bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Austrias first PHC: What lessons can be learned?
Authors: Fröschl B , Antony K , Ivansitis S , Piso B
Published: November 2019

Issue/problem

The Austrian health care system regularly shows high performance. While about 99.9% of the population is covered by the compulsory health insurance system, the system is highly fragmented with shared responsibilities for inpatient and outpatient care.

Description of the problem

Primary health care in Austria is mainly provided by general practitioners (GP) in solo practises with average opening hours of 16-20 hours a week. This leads to high frequencies in outpatient care departments of hospitals and secondly to inefficiencies due to a high level of uncoordinated care. Thus in June 2014, the Federal Target-Based Governance Commission adopted a new concept for providing primary Health Care in an integrative, quality-assured manner and steering patients to the Best Point of Service. PHC centres are providing care in a multiprofessional approach (psychologists, nutritionists, and nurses) and have significantly longer opening hours with 45 hours per week.

Results

In 2015, the State Target-Based Governance Commission of Vienna commissioned the Austrian Public Health Institute (Gesundheit Österreich GmbH) with the evaluation of these pilot centers. The evaluation results of the first two years of the first PHC center shows a high level of satisfaction with the services provided by PHC and high level of utilisation, indicating an improvement in the service offered. PHC patients show a significantly higher level of utilisation of general medical care and at the same time a lower level of utilisation of specialist medical care than patients of the control group. Furthermore PHC patients have a significantly lower frequency of contacts in general emergency outpatient clinics.

Lessons

Changes in structural conditions such as the expansion in the range of services and the provision of care by a multiprofessional team results in advantages for patients, the team and the utilization of services at the best point of service.

Key messages

PHC centers can lead to a lower utilization of outpatient departments and thus to an improvement in the coordination of care. Cooperation in multi-professional teams can lead to a relief of the physicians and a higher job satisfaction.
Relationship between burnout and work engagement among Sri Lankan collegiate cycle students
Authors: Wickramasinghe N , Dissanayake D , Abeywardena G
Published: November 2019

Background

Keeping on par with the emerging trend towards positive psychology focusing on optimal functioning, burnout research is also associated with a shift towards its positive antipode; work engagement. This study was aimed at determining the relationship between burnout and work engagement among collegiate cycle students in Sri Lanka.

Methods

A school-based, cross-sectional study was conducted among 872 grade thirteen students in 15 government schools in the Kegalle district, Sri Lanka. The validated Sinhala versions of the 15-item Maslach Burnout Inventory-Student Survey and the 16-item Utrecht Work Engagement Scale-Student Version were used to assess burnout and work engagement respectively. The relationship between subscales of burnout; viz., exhaustion (EX), cynicism (CY) and reduced professional efficacy (rPE); and subscales of work engagement; viz., vigor (VI), dedication (DE) and absorption (AB); were assessed using Pearson product-moment correlation coefficient.

Results

The response rate was 91.3%. The EX subscale of burnout had strong negative correlations with VI (r=-0.699) and AB (r=-0.642) subscales and a moderate negative correlation (r=-0.475) with DE subscale of work engagement. The CY subscale of burnout had a strong negative correlation with AB subscale (r=-0.577), a moderate negative correlation with VI subscale (r=-0.391) and a weak negative correlation (r=-0.195) with DE subscale. The rPE subscale of burnout had weak negative correlations with DE subscale (r=-0.218), AB subscale (r=-0.206) and VI subscale (r=-0.128). All these correlations between the subscales of burnout and work engagement were statistically significant (p < 0.001).

Conclusions

Given the significant negative correlation between burnout and work engagement, exploring student work engagement may allow identification of their positive psychological characteristics that can be incorporated in formulating packages for preventing burnout.

Key messages

Bivariate correlation revealed that all three subscales of burnout had statistically significant negative correlations with all three subscales of work engagement. Exploring student work engagement may allow identification of their positive psychological characteristics that can be incorporated in formulating packages for preventing burnout.
Policies for psychiatric rehabilitation: inclusion through planning permit legislation changes
Authors: Chrysikou E , Savvopoulou E
Published: November 2019

Issue

Mental illness increases. Europe has the highest suicide rates. Yet, psychiatric provision is stull pushed towards the fringes even in new small-scale structures. This, contradicts Social Psychiatry, ignores WHO directions and undermines European health and equity.

Description of the problem

Changing mental health facilities planning legislation could support integration. Using Greece as a case study, we examine how mental health planning and licensing legislation affected national integration outcomes. This was policy, time-intensive project to address gaps remaining at the end of Psychargos-the national de-institutionalisation programme. It revisited the licensing of facilities to prevent the Greek psychiatric population from facing homelessness with Psychargo’s closure. The research identified solutions for the licensing of psychiatric service provision. Most of the remaining issues related to planning permits. Methodology included literature review, site-visits, consultations with Psychargos leadership and a detailed questionnaire designed by the researchers distributed via email to all facilities of Greece. 112 out of 116 of all community based facilities chose to participate.

