bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the take up of public insurance programs improves health care consumption of poor individuals?
Authors: Carré B , Thomas M , Jusot F , Wittwer J , Gastaldi-Ménager C
Published: November 2019

Background

The French health insurance system is universal but 95% of the population is also covered by a complementary private health insurance (CHI). The CHI take up is not uniform across the income distribution and health care access is partly conditioned by its coverage. The Complementary Universal Health Coverage (CMU-C) and the Health Insurance Vouchers Scheme (ACS) are mean tested programs providing CHI to the poor. The former is free while the latter takes the form of a voucher to buy private CHI. Our objective is to study and compare the evolution of health care use and consumption associated with the take up of the CMU-C or the ACS.

Methods

In a nationwide cohort of ACS and CMU-C beneficiaries we compute bi-annual expenditures, out of pockets expenditures and rates of use for different types of care: outpatient, inpatient, dental, optical and audiology. We use panel data regression methods to model the evolution of health care use and expenditures before, during and after the coverage periods of both programs.

Results

Our population is composed with about 10 million individuals benefiting at least once from either the ACS or the CMU-C on the 2012-2017 period. Preliminary results suggest that inpatient expenditures are increasing concomitantly with the take up of any program whereas outpatient expenditures tend to increase after. Results will be provided for the conference on the variations of the consumption according to the program (CMU-C or ACS), type of care, individual characteristics and health status.

Conclusions

Free or subsidized complementary health insurance may play an important role in the access to care for poor population, even in the presence of mandatory coverage. The take up of complementary health insurance for the poor population could be partly driven by the use of inpatient services but coverage may impact positively outpatient expenditures.

Key messages

Unlocking poor individuals financial constraint tends to increase their use of medical services. Generous insurance coverage targeting financially constrained individuals could be a tool to reduce health care use inequalities.
Economic burden of HIV disease from 2012 to 2017 based on the French national claim database (SNDS)
Authors: Pestel L P , Constantinou P C , Nicolas M N , Rivière S R , Rachas A R , Gastaldi-Ménager C G M
Published: November 2019

Background

The aim of this study was to assess the economic burden of HIV disease in France, by analyzing structure and trends of expenditure between 2012 and 2017.

Methods

We identified people with HIV disease among beneficiaries of the health insurance general scheme (covering more than 57 million people, 87% of the French population), applying algorithms combining inpatient and outpatient diagnoses and claims for specific drug treatments or laboratory examinations. The individuals’ expenditure (26 different items) reimbursed for hospitalizations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to HIV disease based on the average expenditure calculated for individuals with only HIV disease. To analyze trends, we applied the same methodology from 2012 through 2017.

Results

In 2017, HIV disease was identified for 131 800 individuals (0.2% of the population) and expenditure attributed to HIV disease corresponded to €1.3 billion (1% of the 140.1 billion reimbursed by the general insurance scheme). Drug treatment accounted for 85% of total expenditure reimbursed (1.2 billion). Between 2012 and 2017, the number of HIV patients identified increased steadily (+16,800 patients with an annual growth rate of 2.8%) and expenditure attributed to HIV disease increased by €8 billion. However, annual expenditure growth was variable, as a result of instability in the average annual cost per patient, ranging from 9,700€to 11,100€per year per patient. This reflects changes in practice and drug prices.

Conclusions

The detailed analysis of expenditures attributed to HIV disease showed that drug treatments account for the large majority of total reimbursements. Annual variation in total expenditure could therefore reflect evolution in prescription practices, such as the extension of treatment indications; or in drug prices, with the availability of combined treatments.

Key messages

Drug treatments account for the large majority of total reimbursements among HIV patients. Variation in total expenditure attributed to HIV disease is mainly driven by prescription practices and drug prices.
Being Born during a Flu Pandemic as Risk Factors for Development of Schizophrenia
Authors: Grima F Guillen , Brugos-Larumbe A , Guillen-Aguinaga S , Alvarez-Mon M A , Pereira-Sanchez V , Ortuño F , Al-Rahamneh M J , Onambele L , Aguinaga-Ontoso I
Published: November 2019

Background

Schizophrenia is a neurodevelopmental disorder of complex etiopathogenesis involving genetic and environmental factors. Mother’s exposure to infectious agents during pregnancy has been, implicated in the pathogenesis of schizophrenia. Studies in experimental models support that flu virus can cause embryonic neurodevelopment damage such as that described for embryos that later develop schizophrenia, but epidemiological studies of the association between schizophrenia and gestation in times of a documented flu pandemic) are contradictory.

