bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging the information gap on cancer survivors in Europe: results from the iPAAC Joint Action
Authors: De Angelis R , Demuru E , Rossi S , Ventura L , Baili P , Bettio M
Published: October 2020

Background

Due to demographic transition cancer survivors are dramatically growing and challenging the sustainability of public health systems. Despite accurate indicators are increasingly needed for Health Technology Assessment and health care planning, population-based cancer prevalence is not systematically available in many countries. The European Joint Action “Innovative Partnership for Action Against Cancer” (iPAAC) aims at bridging this gap by supporting the inclusion of indicators on prevalence to complement the cancer burden statistics already available in the European Cancer Information System (ECIS).

Methods

Analysis of a European-wide standardized dataset gathering information on 26 million patients from 100 cancer registries in 29 countries (EUROCARE-6). Methods to estimate and project complete and limited duration population-based prevalence indicators by demographic variables, cancer type and phase of care.

Results

Cancer survivors are mostly women (about 55%) and people over-60 years. Highest crude prevalence proportions in women are observed for breast, colon-rectum, corpus uteri, skin melanoma and cervical cancer (from 1,600 to 200 x 100,000). Prostate, colon-rectum, bladder, non-Hodgkin lymphoma and skin melanoma were the most frequent cancers among male survivors (from 1,000 to 200 x 100,000). Between-country differences are wide, consistently with varying demographic structure, incidence and survival patterns. Impact of long-term survivorship strongly depends on disease lethality.

Conclusions

Cancer survivors are a quite heterogenous population in respect of age, sex, cancer type and disease duration. Reliable and comparable prevalence indicators are essential to improve cancer care planning in European countries. Joint analysis of European wide population-based datasets strengthens the impact of cancer registries information and foster the release of complete statistics on cancer survivors.

Key messages

Cancer survivors are a growing and heterogeneous population to be monitored in public health. Detailed and comparable indicators on cancer prevalence are proposed to complement the cancer burden statistics of the European Cancer Information System (ECIS) through improved collaborative efforts.
Child abuse and all-cause mortality in the Canadian population
Authors: Bhattarai A , Dimitropoulos G , Williams J , Bulloch A , Patten S
Published: October 2020

Background

A history of child abuse is common and is associated with the later occurrence of risky health behaviors, mental disorders, and chronic conditions, strongly suggesting that child abuse may be associated with elevated mortality. However, most of the literature on child abuse has studied psychosocial/behavioral or medical outcomes and have not addressed mortality directly.

Methods

Data from the 2012 Canadian Community Health Survey, linked to the Canadian Vital Statistics Database, were used in the analysis. The CCHS-2012 interview (n = 19,830) retrospectively assessed childhood physical abuse, sexual abuse, and witnessing intimate partner violence before the age of 16. Each type of abuse was analyzed separately using Cox proportional hazards models for all-cause mortality. Hazard ratios (HR) and associated 95% confidence intervals (CI) were estimated with and without adjustment for covariates.

Results

An effect on mortality was observed among men for witnessing interpersonal violence (age-adjusted HR 2.47, 95% CI 1.48-4.12), and severe physical abuse (age-adjusted HR 2.3, 95% CI 1.21-4.36). In each case, the association was not significant for women; the age-adjusted HRs being 0.93 (95% CI: 0.51-1.70) and 0.59 (95%CI: 0.64-2.60) respectively. The association was seen only among those reporting frequent abuse ( > =10 times) and weakened (became not significant) with adjustment for covariates that may mediate the association such as smoking and chronic conditions.

Conclusions

As predicted by a broader literature on childhood adversity, child abuse increases the risk of mortality. The effect was significant for severe physical abuse in men, but imprecision due to a limited number of deaths may have rendered other associations non-significant. The study provides some degree of confirmation that child abuse contributes to later life mortality. Hence public health strategies that prevent child abuse and mitigate the harms of the mediators might prevent mortality.

Key messages

Witnessing intimate partner violence is just as harmful as actually experiencing physical abuse. Preventing children's exposure to violence in family is valuable in preventing mortality in adulthood. Enhancing child abuse prevention programs and mitigating the harmful effects of the mediators such as smoking, substance use, and chronic conditions is important in reducing mortality in adult life.
Supportive maternity care services: A Danish study exploring parents’ experiences with perinatal mental health issues
Authors: Frederiksen M S , Schmied V , Overgaard C
Published: October 2020

Background

Mental illness can have negative impact on pregnant women, their infants and their families, including adverse birth outcomes, as well as place children at risk of developing mental illness later in life. It is recommended to offer additional support in the ante - and postnatal period, but to be able to offer appropriate, timely and effective care, more knowledge is needed on women's own experiences. The aim of this paper is to explore women's experiences with mental illness in the context of pregnancy and early motherhood, and how they experience and engage with supportive services.

