bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of influenza vaccine among health care personnel in Thailand, 2018/19 season
Authors: Eamchotchawalit T , Piyaraj P , Narongdej P , Charoensakulchai S , Chanthowong C
Published: October 2020

Background

Influenza vaccination is the most effective way of preventing influenza infections and it is recommended for the entire health care personnel in Thailand. However, the evidence of influenza vaccine effectiveness (VE) among health care personnel is lacking in Thailand. The objective of this study was to estimate influenza vaccine effectiveness (VE) against laboratory confirmed medically attended influenza illness for the 2018/9 season among health care personnel who at risk for influenza infection in Bangkok, the capital of Thailand.

Methods

Throat swab specimens were collected from patients with influenza-like illness (ILI) presenting to outpatient clinics and tested for influenza virus by RT-PCR, between October 2018 and September 2019. A test-negative case-control design was used to estimate influenza VE against medically-attended laboratory-confirmed influenza in outpatient settings. Cases were influenza-like illness (ILI) patients who tested positive for influenza, and controls were influenza negative patients.

Results

During the 2018/19 season 373 samples were collected; 57 (15.3%) were positive for influenza, 70.2% A un-subtyped and 29.8% B. Adjusted VE against all influenza viruses for this influenza season was -31.7% (95% confidence interval (CI): -40.2 to 66.4), against influenza A un-subtyped, it was 43.9% (95% CI: -30.6 to 75.9) and against influenza B, it was 52.0% (95% CI: (-73.9 to 86.8).

Conclusions

The seasonal influenza vaccine was moderately effective against medically attended lab-confirmed influenza infection in health care personnel in Bangkok, Thailand in the 2018-19 influenza season.

Key messages

The seasonal influenza vaccine was moderately effective against medically attended lab-confirmed influenza infection in health care personnel in Bangkok. Increasing seasonal influenza vaccination among health care personnel in Thailand may decrease medically attended influenza-associated ILI cases in this population.
Epidemiology of influenza: findings from surveillance system of 40 hospital in Thailand, 2010-2019
Authors: Eamchotchawalit T , Piyaraj P , Narongdej P , Charoensakulchai S , Chanthowong C
Published: October 2020

Background

Although recent efforts from some Asian countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including the private section of Thailand. A near real-time laboratory-based influenza surveillance system, in a network of 40 hospitals was implemented aiming to determine influenza strains circulating in the private hospitals of Thailand and know characteristics, trend and burden of influenza viruses.

Methods

We obtained the data by monitoring patients with influenza-like illness (ILI) at a network of 40 private hospitals across Thailand. Throat-swab specimens in viral transport media were collected and transported within 24 h of collection using a cold-chain system. The respiratory samples were tested by rapid influenza diagnostic tests and real-time reverse transcription polymerase chain reaction.

Results

From January 2010 to November 2019, a total of 1,300,594 subjects were tested and 320,499 cases of influenza were identified. Of those positive cases, 116,317(36.3%) were influenza type B, 185,512(57.9%) were influenza A unspecified subtype, 8,833(2.7%) were influenza A(H1N1)pdm2009 and 6,371(1.9%) were seasonal influenza A(H3N2). Positive rate were 50.5 and 49.5 in female and male. Positivity rate was 41.4% in persons 15-49 years followed by 29.1% in 15-14 years, 17.6% in under five children and 11.7% in > 49 years. In 2018-2019 season, the highest positivity rate observed in February and March (39.3%) followed by April (34.2%) and January (32.3%) while the lowest positivity rate was in May (18.1%).

Conclusions

In Thailand, seasonal Influenza A(H3N2), Influenza A(H1N1)pdm2009 and Influenza B viruses were circulating during 2010-2019. In last season, positivity rate and number of cases peaked in February and March.

Key messages

Influenza is one of public health problems in Thailand. The need to introduce influenza vaccine and antivirus is important to prevent and treat the disease in future.
2.H. Workshop: Vaccination challenges in developed & developing countries: where does the responsibility lie?
Authors:   Organised by: World Federation of Public Health Associations,   Chair persons: Walter Ricciardi - WFPHA, Michael Moore - Australia
Published: October 2020

The world is facing multiple health challenges, among those the outbreaks of vaccine-preventable diseases and the rise of anti-vaccination groups. Vaccination is one of the most cost-effective ways of avoiding disease; it currently prevents 2-3 million deaths a year and a further 1.5 million could be avoided if global coverage is improved. Moreover, global immunization will contribute towards achieving broader global health goals under the UHC and SDG initiatives.

Barriers to immunization may vary according to the country and specific context ranging from hesitancy, inappropriate communication, lack of resources, access, individual belief, management of adverse events following immunization etc.