Methods

The study is a cross-sectional study within the APNA Study (Navarre primary health care prospective cohort) that included 470942 people over 18 years old in Navarre (Spain). Date of birth, sex, and schizophrenia diagnoses made by psychiatrist on the basis of ICD-10 were extracted. People were classified according if their birth dates occurred within or around periods of flu pandemics in the second half of the 20th century: 1957, 1968 and 1977. The dates for these groups were from January of the year of the pandemic until December of the subsequent year. Logistic regression of adjusted by sex, age, and month of birth was performed. Because the cohort only includes people over 18 years of age, data for patients born during the influenza A subtype H1N1 outbreak of 2009 were not available.

Results

Males have a higher prevalence of schizophrenia than females (OR = 1.516, 95% CI:

1.388-1.655), Adjusting by gender, month of birth and age, subjects born during (or the year after) years of flu pandemic relative to subjects born in non-pandemic years (OR = 1.335, 95% CI = 1.199-1.486). The latter relationship held for each pandemic studied in isolation of the others, with ORs of 1.476 (95% CI: 1.244-1.750) for the 1957-59 pandemic, 1.261 (95% CI: 1.060-1.493) for the 1968-70 pandemic and 1.280 (95% CI: 1,072- 1,528) for the 1977-78 pandemic.

Conclusions

Been born during a flu pandemic may increase the risk of developing schizophrenia.

Key messages

Exposure to the influenza virus during gestation may increase the risk of schizophrenia. Flu Vaccination in pregnant women may reduce the risk of schizophrenia in their children.
The role of unjust treatment for experienced unmet need for health care among Finnish Roma
Authors: Kuusio H , Lämsä R , Laalo M , Castaneda A
Published: November 2019

Background

Finland is currently undergoing a major reform of social and health care, one aim of which, is to reduce inequalities between different population groups in access to care. Previous studies showed that Finnish Roma minority are more likely to experience unjust treatment in health services and other public services in comparison to other minorities in Finland. Unjust treatment may influence health behaviors, including the use of health services, by decreasing trust towards health professionals as well as decreasing social, emotional, and physical resources. This study examined the association between experienced unjust treatment in public services and self-assessed unmet need for health care among Roma in Finland.

Methods

We used data from the Roma health and wellbeing study (Roosa), conducted in Finland (2017-2018). The data was collected by the snowball method in different areas of Finland including a health examination and a structured interview. It covers 365 adults, and of those 223 (61.1%) were women. The outcome measure for unmet health care need was based on the question: “Do you feel that you have adequately received primary care services during the past 12 months?” Logistic regression was used to test the association between unjust treatment and unmet need for health care. Potential confounders were gender, age, marital status, education, employment and self-estimated health.

Results

The prevalence of unmet need for health care was 37.8 percent among men and 43.7 percent among women. Those who experienced unjust treatment in public services had higher odds (OR = 6.23; p < 0,001) for unmet need for health care than those who felt treated just. This association remained after adjustments for the confounders.

Conclusions

Over every third of the Finnish Roma experienced unmet need for health care. Unjust treatment seems to be a significant risk factor in access to care among Finnish Roma and its role needs further studies.

Key messages

Unjust treatment in public services is an indirect indicator of systematic and/or institutional discrimination. It is important to study the extent, nature and consequences of unjust treatment and discrimination to allow vulnerable groups to be taken into account better when renewing health services.
Pharmacist to improve hypertension management: concordance between Europe and North America
Authors: Anker D , Tsuyuki R T , Paradis G , Chiolero A , Santschi V
Published: November 2019

Problem

Hypertension is highly prevalent but remains poorly controlled, notably in European countries where control rates are frequently worse than in Canada and the United States. One innovative solution for improving hypertension management is team-based care (TBC) with the involvement of a pharmacist.

Description of the problem

We systematically compared recommendations for TBC in hypertension management in recent European (ESC/ESH), American (ACC/AHA), and Canadian (Hypertension Canada) guidelines and pinpointed potential roles and responsibilities of pharmacists.

Results

The three guidelines recommend TBC for the management of hypertension, with the ACC/AHA Guidelines giving a stronger emphasis by providing a more exhaustive definition of TBC and by describing the composition of the team. The three guidelines assign roles and responsibilities in hypertension management at the team level, but no firm role is defined for each specific team member. The three guidelines also refer to evidence showing that the pharmacist’s involvement can embrace several activities, that is, diagnosis of hypertension, blood pressure monitoring, medication management, education of patient and health care providers, and communication and organization within the care team. Recent systematic reviews have shown that a pharmacist’s involvement in these steps in hypertension management improves hypertension control compared to standard of care.

Lessons

International guidelines, including European ones, recommend using TBC in hypertension management, based on strong evidence that a pharmacist’s involvement improves hypertension control.