Results

We identified the country’s planning legislation as important contributor to exclusion. The uses of land prevented facilities from being located in neighborhoods and promoted the development of mental health accommodation in industrial-type buildings or segregated areas. Uses needed relaxing for mental health. This generated functional complications. It necessitated the introduction of new national design guidelines.

Lessons

This project shed light on a model of de-institutionalisation that has already been applied in a European country with limited resources. It could have great value to countries starting de-institutionalisation. It could be relevant to the most advanced countries such as the UK, as several of their ’community-based wards’ are still in hospital campi.

Key messages

Buildings affect psychiatric de-institutionalisation (types, location, layout and equipment). De-institutionalisation buildings might undermine re-integration. National provision(s) need revisiting. Special use creates difficulties for mental health facilities to be located close to where people leave. Enabling flexibility in the choice of buildings promotes inclusion.
The social invisibility of mental health: understanding social exclusion through place & space
Authors: Chrysikou E , Savvopoulou E , Kostopoulou E , Mukadam N , Tsimopoulou I , Pickering S , Fatah gen. Schieck A
Published: November 2019

Background

The European target that the 5% of the healthcare service budget goes to mental health might not be enough to cover the inequity between health and mental health provision. The project is a multi-disciplinary, research-through-arts project, involving a Faculty of the Built Environment, a Division of Psychiatry and a School of Art. The project aims to identify elements demonstrating inequality demonstrated from place and space related to the facility provision.

Methods

The research compares mental vs healthcare facilities inside a catchment area, with photographs of the facades of the buildings and mapping their proximity to public transportation. It juxtaposes mental/healthcare facilities for access, condition and status compared to their surroundings.

Results

A book and an exhibition close to Bentham’s auto-icon, the designer of Panopticon custodial facility, demonstrated inverse links between his Panopticon, and the invisibility that NIMBYism produces towards the mentally ill that resulted in their exclusion, within deprived, vandalized, under-funded, isolated from public transport facilities “in the community”.

Conclusions

The project identified factors that contribute to the isolation of mental health facilities in terms of both space and place, and set the basis for further research in future projects. It demonstrated visually the under-budgeting of mental health facilities and their stigmatization as expressed by the centrality of locations and their overall projected image. This outlined the path for integrated, transdisciplinary research in the future involving architecture, arts and psychiatry. The project increased the awareness of the general public on social injustice, stigma and mental health. It combats NIMBYism and supports the fairer allocation of resources and placement of health facilities, aiming to put pressure to stakeholders involved in the NHS decision. Actions have been taken by the Trust involved to change.

Key messages

Inequalities between building (facades and location) contribute to mental illness stigma: this is what the general public views daily. Architecture can be a powerful medium to support inclusion.
Sexual violence and suicidal ideation among French adults, a mediation analysis
Authors: El-Khoury F ,   Equipe Baromètre Santé 2017
Published: November 2019

Objectives

Sexual violence against women is endemic and is linked with a host of mental health problems and suicidal behaviour. We test whether sexual violence is more prevalent and have more damaging psychological effects among women compared to men, and quantify its mediating role in the association between sex and suicidal ideation and behaviour.

Methods

We used data from the “Health Barometer” (Baromètre Santé) 2017 a cross-sectional phone survey, which recruited a nationally representative sample of French adults aged 18 to 75 years in 2017 (n = 25319). Data were weighted to be representative of the French adult population. Outcomes included suicidal ideation, imagery of suicide, and suicide attempts in the preceding year. We conducted mutlivariable mediation analysis using the counterfactual approach to evaluate the contribution that lifetime sexual violence has in the association between sex and suicidal ideation and behaviour.

Results

We found that women are five times more likely to have experienced sexual victimisation, and are more at risk of any suicidal ideation and imagery of suicide in the preceding year compared to men. Women and men had comparable rates of suicide attempts in the preceding year.

We estimated that 47% of the increased risk of suicidal ideation in the preceding year women have compared to men is mediated by lifetime sexual assault. Lifetime sexual assault also explained 39% of the association between sex and having imagery of suicide.

Discussion

Our findings reiterate the importance of the prevention of sexual violence and an adequate care for sexual assault victims, especially women, in public health and mental health policies and initiatives.

