bluuebunny/crossref_metadata_2025 huggingface dataset:
The Nordic @geing Online project: Co-creating a social application together with older adults
Authors: Nordmyr J , Forsman A K
Published: November 2019

Background

Online resources present various possibilities for health promotion, also in the growing older adult population. Tailored online services aiming to support social participation among users could potentially promote older adults’ psychosocial health. In the @geing Online project an online application is developed, focusing on access to meaningful social activities among older adults in rural areas in Finland and Sweden. The innovation project (2017-2020) is funded by the Interreg Botnia-Atlantica programme (European Regional Development Fund).

Methods

A collaborative, user-centred design approach is applied when developing the online application, allowing older potential users and personnel groups from the social and health care sector to evaluate application features in a step-wise process. The inclusion of personnel groups allows for the exploration of the feasibility of introducing the tool in home care services and similar relevant contexts from an organizational perspective. Further, the inclusion of regional IT-companies presents opportunities for them to develop their competence regarding eHealth tools and older adults as a target group.

Results

An advanced prototype of the application and its core features is presented. Promising approaches and outcomes regarding the co-creation methods applied to ensure the involvement of stakeholders in the development process are elaborated upon. Challenging issues related to the project theme, such as stereotypical and negative views of older adults’ competences and motivation related to application use are also discussed.

Conclusions

The project highlights possibilities - but also challenges - when co-creating a social application together with older adults, some of whom have no experience in internet use. The gathered project outcomes will provide lessons on the potential of new technologies for delivering health promotion initiatives among older adults.

Key messages

Tailored online services aiming to support social participation among users provide possibilities for promoting psychosocial health in the growing population of older adults. Application development utilizing a user-centered design approach can be implemented even if the end-users are not familiar with the internet or application use.
Assessments, evolutions and transformations in French nursing homes
Authors: Delespierre T , Haÿ P E , Armaingaud D , Josseran L
Published: November 2019

Background

Korian is a private group specialized in medical accommodation for elderly and dependent people. A professional data warehouse EasySoins® set up in 2010 hosted 126 nursing homes (NH) residents’ data. Then in 2013, another data warehouse NetSoins® replaced the former; with a completely new information system (IS). Deployment ended in July 2014 with 151 NH but since then, the number of NH has increased steadily to reach 288 at the end of 2018. Inside both systems, the transmissions’ table fed on a daily basis by the caregiver contains key data about the residents’ care and health. It also allows us to build residents’ life trajectories. A recent study compared the 2011 and 2015 NH populations in France. Other research papers explored similar issues in the USA, Belgium and Great Britain. The objective of this study is to show that our data extraction method offers a vivid image and faithful reflection of the French residents’ population evolution over time.

Methods

Wanting to replicate and update the French study, we built two sets of Korian residents: those having at least one transmission over the last six weeks of 2014 and 2018. We then joined these two tables with their socio-demographic profile. Finally, we searched among the residents’ autonomy level evaluations (GIR=ISO resource group), the ‘nearest’ ones to each periods. We were then able to assess the residents’ population evolution.

Results

We found respectively 12,279 residents living in 156 NH and then 23,926 residents, living in 288 NH. In 2014, 9,174 women with a mean age of 87.5 (standard deviation=7.4) and 3,105 men with a mean age of 84.6 (standard deviation=9). In 2018, 3,075 were still there (25%) with 17,561 women, mean age of 88.4 (standard deviation=7.5) and 6,365 men, mean age of 85.2 (standard deviation=9.4). The GIR modal class stayed stable at two for both sexes at 30%.

Conclusions

As elsewhere, men and women are growing a little older, reaching a glass ceiling, with a narrowed gender gap.

Key messages

As nursing home residents’ profiles are rapidly changing over time and caregiver resources do not increase accordingly, allocating adequate resources to every resident becomes essential. The transmissions’ table with its nursing care narratives textual content can help us track every resident on almost real time and, through this process, define health paths and health subgroups.
Health impact of substituting red meat by fish: addressing variability in risk-benefit assessments
Authors: Thomsen S T , de Boer W , Pires S M , Devleesschauwer B , Fagt S , Andersen R , Poulsen M , van der Voet H
Published: November 2019

Background

Sufficient intake of fish and limited red meat intake is commonly encouraged by national dietary guidelines to prevent various lifestyle diseases. One way to fulfill these guidelines would be to substitute red meat by fish. However, quantitative evidence of the public health gain of such substitution is lacking. Moreover, contaminants in these foods may compromise nutritional benefits. We aimed to estimate the health impact of substituting red meat by fish in the Danish diet in a risk-benefit assessment (RBA). Our study can support policy makers in defining evidence-based public health strategies.

Methods

We quantified the health impact of substituting red meat by fish among Danish adults in terms of Disability-Adjusted Life Years (DALY) using data from a national dietary survey and food monitoring. We investigated the use of probabilistic methods to model variability in individual substitution behaviors and to assess health impact distributions in RBA of food.