Methods

This paper presents selected findings from an ethnographic field study carried out in a Danish municipality. The findings are based on data from 22 women, who were recruited when they were pregnant or had a newborn baby. The women were currently facing or had previously suffered from one or multiple mental health conditions.

Results

Analysis found that women with current or prior mental illness experienced a high level of fear, worries and uncertainty during pregnancy and early motherhood, which shaped how they engaged with supportive maternity services. Some were deeply worried about their mental health and reached out for support to cope with this. Concerns about being a bad mother and about the potential influence of their mental illness on their infants were common. Furthermore, some women were scared of being judged as unfit mothers and losing custody of their children. Many experienced stigma surrounding mental illness, making some more hesitant about reaching out for support.

Conclusions

By providing new insight into women's own perspectives, this study contributes with in-depth knowledge on women's experiences with mental illness during pregnancy and early motherhood, and illustrates how engaging with supportive services may be an ambivalent experience.
Social inequalities in overweight and obesity in 26 European countries
Authors: Charafeddine R , Demarest S , Drieskens S , Renard F
Published: October 2020

Background

Previous studies have shown inequalities in overweight and obesity in disfavor of the socially disadvantaged groups. This study examines the extent of these inequalities in 26 European countries.

Methods

Data from the 2017 EU Statistics on Income and living Conditions (EU-SILC) were used (18 years and older, n = 482,595). A body mass index of 25.0 to 29.9 kg/m2 was classified as overweight and 30.0 and more as obese. Educational level (EL) was used as socioeconomic indicator. Generalized linear models were fitted to compute low-versus high absolute (RD) and relative (RR) inequality. Absolute inequality amplitude (RDA) was calculated as RD/Prevalence.

Results

Among men, average EU inequalities for overweight were slightly in disfavor of the low educated (RR = 1.05, RDA=5%). A mixed inequality pattern was observed across countries, as the risk of overweight was higher among high educated men in most Eastern countries, in contrast to other parts of Europe (RR from 0.74 to 1.19, RDA from -27% to 20%). Male obesity showed more pronounced inequalities (RR = 1.22, RDA=18%), and a consistent pattern of higher risk among the low educated and wide variation across countries (RR from 1.20 to 2.18, RDA from 16% to 49%). Among women, significant inequalities in overweight were observed (RR = 1.23, RDA=21%), with a consistent pattern of higher risk among the lowest EL, and substantial variation across countries (RR from 1.06 to 1.53, RDA from 7% to 36%). Inequalities were even larger for female obesity, with average RR and RDA reaching 1.49 and 35%, and wider variation (RR from 1.35 to 2.77, RDA from 12% to 88%).

Conclusions

Social inequalities in weight status are widespread in Europe, but vary substantially between countries. Inequalities are larger among women. For male overweight, a reverse inequality is observed in most Eastern countries. This study allows countries to benchmark the inequalities observed nationally to the situation in other EU countries.

Key messages

Social inequalities in weight status are widespread in Europe. The pattern of social inequalities in overweight and obesity varies substantially by country and gender.
The risk of preterm birth in combinations of mental disorder and socioeconomic position among Danish women
Authors: Knudsen C K , Christensen A M S , Heuckendorff S , Fonager K , Overgaard C
Published: October 2020

Background

Inequality in preterm birth is a public health challenge requiring identification of pregnant women at particularly high risk of preterm birth. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of mental health conditions and socioeconomic position.

Methods

Based on Danish registries, we conducted a nationwide cohort study including all first-time mothers giving birth to a singleton liveborn infant in Denmark between 2000 through 2016. We examined the risk of preterm birth (<37 weeks of gestation) in different combinations of mental health conditions (no, minor, and moderate/severe) and educational level (high, intermediate, and low) in three age strata (<25, 25-30, and >30 years). The relative risk of preterm birth was estimated using Poisson regression with a robust error variance. We measured the attributable proportion to assess additive interaction between the effects of exposures.

Results

Of the 415,523 included first time mothers, 29,069 (7,0%) gave birth preterm. The risk of preterm birth increased in combinations of higher degree of mental health conditions, lower degree of educational level, and increasing age. Women aged>30 years with moderate/severe mental health conditions and low educational level had the highest risk of preterm birth (13.7%). The analysis of additive interaction revealed only a limited additional effect of being exposed to mental health conditions and lower educational levels in each age strata. However, positive additive interaction was found between age>30 year and combinations of mental health conditions and educational level.