Vaccine hesitancy threatens to reverse progress made in tackling vaccine-preventable diseases and is listed by WHO in the 10 threats to global health in 2019. Access to vaccinations is sometimes difficult especially in rural areas affecting most vulnerable populations. Immunization history is not always well managed thus affecting the proper vaccination for all ages. Immunization is one of the best uses of limited public funds for health; however, financing for immunizations are often not covering in a sustainable matter the needs.

The World Federation of Public Health Associations has developed a high-level “International Immunization Policy Taskforce” on vaccination policies to engage with public health associations, international organizations and like-minded partners to sustain the development, adoption and implementations of key vaccination policies at country level. The taskforce has developed a position paper that will be launched during the workshop to debate about role and responsibilities as well effective approaches to be applied both in developed and developing. The position paper has its roots in vaccination as human right and as a key component of UHC and SGD initiatives.

Global immunization is crucial for every individual and the broader community to prevent diseases, promote health and wellbeing and protect the global population as highlighted in WFPHA Global Charter for the Public's Health. Key experts from different parts of the world will discuss strategies and synergies to create a global coordinated advocacy movement to foster engagement for equitable and effective global immunisation by governments and society at large.

Key messages

Vaccination challenges may vary from developed & developing countries. Responsibility for immunization uptake lies at different levels. Analyses, advocacy, action are key to prevent & face epidemics. Vaccination is not a personal choice rather a political choice. A strong advocacy movement by PHW is key to guarantee the best equitable and sustainable immunization worldwide.
Back pain trajectories from midlife to retirement as a predictor of old age mobility and disability
Authors: Kyrönlahti S , Nygård C H , Neupane S
Published: October 2020

Background

Low back pain (LBP) is a leading cause for mobility limitations and disability at older age. However, little is known about the developmental pathways of LBP and its associations with old age mobility and disability. We studied trajectories of LBP from midlife to retirement (16-years follow-up) and assessed the association after 12 years with mobility limitations and disability in activities of daily living (ADL) at old age.

Methods

Finnish municipal employees were studied at baseline in 1981 and followed for 28 years. A total of 6257 persons aged 44-58 years, answered a questionnaire on health, work ability, and working conditions. Follow-up data on frequency of LBP (never, occasionally, consistently) was collected similarly at four waves. The study population consisted of persons who answered questions about LBP at baseline and at least in one of the follow-up waves and had information about ADL disability (n = 2787) and mobility limitations (n = 2723) at the 28-year follow-up. Latent class growth curve analysis was used to study LBP trajectories. Odds ratios (OR) with their 95% confidence intervals (CIs) for associations of LBP trajectory with ADL disability and mobility limitations were estimated using multivariable logistic regression.

Results

We identified two trajectories of LBP: high (77%) and low (23%). People in the high trajectory group had 2.35 times higher odds (95% CI 1.88- 2.97) of ADL disability and 1.86 times higher odds (95% CI 1.56-2.22) of mobility limitations as compared to the low trajectory group. Effects were attenuated by adjustment for lifestyle factors and chronic conditions but remained statistically significant for both outcomes [OR 1.74 (95% CI 1.37-2.24) and 1.44 (1.18-1.77), respectively].

Conclusions

High LBP experienced during midlife may have far reached consequences on well-being at old age. Prevention of LBP during mid-life could reduce mobility limitations and disability at old age and promote a healthy ageing.

Key messages

Our results show that low back pain experienced during midlife is associated with mobility limitations and disability in activities of daily living at old age. Our results suggest that emphasis should be put on promotion of musculoskeletal health in midlife as this may help to reduce disability and mobility limitations at old age.
The Women's Hospital: the birth of the first gender hospital in Italy
Authors: Cavazzana L , Errico M , Gimigliano A , Anniverno R , Bernardo L , Brucato A , Di Chio S , Liprandi V , Vignali M , De Filippis G
Published: October 2020

Issue

Many diseases show differences in incidence, symptoms, and severity between men and women, combined with a different response to therapies. There are some international experiences of health policies about Gender Medicine, but the practical realizations are few and, for the female sex, usually focused only on fertile age.

Description of the problem

A Milan hospital (ASST Fatebenefratelli Sacco) decided to dedicate one of its sites, with gynecological and pediatric vocation but also with an Internal Medicine Unit in within, entirely to women's health. The focus of this site is a holistic approach to women's health needs, both physiologic and pathologic. Realized without additional institutional funds, this project was designed between June and October 2019, started in December 2019 and is still ongoing.