Key messages

International guidelines recommend TBC and the involvement of pharmacists to improve hypertension management. Programs and policies to improve hypertension control in European countries should consider the involvement of pharmacists.
Parental health literacy and health behaviors in children: a 2017 cross-sectional survey in Germany
Authors: de Buhr E , Tannen A
Published: November 2019

Background

Health literacy (HL) is closely associated with leading health indicators. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but the relationship between parental HL and child health is not yet well understood.

Methods

A cross-sectional survey was implemented in 2017 in 28 public schools in Germany. The parent questionnaire was completed by 4217 caregivers and included the short form of the HLS-EU-Q16. The child questionnaire examined health knowledge, behaviors and outcomes. For children under 11 years, the caregiver reported on behalf of their children (N = 1518). In all other cases, the children completed the questionnaires (N = 2776). Bivariate and multivariate analyses were carried out.

Results

Among the interviewed parents, 45.8% showed a problematic or inadequate HL. Parents with higher HL reported a better subjective health and quality of life, and they judged their children as being healthier. The major determinant of high parental HL was socio-economic status (r=.088***). High parental HL was associated with positive health behaviors in children including higher consumption of fruits and vegetables, fewer sweetened beverages, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol consumption, sexual activity among children and children’s weight were not significant.

Conclusions

The results confirm a relationship between low parental HL, SES and some problematic health behaviors in children. Strengthening the HL of vulnerable parents may contribute to improved health outcomes particularly in the areas of children’s nutrition, exercise and dental health, and parents should be integrated in school-based activities of health promotion and prevention.

Key messages

There is a strong statistical relationship between parental health literacy and socio-economic status. Parental health literacy is associated with child health behaviors (e.g., nutrition, exercise).
Associations between mental illnesses and acute cardiovascular events and cancers in France in 2016
Authors: Lesuffleur T , Coldefy M , Rachas A , Gastaldi-Ménager C , Tuppin P
Published: November 2019

Background

People with a mental illness have higher risks of somatic diseases and higher mortality, but this has been poorly documented in France. We studied the associations between mental illnesses and acute cardiovascular events (ACEs) and cancers in the French national health data system (SNDS).

Methods

We included all health insurance general scheme beneficiaries ≥18 years-of-age in 2016. Mental illnesses (psychotic disorder, neurotic or mood disorder, mental retardation and addictive disorder), ACEs (acute coronary syndrome (ACS), stroke, acute heart failure and pulmonary embolism) and cancers (breast, colorectal, lung and prostate) were identified using algorithms based on long-term disease registry, hospitalization diagnoses and specific drug deliveries. The associations were measured using morbidity ratios standardized by age and gender when appropriate (SMRs).

Results

ACEs were more frequent in the subjects with a mental illness than in the general population: ACS (SMR: 1.6), stroke (2.3), acute heart failure (1.9), pulmonary embolism (2.4). Similar results were found for each mental illness, except for ACS, which were less frequent in those with a mental retardation (SMR: 0.5) and were not associated with psychotic disorder (SMR: 1.0). Mental illness was also associated with more frequent breast (SMR: 1.3), colorectal (1.3), lung (2.0) and prostate (1.2) cancers, in particular for those with a neurotic or mood disorder (SMRs: 1.3, 1.5, 2.3, 1.2, respectively) and, for lung cancer, those with an addictive disorder (SMR: 2.6).

Conclusions

Globally, ACEs and cancers were more frequent in patients with a mental illness relative to the general population after standardization by age and gender, which could be related to adverse effects of certain psychotropic drugs or behaviours or risk factors related to the mental illness. Healthcare professionals should be aware of this to more adequately account for the specificities of the patients with a mental illness.

Key messages

ACEs and cancers were more frequent in patients with a mental illness relative to the general population after standardization by age and gender. Healthcare professionals should be aware of this to more adequately account for the specificities of the patients with a mental illness.
Piloting Sexual Assault Care Centers in Belgium: Who do they reach and what care is offered?
Authors: Baert S , Roelens K , Gilles C , Bay V , Keygnaert I
Published: November 2019

Background

Care for victims of sexual violence is fragmented in Belgium. Therefore, sexual assault care centers (SACCs) were piloted in three cities from November 2017 onwards. The SACCs offer forensic, medical and acute psychological care through a forensic nurse, while vice inspectors perform an interrogation at the SACC for those wishing to report. The nurse coordinates the follow-up care and a psychologist provides mental health support. A quantitative prospective study was carried out assessing the characteristics of SACC patients, the sexual violence they experienced and the care received, in order to inform the national scale-up of the model.

Methods

Data on SACC patients was routinely collected in the electronic patient files by the SACC personnel between November 1st 2017 and October 31th 2018. Data was analyzed in SPSS.

