed increased risk of visiting ED after discharge.

Conclusions

ED visits after inpatient discharge are frequent and mostly due to urgent and very urgent needs. Older age, mental, respiratory and endocrine conditions are relevant patient risk factors for returning hospital for ED care shortly after discharge.

Key messages

Improved quality of inpatient care and care transitions that reduce ED visits after discharge may benefit a significant part of patients. Future initiatives to reduce adverse events after discharge may target patients with older age or with mental conditions.
Patients’ perception of role of pharmacists in health promotion
Authors: Kazaryan I , Amirkhanyan A , Sevikyan A , Vardanyan L , Melikyan M
Published: October 2020

Background

Perceptions of patients is very important for accepting new role pharmacists play. The objective of this work was to study opinion of patients about role of community pharmacists in health promotion in Armenia.

Methods

Visitors (N = 2066) of community pharmacies in Yerevan were interviewed according to previously designed questionnaire.

Results

Some respondents suppose that pharmacists already provide advices on diet and physical activity for preventing obesity (32.1%), advices on healthy lifestyle for preventing cardiovascular diseases and cancer (30.9%), in promoting healthy lifestyle for preventing chronic diseases (27.5%). The number of patients who thinks that pharmacists are involved in providing advices on smoking cessation (38.1%) is significantly higher than the number of those who believe that pharmacists participate in campaigns on smoking cessation (27.1%) (p < 0,001). Part of respondents wish that community pharmacists would be involved in providing advices on smoking cessation (55.9%), advices for preventing obesity (57.7%), cardiovascular diseases and cancer (57.2%), promoting healthy lifestyle for preventing chronic diseases (51.5%).

Conclusions

Most of patients are interested that community pharmacists would be involved in implementing activity in the area of health promotion. The number of patients who wish pharmacist would be involved in health promotion is higher than the number of those who suppose that pharmacists already have such functions.

Key messages

Patients are interested in receiving advices related to health from community pharmacists. It is important to improve education of pharmacists in the area of health promotion.
18.G. Workshop: Feasible and effective anti-corruption for public health: from analysis and advocacy to action
Authors:   Organised by: LSHTM (UK),   Chair persons: Martin McKee - UK, Dina Balabanova - UK
Published: October 2020

Being able to identify corruption and call corrupt officials, health workers and citizens to account is critical in ensuring that public health policy and practice is shaped by evidence and reason rather than by powerful political forces. Despite substantial financial investments by bilateral and multilateral agencies to combat corruption, twenty years of initiatives based on good governance, improving law and changing regulatory approaches have been hugely disappointing - failing to effect significant changes in low- and middle-income countries. Public health activism on corruption is stepping up, diverse groups of actors are organizing around the threat that corruption creates to UHC, equity, social justice and the drive for global solidarity. They cannot rely on traditional good governance accountability and transparency approaches that pay insufficient attention to combinations of poor policy, under-funding and powerful interests that shape health systems, create perverse incentives, the need for survival corruption. To be effective, we need evidence of feasible and effective anti-corruption strategies. In this workshop, building on two years of theory development, qualitative and quantitative data collection and analysis in health services in LMICS we will set how feasible and effective anti-corruption strategies can be crafted and implemented. The session will introduce the Anti-Corruption Evidence ('ACE approach') and the idea of “developmental governance”. These have been used in other sectors but this is the first time that they have been applied to health. The approach is innovative in its targeted approach and focus on welfare-enhancing policies, seeking out space where for action that simultaneously tackles corruption and improves health systems but which is also politically and institutionally feasible to introduce. These strategies mark a shift away from blue-prints, interventions applied across countries without attending to context. We will use this workshop to show participants how to attend to the ways in which power and politics, culture and social networks shape health seeking and health care provision and how targeted, politically sensitive strategies offer the best anti-corruption solutions.

Key messages

New approaches to anti-corruption are critical for public health. Context-sensitive politically feasible, welfare-enhancing interventions offer the best way forward for anti-corruption.
Toward a new framing of corruption in health systems in LMICs: what questions should we be asking?
Authors: Balabanova D
Published: October 2020

Understanding and addressing corruption is critical for equitable and socially just development, and is therefore central to the realisation of the SDGs including the creation of responsive and trusted heath systems. Some conventional definitions of corruption do not reflect the complex reality in LMICs. Corruption is often conflated with poor governance, weak accountability or inefficiency but each manifestation has different structural and institutional causes, triggers and so requires different strategies to address it. 'Survival corruption' can be an informal coping strategy, other forms are manifest as reciprocal social exchanges within networks which may benefit wider groups of people and mask or contain health system dysfunctions. A proposition is made that we ask new questions that move away from a focus on the individual transaction towards locating it within health system and societal contexts that ultimately consider power and individual actor motivation.
Targeted anti-corruption in LMICs: developmental governance and health systems research
Authors: Hutchinson E
Published: October 2020