Results

One of the first actions taken was to admit only women in the Internal Medicine Unit. The Unit is now entirely focused on dealing with most frequent female pathologies, in particular on autoimmune, vascular, endocrinology and nephrology conditions. The Mental Health Unit, already specialized in supporting pregnancy and new mothers, is going to activate a “Mother-Baby Unit” to support potential hospitalization issues. Among its major aims, the Occupational Medicine Unit supports female workers in managing maternity leave. New outpatient clinical paths have been planned to strengthen key moments of women's life: developmental age, fertile age, menopause, and senescence. Based on multi-professional teams, these programs are targeted toward age-specific needs and combine knowledge of disease epidemiology with sociological needs. To better face emerging issues, a path is activated for each area every month.

Conclusions

The birth of the first Italian hospital entirely dedicated to Gender Medicine allows care of women's health on a holistic perspective. This is, indeed, a key step in the general appraisal of Gender Medicine at the national and international levels.

Key messages

A gender hospital with a holistic approach to women’s health needs, both physiologic and pathologic, was borne in Milan. Integrated clinical paths have been activated to assist women in the key moments of their life (developmental age, fertile age, menopause, and senescence).
Life course socioeconomic conditions, multimorbidity and polypharmacy in older adults
Authors: Jungo K T , Cheval B , Sieber S , van der Linden B W A , Ihle A , Carmeli C , Chiolero A , Streit S , Cullati S
Published: October 2020

Many older adults have multiple chronic conditions (multimorbidity). With multimorbidity often comes the concurrent intake of multiple medications (polypharmacy). Our aims were to assess if childhood socioeconomic conditions (CSC) are associated with multimorbidity and polypharmacy in older adults, and how these associations change when adjusting for adulthood socioeconomic conditions (ASC).

We used data from the European longitudinal Survey of Health, Ageing, and Retirement (SHARE), which follows individuals aged 50 years and over in 27 countries since 2004. We analysed data from 35,229 individuals with multimorbidity (mean age: women=64.1, men=65.4) and 20,757 individuals with polypharmacy (mean age: women=69.2, men=70.2). Multimorbidity was defined as 2 or more self-reported chronic conditions and polypharmacy as the intake of 5 or more medications. Confounder-adjusted multilevel logistic regression models were used to analyse associations of CSC (5 categories: most disadvantaged-most advantaged) and ASC with multimorbidity and polypharmacy. All analyses were adjusted for country, age, weight, alcohol consumption, smoking status and physical exercise. In addition, we adjusted the polypharmacy model with the number of chronic conditions, mental health, activities of daily living and living situation. We stratified the analyses by sex.

34% of women had multimorbidity and 26% received polypharmacy. In men, these percentages were 34% and 28%. All categories of CSC (except for disadvantaged CSC in men) were associated with multimorbidity. In both sexes, a higher advantage was associated with lower odds of multimorbidity. In women, advantaged and most advantaged CSC were associated with lower odds of polypharmacy (OR = 0.53, 95% CI 0.31-0.89; OR = 0.48, 95% CI 0.24-0.94). In men, CSC were not associated with polypharmacy. ASC attenuated the association of CSC with multimorbidity among women, but CSC remained associated. In men, CSC were attenuated after adjusting for ASC.

Key messages

Lower childhood socioeconomic conditions increase the odds of having multiple chronic conditions in older adults. In women, the odds of polypharmacy are marginally linked with CSC. Less disadvantaged socioeconomic conditions in adulthood may allow for compensating a more disadvantaged start in life, particularly in men.
Results of process evaluation of the Unplugged school-based prevention program in Nigeria
Authors: Vigna-Taglianti F , Emelurumonye I N , Donati L , Alesina M , Akanidomo I , Pwajok J , Prichard G , van der Kreeft P , Virk H K , the Unplugged Nigeria Coordination Group
Published: October 2020

Background

The UNODC with the collaboration of the Government implemented in Nigeria a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the prevention program Unplugged was tested through a randomized controlled trial. This study aims to evaluate the implementation of the program in the intervention schools and the satisfaction of teachers and students.

Methods

32 schools were randomly extracted from a list of 60 schools provided by the Federal Ministry of Education. 16 schools were randomly allocated to intervention and implemented Unplugged. To monitor program implementation, the teachers filled a form reporting data on fidelity of implementation. To monitor satisfaction, teachers and students filled an anonymous form at the end of the program.

Results

69% of intervention schools participated in the process evaluation. The duration of the units was on average 55 min. The implementation rate was very high. All classes implemented six units whilst less than 10% did not implement the other six units. The highest rate of not implementing classes was observed for unit 11 and 12. The highest student interest as declared by the teachers was observed for Unit 1 and 8, the highest interactivity for Unit 9 and 8. Most teachers found the units easy to lead and referred an improvement of teaching skills, knowledge about substances, relationship with the students and class climate, and found very useful the Teacher Handbook. Ninety percent of students considered Unplugged useful for their choices, for 82% it improved the vision of themselves, for 95% their knowledge, for 80% the relationship with mates and for 77% the relationship with teachers. 97.5% of students would like to have a similar program next year.