Key messages

Women are five times more likely to have experienced sexual victimisation compared to men, and are more likely to suffer from suicidal ideation in the preceding year. Experience of lifetime sexual violence contributes substantially (around 50%) to women’s increased likelihood of suicidal ideation compared to men.
Association among defense mechanisms, causes of procrastination and well- being; Gender differences
Authors: Vlachopanou P , Karagiannopoulou E , Tsiampalis T
Published: November 2019

Background

Defense mechanisms have been a central concept in the field of mental health and psychotherapy. Recently, there has been some research interest in defence mechanisms in empirical psychology. Causes of procrastination are shown to be related to defence mechanisms in terms of students’ dilatory behaviour. Furthermore, the causes of procrastination seem to affect students’ well-being. The aim of the present study is to investigate the effect of defence mechanisms and causes of procrastination on well-being, separately for each gender.

Methods

A cross-sectional study was conducted in Greece with 628 college students at the University of Ioannina (490 females and 138 males). Specially designed and validated instruments were used to record students’ sociodemographic characteristics, defence mechanisms (DM), causes of procrastination (CP) and well-being (WB). Analysis of Variance (ANOVA) and Covariance (ANCOVA) was used to investigate the effect of DM and CP on students’ WB separately for each gender.

Results

Students’ defence mechanisms and causes of procrastination had a statistically significant effect on their well-being. More specifically, female students with a lower percentage of fear of success/ influence of peers (p < 0.001) and maladaptive defense style (p < 0.001) as well as those with higher image-distorting (p < 0.001), self-sacrificing (p = 0.004) and adaptive defense styles (p < 0.001) seemed to have a significantly higher percentage of well-being. On the other hand, male students with a lower percentage of lack of duty/ tolerance of frustration (p = 0.039) and maladaptive style (p < 0.001) but a higher percentage of image distorting (p < 0.001) and adaptive defence styles (p < 0.001) had a significantly higher percentage of well-being.

Conclusions

Students’ causes of academic procrastination in the combination with the use of defence mechanisms significantly affect their well-being despite, being differentiated according to their gender.

Key messages

Defense mechanisms play a crucial role in students’ adaptation at the university as well as in their mental health. Emphasis should be given on the design of intervention on students’ procrastination involving non-conscious processes and more structural elements of personality.
Physical education, leisure time physical activity, and psychological distress in adolescence
Authors: Vilhjalmsson R
Published: November 2019

Background

Participation in physical education classes can positively affect mental and physical well-being in children and adolescets. The current study focused on the relationship between participation in gym and swimming classes and psychological distress symptoms in Icelandic adolescents.

Methods

The analysis is based on a national school-based study, conducted in Iceland every fourth year, as part of the WHO collaborative cross-national survey titled Health Behavior in School-Aged Children (HBSC). Data collection took place between November 2013 and February 2014. Students filled out an anonymous study questionnaire in the classroom. The data is based on responses from 15 year old (10. grade) students attending the final year of compulsory school (N = 3618; response rate 81%).

Results

Positive associations were observed between participation in curriculum-based gym and swimming classes and lower psychological distress symptoms. A closer multivariate path analysis suggested that beneficial effects of PE classes were direct, and also indirect because participation in such classes were positively related to leisure time physical activity.

Conclusions

The study suggests that school-based physical activity enhances psychological well-being in adolescence. The benefits may be both direct and indirect through increased leisure time physical activity.

Key messages

School-based physical activity enhances psychological well-being in adolescence. The benefits may be both direct and indirect through increased leisure time physical activity.
Added value of combining health examination surveys and human biomonitoring studies
Authors: Tolonen H , Andersson A M , Agergaard Holmboe S , Namorado S , Rambaud L , Kolossa-Gehring M
Published: November 2019

Background

In many European countries, parallel to health examination surveys (HES), human biomonitoring (HBM) studies are conducted to monitor chemical exposures of the population. HES and HBM studies use survey based data collection with similarities in sample selection and recruitment, ethics and data protection, collection of data by questionnaire and through biological samples.

Methods

In the framework of European Human Biomonitoring Initiative (HBM4EU), evaluation of opportunities and potential obstacles related to combining HES and HBM surveys has been conducted. Experiences and expectations of principal investigators (PI) of studies from 19 European countries have been evaluated.

Results

The most common reasons for omitting an HBM module from a HES were lack of knowledge related to chemical measurements, lack of funding and capacities for chemical analysis. Many PIs feared that adding an HBM module to their survey would increase the participant burden and decrease participation rate. In surveys where these two different modules were already combined, the biggest benefits were seen on use of same infrastructure for recruitment of survey invitees, collection of questionnaire information and biological samples, and additional information on health, resulting more cost-effective data collection with more information on each participant. Combining these two modules had challenges on fitting together needs from the two study objectives. While survey content broadens, balancing participant burden and research interest of both HES and an HBM module is challenging. The amount of collected biological samples such as blood samples is limited. Coordination of the activities between several research groups can be challenging and time consuming.

Conclusions

Several examples have shown that combining HBM and health surveys is possible and provide several benefits. However, it requires a good preparation and planning and sufficient coordination capacity to be successful.