Results

Within the first year SACCs were attended by 930 victims. Mean age was 24,5 years (SD = 12.8), and one third were minors. Eighty-eight percent of victims was female and 67% presented for rape. Fifty-seven percent of the assailants were known to the victim. Thirty-five percent of the victims self-referred to SACC, 41% were referred by the police, and 66% of victims attended services within 72 hours. Respectively 75%, 61%, 47% and 68% of victims received medical care, a forensic examination, psychological care and reported to the police.

Conclusions

Without big publicity the SACCs received a higher than expected number of victims. Expansion of the collaboration with police and targeted communication strategies should further increase the number of victims receiving appropriate care. Qualitative research assessing the acceptability of the SACC model will further inform the scale-up of the model.

Key messages

The quantitative study led to a better understanding of the population using the SACCs. The study allowed to improve the training of the staff members, adapt the SACC procedures before scale-up and define targeted service-promotion strategies.
Adolescent’s substance use and suicidal thoughts in Tunisia
Authors: El Ghardallou M , Sahli J , Mellouli M , Limam M , Zedini C , Mezougui L , Mtiraoui A , Ajmi T , Mannai J
Published: November 2019

Background

Experimentation with substance use is common during adolescence. Substance use may result in many health-related problems and contribute to adolescent suicidal behavior. We conducted this study to examine the relationship between substance use and suicidal ideation.

Methods

This is a cross sectional study conducted among a representative sample of 2020 adolescents enrolled in Tunisian secondary schools using a self-administered questionnaire.

Results

The prevalence of tobacco, alcohol and cannabis use was respectively 3.7% (95% CI [2.87%-4.52%]), 4.4% (95% CI [3.5%-5.29%]) and 0.8% (95% CI [0.40%-1.18%]) Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months. Tobacco (Odds Ratio = 2.61; 95% CI = 1.59–4.29), alcohol (Odds Ratio = 2.77; 95% CI = 1.76–4.36), and cannabis use (Odds Ratio = 4.98; 95% CI = 1.85–13.96) were significantly associated with suicidal thoughts among adolescents (p < 10-3).

Conclusions

This cross study has shown a significant association between substance use and suicidal ideation. This relationship can be bidirectional and suicidal ideation and substance use may affect each other.

Key messages

In his study, the prevalence of substance use was relatively low and was associated with suicidal ideations. The reciprocal link between the two problems and their co-occurrence should be taken into account when planning preventive substance use and suicide programs.
Addressing & understanding citizens’ perceptions of homelessness: a cross-European study
Authors: Taylor O , Loubiere S , Tinland A , Loundou A , Auquier P , EU HOME , Ornelas Jose
Published: November 2019

Objective

Addressing Citizen’s perspectives on homelessness is crucial for the design of effective and durable policy responses, and available research in Europe is not yet substantive. We aim to explore citizens’ opinion about homelessness and to explain the differences in attitudes within the general population of eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden.

Methods

A nationally representative telephone survey of European citizens was conducted in 2017. Three domains were investigated: Knowledge, Attitudes, and Practices about homelessness. Based on a multiple correspondence analysis, a generalized linear model for clustered and weighted sample was used to probe the associations between groups with opposing attitudes, adjusted for sociodemographic characteristics.

Results

The response rate ranged from 30.4% to 33.5% (N = 5,295). Most respondents (57%) had poor knowledge about homelessness. Respondents who thought the government spent too much on homelessness, homeless people should be responsible for housing, people remain homeless by choice, or homelessness keeps capabilities/empowerment intact clustered together (negative attitudes, 30%). Respondents who were willing to pay taxes, welcomed a shelter, or acknowledged homeless people may lack some capabilities (i.e. agreed on discrimination in hiring) made another cluster (positive attitudes, 58%). Older respondents (OR = 0.99; p=.011), those living in rural areas (OR = 0.78, p<.001), those with a poor level of knowledge about homelessness (OR = 0.68, p=.007), and those from France and Poland (p<.001) were less likely to report positive attitudes.

Conclusions

Although it is clear that there is strong support for increased government action and more effective solutions for Europe’s growing homelessness crisis, there also remain public opinion barriers rooted in enduring negative perceptions.

Key messages

A majority of European citizens reported positive attitudes towards Homelessness. There is strong support for increased government action and more effective solutions for Europe’s growing homelessness crisis.
’I had no idea what could come’- health care support for AMD in Germany- The patients’ view
Authors: Thier A , Holmberg C
Published: November 2019

Background

Due to the demographic change visual impairment and blindness in the elderly caused by chronic eye diseases become major public health themes. Age- related macular degeneration (AMD) is one of the most common causes of visual impairment and blindness in older adults above 60 years of age in the western countries, followed by glaucoma and diabetic retinopathy.