Conclusions

Unplugged reached in Nigeria very good results in terms of implementation and satisfaction of teachers and students. Process evaluation is useful to improve the quality of prevention interventions.

Key messages

School based prevention interventions like Unplugged can be successfully implemented in low income countries, especially when supported by printed Handbook for teachers. Teachers and students participating in Unplugged perceived an improvement of class climate and relationship between teachers and students due to the program.
Schools health promotion among adolescents in Northern Nigeria
Authors: Smith L , Sarki A , Onukwugha F , Magadi M
Published: October 2020

Background

Jigawa and Kano States, Northern Nigeria have some of the worst human development outcomes globally for adolescents across a wide range of health indicators. Our aim was to understand health awareness, beliefs, and behaviours of adolescents in school in Jigawa and Kano States, to inform prioritization and development of health promotion interventions in the region.

Methods

We carried out a cross-sectional survey followed by focus group discussions (FGDs) with adolescents aged 15 to 20 years from four schools in Jigawa and Kano States (July-August 2019). Adolescents (274 per school) were randomly selected stratified by class-year (SS1 and SS2); 64 participated in FGDs (8 groups of 8). Trained researchers administered a questionnaire face-to-face via smart phones. Topics included: mental health; tobacco use; substance misuse; violence and unintentional injury; physical and dietary behaviours; and hygiene. FGDs investigated topics in greater depth. Here we report prevalence and predictors of mental health calculated from survey responses, and thematic analysis of interview findings.

Results

One thousand and seventy-nine students completed the survey (98%);∼50% girls. Preliminary analysis showed prevalence of moderate-severe anxiety was higher in girls than boys (6.8% girls, 0.8% boys, p < 0.001); and moderate-severe depression (10.3% girls, 0.5% boys, p < 0.001). Up to 50% boys and girls experienced violence or abuse in school, and 16% used a prescription drug without a prescription in past 30 days. Multivariable logistic regression showed female gender (aOR =4.0, 95% CI; 2.7,6.0); 30-day off-prescription drug use - aOR=2.3 (1.5,3.8); and being hit or slapped by a teacher - aOR=1.7, (1.1, 2.6) were predictors of moderate to severe anxiety. Results were similar for moderate to severe depression. Qualitative findings supported and contextualized these results.

Conclusions

Results will inform school-based interventions to improve health of adolescents in the region.

Key messages

Administering a health questionnaire to gather health information of adolescents in school in Kano and Jigawa states, Nigeria was feasible. Health questionnaire and focus group data will be shared with school and community leaders to shape school-based interventions to improve health outcomes amongst adolescents.
When merging two international surveys (HBSC/ESPAD) leads to better monitoring at national level
Authors: Godeau E , Spilka S , Ehlinger V , Philippon A , Lenezet O
Published: October 2020

In France, since 1994, adolescents' substance use was measured among 11-13-15 year-olds with the Health Behavior in School-aged Children (HBSC) & among 16-year-olds with the European School Project on Alcohol and other Drugs (ESPAD). Since 2018, with EnCLASS, (National Survey in Middle- and High-school for Adolescents on Health and Substances), France conducts those 2 surveys in a unified way across middle- & high-school, improving the monitoring of health behaviours, substance use included throughout adolescence at national level, while ensuring optimum comparability internationally. Our paper will summarise substance use by secondary students in France with a focus on preventive interventions on substances organised in class. Data collected in 2018 in 1137 classes; nationally representative sample of 20 128 secondary-school students (grade 6-12); confidential & anonymous online self-questionnaire. Schools, parents & students could refuse to participate. Inclusion rate: 74%. Secondary school is the main period where alcohol, tobacco & cannabis are experimented. With subsequent timing: Alcohol, mainly initiated during middle school, is still the first substance used during adolescence, followed by tobacco. The consumption of cannabis tends to begin at the end of middle school, with experimentation & use developing & strengthening during high school. Overall, 10% of 6th grade students report having had an intervention on substance use, up to half in 9th grade. Regarding speakers, 1/2 report external experts, 1/3 teachers & 1/4 school nurses. It seems that alcohol, tobacco & cannabis are discussed at the same occasion. Such findings show a rather good coherence between school intervention & prevalence of substance use EnCLASS by merging HBSC & ESPAD ensures an excellent comparability of data internationally while providing a strong national monitoring of French adolescents' substance use throughout secondary school.
Factors associated to uncontrolled hypertension in Brazilian adults: National Health Survey
Authors: Vieira M A , Felisbino-Mendes M , Velásquez-Meléndez J G
Published: October 2020

Background

Hypertension is the main risk factor for cardiovascular diseases, contributing significantly to the increase in the number of deaths and disabilities worldwide. Moreover, hypertension control is a major action for NCDs prevention. Although pharmacological treatment has been shown effective, high rates of uncontrolled hypertension remain. The objective is to estimate the prevalence of uncontrolled arterial hypertension and the factors associated to this outcome in a representative adult Brazilian population under a pharmacological treatment.