Conclusions

Substantial inequality in preterm birth remains with increasing risk in women with combinations of higher degree of mental health conditions and lower degree of educational level. In the prevention of inequality in preterm birth special attention on women aged>30 years exposed to mental health conditions and lower educational levels is essential
Variations in use and access of mental health services in Europe
Authors: Borghini A , Seghieri C , Brodo L , Breschi M
Published: October 2020

Background

Mental illnesses comprise a wide range of mental health (MH) conditions -prevalence 3,90%- among European (EU) countries with significant effects on quality of life, life expectancy and disability. They are also related to substantial direct and indirect costs, consequences of inpatient care - not always beneficial for those patients. The main goals of our study are: to report on geographic variations in utilization rates and quality of care for adults MH diseases among 30 EU countries and regions; to explain the determinants of such variations.

Methods

Different data from EUROSTAT regarding healthcare resources, activities and self-perceived health and wellbeing for the years 2013-2015 are combined in a unique database at level of EU countries and NUTS 2 regions to allow for comparisons in utilization rates, perceived conditions and service local supply for MH diseases in Europe.

Results

Preliminary findings show a decline in the global trend of hospitalization rates for mental diseases; however, significant variations were observed among and within countries (High-Low ratio=25 in 2015, at country level). Males were more hospitalized than females (p = 0.40). Women were more likely than men to report depressive symptoms and to access to MH consultations (p < 0.001). Significant and positive correlations were found between resources (hospital beds and psychiatrists per capita) and adjusted hospitalization rates for MH disorders and between self-reported MH consultations and psychiatrists per capita (p < 0.001).

Conclusions

Preliminary findings confirm the presence of wide variations in the care of mental diseases across and within EU countries. Significant correlations between utilization rates and local supply of resources might indicate that part of the variation might be explained by differences in the local organization and availability of resources rather than patients' needs.

Key messages

There is a wide variation in the care of mental diseases across and within EU countries which might be explained by differences in the local organization and resources instead patients’ needs. These results can help policy makers and professionals to identify unwarranted variations that need to be removed and to shift to value-based healthcare.
Impact of maternal mental health problems on perinatal outcomes for the infant
Authors: Christensen L F , Heuckendorff S , Fonager K , Overgaard C
Published: October 2020

Background

Mounting evidence suggests that mental health problems in pregnant women may negatively affect the intra- and extrauterine health and development of the child. This is especially of concern as the prevalence of mental health problems in pregnant women is high and believed to be increasing. We set out to quantify the effect of maternal mental health status on the risk of adverse perinatal outcomes for the infant.

Methods

We undertook a nationwide register-based cohort study including children born alive in Denmark between 2000 and 2016. The exposed cohort was children born to mothers with mental health problems in the two years prior to childbirth that had been cared for in primary care settings only (Group 1, minor problems, n = 71 759) or had required psychiatric intervention (Group 2, moderate-severe problems, n = 41 099). All non-exposed children served as comparison group (n = 908 268). We calculated risk ratios (RRs) with 95% confidence intervals (CI) for each perinatal outcome of interest.

Results

Infants in Group 1 as well as Group 2 were at higher risk of neonatal death than infants born to unaffected mothers, although for Group 2 the trend was non-significant (Group 1: adjusted RR (aRR) 1.34, 95% CI 1.17-1.52; Group 2: aRR 1.11, 95% CI 0.94-1.32). Both exposure groups were furthermore at significantly increased risk of 5-minute Apgar scores <7 (Group 1: aRR 1.27, 95% CI 1.17-1.37; Group 2: aRR 1.52, 95% CI 0.94-1.32) and <4 (Group 1: aRR 1.26, 95% CI 1.10-1.44; Group 2: aRR 1.28, 95% CI 1.08-1.52) and of hospital admission in the neonatal period (Group 1: aRR 1.22, 95% CI 1.19-1.24; Group 2: 1.29, 95% CI 1.26-1.32), paralleled by a significantly higher risk of preterm birth and several neonatal morbidities.

Conclusions

Infants born to mothers with moderate-severe as well as minor mental health problems were at increased risk of multiple adverse perinatal outcomes, thus calling for effective preventive strategies to improve outcomes in both groups.
28.K. Workshop: Advancing health inequality monitoring in Europe – challenges, opportunities and actions
Authors:   Organised by: JAHEE,   Chair persons: Malin Ahrne - Sweden, Gabriella Olsson - Sweden
Published: October 2020

Much of the focus on health inequality monitoring is based on aggregate descriptions at national levels where averages or proportions are compared. However, inequalities evolve from systematic differences in living conditions, circumstances, and opportunities between population groups within geographical entities. To be able to follow such trends in health, to detect less favourable trends at an early stage, and to reveal the trends in the population and in subgroups of the population, it is essential to have a national health inequality monitoring system (HIMS) in place. In fact, in line with the “no data, no problem” notion, one might even claim that the most essential part of combatting social inequalities in health is a well-functioning health inequality monitoring system.