Results

Health impact of the substitution varied largely by the type of fish consumed and by age and sex of the consumer. We estimated that 134 (95% uncertainty interval: 102; 169) DALYs/100,000 could be averted per year if a mix of lean and fatty fish is consumed in the Danish recommended amounts and intake of red meat decreased among Danish adults. The highest benefit was estimated for women in the childbearing age and for men above 50 years of age. However, a small fraction of women were assigned an overall health loss due to methylmercury exposure during pregnancy and the associated adverse effects in unborn children.

Conclusions

Our study estimated an overall health gain of substituting red meat by fish in the general Danish adult population, while providing insight in the variability in health impact at the level of individual consumers. Our approach can be applied in other RBAs and the results support the need for targeted public health strategies to ensure consumer health and safety.

Key messages

The health impact of substituting red meat by fish in Danish adults was quantified in terms of disability-adjusted life years (DALYs), while accounting for variability between individuals. We estimated that young women and men above 50 years of age will experience the largest health gain while a small fraction of the women were assigned a health loss due to chemical exposure.
Who, why, when and how do people use urban green spaces? A study of users from 18 parks in France
Authors: Porcherie M , Faure E , le Gall A Roué , Vaillant Z , Thomas M F , Rican S , Héritage Z , Bader C , Simos J , Cantorregi N
Published: November 2019

Introduction

Urban green spaces impact the individual and collective health of populations. At the city level, they act as regulators of environmental hazards and constitute collective protective factors. At the individual level, they constitute social spaces for encounters and rejuvenation. But, these functions depend on the use made of these green spaces which can be inequitable. This paper presents the results of the analysis of the use of green spaces in the 6 French cities selected in the WHO French Healthy City Network conducted as part of the GREENH-City research project.

Methods

Based on park profiles, a qualitative survey was conducted among users of 3 different parks in each of the 6 selected cities with both observations and semi-directive interviews. Thematic analyzes were performed. Observed activities were classified into 8 groups (supervised educational, food, activities i.e. calm, commercial, artistic and cultural, physical non-sport, sports) and related to a specific use (professional/ personal, individual/ collective, authorized/ not and conflictual/ not). The uses described by the individuals interviewed were classified into 4 categories: attendance, utility, opinions and activities.

Results

186 observations and 591 recorded and unrecorded interviews with individuals or groups were conducted in the 18 parks. Overall, calm activities are dominant. However, activities and uses differ between cities and within the city depending on the nature of the parks (ancient, new..), their management, their location (more or less central, located in a deprived area or not) and people expectations.

Conclusions

Park uses are only partially dependent on amenities within the park. The nature of the park itself, its geographical location and its landscape characteristics seem to be decisive for the uses observed. These data are essential to inform public decision-makers and guide the creation and development of green spaces in cities in a vision of social justice.

Key messages

Urban green spaces can improve population health but their uses may be inequitable. Study of population use of urban green spaces may help to shape local policies towards more equity.
Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis
Authors: Mohsenpour A , Biddle L , Bozorgmehr K
Published: November 2019

Background

Asylum seekers arriving in Germany are assigned to a local district and an accommodation centre wherein. We developed and validated a six-item questionnaire for rapid assessment of housing deterioration and investigated its association with inhabitant mental health.

Methods

Using cross-sectional data from a state-wide survey in Germany, we applied a random-effects modelling approach to estimate the exposure effect of housing deterioration on depression and general anxiety among a random sample of asylum seekers, using validated instruments (GAD2/PHQ2) for outcome variables. Housing deterioration was assessed on six items (windows/glass, walls/roof, garbage, graffiti, outside spaces, overall living environment) resulting in a deterioration score as exposure of interest. Additionally, we assessed the instrument’s intra- and inter-rater reliability and internal consistency.

Results

Of the 412 asylum seekers living in 58 accommodation centres, 45.7% reported symptoms of depression and 45.0% suffered general anxiety. Most centres (76.7%) were based in urban municipalities and 45.7% of inhabitants were living in an accommodation centre hosting ≥51 inhabitants. Preliminary adjusted odds ratio for accommodation centres with highest deterioration (Q 4) was 2.07 (0.67-6.40) for generalized anxiety, compared to 1.17 (0.45-3.08) for centres with lowest deterioration (Q 1). For depression, preliminary odds ratio was 1.92 (0.87-4.27) compared to 1.26 (0.63-2.50). The validation study confirmed inter-/intra-rater reliability (Brennan-Prediger coefficient: 0.81 and 0.92, respectively) and internal consistency (Crohnbach’s α: 0.80).

Conclusions

There are higher odds ratios for generalized anxiety disorder and depression among asylum seekers based on higher deterioration of housing environment. A questionnaire for rapid deterioration assessment and identification of accommodations needing further evaluation has been developed and successfully validated.