Methods

This is a cross-sectional study conducted with 10,016 Brazilian adults over 18 years old who participated in the National Health Survey in Brazil carried-out in 2013. The sample comprised of residents from all Federative Units, Poisson multivariate regression was used to calculate the prevalence ratio (PR) and 95% confidence interval.

Results

45% (95% CI: 44; 48) of hypertensive adults under drug treatment have uncontrolled blood pressure levels. Female gender [PR = 0.92; CI: 0.85; 0.99] and not having previous hospitalizations due to complications from hypertension or other causes [PR = 0.86; CI: 0.78; 0.94] were associated to low the prevalence of uncontrolled blood pressure. Participants aged 60 years old or more [PR = 1.31; CI:1.04; 1.64], who self-declared as black [PR = 1.19; CI: 1.04; 1.36], without health insurance [PR = 1.15; CI: 1.05; 1.27] and not attending the health service because of arterial hypertension [PR = 1.10; CI:1.01; 1.20)] presented higher prevalence of uncontrolled blood pressure.

Conclusions

The prevalence of uncontrolled hypertension among Brazilian adults was high among the male gender, black people, elderly, without previous hospitalizations, without health insurance and not regularly attending the health service. These results may alert the need for a reassessment of the assistance provided, in addition to raising awareness of a possible change in public policies in these groups.

Key messages

Evidence the magnitude of people who are at risk of hypertension even under pharmacological treatment. Highlight inequities related to the uncontrol of hypertension.
Behavioural risk factors in university students in Bucaramanga, Colombia
Authors: Martinez-Rueda R , Camacho M A , Díaz I J
Published: October 2020

Background

The changes generated in the studentś lifestyle due to the academic demands, may favour the prevalence of risk factors for non-communicable diseases as well as compromise other domains of their life. The purpose of this study was to establish the prevalence of behavioural risk factors in students of the Professional in Physical Activity and Sports program of a University in Bucaramanga, Colombia.

Methods

A cross-sectional study with a sample of 189 students was conducted. The students were surveyed with the first step of the STEPs questionnaire, which evaluates the behavioural risk factors for non-communicable diseases. A descriptive data analysis was performed, and Pearson tests were applied to determine the correlation between the analysed variables with a level of significance α = 0.05 using STATA 13.0.

Results

80% of the participants were men. The age average was 22.7 ± 3.85 years. Regarding tobacco use, 10.1% of the participants were current smokers, while 30% smoked before. The majority of the participants (92.2%) have consumed alcohol within the past 12 months, while 69.8% consumed alcohol within the last month, with 8.7% of hazardous drinking. Concerning the diet, only 24.9% met the recommended consumption of fruits and vegetables per day. When assessing physical activity levels, only 6.3% were classified as physically inactive. Additionally, an average of 6 hours of sedentary behaviour was found, with 31.2% of excessive sedentary time. A weak correlation was found between age and academic cycle with the amount of physical activity at work (r = 0.24), (r = 0.18) and with sedentary time (r = -0.28), (-0, 32).

Conclusions

Although the prevalence of tobacco consumption was slightly higher than the national average, the students showed a lower prevalence of behavioural risk factors than the general population. However, it is necessary to promote strategies aimed at the control and prevention of these risk factors.

Key messages

Being a student of a program focused on physical activity and sport, can behave as a protective factor against the most prevalent risk factors in university life. It is necessary to implement more strategies centred on making students aware of the importance of the maintenance and improvement of their lifestyles in accordance with their professional profile.
Nationwide health check program by patients with severe mental illness or long-term antidepressants
Authors: Garriga C , Robson J , Coupland C , Lay-Flurrie S , Hippisley-Cox J
Published: October 2020

Background

The English NHS Health Check is a unique national risk assessment, awareness and management programme for preventing cardiovascular disease (CVD), diabetes and chronic kidney disease (CKD). We aimed to assess their uptake and association with new diagnoses (CVD, hypertension, type-2 diabetes and CKD) in patients with severe mental illness (SMI) compared to patients without this condition and for patients on long-term antidepressant treatment (LTAD) (≥6 prescriptions vs < 6).

Methods

Cohort study (2013-2017) using the QResearch database. 1,319 general practices across England contributed of over nine million patients aged 40-74 years. 3,492,186 patients were eligible for NHS Health Checks of which 590,218 attended. Outcomes: hazard ratios (HR) with 95% confidence intervals (CI) for uptake of NHS Health Checks and for new diagnoses within 1 year in attendees. Models were adjusted for sex, age, ethnicity, deprivation and region.