The Joint Action Health Equity Europe (JAHEE) is a Joint Action financed by the Third Health Programme 2014-2020 of the European Union. It represents an important opportunity for countries to work jointly to address health inequalities and achieve greater equity in health outcomes across all groups in society in all participating countries and in Europe at large. One of the aims with JAHEE and the specific focus of work package five (WP5) is to advance member states ability to monitor national health inequalities.

The overall objective of the work conducted in JAHEE WP5 is to attract attention to and improve countries' capacity to monitor health disparities in a “do something, do more, do better” manner. The advancement of HIMS varies greatly between countries in Europe. Yet, there is scope for improvement in virtually all countries. In addition, challenges that impede the way health inequality monitoring can be conducted are often common across countries. These challenges cannot be eliminated within the course of a three-year EU project. The JAHEE project, however, offers an unique opportunity to move forward by working together in a structured work process that allow partner countries to share, build and transform available knowledge into concrete actions aimed at strengthening national health inequality monitoring systems in Europe.

In this workshop, we will present the experiences from JAHEE WP5 and give examples on concrete actions and initiatives taken across Europe to challenge some of the barriers faced and to strengthen the national health inequality monitoring processes in Europe. There will be room for discussion between each presentation and in the end of the workshop.

Key messages

Raised awareness a politically committed system infrastructure to assure sustainability in health inequality monitoring. Raised awareness of need for agreed data but also agreed methods to compile data to measure inequalities within populations.
Joint Action Health Equity Europe - turning knowledge on health inequality monitoring into actions
Authors: Olsson G , Henriksson G
Published: October 2020

Growing social inequalities in health challenge a sustainable development. To reduce health inequalities, it will be necessary to provide relevant data to policymakers on how health inequalities and the social determinants of health are distributed within populations over time, i.e. it will be necessary to form appropriate health inequality monitoring systems (HIMS).

One of the aims with Joint Action Health Equity Europe (JAHEE) and the specific objective of work package five (WP5) is to advance partner countries ability to monitor national health inequalities. Country assessments has been conducted to assess the status of the HIMS in the participating countries, and a joint framework has been developed, describing the core components of an “ideal” HIMS. All partners have committed to the overall objective of the WP5 through the identification and implementation of concrete actions, which is now ongoing.

The countries in JAHEE WP5 are Cyprus, Finland, Germany, Italy, Lithuania, Netherlands, Poland, Romania, Serbia, Slovenia, Spain and Sweden, where The Public Health Agency Sweden is the lead.

The aim of this presentation is to present the experiences from JAHEE WP 5, and what they imply is needed to build coherent health inequality monitoring systems at a national level. More specifically, the JAHEE project in general, the WP5 project in particular will be presented, the structured work process described, and some general results and conclusions discussed
Towards a national health equity monitoring strategy
Authors: Costa G , Zengarini N , Marra M
Published: October 2020

The 2017 Italian Review on health inequalities identified two main needs with regards to Italian health equity monitoring. (1) The need to collect a social covariate at individual level in each health information system at local, regional and national level. Such a social covariate is fundamental for monitoring if any avoidable inequality in access, use, quality of care and health outcome is occurring at local, regional, national level. (2) The need to re-engineer and frame the different health equity monitoring surveys already established into an explicit health inequalities monitoring strategy (HIMS). Both challenges are accounted for by Italy in the Joint Action Health Equity Europe workplan.

As for the social covariate, a pilot project is conducted. Data from 2011 census (education and area deprivation) and the national identification code used to link individual data on health and services utilization in four representative regions is linked. This will allow monitoring the social variation in selected performance indicators by region, across regions and through time.

As for HIMS, previous research projects have designed and successfully piloted different models of low-cost data linkage for already established longitudinal studies. Now these pilot results will evolve into a national HIMS. As a first step, a special project of consensus building will be implemented among institutional partners responsible for the following national longitudinal studies based on record linkage: a) Work Histories Italian Panel followed up prospectively for health outcomes; b) Italian Longitudinal Study: 2000, 2015, 2013 Health Interview Surveys followed up prospectively for health outcomes; c) differential mortality 2011-2017 in the 2011 censused Italian population; d) the network of the metropolitan and regional census based longitudinal studies followed up prospectively for mortality disease registries and health care utilization. Experiences gained will be shared and discussed.
Effectiveness of a school-based intervention for adolescents and teachers to promote mental health among refugee and migrant adolescents
Authors: Osman F , Sarkadi A , Feldman I , Tökés A , Perez-Aronsson A , Torp L , Durbeej N
Published: October 2020