Key messages

Combining HES and HBM is possible but requires detailed planning and good collaboration between research groups. Combined HES and HBM studies provide a wide range of information about population health status and its determinants as well as chemicals levels of exposure.
Contamination of Poultry Meat with Salmonella infantis should be considered a Risk for Food Safety?
Authors: Finazzi G , Bertasi B , Pavoni E , Filipello V , D’Incau M , Losio M N
Published: November 2019

Issue/problem

EU Regulation regarding fresh poultry meat considers only S. enteritidis or S. typhimurium as Food Safety Criteria. On the contrary, the isolation of other Salmonella spp. in this food matrices is considered compliant. Several bibliographical sources indicate an increase in the isolation trend of S. infantis in the poultry industry and in derived products.

Description of the problem

Episodes of food poisoning caused by fresh chicken meat contaminated with S. infantis have been recently reported. According to CDC, last year in USA, an outbreak caused by a S. infantis strain, resistant to multiple antibiotics, ended with 129 sick people, 25 hospitalizations and a death. National Salmonellosis Control Plan for Poultry 2019-21 establishes in Italy the abatement conditions for poultry farms in case of positive isolation of S. enteritidis, S. typhimurium and S. infantis.

Results

In 2018, the National Health System disposed the analysis of batches of fresh chicken meat from Poland, sampled in a cold storage facility in Northern Italy. Food Control Dept. of IZSLER analysed 156 samples for a total of 780 sampling units (s.u.), for Salmonella spp.: 72 samples were positive (46,15%;corresponding to 222 s.u. - 28,46%). 42 strains were serotyped as S. enteritidis, 149 as S. infantis, 26 as S. newport, 4 as S. kentucky and 1 as S. mbandaka. According to EU Regulation, batches positive for S. enteritidis were indicated as not compliant, but batches positive to other Salmonella were considered regular.

Lessons

EU legislation allows the circulation of chicken meat contaminated with S. infantis. Chicken meat should be consumed after appropriate well cooking eliminating this hazard, but it does not protect the consumer from the risk of cross-contamination of tools and surfaces at the household level. It’s therefore fundamental the application of correct processing practices in order to prevent the spreading of Salmonella in home kitchens and limit dangerous episodes of infection.

Key messages

S. infantis trend of isolation in the poultry industry is increasing. application of GMPs in home cooking is fundamental to limit food outbreaks of infection.
Evading the price: do French smokers go abroad to buy cheaper tobacco?
Authors: Andler R , Guignard R , Lermenier-Jeannet A , Richard J-B , Pasquereau A , Quatremère G , Nguyen-Thanh V
Published: November 2019

Background

In France, selling tobacco is strictly supervised and can only be done by official “tobacconists” making the price lever all the more efficient in preventing smoking. However, tobacco prices are rather heterogeneous in Europe and France is surrounded by countries with lower tobacco prices. The aim of our study was to investigate tobacco cross-border purchases by French smokers.

Methods

Data come from the Santé publique France health Barometer, a national representative phone survey. In the 2014, 2017 and 2018 editions, respectively 4,721, 1,854 and 2,594 smokers where asked about their habits regarding purchasing tobacco.

Results

In 2018, among adults, 77.8% of cigarette smokers (including RYO cigarettes) made their last purchase from an official French tobacconist and 16.4% made it in a neighboring country. Rates in bordering regions are drastically higher. These figures are quite similar to the ones observed in 2014 while tobacconist purchases had increased in 2017 and abroad purchases had decreased. In 2018, among adults, 44.3% of cigarette smokers stated they had bought tobacco abroad at least once during the past 12 months.

Conclusions

Our study suggests that the frequency of cross border tobacco purchases by French smokers decreased between 2014 and 2017 while tobacco prices were not modified in France but increased between 2017 and 2018 as French tobacco prices went up. Our study also emphasises the fact that cross border purchases were a lot more common in bordering regions.

Key messages

Part of French smokers avoid price increases by purchasing tobacco abroad. This public health policy measure could be more efficient if tobacco prices were aligned in Europe.
ENDS - a growing threat: results from Russian tobacco control policy evaluation survey EPOCHA-RF
Authors: Gambaryan M H , Kalinina A M , Popovich M V , Starovoytov M L , Drapkina O M , Boytsov S A
Published: November 2019

Background

Electronic nicotine delivery systems (ENDS) including heated tobacco products not yet legally regulated are more and more imposed over the Russian population. Still very little is known about these products.

Aim

To assess the exposure of Russian population to advertisement, promotion, of ENDS, and its attitudes and beliefs regarding these products.

Methods

Data from Russian tobacco control policy evaluation survey (2017-2018) are analysed which used a systematic stratified multistage random sampling based on territorial household principle, representing the adult population (18+) of Russia in 10 Federal subjects. 20380 randomly selected respondents were interviewed and a stratified sample (n = 11625) of smokers (n = 6569), former smokers (n = 2377) and never smokers (n = 2679) participated in the survey.