Key messages

Deterioration of small-scale housing environment is associated with poorer mental health for asylum seekers living in accommodation centres. A highly reliable new tool has been developed for rapid assessment of deterioration status of accommodation centres and identification of those needing further evaluation.
Prevalence of home smoking bans in six European cities: a repeated cross-sectional study (2013-2016)
Authors: Anastasi D , Federico B , Rimpela A , Richter M , Clancy L , Perelman J , Kunst A E , Lorant V
Published: November 2019

Background

Secondhand smoke exposure is responsible for over half a million premature deaths. With regulation now reducing smoking in most public enclosed spaces, one major source of indoor exposure remains the home environment. Home smoking bans (HSBs) are household rules that restrict smoking from certain (partial HSB) or all areas (complete HSB). Recent data suggest growing trends of HSB adoption over time, but it is not known whether time trends vary according to household characteristics.

Objectives

The aim of this study is to examine changes in the prevalence of HSB in six European cities between 2013 and 2016, according to socioeconomic characteristics of the household and smoking behavior of household members.

Methods

Data were collected in all schools participating in both waves of SILNE study in 6 European cities. A self-administered questionnaire was used, targeting students age 14 to 16 (n = 22,326). Students reported their parents’ smoking status and if there was a HSB at their home. Detailed information on socio-economic characteristics were collected as well.

Results

Between 2013 and 2016 the percentage of households with a complete HSB increased from 51.5% to 53.1%, while partial HSB increased from 30.7% to 32.1%. The prevalence of HSB increased in Hannover (G), Latina (I), Amersfoort (N) and Coimbra (P), whereas decreased in Namur (B) and Tampere (F). Socioeconomic differences in HSB were reduced, with larger increases in HSB in households with a lower parental educational level. Increases in HSB were observed among intact households, those without migration background and those with non-smoking parents.

Conclusions

The increase in the prevalence of HSB observed in most cities and throughout a variety of household types and characteristics between 2013 and 2016 may reflect the effect of smoking denormalization in different social contexts. Further actions of the tobacco control community should target the most vulnerable groups.

Key messages

The percentage of households with a complete HSB increased between 2013 and 2016 in 4 out of 6 European cities. Increases in the prevalence of HSB over time were observed across all socio-economic groups.
Sickness absences among young employees in private and public sectors
Authors: Narusyte J , Svedberg P
Published: November 2019

Background

Mental health problems among young adults is a public health problem as well as increasing work incapacity in terms of sickness absence (SA) due to mental diagnoses in Sweden. SA levels among those working in the public sector tend to exceed those working in the private sector. Knowledge is however lacking on whether experiencing mental health problems in young years can contribute to the association. The aim was to examine the association between type of employment and sickness absence among women and men, also adjusting for previously experienced depression and anxiety as well as for familial factors.

Methods

The study included data on 25,496 twins born in Sweden 1959-1990. Information on depression and anxiety as well as on type of employment was obtained from a web-based survey conducted in 2005. Twins were followed prospectively until 2013 through national register data on SA. Logistic regression analyses were run with adjustment for familial factors, such as common genetics and environmental factors related to the family. Odds ratios (OR) with 95% Confidence Intervals (CI) are presented.

Results

Higher rates of SA in the public (59%) as compared to the private (50%) sector were observed among women. There were 29% and 30% of men in public and private sectors, respectively, that have had at least one SA spell during the follow-up. Preliminary results showed that working in the private sector was associated with a higher risk for future SA among women (OR 1.63, 95% CI 1.14-2.33) but not among men (OR 0.66, 95% CI 0.41-1.07). The results changed only slightly after adjusting for previous depression or anxiety as well as for familial factors.

Conclusions

Higher rates of SA among women working in the public as compared to the private sector were not explained by previously experienced depression or anxiety disorders.

Key messages

Higher rates of SA were observed among women working in public as compared to private sector. Previously experienced depression and anxiety were of similar importance for future SA in both public and private sectors.
Levelling the Playing Fields: A Pilot Intervention
Authors: Alexander S , Frohlich K
Published: November 2019

Despite the benefits of outdoor free-play for children (physical activity, well-being, independent mobility), access to urban spaces for play is on the decline in many cities. As such, there are increasing calls from public health officials, city planners and childhood advocates in Canada to promote outdoor play in cities. Responding to these calls, our pilot intervention will examine whether creating urban play spaces through road closures around schools and in neighbourhoods can increase children’s outdoor play, physical activity and social interaction among residents.

The year-long intervention will involve road closures in four Montreal (Canada) neighbourhoods with different socio-economic profiles. After a diagnostic portrait of each site, participatory planning will engage children aged 8-12 and youth aged 13-18 to help redesign their neighbourhood streets for better access and playability. Outdoor play will be measured using a “playability index” to determine if increased outdoor play is due to intervention changes. Children’s physical activity, play and mobility patterns will be captured with GPS loggers and accelerometers, and play duration and location will be recorded through daily diaries. Questionnaires will be given to parents and children regarding changing behaviours and perceptions about outdoor play, risk/safety and independent mobility. While still in a pilot phase, this paper will present the intervention approach and outline how it promises to impact multiple components of urban life for children and adults (physical/mental health, safety, social interaction, environment/equity).