Objectives: The purpose of this study is to find out how patients with AMD assess their medical care, tool-based and psychosocial counseling services in Germany.

Methods

Data was collected by using narrative, semi-structured interviews. A purposive sampling strategy was used to sample the study population with patients with AMD, which is characterized by a variety of different life experiences of the patients. The data analysis followed the principles of grounded theory.

Results

The interviewed AMD patients were between 72 and 87 years old. Before the patients were diagnosed with AMD, AMD was not known to them and suffering from an unrecoverable disease resulting in blindness, made many of the patients anxious. Patients with AMD complained about missing information about the AMD and its treatment. Tool-related and psychosocial counseling services and their benefits were unknown to most of the patients. Therapy with Anti-VEGF injections gives hope to many patients with neovascular AMD, but at the same time it is associated with a time, psychological and physical strain. The time spent in clinics and practices, the waiting for appointments, the number of examinations and injections, communication problems with the medical staff, information deficits, the injections themselves and their side effects were often severe and nerve-wracking for the elderly.

Conclusions

New strategies need to be developed to facilitate access to AMD information for patients with AMD, as well as to reduce the time required for medical treatment, e.g. waiting times in clinics and practices.

Key messages

Therapy with Anti-VEGF injections gives hope to many patients with neovascular AMD, but at the same time it is associated with a time, psychological and physical strain. Patients with AMD complained about missing information about the AMD and its treatment.
Integrating priorities of disadvantaged parents and professionals for community family health
Authors: Wink G , Fransen G A J , Huisman M J , Boersma S N , Assendelft W J J , Wagemakers M A E , van der Velden J , van den Muijsenbergh METC
Published: November 2019

Background

Health inequalities persist, and policymakers, researchers and practitioners seek for effective ways to positively impact the health of disadvantaged people. Researchers point to a multi-component program with an integral design including various perspectives and involving different stakeholders. Few studies address the perspectives on health of disadvantaged people themselves. This study describes what parents in a socially disadvantaged situation and professionals working in that community perceived as 1) priority aspects to improve family health 2) barriers and facilitators for health behaviour changes 3) important health program activities.

Methods

Design: Community-based participatory action research. 10 parents participated in 6 panel meetings. 46 professionals received 4 panel meetings summaries. 18 parents and 25 professionals responded to questions in (panel) meetings and consultation by phone and e-mail.

Results

(preliminary) 1) Parents’ top priorities for improving health were: less stress related to finances and communication with related organizations, followed by a safe place for kids to meet. Of the program financers’ aims (reducing tobacco, alcohol use and overweight) reducing overweight got relatively most support of parents. 2) Parents perceived their family financial situation as barrier to behaviours reducing stress and overweight. 3) Program activities related to reducing stress got more support from parents and professionals than activities related to reducing overweight.

Conclusions

Insight in the perspectives of disadvantaged parents and professionals resulted in a program plan supported by them, aiming to reduce stress and overweight. Most participating parents and professionals committed themselves to invest time in program activities execution.

Key messages

Disadvantaged parents perceived reducing stress related to finances as top priority to improve family health. They perceived family finances as barrier to behaviours reducing stress and overweight. Community-based participatory action research with disadvantaged parents and professionals can result in an integrated family health program plan with stakeholder support.
The association between frailty and satisfaction with social contacts in the general older population
Authors: Nguyen D , Braekman E , Demarest S , der Heyden J Van
Published: November 2019

Background

As a result of the demographic evolution, the proportion of older people will continue to increase in the coming decades. Frailty among elderly is one of the important challenges that Europe is facing. From a biomedical, perspective frailty is considered as a clinical syndrome that increases vulnerability. However, the role of social contacts in relation to frailty needs to be investigated. In this study, we assessed the association between frailty and perceived satisfaction with social contacts in a sample of the general older population.

Methods

This study was conducted on a representative sample of 2364, both institutionalized and non-institutionalized older participants (≥65 years) from the Belgian Health Interview Survey 2018. Frailty was assessed with the instrument used in the Survey of Health Ageing and Retirement in Europe (SHARE) including dimensions of the Fried phenotype: exhaustion, weight loss, muscle strength, weakness and physical activity. The Oslo-3 Social Support Scale (OSS-3) was used to assess perceived quality of social support. Logistic regression was used to determine the association between frailty status and satisfaction with social contacts while controlling for age, gender, region, educational attainment and household composition.

Results

The prevalence of frailty was 22.8% (95%CI:21.2-24.6). The results showed that elderly who are unsatisfied with their social contacts are more likely to be frail (OR(95%CI):4.65 (2.82-7.66)). In addition, being older ≥75 years (OR(95%CI):2.40 (1.68-3.43)), being female (OR(95%CI):2.48 (1.73-3.56)), having a lower education (OR(95%CI):2.57 (1.71-3.87)), living alone (OR(95%CI):1.58 (1.10-2.27)) were associated with frailty.