Results

In past 6 months 15.7% of the respondents were exposed to promotion of ENDS via internet, 14%-via social networks and 13.4% at the points of sale. Remarkably the youngest age group (18-24) was significantly more exposed to advertisement and promotion of ENDS from all sources than the rest of age groups: 32.6%, 32.3% and 24.3% respectively (p<.0001).

48% of respondents believe that secondhand vape of e-cigarettes is harmful for health of people, with significant differences among current smokers (40%), recent quitters (53%), former smokers (60%) and never smokers (66%). Majority agreed that it is necessary to regulate allowed amounts of nicotine in e-liquids (54%), to ban vaping in public places where tobacco smoking is banned (59.2%), ban the sales of these products to minors (68%), and the use of e-cigarettes by those (71.2%). 61.5% support the need for ban of all forms of advertisement, marketing and promotion of ENDS.

Conclusions

ENDS present a real threat for Russian tobacco control policy achievements. The findings will be used to support new strong legislation to regulate ENDS in Russia.

Key messages

Young people much more than the others are targeted with advertisement and promotion of ENDS. ENDS present a real threat for Russian tobacco control policy and should be legally regulated like any tobacco products.
Challenges of a French Hospital Discharge algorithm to detect non-accidental paediatric burns
Authors: Hermetet C , Laurent E , El Allali Y , Gaborit C , Lecuyer A-I , Urvois-Grange A , Saint-Martin P , Biotteau M , Le Touze A , Grammatico-Guillon L
Published: November 2019

Background

Child maltreatment includes physical, psychological, sexual abuse and acts of neglect. Among the resulting non-accidental injuries, burns are responsible for an important morbi-mortality. The main objective was to build a detection algorithm of non-accidental paediatric burns (NAB), using ICD-10 codes in the hospital resumes from the French Hospital Discharge Database (HDD).

Methods

Children aged 0 to 16 years old hospitalised at the University Hospital of Tours from 2012 to 2017 with a coded burn were included. “Probable” or “possible” HDD cases of NAB were defined based on specific ICD-10 codes during the inclusion stay or the previous year. A chart review was performed on all the HDD cases and HDD non cases matched on sex and age with a 1:2 ratio. Performance parameters were estimated for three clinical definitions of suspected child maltreatment: excluding neglect, including neglect with restriction then broad definition. For clinical cases, report to the judicial authority (RJA) or worrying information (WI) was searched.

Results

Among the 253 included children, 83 “probable” cases and 153 non cases were analysed. Sensitivity varied from 48% (95%CI [36-60]) to 90% [55-100] when excluding neglect, specificity from 70% [63;77] to 68% [61;74]. The positive and negative likelihood ratios varied respectively from 1,6 [1,2;2,3] to 2,8 [2,1;3,7] and from 0,7 [0,6;0,9] to 0,1 [0,0;0,9]. The proportion of clinical cases with no RJA/WI without reason varied from 0 (when excluding neglect) to > 85% (with broadest definition); all corresponded to a possible isolated neglect.

Conclusions

The performances of the algorithm varied tremendously according to the clinical definition level of child maltreatment. Neglect is obviously difficult to clinically detect. Training for healthcare professionals and qualitative studies on obstacles to RJA/WI should be added to this work.

Key messages

The performances of an algorithm to detect non-accidental pediatric burns (maltreatment) using the French hospital discharge database dropped when including neglect, difficult to diagnose clinically. Training for healthcare professionals and qualitative studies on obstacles to the judicial authority (RJA) or worrying information (WI) should be added to this diagnostic study.
Géodes: the health indicators web portal of the French Public Health Agency
Authors: Lucas E , Guillet A , Bonaldi C , Caserio-Schönemann C , Le Strat Y
Published: November 2019

Background

Santé publique France, the French Public Health Agency, produce numerous health indicators (diseases or health determinants) from many different data sources (specific or unspecific surveillance systems, epidemiological and behavioural surveys, administrative databases). In order to improve visibility and accessibility of these indicators, a web portal “Géodes” was created.

Methods

Géodes was built with Géoclip Air© developped by a French start-up. This ergonomic tool allows to explore the geographical dimension of health indicators through interactive maps along with graphs and tables. In addition, Géodes is designed to explore the temporal dimension of indicators produced yearly or weekly through dynamic maps or time series. All indicators are linked to an explanatory sheets. Description, sources, precisions or limits of interpretation are discribed. It is also easy to present indicators in interactive tables, exportable in different formats such as Excel spreadsheets.