Results

65,490 people with SMI and 46,437 people on LTAD (20% of the total eligible with SMI/LTAD, respectively) attended an NHS Health Check. People with SMI or on LTAD were more likely to attend compared to people without those conditions, adjusted HRs 1.05 (95% CI 1.02-1.08) and 1.10 (95% CI 1.08-1.13), respectively. Among attendees, people with SMI and on LTAD were 23% and 55% more likely to be diagnosed with CKD (95% CI 1.12-1.34 and 1.42-1.70, respectively) than people without these conditions. Attendees on LTAD were 66% more likely to have a major CVD event within 1 year than those without LTAD (95% CI 1.41-1.94) or a new diagnosis of hypertension and type 2 diabetes, HRs 1.12 (95% CI 1.05-1.20) and 1.45 (95% CI 1.31-1.60), respectively.

Conclusions

People with SMI or on LTAD were more likely to attend NHS Health Checks than people without these conditions. Higher rates of CKD in patients with SMI/LTAD and CVD, hypertension and type 2 diabetes in the latter might indicate increased risks and unmet need in these patient groups

Key messages

People with SMI/LTAD were more likely to attend NHS Health Checks. People on LTAD were more likely to be diagnosed with CVD, CKD, hypertension and type-2 diabetes than people without these conditions. SMI attendees were more likely to be diagnosed with CKD.
The health and economic burden of antimicrobial resistance
Authors: Ait Ouakrim D , Cassini A , Cecchini M , Plauchoras D
Published: October 2020

Antimicrobial resistance (AMR) has profound consequences for the treatment of infections. By limiting treatment options, it often makes it necessary to resort to antibiotics with a broader spectrum of action some of which are potentially less effective or safe than narrow-spectrum antibiotics. This limitation in our ability to treat infections effectively has an impact on health care budgets but also broader and potentially disastrous consequences on a variety of economic sectors. This presentation provides an overview of the health and economic burden of AMR. It first presents the current state of knowledge on the epidemiology of AMR and discusses the main analytical challenges in determining the current and long-term effects of resistance on populations in terms of morbidity, mortality, and length of hospital stay. In addition, a summary of the current literature on the economic impact of AMR is provided along with a detailed discussion of the characteristics and limitations of existing economic models. Finally, it identifies the main knowledge gaps and suggests avenues for future research and approaches to address them.
Integrating qualitative and quantitative content analysis for assessing and improving evaluability
Authors: Reed E
Published: October 2020

The second presentation will cover integrating qualitative and quantitative content analysis for addressing 'why' and 'how' as well as 'what' questions relating to monitoring and assessing interim and instrumental outcomes achieved or not achieved in public health initiatives and programs. Steps for developing meaningful scoring systems for synthesizing the review of multiple types of documents will be described. Examples will be given from global health engagement projects with the development or strengthening of partnerships as a key objective. Using document review as a management tool in integrating strategic planning, monitoring, and evaluation will be discussed, as a way of assessing the gaps between planning and evaluation and strengthening their relationship.
Illuminating (digital) health literacy practices using applied linguistics
Authors: Harsch S , Bittlingmayer U
Published: October 2020

Background

Health literacy (HL) is key to making well-informed health decision in analogous and virtual social situations and organizational contexts. Multiple models and instruments of HL exist, but an in-depth understanding of the various HL-related everyday life situations and their digital and linguistic requirements are scarce. Here, the expertise of second language courses (SLC) can be of great value as they support newcomers acquiring the necessary skills for everyday communication, including health. In the project SCURA, funded by the German Federal Ministry for Education and Research, we explored the German SLC, attended by 2.1 million migrants and refugees since 2005, and developed interventions to promote HL in it. The aim is to understand what everyday situations require (digital) HL skills, what characterizes them and what can we learn for HL models and interventions.

Methods

We conducted a qualitative content analysis (Bowen 2009) of the 8 newest, approved German second language textbooks series, identified all tasks related to HL, analyzed the situation, topic, language skills, analogue/digital and HL dimension and compared the findings with the HLS-EU conceptual model of HL.

Results

We identified 180 HL-related communication situations, including 33 tasks related to digital HL. Compared to the HLS-EU conceptual model, the HL activities in SLC reveal a broad understanding of HL including physical, mental and social aspects of HL, linguistic, cultural and digital skills and even critical HL. 5 HL-related dimensions emerged: communication for health, health literacy, health knowledge, health behaviour and life-skills. The differentiation and activities can help to develop further models and interventions that target specific situations requiring digital HL more effectively.