The intervention is innovative by engaging children and families in its design and development, and by involving schools, municipalities and residents in its implementation and assessment. This co-creation and development promises broad impacts on local social practices and policy development, results which may be transferable to other Canadian and international cities.

Key messages

Access to urban outdoor play is critical for children’s well-being. Road closures can increase urban outdoor play, thereby contributing to physical and mental health and promoting social interaction. Child and youth participation in the planning and development of urban play spaces can increase their relevance and broaden their social, environmental, health and policy impacts.
PrEP users among Lisbon MSM Cohort participants – A first look after PrEP implementation in Portugal
Authors: Fernandes F , Meireles P , Rocha M , Rojas J , Barros H
Published: November 2019

Background

Pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine has shown to be effective in preventing HIV among high-risk HIV-negative men who have sex with men (MSM). Portugal made PrEP available in February 2018, but few MSM reported PrEP use before. We aimed to compare the sociodemographic characteristics of MSM using PrEP and those knowing PrEP but not using and to compare MSM who started PrEP before and after its implementation in Portugal.

Methods

We performed a cross-sectional analysis, using Lisbon MSM Cohort data - an open prospective cohort of HIV-negative MSM testing at a community-based center in Lisbon - regarding the first time PrEP use was reported. Data from March 2015 to April 2019 was used. In this period 2142 MSM participated in the cohort and reported to know PrEP of whom 160 (7.5%) reported to use it. 83 PrEP-users answered a subset of questions about PrEP. Comparisons were performed using t-test, Chi-square or Fisher’s exact test.

Results

Comparing with non-users, PrEP users were significantly older (Mean: 35.7, SD 9.4 vs. 30.8, SD 9.2, p < 0.001), had more frequently a Master or PhD degree (37.2% vs. 27.4%, p = 0.017), and were more frequently born in a foreign country (42.2% vs. 31.8%, p < 0.001). Groups were similar in terms sexual orientation. Among the 83 PrEP users answering more questions about PrEP, 28 (33.7%) reported to have ordered their PrEP medication online, 24 (28.9%) obtained it in a medical appointment in Portugal, 15 (18.1%) in a foreign country, 4 in a clinical trial or demonstration project. Of all PrEP users, 30 (19.4%) started PrEP only after February 2018, and no sociodemographic differences were found comparing with those who started before.

Conclusions

MSM reporting PrEP use were more educated, older and more frequently born in a foreign country than non-PrEP users. MSM starting PrEP before and after February 2018 were similar, which may indicate that making PrEP available did not yet reach a more diverse group of MSM.

Key messages

MSM reporting PrEP use were more educated, older and more frequently born in a foreign country than non-PrEP users. MSM starting PrEP before and after February 2018 were similar, which may indicate that making PrEP available did not yet reach a more diverse group of MSM.
Psychiatric comorbidity and intellectual disability
Authors: Keyes K
Published: November 2019

Most research on the prevalence, distribution, and psychiatric comorbidity of intellectual disability (ID) relies on clinical samples, limiting the generalizability and utility of ID assessment in a legal context. This study assessed ID prevalence in a population-representative sample of U.S. adolescents, and examined associations of ID with socio-demographic factors and mental disorders. Data were drawn from the National Comorbidity Survey Adolescent Supplement (N = 6256). ID was defined as: 1) IQ ≤ 76, measured using the Kaufman Brief Intelligence Test; and 2) an adaptive behavior score ≤76, measured using a validated scale. The Composite International Diagnostic Interview assessed fifteen lifetime mental disorders. The Sheehan disability scale assessed disorder severity. We used logistic regression models to estimate differences in lifetime disorders for adolescents with and without ID. ID prevalence was 3.2%, and was more common among those with specific phobia (OR = 1.66, 95% C.I. 1.02, 2.68), bipolar disorder (OR = 7.24, 95% C.I. 2.10-24.99), after adjusted for demographic and clinical covariates. Among those with Axis I psychiatric disorder, adolescents with ID and mental disorders were significantly more likely to exhibit severe impairment than those without ID, across a broad range of disorders. These findings highlight how sample selection and overlap between ID and psychopathology symptoms might bias understanding of the mental health consequences of ID. For example, associations between ID and behavior disorders widely reported in clinical samples were not observed in a population-representative sample after adjustment for socio-demographic confounders. Valid assessment and understanding of these constructs may prove influential in the legal system by influencing treatment referrals and capital punishment decisions.
The positive effect of workplace accommodations on employment five years after a cancer diagnosis
Authors: Alleaume C , Paraponaris A , Bendiane M-K , Peretti-Watel P , Bouhnik A-D
Published: November 2019

Background

Each year, almost 400,000 new individuals are diagnosed with cancer in France and nearly half of them are in the working age. The disease was found to have a negative impact on professional life, especially for the most vulnerable cancer survivors. Literature reviews have pointed out the lack of studies focusing on the evaluation of interventions. In France, workstation layouts are recommended by the French law, but not mandatory to facilitate return to work. The aim of this study was to explore the effect of having a workstation layout after a cancer diagnosis on maintenance in employment five years after diagnosis.