Traditional approaches to anti-corruption have relied upon broad-based legal change and the introduction transparency and accountability measures. The evidence to date shows that these have been unsuccessful in reducing corruption in health and other sectors in low and middle income countries. Traditional approaches often assume that corruption is driven by individual greed, immorality or opportunism caused by a lack of accountability measures and that once corruption is rendered visible that there will be a channel through which it can be acted upon. In many LMICs, however, corruption and rule breaking is widespread and much better understood as a systemic problem. In these settings, health workers often break rules to solve the problems of working in overstretched, underfunded health systems. In these settings, policy often does not match the realities of an underfunded health system, and so sticking to the rules can have harm career progression or the ability to care for ones family. New approaches to anti-corruption based on Mushtaq Khan's idea of developmental governance take these context specific factors into account and look for targeted, feasible and high impact action that can create improvements of rule abiding behaviour that benefit the health system and the delivery of care. This presentation examines how it can be applied to the health system and the adaptations that it makes in the ways that we work on anti-corruption in health. It examines the ways in which policy can be changed so that groups of actors in the system are be incentivised to engage in abiding behaviour as they recognize that it is in their interests to do so.
Coronavirus disease (COVID-19) outbreak: can HTA improve preparedness and response in emergencies with a high degree of uncertainty?
Authors: Timen A , Miglietta A
Published: October 2020

Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking. The Coronavirus disease (COVID-19) outbreak is determining a scenario of uncertainty for public health decision-making with fragmented and different responses also within countries (i.e. regional level), which are implemented quickly, sometimes not fully supported by the necessary body of scientific evidence. In such a situation, following a common line and having a shared tool that would allow to include evidence in public health decision-making, would be strategic to strengthen the impact of interventions, enabling stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent. The objective of this presentation is to use the example of the COVID-19 outbreak, in order to explore how HTA can improve preparedness and response in emergencies with a high degree of uncertainty, representing the mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies, addressing the link between scientific evidence and decision-making in public health emergencies, overcoming the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines.
Capacity building and support from international organizations
Authors: Hoejskov P
Published: October 2020

WHO has a critical role to provide the evidence for action to improve food safety and to support Member states to effectively collect, analyse, report and use data on foodborne diseases. In 2006, WHO launched the initiative to estimate the global burden of foodborne diseases. The estimates were published in 2015 and showed that every year, 31 selected food-associated hazards contribute to 600 million people falling ill and 420,000 people dying because of contaminated food. About 40% of the burden was borne by children under 5 years of age. Due to limitations of diseases surveillance systems and the fact that not all ill people seek medical care, the estimated burden is recognised to be only the 'tip of the iceberg'. The actual burden is expected to be significantly higher.

In line with global and regional action frameworks and based on country support plans and biennial collaboration agreements with Member States, WHO, in collaboration with its partners and collaborating centres, provides technical assistance to Member States to strengthen national food safety systems. This includes technical assistance to generate, collect and analyse food safety information underpinning evidence.

Information about the burden of foodborne diseases is important to inform policy, guide resource allocation and to determine potential prevention and control measures for food safety. Acknowledging that most food safety policy work takes place at country level, WHO is developing tools for Member States to estimate the national burden of foodborne diseases. The tools are being developed to build capacity in Member States to collect, analyse and use foodborne disease data, prioritize specific food safety issues, identify risk factors in foodborne diseases and provide a baseline against which future food safety interventions can be evaluated.
Community-based participatory research in population-based health surveys - a case example from East Friesland (Germany)
Authors: Sisenop F S , Natan M N , Lindert J L
Published: October 2020

Background

The ongoing community-based participatory research (CBPR) project is based on a representative cross-sectional study on health and well-being in a rural region of Germany (n = 655).

Methods

We use a wide array of participatory methods to involve the general public, politicians and experts such as conferences open to the public including the use of the Mentimeter app, e-participation via an online-forum, working groups on topics identified by the public, a Delphi survey elicit expert opinions and focus groups to get deeper knowledge on key aspects.

Results

The results confirm the interest the public has in understanding better scientific research in the field of public health. The diversity of people (most notably age, social background) is a challenge in reaching out to people. Presenting statistical data to non-experts requires the researchers to re-think ways of presenting data, therefore basic knowledge on data research has to be taught. Usage of the tools such as the Mentimeter app offers a low-threshold for empowering people to take part in participatory conferences.