Refugee youth have often experienced trauma during relocation and continue to face adversity in their host country in the form of acculturation stress, residence insecurity, social isolation, and experiences of discrimination. These experiences are associated with a significant risk of developing mental health problems such as post-traumatic stress disorder (PTSD). This cluster randomised trial aims to evaluate the effectiveness of a school-based intervention that provides a manualized, trauma-focussed programme called Teaching Recovery Techniques (TRT) to target refugee and migrant youth and an In-Service Teacher Training (INSETT) programme to teachers. The study will consider the impact of the intervention on the mental health of adolescent refugees and their guardians who participate in the TRT programme. It will also consider the intervention's impact on the interrelationships between teachers and parents and teachers' cultural competence, as well as the social support and school belonging experienced by adolescents who do not participate in TRT but whose teachers receive INSETT training. Further details on TRT and INSETT, trial design and preliminary findings will be presented at the workshop.
Psychiatric care utilization among children in refugee families – a Swedish population-based study
Authors: Berg L , Hjer A , Mittendorfer-Rutz E
Published: October 2020

Background

Previous studies have demonstrated a high prevalence of mental health problems, in particular depression, anxiety, and posttraumatic stress disorder (PTSD), among individuals with experiences of war, persecution, and torture. Mental health problems can affect parenting and the well-being of the children. However, few large-scale studies have investigated the intergenerational effects of psychological trauma on children in refugee families.

Methods

Register data on all children living in Stockholm, Sweden, in 2016 (>90 000) were used to investigate utilization of child and adolescent psychiatric care in relation to parental PTSD, in foreign-born and Swedish-born refugee children compared to non-refugee children.

Results

In total, 13% of children in refugee families had a parent who had been treated for PTSD. Preliminary results showed an increased risk of psychiatric care use among foreign-born refugee children (HR: 2.68, 95% CI: 2.08-3.44) and in Swedish-born children in refugee families (HR: 1.86, 95% C.I: 1.43-2.41), whose mothers had been treated for PTSD. No association was observed in relation to PTSD diagnoses in fathers.

Conclusions

The findings indicate that refugee children with experience of PTSD of the mother were more than twice as likely to have been in contact with child and adolescent psychiatric services. This underlines the importance of making mental health care available so that adequate support and treatment is offered to refugees and their children.

Key messages

This study contributes with important information on the intergenerational effects of psychological trauma in refugee families. In order to prevent mental health problems in refugee children, Public health interventions for their parents with PTSD are crucial.
29.A. Workshop: Implementation of smokefree prisons across a national prison estate: experience from Scotland
Authors:   Organised by: University of Stirling (UK),   Chair persons: Alastair Leyland - UK, Kate Hunt - UK
Published: October 2020

Objective

To present findings from the multi-methods, 3-Phase Tobacco in Prisons (TIPs) study, a comprehensive evaluation of the development, preparation for, implementation and outcomes of smoke free policy across Scotland's prison. Prisons had partial exemption from UK policy banning smoking in enclosed public spaces, and became one of few workplaces with continued exposure to secondhand smoke (SHS). Prison smoking bans have been introduced elsewhere, but evidence of the process and impact of implementing smokefree prisons is sparse. By presenting papers using different methods (objective measurements of SHS; qualitative focus group/interview data, surveys with people in custody and staff; prisoner purchasing data and an economic analysis), the workshop will demonstrate the success of implementing smokefree prison policy and the factors contributing to this success and related outcomes. It will discuss some of the challenging issues and decisions which other jurisdictions may face when considering a smokefree policy.

Format

The format of the workshop will comprise oral presentations from members of the TIPs research team. This will begin with an overview of a) the rationale for and challenges of implementing smokefree policies in the prison context, and b) the methods used during the three phases of the TIPs study. There will then be presentations on: (i) SHS exposure pre-post ban; (ii) experiences and opinions of staff including the use of e-cigarettes in prisons; (iii) the impact of smokefree policy on prisoner spend in the 'canteen' (prison shop); the impact of smokefree prison policy on medications dispensing; (v) the economic impacts of the smoke-free prison policy.

As a study of an entire national prison service. This evaluation of the development, planning, implementation and impact of smokefree policy demonstrates the importance of research evidence for policy implementation, providing new evidence for other jurisdictions contemplating bans on smoking in prisons.

Key messages

Smokefree prison policy can be successfully implemented with support, partnership working and good communication. Exposure to secondhand smoke in prisons rapidly declines.
Changes in exposure to second-hand smoke following a smoking ban across a national prison system
Authors: Demou E , Dobson R , Sweeting H , Brown A , Sidwell S , O'Donnell R , Hunt K , Semple S
Published: October 2020

Background

Prisons were one of few workplaces where smoking was still permitted after the smoking ban in indoor public places in Scotland in 2006. This study compares SHS exposure assessments in Scotland's 15 prisons six months after smokefree policy was introduced (in Nov 2018) with levels measured in 2016 before the policy was announced.