Conclusions

The analysis of the SLC curricula specified the various (digital) HL-related everyday life situations and! the differentiated model helps to develop promising interventions.
Beyond gender to intersectionality in NCD policy
Authors: Hankivsky O
Published: October 2020

Olena Hankivsky, PhD (School of Population and Global Health, University of Melbourne) will present an analysis of key policy shifts in the NCDs field internationally, which reflect more nuanced thinking about gender, and the explicit recognition that gender intersects with other factors. She will outline key issues that need to be addressed for further movement to be made on the intersectionality front including clarification of the similarities and differences between gender mainstreaming and intersectionality and how to accurately apply intersectionality in the analysis of NCDs. The presentation will include suggestions and research and policy strategies for how to addressing operational challenges and advance intersectionality in the context of NCDs related policies and how to draw on intersectionality to improve the development of comprehensive multi-sectoral approaches to national and international NCD policies.
Costs of loneliness: the association between loneliness and healthcare expenditure
Authors: Meisters R , Westra D , Putrik P , Bosma H , Ruwaard D , Jansen M
Published: October 2020

Background

Loneliness is a growing issue. It has been associated with a range of unhealthy behaviors, poorer health, and increased morbidity. However, the healthcare costs of loneliness are poorly understood as limited existing research on loneliness focused on older age populations, few expenditure categories, and controlled for just a few potential confounders. Our study aims to fill this evidence gap.

Methods

Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (>18 y.o.). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e. demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for multiple age groups. Excess expenditure attributed to loneliness was extrapolated to the entire population.

Results

Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5% and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19-40, the contribution of loneliness represented 61.8% of the overall association).

Conclusions

Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue.

Key messages

Loneliness is associated with increased healthcare expenditure independent of demographic and socioeconomic factors. Excess healthcare expenditure related to loneliness are particularly apparent in mental healthcare and in younger age groups.
Engaging the youth: co-designing health promotion messages
Authors: Finlay S
Published: October 2020

We were all young once, right? Moreover, many of us still feel young despite our birth certificate suggesting otherwise. Does that mean we understand what health promotion messages are going to resonate with young people today? Does it mean we know which platforms messages for young people should be used?

The short answer is no. This is particularly true for marginalised communities whose needs are often very different and therefore require tailored communication. Marginalised communities such as Indigenous people, the LGBTQI community, migrant populations and refugees.

Youth is a perfect time to communicate prevention, sexual and reproductive health and other health promotion messages. Young people are our future leaders. As health professionals, we want to make sure they transition to adulthood as healthy in mind and body as we can. Part of that is developing health promotion messages which reach with young people.

However, too frequently, messages are not tailored for young people; therefore, not equipping them with the knowledge and skill to make healthy choices. To ensure that as health professionals that we are maximising our impact with young people, we need to co-design health promotion messages with them.

Like with many Indigenous people in colonised countries, half of the Aboriginal and Torres Strait Islander population, Australia's Indigenous people are under the age of 30. Young Australian Indigenous people's health and wellbeing needs are distinctive because of the uniqueness of their culture as well as the historical, political and social context (Azzopardi 2017). To ensure that health promotion effectively reaches its target audience, a co-design methodology is often employed with Aboriginal and Torres Strait Islander people. This presentation will detail the development of co-designed quit smoking and suicide prevention health promotion campaigns to demonstrate their effectiveness. A method that can be applied with other young people for maximum impact.
“Sometimes you need to go beyond the manual” – TRT facilitators’ experiences when refugee youth disclose suicidal ideation
Authors: Gupta-Löfving S , Wijk K , Warner G , Sarkadi A
Published: October 2020

Community-based mental health interventions offer a way to reach lots of people when there is a high level of need. However, it is important to consider safety aspects when pushing interventions out to community settings. Teaching Recovery Techniques (TRT) is a manualised intervention based on trauma-focused cognitive behavioural therapy for children and adolescents reporting symptoms of post-traumatic stress. Facilitators with no previous therapeutic experience or specialist training in psychiatry are eligible to deliver the intervention after a three-day training workshop. Although TRT was not developed for a specialist health care setting, a substantial number of refugee minors who receive the TRT programme in Sweden report severe high-risk psychiatric symptoms. The objective of this study was to examine how facilitators, without extensive psychological training, experience the intervention including the inbuilt safety protocol when participating refugee minors are in an unstable setting and disclose suicidal ideation. Semi-structured interviews were conducted with TRT facilitators. Data were analysed using systemic text condensation. Findings will be presented at the workshop.
'I felt like a human being' – An exploratory, multi-method study of refugee involvement in the development of mental health intervention research
Authors: Warner G , Baghdasaryan Z , Osman F , Lampa E , Sarkadi A
Published: October 2020