Conclusions

Sustainability is of utmost importance for participatory research. The population not only has the need but deserves timely information on results. Key challenges are communication, building trust and implementing sustainable CBPR projects. CBPR helps in building mutual trust, knowledge and science - public co-operations. Conferences open to the public that are tailored to the public`s needs and competences show the great interest people have in scientific knowledge generated through population-based surveys. By participatory research, Public Health Science can contribute to society, empower the general public.

Key messages

There is an existing interest in CBPR by the general public. It can be assumed that promoting CBPR in a sustainable manner will increase that interest. The diversity of participants is a challenge as well as communicating scientific data to non-experts.
18.M. Workshop: Institutional barriers and support influencing the health and well-being of LGBT individuals
Authors:   Organised by: EUPHA Sexual and gender minority health section,   Chair persons: Corina Lelutiu-Weinberger - USA, Richard Bränström - EUPHA-SGMH
Published: October 2020

Research studies from many parts of the world have demonstrated significantly elevated risk of poor mental health among lesbian, gay, bisexuals, and transgender (LGBT) individuals compared to cisgender and heterosexual individuals. A growing body of evidence suggests that the elevated risk of poor mental health among LGBT people can be partly attributed to greater exposure to stigma-related stress and institutional barriers, such as, limited access to adequate health care, discriminatory legislation (e.g., regarding recognition of same-sex unions), and limitations in open expression of identity.

Today many governmental public health agencies call for policy and intervention programs addressing specific needs of LGBT individuals. Still, the public health consequences of discrimination towards LGBT individuals have only recently been a topic of investigation and current knowledge in the area is limited.

This workshop will include presentations of studies on strategies to reduce healthcare inequalities including the barriers LGBT individuals face when they access care and give examples of how institutional support can be provided. Laetitia Zeeman and Nigel Sherriff from University of Brighton, will present results from a European Union funded pilot project. Dr Corina Lelutiu-Weinberger from Rutgers University will present results from a study of the influence of gender affirmation and discrimination on transgender individuals mental health in a large US sample. Next, Daniel Hagen from New York University will present data analysing the protective effects of legal same-sex unions on the mental health of lesbian and gay couples. Lovro Markovic will present a study of predictors of being open with an LGBT identity in the workplace among employees in Austria.

Key messages

Although encouraging promising practices to reduce LGBT healthcare inequalities have been initiated in many parts of the world, much remains to be done to ensure equal access to care for all. Barriers to social integration in the form of discriminatory marriage legislation and work-place discrimination can have a negatively influence on LGBT individual's health and well-being.
20.C. Round table: Harnessing the digital transformation of disease prevention: a focus on m-health and genomics
Authors:   Organised by: EUPHA Public health epidemiology section, EUPHA Public health genomics section, EUPHA Digital health section, EUPHA Health promotion section,   Chair persons: Róza Ádány - EUPHA - PHG, Anna Odone - Italy
Published: October 2020

Digital transformation in the health sector is one of the key drivers of innovation that can contribute to the health systems goals of being more effective, resilient, and sustainable. In December 2019, EUPHA published a conceptual framework on the potential value of digitalization for public health. In this framework the two digital health technologies that can impact disease prevention and health promotion are m-health and genomics, which are also two key facilitators of the broader asset of technologies that allow for a greater personalization of health and care. Digital transformation, however, is not only a technical process but an organizational and cultural one. In view of such complexity, there is a growing need for robust evidences to support digital solutions and the related organizational models that can positively contribute to such health system goals. In this context it is worth mentioning the latest report on the Digital Transformation of Health Services from the Expert Panel on Effective Investing in Health, which outlined some positive impacts in terms of effectiveness and cost-effectiveness of m-health interventions. In this field of genomics, the use of polygenic scores (PRS) for common disease risk assessment are becoming an important area of development that warrants close attention from public health professionals as it brings the potential for improving the effectiveness and efficiency of current models of health promotion and disease prevention.

This WS aims to convene a discussion between different stakeholders including academia, industry, international organizations and policy makers to discuss the current evidence and implications that such new technologies have for public health practitioners, and suggests next steps to support the adoption of technology that currently demonstrate their value for population health.

Key messages

Although digital technologies brings the potential to improve adherence to health promotion and prevention at population level, the real value needs to be addressed from well conducted large studies. PRS might increase the effectiveness and reducing the costs of available preventive interventions: we need large studies to address the clinical utility for implementation in healthcare.