Methods

In 2016, 128,431 mins of PM2.5 (marker of SHS) concentration data were collected from residential halls and 2,860 mins for 'task-based' measures; 2019 figures were 126,777 and 3,073 mins. Six days of fixed-site monitoring in halls in each prison commenced on 22.5.19. Task-based measurements were conducted to assess SHS for specific locations and activities (e.g. cell searches). Typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average exposure concentrations were estimated for shift patterns for residential staff pre- and post-implementation of the policy. Staff self-reports of exposure to SHS were gathered via surveys.

Results

Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by > 91% compared to baseline. Changes in the task-based measurements (89% average decrease for high-exposure tasks) and time-weighted average concentrations across shifts (>90% decrease across all shifts), provide evidence that staff exposure to SHS has significantly reduced. The percentage of staff reporting no exposure to SHS rose post-ban.

Conclusions

This is the first study to objectively measure SHS levels before, during and after implementation of smokefree policy across a country's prison system. The dramatic reduction in SHS exposures confirm complementary qualitative data and stakeholder reports of the ban's success in removing tobacco. The findings show that SHS can be effectively eliminated through a well-applied smoking ban in the challenging context of prisons; and are highly relevant for other jurisdictions considering changes to prison smoking rules.
Understanding how corporations both drive & use neoliberalism to block progress in public health
Authors: Miller D
Published: October 2020

This paper examines the role of corporations in the creation and utilisation of think tanks, lobby ventures and front groups, both nationally and internationally. It examines how these were implicated in the introduction of neoliberalism in the 1970s/80s. It briefly tells the story of the development of the Mont Pelerin Society and how its acolytes 'littered the world' with free market think tanks which then did battle in the struggle to introduce neoliberalism. It examines how this led to the 'disembedding' (Polanyi 1944) of political and economic elites from society via the rise and maturation of a wide range of intermediary institutions and organisations including three main kinds of groups: National and transnational policy planning groups; Think tanks and think tank networks; lobbying and public relations consultancies. This part of the paper concludes by examining the role of those industrial sectors that have had the most significant Public Health footprint in the neoliberal revolution, in each of the three kinds of groups mentioned above.

The paper then turns to the concrete advantages that these ongoing changes gave specific corporate actors with negative public health effects
Breast cancer screening: a survival analysis in Algarve, Portugal
Authors: Rodrigues Gouveia C , Horta Correia F , Pereira R , Ferrinho D , Almeida D
Published: October 2020

Background

Breast cancer is the leading cause of cancer death in women worldwide and it is an health concerns in Algarve, a southern region in Portugal. The mammographic screening is performed with the aim of early detection and reduce mortality due to breast cancer. However, there are some controversies with mass screening due to overdiagnosis, overtreatment and false-positive results. We examined whether tumor characteristics were different for women with breast cancer diagnosed via mass screening compared with women non-participants of the screening programme. We also explored the survival differences between the groups.

Methods

We performed a cohort study using the data obtained from Registo Oncológico Nacional, the Portuguese national cancer registry, and the regional breast cancer screening programme. The Chi-squared test, Fisher exact test, and Mann-Whitney test was performed to test the differences with the screening status. For survival analysis, the Kaplan-Meier curves were examined and then we used Cox regression to explore the differences in survival by screening status.

Results

The worsen stages and the HER2 expression were significantly associated with being a non-participant of the regional screening programme. The survival time was also different with women screened having a bigger survivance when compared with non-participant. After the adjustment for variables associated with screening status, there was no evidence that the risk of women with breast cancer screening-detected was different from women non-participant.

Conclusions

Screening status was associated with a better tumor stage and non HER2 expression. Despite the lead-time bias, it was not identified survival differences between screening status, which is in agreement with other breast cancers survival analysis. These results are in agreement with the commission of the regional breast cancer screening programme in identifying precociously the breast cancers.

Key messages

Breast cancer screening in Algarve identify precociously the breast cancers. There is no evidence that the risk of women with breast cancer screening-detected was different from women non-participant in breast cancer screening in Algarve.
Mortality Outcomes in People Experiencing Homelessness Across England: a population-based study
Authors: Menezes D , Lewer D , Yavlinsky A , Tinelli M , Aldridge R
Published: October 2020

Introduction

The number of people experiencing homelessness in England has increased since 2010 and a recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries. In this study we examine the death rates in people experiencing homelessness after discharge from hospital.