Results

Since February 1st 2019, Géodes is available online without any access restriction (https://geodes.santepubliquefrance.fr). Over 300 health indicators are provided related to infectious and chronic diseases, occupational and environmental health, behaviours, emergency departement attendances, etc. An indicator is either a number of cases, a proportion or an incidence rate. Most indicators are stratified by categories such as sex or age group. It is possible to represent two indicators on a single map, e.g. the smoking prevalence and the standardised rate of lung cancer.

Conclusions

The days following the opening to the public, the site recorded up to 10,000 connections per day. In routine, the site knows up to 200 visits per day, up to 3,000 in case of quoting aparticular indicator in the media. These figures show that this health data observatory meet a real need.

Key messages

A web portal of health indicators created by Santé Publique France is now available. More than 300 health indicators are integrated in the portal. Indicators can be visualized through interactive maps, tables and time series and their values are easily exportable and communicable.
Injury profile and healthcare expenditure of cyclists admitted in intensive care units
Authors: Papadakaki M , Gnardellis C h , Tsalkanis A , Stamouli M A , Petelos E , Morandi A , Otte D , Sarris M , Tzamalouka G , Chliaoutakis J
Published: November 2019

Background

The current paper is part of the EU-funded REHABILAID Project and aims to describe the profile of cyclists sustaining severe injuries in a road traffic incident as well as the healthcare costs associated with their injury, including hospitalization costs and out-of-pocket expenditure.

Methods

Seven public hospitals were involved; Greece=5, Italy=1 and Germany=1. Both the intensive care units (ICU) and sub-intensive care units (as high-dependency areas) were involved. Participants enrolled during a 12-month period starting from April 2013 and were followed for one year from admission date. The study used widely recommended classifications for injury severity (AIS-Update 2008, MAIS). Information on the injury was retrieved upon patients’ consent, from medical records while interviews were carried out at months 1,6,12 for personal and cost-related information. Health Care Expenditure was assessed through the MUARC’s framework. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs.

Results

120 subjects enrolled in the study in total and 14 were cyclists(Greece=1, Germany=3, Italy=10). Most of them were men(n = 9, 64.3%), with a mean age of 55.5 years (SD16.3;min 32-max 84). As for the current incidents, the majority occurred at city roads (n = 10;71.4%), straight roads (n = 9;64.3%) and intersections (n = 3;21.4%). Many were single-vehicle (n = 4;28.6%), lateral (n = 4;28.6%) and front-lateral (n = 3;21.4%). Half of the cyclists sustained an injury of MAIS3+ severity (n = 7;50.0%). A major injury was primarily sustained at the lower extremities (n = 10;71.4%), head (n = 7;50.0%), face (5=35.7%) and upper extremities (n = 5;35.7%). The mean total hospitalization cost was 5815,6(min 209,00-max 20.647,00) and the mean direct costs arising from injury was 4.047,5(min 0,0-max 24.670,00).

Conclusions

Individual differences need to be taken into account in future injury prevention efforts as well as in attempts to improve healthcare system’s response to road victims.

Key messages

Systematic collection of data relevant to health condition and economics of the victims is necessary at European level. Personalized rehabilitation plans are necessary to facilitate the recovery process of victims.
Knowledge and sexual behaviors of transgender individuals faced with the risk of STI/HIV in Benin
Authors: Hessou S , Glele Ahanhanzo Y , Kpozehouen A , Biaou A , Yadouleton T , Sodoloufo O , Capo-Chichi V , Dossoh B , Gnanhoui-David B , Nelson M
Published: November 2019

Introduction

The issue of sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) cannot be solved without considering the transgender population. This research aims to describe the knowledge, attitudes and sexual behaviors of transgender individuals faced with the risk of STIs and HIV/AIDS in Benin.

Methods

Transgender individuals were selected by respondent-driven sampling throughout the country in 2017. Included in this analysis were individuals who identified as transgender and adopted its mode of expression, aged 15 years and greater, and who gave their consent to participate.

Results

A total of 308 transgender individuals were surveyed, of which 89.6% were of male gender at birth. The participants had a good level of knowledge in the matter of STI and HIV/AIDS. In fact, 99.9% among them cited at least one symptom of STIs; 95.1% cited the three main methods of transmission of HIV and 54% are aware the risk of sexual transmission of HIV is higher between men. Participants were more than 90% likely to declare a positive attitude to care for persons living with HIV (PLWHIV) or to share the same room with them (93.2%). Concerning sexual behaviors, the average age at the first sexual encounter as a transgender individual was 14 years old. During the last three months, transgender individuals declared three regular male partners on average. The usage of condoms during the last sexual intercourse was reported in 86.6% of cases. Knowledge of the serological status of the sexual partner (31.7%) and the loss of sensation induced by the condom (26.8%) constituted the main reasons of non-usage of condoms.