Methods

We used the French VICAN survey carried out in 2015/2016 on living conditions five years after a cancer diagnosis. Using propensity score matching, we matched two subsamples (with and without workstation layout) to investigate the effect of workstation layout taking into account the characteristics associated with the access to these arrangements.

Results

Among the 1,514 individuals aged between 18 and 54 at diagnosis and employed in a salaried job at this time, three in five (61.2%) had a workstation layout within the five years following the diagnosis: 35.5% had a position type layout, 41.5% had a schedule layout, and 49.2% had a working time layout. Among those who had a workstation layout, 89.7% were still in employment five years after diagnosis against only 77.8% of those who did not so (p.value<0,001). After matching, having a workstation layout increased maintenance in employment from 77.8% to 95.0% (Average workstation layout effect on the treated of 0.172, 95% CI = [0.114; 0.229]).

Conclusions

Having a workstation layout after a cancer diagnosis strongly increases maintenance in employment of five years cancer survivors. More research is needed to better understand the differences in access to these arrangements and the related selection effect.

Key messages

Workstation layout increases maintenance in employment of survivors five years after a cancer diagnosis. Therefore, it should be used more systematically to facilitate work with a chronic disease. Having a workstation layout may constitute a disadvantageous selection bias for more vulnerable workers. It can also lead to discrimination feelings.
How does education affect diet in women? A comparison between Central and Southern Europe cohorts
Authors: Agodi A , Maugeri A , Magnano San Lio R , Favara G , Vinciguerra M , Barchitta M
Published: November 2019

Background

Comparisons among European populations is useful to identify opportunities for planning nutrition strategies to reduce social inequalities in health. Our study aims to identify dietary patterns in adult women and to evaluate their association with educational level in Czech Republic and Italy, which display different health inequalities.

Methods

We performed a cross-sectional analysis of women (aged 25-64 years) with no history of severe diseases, who have been recruited in Brno (Czech Republic; n = 957) and in Catania (Italy; n = 841). Dietary patterns were derived by Food Frequency Questionnaire and Principal Component Analysis. We tested the association between educational level (low vs. high) and adherence to dietary patterns. Logistic regression models were used to assess Odds ratio (OR) and 95% confidence interval (CI), after adjusting for age, employment status, marital status, smoking status, parity, BMI, and menopause.

Results

In both cohorts, we identified the healthy and the unhealthy dietary patterns. We observed that women with high adherence to the healthy dietary pattern were less educated in Czech Republic, and more educated in Italy. After adjusting for covariates, low educational level was positively associated with adherence to the healthy dietary pattern among Czech women (OR = 2.033; 95%CI=1.301-3.176; p = 0.002), and negatively associated among Italian women (OR = 0.166; 95%CI=0.029-0.952; p = 0.044). No association was identified between educational level and the unhealthy dietary pattern.

Conclusions

In the Italian cohort, findings were consistent with the notion that healthy dietary choices are less common among low-educated groups. By contrast, in newly developed countries such as the Czech Republic, the “nutrition transition” from traditional staples to western foods might be more common in highly-educated groups, probably due to the advocacy of Western culture through mass media and commercial marketing.

Key messages

Low educational level has an opposite effect on healthy diet, exhibiting a positive association in Czech women, and a negative association in Italian women. From a broader perspective, the observed effect of education on diet quality helps explain social health inequalities in Central and Southern Europe.
A future for all to INHERIT: taking integrated action on the environment, health and equity
Authors: Stegeman I , Strube R , Bell R , Zvěřinová I , Staatsen B
Published: November 2019

The need to act on climate change, and to modify how we live, move and consume is urgent; failure to do so will have catastrophic effects on health and wellbeing over the medium and long term. INHERIT, a large multi-sectoral research initiative (2016-2019) has explored what can be done to seize this as an opportunity to encourage and enable people to modify their behaviours towards ones that simultaneously protect the environment and promote health and health equity (the ‘INHERIT triple-win’).

One strand of INHERIT’s work has involved the identification, implementation and evaluation (qualitative, quantitative and cost-benefit) of 15 promising ‘triple-win’ interventions across the EU. INHERIT has also developed four positive scenarios of more sustainable futures, questioned 183 people about these, and surveyed 10,288 people from five countries across the EU about their current behaviours and incentives for change.