Methods

This is a study of linked hospital admission records and mortality data for two groups. First, a “Homeless group”: people seen by 17 specialist homeless discharge schemes between 1 November 2013 and 30 November 2016. Second, an “IMD5 group”: A matched group of patients who live in deprived areas and have the same age and sex, and were discharged from the same hospital in the same year as the homeless patient. Our analysis entailed calculating mortality rates across each group and by the number of comorbidities.

Results

The mortality rate for the IMD5 group was 1,935 deaths per 100,000 person years, compared with 5,691 for the homeless group, giving a rate ratio of 2.9 (95% CI 2.5-3.5). The mortality risk increased with the number of comorbidities. Individuals in the IMD5 group with zero comorbidities had a death rate of 831 per 100,000 person-years, compared with the homeless group for which the corresponding figure was 2,598 and or those with 4+ comorbidities were 7,324 (IMD5) and 12,714 (homeless). This suggests a 'super-additive' interaction in which the effect of morbidity on mortality risk after discharge is greater for homeless patients. Survival at 5 years for the homelessness group was for men 80% (95% CI 77-85) and women 85 (95% CI 81-87).

Conclusions

This study shows that the well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.

Key messages

The well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.
The social epidemiology of Zika: stigma, transmission, and prevention in Brazil
Authors: Collier K M
Published: October 2020

Zika Virus continues to pose a threat to public health in Brazil. In the absence of an infrastructure-focused approach to eradication, it is crucial to understand points of intervention that may increase preventative action in the population. There has been a lack of studies on how socioeconomic and demographic factors relate to attitudes and behaviors surrounding Zika. The purpose of this study was to investigate factors influencing stigma, transmission knowledge, and prevention method use in Brazil.

This study relied on nationally-representative data collected for the 2016/2017 AmericasBarometer survey. A multi-stage national probability sample design was used, yielding 1,532 participants. Items were selected representing three thematic categories: stigmatizing attitudes, accuracy of transmission knowledge, and the frequency of prevention method use. Multi-level modeling was used to assess the relationship between each item and gender, urban/rural living, income, and education, nested by region.

Education level was the strongest and most common predictor overall in this study. Higher levels of education were associated with less stigma against those with Zika, t(677)= 3.41, p < 0.01, and more accurate transmission knowledge, t(1326)=5.31, p < 0.001. For prevention method use, female gender was the strongest predictor, t(1408)=4.85, p < 0.001. These relationships did not differ significantly by region. 

The governmental response to Zika thus far has focused primarily on vector control. This has had limited success and placed the burden of prevention primarily on women and girls. The results of this study suggest that, in the absence of structural change, targeted interventions may be necessary to increase the accuracy of Zika-related knowledge and prevention method use. In addition to community-level interventions, advocacy for equitable access to education and increased availability of comprehensive family planning are critical.

Key messages

There are multi-level barriers to Zika knowledge and prevention use that will require structural, community, and individual-level interventions. Severe weather events driven by climate change will further damage fragile water/sanitation infrastructures in Brazil. Multi-sector collaboration is needed for environmental and population health.
Precarious employment and stress: any differences between objective or subjective measures of stress?
Authors: Julià M , Pozo O , Gómez-Gómez A , Bolíbar M
Published: October 2020

Background

Precarious employment is an emerging social determinant of health and health inequalities. It is known that it has an impact on health and could be a potential stressor. This study aims to examine the association between precarious employment and stress measured in two different ways: subjectively (questionnaire) and objectively (cortisol and its metabolites concentrations in hair, considered biomarkers of chronic stress).

Methods

Cross-sectional study in a sample of 256 workers of Barcelona, Spain, aged 25-60. We conducted a survey including questions on multidimensional precarious employment assessed by EPRES (Precarious Employment Scale), and perceived stress (measured through the Perceived Stress Scale (PSS)). We also collected hair samples to measure cortisol and metabolites concentrations. The associations between precarious employment and stress were assessed using lineal regression models, stratified by sex and adjusted for age and BMI.

Results

Preliminary analyses show an association between precarious employment and perceived stress for both men and women (B = 5.4,CI95%:3.8-7.1 and B = 5.4,CI95%:3.2-7.7 respectively). While we did not find significant association between precarious employment and Cortisol, we did in several biomarkers of the Hypothalamic-pituitary-adrenal axis for the case of women: 20α-Dihydrocortisol (B = 2.4;CI95%:0.1-4.6), 20β-Dihydrocortisol (B = 1.6;CI95%:-0.4-2.7) and 11-Dehydrocorticosterone (B = 0.6;CI95%:0.0-1.2).

Conclusions

This study found evidence of association between precarious employment and stress. The results were more robust when stress is measured by means of subjective self-reports than by objective measures of cortisol metabolites, implying that precarious employment has a clearer impact on wellbeing and mental health than in physical and hormonal responses. Further research is needed to validate and understand differences among outcomes, as well as differences between men and women.