Conclusions

Although adopting some risky sexual behavior, transgender individuals are a population that is relatively well informed and with favorable attitudes regarding STIs and HIV/AIDS. These factors are significant assets to be considered in the development of programs for STIs and HIV/AIDS control.

Key messages

Transgender individuals good level of knowledge is an asset for STIs/HIV control. Sexual multi-partnership seems to be common despite a good level of knowledge.
Intervention research partnerships: enablers for activating health in all policies approach?
Authors: Porcherie M , Bader C , Faure E , Roué le Gall A , Vaillant Z , Thomas M F , Rican S , Héritage Z , Simos J , Cantorregi N
Published: November 2019

Introduction

Action on the determinants of health and equity involves the participation of all sectors, including non-health sectors. Understanding the opportunities and constraints to engage in the complex issue of health inequalities requires opening the black box of policy making. It also requires close interaction between field actors and researchers. This paper will aim to analyze the modalities of collaboration between researchers and field actors in the service of knowledge sharing, within the GREENH-City project.

Methods

The GREENH-City project was built in an interdisciplinary and intersectoral manner and involves close collaboration with the WHO French Healthy Cities Network (FHCN). Its objective is to characterize the most promising health interventions in all policies at the city level to promote equity through green space policies. Based on the knowledge sharing model and the theory of diffusion of innovations, we will analyze how this research allows initiating collaborations between the different municipal sectors on health issues.

Results

The intervention nature of the project seems to help the dissemination of collaborations, particularly between health services and green space services within the cities of the FHCN. The analysis, using theoretical models, of the body of empirical data collected from cities will make it possible to identify the levers and collateral effects activated by the research project.

Discussion

The GREENH-City project was built on the basis of an interventional research framework. This choice was made precisely because of the interaction it induces between researchers and practice environments. Initial empirical results suggest that it promotes the dissemination of knowledge, a necessary first step in the evolution of practices. Indeed, the effective appropriation of research results can only be assessed in the long term and must take into account the contextual elements specific to each FHCN involved in the research.

Key messages

Implementation of interventional research helps to engage fields collaborations. Health in all policies may be supported by a research project at the local level.
Medical students’ involvement in health policy: current focus and trend
Authors: Kaymaz K
Published: November 2019

Background

European Medical Students’ Association (EMSA) and International Federation of Medical Students’ Associations (IFMSA) are two leading student organizations advocating for better health in Europe and the World. How student organizations support global public health policy and particularly which topics students place greater emphasis on are not documented, although it is crucial to understand their involvement and areas of interest.

Methods

Data on the valid policy documents of the last three years until April 2019 were retrieved from the official websites of EMSA and IFMSA. These documents were categorized using abstract submission tracks of the 12th European Public Health Conference.

Results

Twenty-nine policy documents were retrieved, ten of which were from EMSA and 19 from IFMSA. Fourteen of all 22 abstract submission tracks (63.6%) were covered by these policy documents. Of all policy documents, 20.7% fell under the track of ’infectious diseases, preparedness and vaccines’. Most commonly advocated topic in policy documents of IFMSA was infectious diseases and vaccines, whereas that of EMSA was healthy living and health promotion.

Conclusions

Medical students often take part in health policy by conveying their perspectives and calling other stakeholders to action via their policy documents. Policy documents of IFMSA were more related to global health challenges such as infectious diseases while special concerns in Europe such as healthy living and health promotion dominated EMSA’s policies. In the near future, more student advocacy work on climate change, noncommunicable diseases and primary health care would be expected in accordance with ’ten threats to global health in 2019’ announced by the World Health Organization.

Key messages

Medical student organizations, EMSA and IFMSA, are important stakeholders in health policy. The focus of their policy documents differs, and this trend is influenced by changing public health challenges in Europe and the World.
Evaluation of the health pathway through the patient-experience in the French program PAERPA
Authors: Donio V , Defebvre M M , Pamart R , Caron B , Delval-Bugny C , Dambre D , Di Martino C , Beuscart J B
Published: November 2019

The patient-experience is an emerging concept in research and medico-social action, and its consideration in the development of care pathways is encouraged (e.g. ’Ma Santé 2020’ national plan in France). In addition, the patient-experience of the elderly subject has specific dimensions and his collection presents difficulties insufficiently explored. PAERPA (elderly people at risk of loss of autonomy), French national experiment for the care of frail elderly patients, offers an opportunity to return to these issues.

The objective of this study, mandated by the ARS of Hauts-de-France, was to collect the experience of the elderly PAERPA. Faced with the difficulties of current methodologies, several methodological approaches have been combined: semi-structured individual interviews face-to-face or by telephone, dedicated questionnaire. In addition, a specific grid was developed to explore the home-based patient experience, including seven dimensions of the patient-experience identified in the literature. This study was conducted in the second half of 2018 (3 years and a half of the start of the project).