Conclusions

Frailty is associated with living alone and being unsatisfied with the social contacts, among older people in Belgium. These findings confirm that the social component should be taken into account in strategies to reduce frailty in the general older population.

Key messages

Frailty is associated with living alone and being unsatisfied with the social contacts, among older people in Belgium. The social component should be taken into account in strategies to reduce frailty in the general older population.
Social inequalities of postpartum depression: the mediating role of social support during pregnancy
Authors: Nakamura A , Melchior M , van der Waerden J
Published: November 2019

Introduction

A disadvantaged socioeconomic position (SEP), as well as insufficient social support during pregnancy (SSP) increase the probability of subsequent postpartum depression (PPD). The aim of this study was to quantify the part of social inequalities in PPD due to insufficient SSP and in particular assess the impact relative to women’s migrant status.

Methods

The sample included 15,000 women from the nationally representative French ELFE birth cohort study. Depressive symptoms were assessed at two months postpartum by the EPDS. SEP was constructed as a latent factor explaining educational level, occupational grade, employment during pregnancy, household income and financial difficulties. SSP was characterized by informal support (partner perceived support, frequency of quarrels and paternal leave) and formal support (early prenatal psychosocial risk assessment and antenatal classes’ attendance). Causal mediation analyses between SEP, dimensions of SSP and PPD were conducted and stratified on migrant status (categorized as native French, first or second generation migrant or immigrant).

Results

A disadvantaged SEP and a lack of informal SSP during pregnancy were both associated with an increased risk for postpartum depressive symptoms and a disadvantaged SEP was positively associated with lack of SSP. In immigrant women, a larger proportion of social inequalities in PPD could be attributed to lack of SSP, in comparison to native French women (17.5% vs. 8.8%).

Conclusions

Both disadvantaged SEP and SSP are risk factors for PPD. We found evidence that disadvantaged women’s increased risk for PPD can partly be attributed to limited social support.

Key messages

PPD in disadvantaged groups, especially in migrant women, could possibly be prevented early in pregnancy by increasing support from partner and larger family. Access to social support health care systems directed towards pregnant women remains low for women with a disadvantaged SEP, especially in migrant women.
Multidimensional assessment for patients with multimorbidity in primary care – first practice test
Authors: Gredinger G , Trischak C , Reitter-Pfoertner S
Published: November 2019

Background

Multidimensional geriatric assessments are important for early detection of functional deficits, thus contributing to healthy ageing. According to the Austrian Health Care Structure Plan, such bio-psycho-social assessments should be implemented in primary care and build the basis for the care of patients with chronic diseases. Aim of the present study was to test the feasibility of a respective tool at Austrian general practitioners (GP).

Methods

Overall, 16 GP participated in our practice test and conducted the composed assessment in 185 geriatric patients (39% male, Ø82.6 years, Ø8 diagnoses, 9 medications). Data was analyzed using descriptive statistics (SPSS 26.0).

Results

In 181 tested patients (98%), the assessment revealed at least 1 relevant functional deficit (Ø4, max. 8). Level of care and number of functional deficits correlated (Spearman: 0.3, p < 0.01). Defi-cits were mainly found in mobility (55%: Timed Up and Go-Test >20 sec) and activities of daily liv-ing (86% IADL ≤ 15/16 points and 72% Barthel-Index ≤ 95/100 points). The average time to com-plete and document the functional tests was 34 minutes (min. 14, max. 61, n = 121). Use of the elec-tronic (vs. paper) documentation resulted in a significant lower time requirement of 9 minutes. Re-garding subsequent interventions, 11 GP suggested 121 interventions in 57/185 patients (30.8%); thereby, pharmacological interventions were preferred.

Conclusions

We conclude that our tool tool is practicable in primary care as the required time is manageable. Uncovering functional deficits per se did not induce adequate interventions (neither in number nor in quality); therefore, medical algorithms are needed that make precise recommendations for subse-quent diagnosis and/or treatment/care.

Key messages

Multidimensional assessments are manageable in primary care and reveal functional deficits. Subsequent to the assessment, algorithms are important in order to induce a benefit through inter-ventions.
Inequalities in the participation and outcomes of breast cancer screening programs in Valencia, Spain
Authors: Muñoz-Miguel J , Molina-Barceló A , Vanaclocha M , Ibañez J , Romeo P , Pinto M , Hernández M , Alcaraz M , Salas D
Published: November 2019

Background

Breast cancer remains the most frequent tumour and first cancer related cause of death in the Valencian Community. Despite most of the population being aware of the existence of breast cancer screening programs (BCSP), there are great differences in uptake that are likely attributed to social determinants. The objective of this study, alligning with SDGs 3 and 10, is to assess inequalities in breast cancer screening uptake, diagnosis and treatment delay in the city of Valencia.