The results of these investigations paint a complex picture of what can be done to encourage and enable more people across the socio-economic gradient to adapt their behaviours. They reflect that improving health is a powerful motivator for action to protect the environment, yet there is often confusion about what is considered ‘sustainable’, whether this is always ‘healthy’ and vice-versa, let alone equitable. There is resistance in some countries to modifying some behaviours, like meat consumption. Many people fear that technological solutions will drive up isolation and inequities, and desire stronger community ownership over processes like food and energy production.

INHERIT outcomes reflect that it is possible to conjure common visions of the kinds of societies we want to transition to, and a willingness and potential to work across sectors to achieve these. This requires stronger individual and collective leadership, also from public health actors, who can play a key role in bringing together different actors and sectors to achieve these visions.

Key messages

The urgent need to address the environmental crisis presents an opportunity to simultaneously manage closely related societal challenges linked to health and equity. Public health actors can play a key role by bringing together the sectors, evidence and examples to instigate change, around the common interest of promoting human, which depends on planetary, health.
Portuguese cultural adaptation and validation of the European Health Literacy Survey (HLS-EU) for children aged 9 to 10 (HLS-EU-PTc)
Authors: Saboga-Nunes L , Dias H , Andrade C , Okan O , Bollweg T , Carvalho G , Bittlingmayer U
Published: November 2019

Introduction

To measure Health literacy (HL) as proposed in the context of the European Health Literacy Survey/questionnaire (HLS-EU-Q), the Health Literacy for Children and Adolescents (HLCA) Consortium (GE) adapted it for children. A trans-cultural adaptation and validation to Portuguese (HLS-EU-PTc), will supply policy makers, experts and health professionals with information that can promote healthier communities while fighting health disparities.

Methods

After permission was granted from the HLCA Consortium the TRAPD model was used (eg parallel translation, focus groups, two back translations). An assessment and pretesting of HLS-EU-PTc was done with 16 children for cognitive testing. A qualitative explanatory (n = 16) and quantitative, cross-sectional study (n = 82), age mean 13, SD 0.96, from Portugal (mainland) was implemented for proceed with the validation process. A variety of measures were obtained like internal consistency and mean scores.

Results

Preliminary results for evaluation of the psychometric properties of the HLS-EU-PTc show satisfactory internal consistency (Cronbach’s alpha coefficient 0.87). In a scale from 1 (very difficult) to 4 (very easy) for indicators of the HLS-EU-PTc, we have a mean of 3.25 and a SD of .478.

Conclusions

This is the first study to examine the feasibility of a Portuguese version (HLS-EU-PTc) of the HLS-EU-Q adapted for children and it indicates high internal consistency and level of self-reported HL. The usefulness of the HLS-EU-PTc instrument can be further discussed while planning public health policy strategies from the HL standpoint. The validated HLS-EU-PTc version of the HLS-EU-Qc survey, with the user’s manual can be accessed at www.literacia-saude.info.
How to frame our behaviour in order to limit climate change?
Authors: Van Den Hazel P
Published: November 2019

The climate is changing and speedy changes in society are needed to keep the damage within survival ranges. The aim is to keep the average raise of global temperature below 2 degrees Celsius. Changes in behavior of the overall population are needed to realize this aim. How can we get people to change? The research field of environmental psychology looks at framing issues to promote changes of behavior. More information helps to make people make decisions. Motivation is more important. Motivation is driven by our values and self-image. Four values are important for environmental behavior: hedonic, egoistic, altruistic and environmental values. Besides that culture, personal and timing issues play a role. The workshop explores the values in persons according to different examples. Can we influence the values to which we adhere? Socio-economic traits in people only explore a few percent in differences.

Discussion: different strategies can be used with people with different dominant values.

Public health is a major domain to support the local authorities to endorse the behavioral changes in the general population in order to limit the temperature increase.
Injuries of adult asylum seekers in Finland: results of the 2018 TERTTU-health and well-being survey
Authors: Doupi P , Skogberg N , Castaneda A , Garoff F
Published: November 2019

Background

Injuries in refugees and asylum seekers result of accidents, violence or most extremely torture. Research in Finland has shown that many refugees experienced major traumatic events in their former home country, incl. permanent injuries. Our study provides new evidence on asylum seekers, a scarcely studied group.

Methods

Data was collected by structured face-to-face interviews. Healthcare staff asked adult participants if they had a bodily injury or scar. If yes, they pointed the location on a pictogram. Interviewers inquired if the injury was accidental or result of violence and if it happened before or during the fleeing trip. Injuries were classified as head (incl. brain) injuries, injuries of torso/extremities or other body areas.

Results

About half (47, 2 %) of 779 adults reported injuries, men more often than women (55,1 % vs. 35,3 %). Frequency was highest in 18-29-year olds. Close to all respondents (94 %) sustained injuries prior to their journey. Over one in five attributed injuries to accident (men 27 %, women 16 %). 16,6 % reported the torso/extremities as injury location, while 9,4 % had head injuries. Violence was cause of injury in over one fourth of cases (28 %). Every third male and every fifth female were violence victims, with no significant age difference. In both genders odds of violence exposure was highest in asylum seekers from sub-Saharan Africa - over 50 % attributed injury to violence. Violence victims had injuries of torso/extremities in 20,5%, and of the head in 15,3%. Head injuries were more frequent in > 40 year-old violence victims of both genders.