The experience of 43 seniors and / or caregivers was collected. Patients PAERPA are generally satisfied with their care but they have difficulties in making the link between their care and the actors and devices specific to PAEPRA experimentation. Human connection and listening seem essential for the elderly patients included. Other dimensions, such as stakeholder coordination, remain controversial and more difficult to grasp. Methodologically, the particular situation of seniors, such as sensory or memory disorders, requires a major adaptation of the survey tools.

In PAERPA, the patient-experience of the frail elderly subject passes mainly through the feeling of a human connection. Current methodologies do not seem fully adapted to collectively capture the experience of frail elderly patients.

Key messages

Evaluating the patient-experience to improve the health pathway is possible and necessary through a qualitative collection, regularly, in itinere. The peculiarities of older people often require the participation of carers, who need to be involved in the assessment of the patient-experience and raised awareness.
Organized colorectal cancer screening: the participation rate according to the precariousness
Authors: Arlotto S , Le Cozannet E , Rinaldi Y , Gentile S , Heid P , Seitz J F
Published: November 2019

Background

The National Organized Colorectal Cancer Screening Program (DOCCR) was introduced in 2008. The participation rate in France is much lower than the European recommendations (33.5% versus 45%). There are significant disparities across France.

The objective was to assess whether there are disparities in participation rates within the Bouches-du-Rhône(BdR) department and to study the possible correlation of these geographical areas with their level of precariousness.

Methods

Based on data collected by the ARCADES association (management structure in charge of cancer screening in the BdR region), 325,207 people in 2012 and 489,953 in 2017 were invited to participate in the DOCCR. The participation was analysed in two aspects: participation rate (TP) (test carried out) and participation rate of those who took a test or expressed a justified refusal (TPJ) (personal or family history, other test under 2 years old, colonoscopy under 5 years old). An average precariousness rate was also assessed per municipality based on 2012 INSEE data for the age group concerned.

Results

The TP were 18.9% in 2012 and 14.4% in 2017; the TPJ were 22.8% and 16.4% respectively and differs significantly between the municipalities in the department (p < 0.001). The average precariousness rate observed in our population was 12.3 (±8.2). The TPJ is inversely correlated with the precariousness rate: the higher the latter, the lower the participation rate (R=-0.58 in 2012, R=-0.539 in 2017; p < 0.05). The average participation rate whatever the year is lower for municipalities with a precariousness rate below the median (19.2 ± 2 versus 16.9 ± 3.5 for the year 2017).

Conclusions

Participation rates in 2012 and 2017 are lower than the European recommendations. The participation is significantly related to the average rate of precariousness; the most vulnerable participate less well. Specific actions towards the most vulnerable are to be considered in order to improve adherence to the DOCCR.

Key messages

The participation organized colorectal cancer screening program is significantly related to the average rate of precariousness. Specific actions towards the most precarious are to be considered in order to improve adherence to the DOCCR.
Changes in physical conditions of militars in training: colombian army military school
Authors: Castro-Jimenez L E , Melo-Buitrago P J , Arguello-Gutierrez Y P , Galvez-Pardo A Y , Cortes-Fernandez S
Published: November 2019

When beginning the military life, a series of loads of trainings is faced, in addition to supporting the discomforts of climate, fatigue, the change of feeding, schedule, among other factors. Therefore, the objective of the study was to know the changes in the physical condition of the students who begin their military training with military physical training. The investigation was quantitative, longitudinal type. A total of 18 male first-degree engineering cadets from the José María Córdova Military School of Cadets (ESMIC) in Bogotá were evaluated. They were given a pre and post-test of body composition, flexibility, resistance and strength and the training program of the Military school. The findings show that after six months of training the cadets increased body weight (64.6 vs. 65.2) in 0.55 (p = 0.002), with a gain of 0.4 kg fat mass (7.9 vs. 8.2g, p = 0.006) and 0.2 kg muscle mass (53.9 vs 54.1g, p = 0.01), in relation to physical abilities there was a decrease in strength in upper limbs (49.4 vs 45.2 p = 0.001) of 4.3 kg and in lower limbs (46.6 vs 43.7, p = 0.000) of 2.9 kg, in terms of aerobic resistance (47.8 vs 48.2)and flexibility (30.8 vs 41.3) there was a slight increase without significant differences. The previous results show possible over-training in the ESMIC cadets; due to the change of habits, specifically physical exercise and lifestyle, leading to an increase in weight, in greater quantity in the fat component and decrease in the physical capacity of strength, which can cause early fatigue, being counterproductive when found in some combat or special situation. This is why a specialized systematic training program is the best option for the optimal development of physical abilities, physical adaptation to the effort and prevention of injuries during the practice.

Key messages

Injury prevention; Military Personnel; Physical Education and Training. Physical Education and Training; Military Personnel; injury prevention.