Methods

The population of study included 128 123 women invited to participate in the BCSP in the city of Valencia between 2014 and 2016. Uptake, diagnosis and treatment delay were assessed as outcomes. Covariates included country of origin, education level, size of family unit, risk of vulnerability, age, presence of disability, assigned health department and a social deprivation index. Bivariate analysis and logistic regression models were performed for each independent variable.

Results

BCSP uptake was of 63,8% with a diagnostic rate of 5,36‰. 76,7% of patients were below the 75th percentile of delay between diagnosis and treatment (52 days). Statistically significant relationships were found between uptake of BCSP and all studied covariates both in the bivariate analysis and regression model. Presence of disability, family unit size, age and health department had a statistically significant relationship with diagnosis in the bivariate analysis, of which only one health department and the social deprivation index’s second quintile remained significant in the regression model. No significant relations were found between treatment delay and any of the covariates.

Conclusions

Strong inequalities in the BCSP have been identified. Influencing factors must be targeted so as to ensure an egalitarian access to BCSP. Given its multifactorial nature, simple analyses must be avoided in the study of inequalities in breast cancer diagnosis. Data on lifestyle may contribute to future models.

Key messages

Social determinants continue to have an impact in the uptake of breast cancer screening programs in the city of Valencia. The assessment of inequalities in breast cancer diagnosis cannot be approached uniquely through the analysis of social determinants and may Benefit from the inclusion of data on lifestyle choices.
Evaluation of the ’sophia’ asthma patient management program at two years
Authors: Aguadé A S , Guillo S , De Rycke Y , Lafourcade A , Chenivesse C , Taillé C , Hejblum G , Tubach F
Published: November 2019

Objectives

To evaluate the impact of a multi-faceted management support program deployed towards asthma patients by the French Health Insurance since February 2015 in 19 (20%) French pilot areas.

Methods

The population is composed of subjects aged 18 to 40 years in 2014, with at least 3 asthma medication deliveries in 2012 as well as in 2013 that were identified and followed-up within the SNDS French claims database. A controlled before-and-after design was used for assessing program impact. Unexposed subjects (i.e. living in non-pilot areas) were matched with exposed subjects (i.e. living in pilot areas) on a propensity score. Adherence to controller treatment (inhaled corticoids), measured by the medication refill adherence MRA, was the primary outcome. Secondary outcomes were medications and heathcare use, sick leaves, exacerbations, costs.

Results

Analysis concerned 29, 746 matched-pairs. With a baseline mean MRA of 40.17% in unexposed subjects, the difference-in-difference was non-significant (0.26%, p = 0.545). However, the program showed a significant impact on the percentage of subjects that moved to a better MRA category or maintained a high adherence (OR = 1.05,p=0.028). The program had no significant impact on the other secondary outcomes. In planned secondary analyses comparing the 11.5% exposed subjects who adhered to the program to their matched-unexposed subjects, the difference-in-difference showed a program impact on specialist consultations, asthma-related and all medication costs, and total asthma-related costs. However, results on this subpopulation must be examined with caution since the matching procedure couldn’t take into account the propensity to adhere.

Conclusions

Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.

Key messages

Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.
Patient safety culture in Austrian hospitals – A qualitative study
Authors: Draganović ŠD , Offermanns G O , Brandl J B
Published: November 2019

Background

Adverse events in the healthcare system often have severe consequences for the patient and healthcare institutions. Thus, various risk management tools have been recently introduced to 11 Austrian hospitals to increase patient safety. The goal of our study was to test whether the introduced risk management tools actually improved patient safety culture (PSC).

Methods

An exploratory research approach was used to examine the current status of five aspects from PSC in hospitals. Semi-structured expert interviews with health professionals were conducted (N = 32). The inductive content analysis and technique of content structuring were used to analyze and systemize extensive qualitative data material. Intercoder reliability (κ = .605) shows satisfactory results.

Results

The results of the first aspect, Critical Incident Reporting System (CIRS), show that hospitals still have potential for improvement in terms of education of employees, coordination, and communication. The data of the second issue, surgical checklist, shows that the education was insufficient and that these checklists are not handled properly and used only fragmentarily. Concerning the third aspect “transfer/report”, it can be stated that systematic transfer/reports are widely unknown. Furthermore, the fourth aspect, hand hygiene, lacks a systematic training concept and control of compliance. The fifth aspect, education of risk manager, has brought a number of general benefits (e.g. methodical knowledge) to risk managers.