Key messages

Some evidence of association between precarious employment and stress, measured both by subjective self-reported measures and by objective measures of cortisol metabolites existed. More research is needed to understand the differences between objective and subjective stress on the impact of precarious employment and differences among indicators for men and women.
Precarious employment and mental health in European welfare state regimes: a multilevel approach
Authors: Padrosa E , Julià M
Published: October 2020

Background

Precarious employment (PE) is a key social determinant of health that is, in turn, shaped by the broader institutional framework of the country in which it is embedded. At the same time, evidence sustains that welfare state regimes (WSRs) have a decisive role in determining people's health. However, the interaction effect between them is yet to be studied from a public health perspective. This article examines how WSRs, PE and mental health (MH) relate in Europe, and whether this relationship differs between women and men.

Methods

Data were derived from the European Working Conditions Survey 2015. PE was measured through the Employment Precariousness Scale for Europe (EPRES-E), validated for comparative research in 22 European countries, which were classified into five WSRs (Bismarckian, Anglo-Saxon, Scandinavian, Southern and Central-Eastern). MH was measured through the WHO-5 Well-Being Index. In a sample of 30,795 formal employees, we performed multilevel poisson regression models stratified by women and men.

Results

Results show a gradual association between PE quartiles and poor MH (PR Q2=1.37 CI95% [1.13-1.65], Q3=1.86[1.51-2.30], Q4=2.96[2.31-3.81] men; PR Q2=1.15[0.97-1.37], Q3=1.48[1.22-1.79], Q4=2.06[1.64-2.58] women) after adjusting for control variables. Further, the Scandinavian WSR displayed an overall protective effect for MH among men, as compared with the Bismarckian (PR = 0.58[0.34-0.99]). Regarding the interaction effects, these were only significant in the Central-Eastern WSR, which was found to boost the negative association between PE and MH among women (PR = 1.17[1.03-1.33]).

Conclusions

These findings point to a differential effect of WSRs on the negative relationship between PE and MH according to gender.

Key messages

European welfare state regimes unequally affect the negative association between precarious employment and mental health. This differential is also gender-based, since the Central-Eastern regime further deteriorates the mental health of precarious employees only among women, as compared to the Bismarckian.
Impact of social determinants on incarceration and women’s mental health in Brazil
Authors: Lindner S R
Published: October 2020

The health status of prison population in Brazil is worrying. Prisons in the country are often overcrowded and host a large proportion of population with pre-existing health problems, that may be aggravated in prison. The conditions of confinement are decisive for the health-disease process and the relationship between problems and health needs of the population. The current increase of the number of prison population contribute to increase the risk of infectious diseases and worsen the general health conditions of those incarcerated.

Mental health disorders are highly prevalent in the prison population globally, including: personality disorders, such as antisocial personality disorder, major depression, and psychotic illnesses, neurodevelopmental disorders, and intellectual disability (ID). Self-harm and suicide attempts are also overrepresented in the prison population.

The prison conditions may worsen the pre-existing mental health problems of those incarcerated. Compared to men, women in prison are particularly vulnerable to mental health disorders, because of several factors including the women's social role and peculiar social stressors affecting women's condition. The social determinants such as: employment, housing and education status; poverty, social exclusion and discrimination; gender-based violence, stigma and adverse life events are particularly affecting the mental health of women incarcerated prior to prison, often worsening when they enter prison. Mental health of women in prison in Brazil represents a public health and security problem. Based on research data the presentation will discuss the status of mental health of women in prison in Brazil.
The health of women and girls released from prison - findings from Australia and internationally
Authors: Janca E
Published: October 2020

Women and girls involved in the criminal justice system experience a higher burden of morbidity than their justice-involved male counterparts and women in the general population. In addition, women with a history of incarceration are more likely than men with a history of incarceration to be exposed to poor social and health circumstances. While both justice-involved men and women have an increased risk of death compared to their counterparts in the general population, justice-involved women experience a greater elevation in risk. Understanding and addressing the health and social needs of women leaving prison is critically important to address high rates of preventable mortality, and to design appropriate gender-sensitive transitional support.

This presentation will first briefly summarise the findings of a scoping review which reported on the health status of girls and young women in detention, published in the Lancet Public Health earlier this year. It will then summarise findings from a global systematic review and meta-analysis on the health of women involved in the criminal justice system, describing what is known about their physical health, mental health and health service use. Finally, this presentation will describe results from a novel prospective cohort study from Australia on differences between women and men in patterns, characteristics and predictors of ambulance and emergency department presentations, describing the implications of these findings in the context of a growing need for evidence-based and gender-sensitive transitional support planning.