Conclusions

Injuries are common among adult asylum seekers in Finland. Prevalence of violence induced injury, especially in sub-Saharan Africans, is alarming. Training in violence victims’ management is required for professionals receiving asylum seekers. Information on injury severity and functional ability is needed for full impact assessment and service planning (incl. rehabilitation).

Key messages

Injuries are common among adult asylum seekers and often a result of violence, thus requiring of receiving services’ professionals skills and knowledge in violence victims’ management. Health examination protocols of asylum seekers should include injury severity assessment and impact on functional ability.
Monitoring Fetal Alcohol Spectrum Disorder during the neonatal period in France
Authors: Laporal S , Demiguel V , Cogordan C , Barry Y , Guseva-Canu I , Goulet V , Germanaud D , Regnault N
Published: November 2019

Background

Alcohol is a known teratogenic and foetotoxic agent. At birth, only the complete foetal alcohol syndrome (FAS) and at most a suspicion for some incomplete syndromic forms can be diagnosed. Yet, other Consequences of prenatal Alcohol Exposure (CAE) can also be observed and recorded in the neonatal period. Our goal was to describe the frequency of diagnosis codes for FAS and CAE at the national and regional level.

Methods

Between 2006 and 2013, we identified the ICM-10 codes Q860 (FAS) and P043 (CAE) in the hospital records for stays occurring in the 28 first days of life in the French national health insurance database (SNDS). Our “potential Foetal Alcohol Spectrum Disorders group” (pFASD), included the FAS and CAE subgroups. The pFASD prevalence was estimated per 1000 live births at the national and regional levels overall and then comparing: 2006-2009 and 2010-2013.

Results

From 2006 to 2013, 3207 neonates were diagnosed with pFASD during the neonatal period, i.e. 0.48 cases per 1,000 live births, including 0.07‰ of FAS. Between 2006-2009 and 2010-2013, pFASD remained stable (p = 0.6). At the regional level, the proportion of pFASD was the most frequent in one of the overseas territories (La Reunion Island, 1.22‰ births) and in the north-eastern part of mainland France (0.90 ‰ births to 1.02 ‰).

Conclusions

This study is the first to produce a national estimate of the frequency of neonatal diagnosis of FAS. It shows a stability of the frequency of pFASD cases recorded over the 2006-2013 period which is certainly underestimated but gives a first minimal estimate of the burden of alcohol use during pregnancy in France.

Key messages

Alcohol use during pregnancy remains a public health issue in France. Estimating the prevalence of FAS is of undeniable priority given the public health implications of these disorders that hinder the development of children exposed, and their avoidable nature.
Motivation for change, cornerstone of diabetes self-management in patients with type 2 diabetes
Authors: Stanojevic V , Jevtic M , Mitrovic M
Published: November 2019

Background

Personal motivation for change plays a fundamental role in creation of sustainable changes regarding diabetes self-management. The aim of this study is to assess the motivation as well as the relation between the level of patient`s motivation in relation to disease characteristics, metabolic control, behavioral determinants and the barriers patients encounter in diabetes self-management.

Methods

The data for this cross-sectional study were obtained by combining anthropometric measurements (body mass index-BMI), biochemical parameters (glycosylated hemoglobin-HbA1c) and by interviewing respondents using certain sub-scale of a structured Personal Diabetes Questionnaire (PDQ).

Results

The sample consisted of 117 respondents with T2DM. The majority (61.06%) was not motivated to make self-management changes. Non-motivated respondents were older than 65 years of age (X^2=8,046; p = 0.005) and had: a lower level of education (X^2=35.320; p = 0.000), diabetes for more than 10 years, poor glyco-regulation (90,14%) and were overweight / obese (81,7%). Motivated respondent were more physically active (X^2=6.439; p = 0.000), more adherent to anti-hyperglucemic therapy (OHAs) (X^2=9.673; p = 0,002), and more adherent to dietary regime. Average barrier scores: in the following healthy diet [t=-7.960; p = 0.000], in therapeutic adherence [t=-4.318; p = 0.000] and physical activity [t=-6.439; p = 0.000] were also statistically significantly different with the high impact in relation to respondents’ motivation.

Conclusions

Assessment of the motivation for changes in diabetes self-management should become an integral part of monitoring patients with T2DM in Primary Health Care (PHC). In this way, individual advisory strategies could be developed, because motivated and not motivated persons have different needs for counseling.