Conclusions

The results provide valuable insights into strengths and weaknesses of the implementation of risk management tools and thus highlight opportunities on how to influence PSC through organizational development and change management. Furthermore, this study has taken the first essential step towards the understanding of the effective and efficient development of PSC by providing valuable insights into the underlying mechanisms of non-functioning PSC.

Key messages

The study showed where the weakness points in processes of implementing risk management tools are and offered a theoretical solution for the development of a patient safety culture. Risk management tools were not equally effective in every controlled aspect. The effective implementation of these tools requires change management as a foundation to develop PSC.
Preoperative evaluation of patients receiving bariatric surgery: a comprehensive Breton study
Authors: Barataud-Reilhac A R B , Rigault A R , Beauvillain J B , Thereaux J T
Published: November 2019

Background

With large demonstrated benefits, volume of bariatric surgery (BS) has increased almost threefold since the late 2000s in France. However, patients seeking for BS must be carefully preoperatively evaluated to reduce risks for late complications (nutritional, neurological and psychiatric). This study aimed to assess preoperative evaluation of BS according to French recommendations.

Methods

The preoperative evaluation (gastrointestinal, nutritional, cardiovascular and psychiatric) during the year preceding BS was assessed from the French national health insurance database. All patients with a primary BS in Brittany in 2015 were included. For each patient, a score of preoperative evaluation was carried-out (from 0 to 6) and classified as follows: “complete” (6), “incomplete” (4-5), “unsatisfactory” (2-3) or “poor” (0-1). Comparisons (chi-square tests) by sex, geographical department, type of institution and health professionals (HP) were made.

Results

Among the 1,446 patients finally included, 1,195 (83%) were women and the median age was 42 (quartiles: 33-51) years old. Gastric by-pass (66%) and sleeve-gastrectomy (33%) were the most performed procedure. The preoperative evaluation was classified as ’complete’ for 501 (35%) patients, ’incomplete’ for 647 (45%) patients, ’unsatisfactory’ for 238 (17%) patients, and ’poor’ for 60 (4%) patients. Better scores were found in 2 departments (Côtes d’Armor and Finistère, p < 0.001), in public institutions (p < 0.001) and in institutions performing 50 or more acts per year (p < 0.001). Heterogeneity according to the HP was also noted in private institutions (median score per HP: 4.5, min-max: 2-6).

Conclusions

This large regional comprehensive French study confirms that preoperative evaluation before BS is not optimal despite clear French recommendations. Collective reflection should be led to improve the pathway of care of patients seeking BS.

Key messages

There are disparities in the performance of BS’s preoperative evaluation in Brittany. This work suggests that preoperative evaluation for patients seeking for BS should be improved and standardized.
Evaluation of observation of the patients with coronary heart disease after surgical treatment
Authors: Bekbergenova Z , Mauletbayeva G , Umbetzhanova A , Derbissalina G , Koikov V , Akhmetova A , Zemlyanskaya N , Alibekova G
Published: November 2019

Background

To reduce mortality from cardiovascular diseases in Kazakhstan, which occupies the leading position, patients are under observation. To evaluate of patients with coronary artery disease who have undergone myocardial revascularization by installing coronary artery stenting or bypass surgery.

Methods

A retrospective analysis of outpatient medical records of patients.

Results

Analysis included medical records of 4% patients at the age of 40-49 years, 49%-50-59 years, 22%-60-69 years, 11%-70-79 years, 4% patients older than 80 year. 92% patients were admitted to the hospital with acute coronary syndrome and were urgently operated. Patients with chronic heart failure were operated routinely. 12% patients received surgical treatment twice, including 4% patients routinely. All patients had comorbidities: 63% of people-arterial hypertension, 12%-cardiac arrhythmia, 14%-diabetes. The analysis showed that only 51% of patients were regularly observed in accordance with the standards of the survey during one year of observation. According to the standards the scheduled ECG study of the patients after surgery should be done after 1, 2, 3 and 6 months. In accordance of the standard 23% patients were examined, 3 times a year - 19% patients, 23% people-twice a year. Other functional studies-echocardiography 1 time per year have been studied on 14% people, treadmill test-5% patients. Coagulation monitoring during one year- 46% patients. One of the criteria of proper observation is the number of readmissions. 11% patients were readmitted where 5% of them in the first month after surgery-6% patient with hypertensive crisis, 11%-with an increase of CHF, 2%-with postoperative pleural effusion. 2% patients hospitalized with restenosis after 7 months.

Conclusions

It should be noted that irregular visits to the doctor questioned the compliance of patients to treatment. Due to the lack of control by medical workers, the patients were not fully examined.

Key messages

The continuity of work between hospital doctors and primary care organizations is necessary. Patients to improve the favorable prognosis requires regular medication.