The purpose of this study was to pilot and methodologically appraise innovative patient and public involvement (PPI) evaluation tools and to describe a case study of refugee involvement in the development of mental health intervention research. 'Refugee Advisors' were involved in the development of a randomised controlled trial protocol evaluating a brief group intervention for refugee children experiencing symptoms of post-traumatic stress in Sweden. During an 8-hour research meeting, observation and questionnaire data were collected using the Active Involvement of Users in Research Observation Schedule and Questionnaire, followed by a focus group discussion. The multi-method approach demonstrated good feasibility. There were clear examples of how the advisors influenced research development e.g. recruitment strategy, cultural brokerage among study group participants, outcome measure validation. The advisors described a perceived impact on the research, equality and acceptance, and knowledge gain. A sense of appreciation and empowerment was also interpreted. However, potential issues relating to the relevance of contributions and use of an interpreter were identified.
Different diagnostic groups and labour market marginalization among refugee youths
Authors: Chen J , Mittendorfer-Rutz E , Klimek P
Published: October 2020

Background

Refugees are at increased risk of labor market marginalization (LMM), which is of high Public Health importance. However, little is known whether specific multimorbidity patterns increase the risk of LMM in this group. We sought to examine whether different diagnostic groups associate with subsequent unemployment and disability pension in refugee youth as compared to their counterparts born in Sweden.

Methodology

We analyzed 249,245 individuals between the age of 16 and 26 at 31.12.2011 from a combined Swedish registry. Refugees were matched to five second-generation-native-born Swedes. LMM was defined as disability pension or > 180 days of unemployment, 2012-2015. Relative risks (RR) were calculated for 114 diagnostic groups (2009-11) with regard to the two outcome measures.

Results

The mean age was 23±1.7 years, 2,841 (1.1%) received disability pension and 16,323 (6.5%) individuals experienced unemployment. The majority of diagnostic groups was associated with a higher risk for unemployment and a lower risk for disability pension in refugees. Hypertensive diseases and external causes of morbidity showed higher risk ratios of unemployment for refugees compared to Swedish-born: RRs (95% Confidence Interval) 6.8 (3.16, 14.6) and 6.31 (4.45, 8.94), respectively. Diabetes and mental disorders were associated with higher risk estimates for disability pension in refugees: RRs (95% CI) 2.4 (1.02, 5.6) and 1.8 (0.80, 3.9), respectively.

Conclusions

Diagnoses are differentially associated with LMM in refugee youth as compared to Swedish-born individuals. In order to prevent LMM in refugees, early intervention for the identified diseases is important.

Key message

The importance of diagnostic groups for subsequent LMM differs for young refugees and Swedish-born individuals. Findings are also divergent regarding the measure of LMM.
Smokefree policy and medication dispensing for people in prison: interrupted time series analysis
Authors: Leyland A , Tweed E , Byrne T , Conaglen P , Craig P , Graham L , McMeekin N , Boyd K , Pell J , Hunt K
Published: October 2020

Background

Previous evaluations of smokefree prison policies have suggested improvements in self-rated health and some smoking-related symptoms. No studies to date have investigated impacts on medication use as proxy measures of objective ill-health or as indicators of potential negative unintended consequences. These is limited evidence to date on these important outcomes.

Methods

We obtained from NHS National Services Scotland aggregate data on medication items dispensed in prisons, based on individual named patient medication records, and from the Scottish Prison Service data on the prison population, for the period Jan 2013-Nov 2019. Items of interest comprised those for smoking cessation (varenicline and buproprion); nicotine replacement; specific smoking-related health conditions (glyceryl trinitrate; inhaled bronchodilators and steroids; antibiotics; chloramphenicol eye drops; and proton pump inhibitors and H2 receptor antagonists), and potential unintended mental health consequences (anti-depressants). We also included a set of negative controls for which dispensing was not expected to be affected by the new smokefree policy (anticonvulsants, excluding pregabalin and gabapentin). Analyses were undertaken using AutoRegressive Integrated Moving Average (ARIMA) time series methods, with the dates of the policy's announcement and of implementation included as pre-specified breakpoints.

Results

The results of ARIMA modelling of medication dispensing are confidential until May 2020 due to their sensitivity and will be available to present at WCPH 2020.

Conclusions

The use of routinely available dispensing data as an indicator of objective health impacts and potential negative unintended consequences provides novel insights into the effectiveness of smokefree prison policies. Results will be of interest to international jurisdictions considering such policies and to those seeking to harness the potential of administrative data for natural experiments.
Manufacturing epidemics: industry influence on trade and governance and how to address it
Authors: Friel S
Published: October 2020

The significant structural, instrumental and discursive power of food corporations has led to the development of trade agreements that enable pursuit of private actors' financial interests to the detriment of nutrition and health. This presentation will examine the ways in which food corporations have influenced and used trade treaties. Drawing on lessons from previous trade and health successes, the paper will also outline ways in which we can recalibrate the power differentials such that the interests of weaker social actors can be achieved.