Key messages

Motivated and not motivated persons with T2DM have different needs for counseling. Assessment of the motivation for changes in diabetes self-management should become an integral part of monitoring patients with T2DM.
Knowledge and attitudes about Human Papillomavirus and its prevention in Italian students, 2018
Authors: Romanese F , Brunelli L , Bravo G , Righini M , Lesa L , De Odorico A , Miceli S , Pascut S , Bastiani E , Brusaferro S
Published: November 2019

Background

Human Papillomavirus (HPV) infections show an estimated prevalence of 290 millions of cases worldwide, being the most common viral infection related to the reproductive tract and the main cause of cervical cancer. Being HPV vaccination currently recommended for both genders, we assessed knowledge and attitudes regarding HPV prevention among high school students in Udine, Northern Italy.

Methods

Between April and May 2018, a sexual and reproductive health anonymous questionnaire was proposed to first-year students in five academic, technical and vocational upper secondary schools of Udine. In particular, students were asked about HPV related diseases, whether they were vaccinated against HPV and how that decision was taken. Data were analyzed by school type and gender using Chi Square Test with α = 0.05.

Results

A total of 747 questionnaires were collected from 990 students; both genders had a mean age of 14.8±0.9 years, 59% of respondents were males. Technical high school students were 42% of the sample, while 30% came from vocational and 28% from academic high schools. Genital warts and cervical cancer were identified as HPV-related by 8% and 20% of students respectively, the latter more frequently in technical institutes (p = 0.0016) and in females (43% vs 13%, p < 0.001). Almost 54% of students did not know if they were immunized against HPV; academic school students and females declared more frequently to have received at least one vaccine dose compared to others (p < 0.001). Almost two thirds of respondents reported to have undergone vaccination due to a parental decision; parents discussed this choice more frequently with academic students (p = 0.0016) and females (22% vs 14%, p < 0.001).

Conclusions

Girls and technical school students are more informed about HPV, while adherence to immunization schedules is higher in females and those attending academic school. Parents appear to create a supportive environment for females.

Key messages

The different level of knowledge by gender can be explained by past vaccination campaigns, mainly focused on girls, and by parental proactivity towards females. There is room for improvement in HPV-related knowledge and prevention among both adolescents in general and males in particular as they can play an important role to reduce the burden of HPV.
Community-based testing of migrants for infectious diseases in the UK (COMBAT-ID)
Authors: Pareek M
Published: November 2019

Background

Migration is a major global driver of population change. Certain migrants may be at increased risk of infectious diseases, including tuberculosis (TB), HIV, hepatitis B and hepatitis C, and have poorer outcomes. Early diagnosis and management of these infections can reduce morbidity, mortality and onward transmission and is supported by national guidelines. To date, screening initiatives have been sporadic and focused on individual diseases; systematic routine testing of migrant groups for multiple infections is rarely undertaken and its impact is unknown. We describe the protocol for the evaluation of acceptability, effectiveness and cost-effectiveness of an integrated approach to screening migrants for a range of infectious diseases in primary care.

Methods and analysis

We will conduct a mixed methods study which includes an observational cohort with interrupted time-series analysis before and after the introduction of routine screening of migrants for infectious diseases (latent TB, HIV, hepatitis B and hepatitis C) when first registering with primary care within Leicester, UK. We will assess trends in the monthly number and rate of testing and diagnosis for latent TB, HIV, hepatitis B and hepatitis C to determine the effect of the policy change using segmented regression analyses at monthly time points.

Concurrently, we will undertake an integrated qualitative sub-study to understand the views of migrants and healthcare professionals to the new testing policy in primary care. Finally, we will evaluate the cost effectiveness of combined infection testing for migrants in primary care.

Ethics and dissemination

The study has received HRA and NHS approvals for both the interrupted time-series analysis (16/SC/0127) and the qualitative sub-study (16/ EM/0159). For the interrupted time-series analysis we will only use fully anonymised data. For the qualitative sub-study, we will gain written, informed, consent.
Integrating HBV, HCV and HIV screening in tuberculosis entry screening for migrants in the Netherlands
Authors: Bil J , Schrooders P A G , Prins M , Kouw P M , Klomp J H E , Scholing M , Huijbregts L , Sonder G J B , Waegemaekers T , Tostmann A ,   Health, Netherlands, EuroHealthNetChair persons: Yvette Shajanian Zarneh - Germany, Anne-Catherine Viso - France
Published: November 2019

We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV)

screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCVpositive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI): 2.37-8.29) and 0.99% (2/203; 95% CI: 0.27-3.52), respectively, all infections were

newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI: 0.07-2.18), 1.17% (3/256; 95% CI: 0.40-3.39) and 0.39% (1/256; 95% CI: 0.07-2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR) = 5.45; 95% CI: 1.12-26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; OR = 0.04; 95% CI: 0.00-0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis

screening. Prescreening selection of migrants based on risk factors merits further exploration.
Experience, challenges and support required by local authorities to implement alcohol control policies
Authors:   Josian Hoareau
Published: November 2019

Panel discussion with speakers, questions and answers

Closing remarks by co-chairs