bluuebunny/crossref_metadata_2025 huggingface dataset:
Low economic growth and health inequalities in a rich country: 27-year Japanese time series
Authors: Hiyoshi A , Honjo K , Platts L G , Suzuki Y , Shipley M J , Iso H , Kondo N , Brunner E J
Published: October 2020

This presentation extends the public health theme in relation to Sustainable Development Goal #8, focusing on the health inequality trend in Japan. it is important to understand whether low economic growth is compatible with a low level of health inequalities. Unlike the UK and USA, life expectancy in Japan continued to improve despite a stagnant economy.

Ten triennial waves of a nationally representative survey in Japan, 1986-2013 (n = 731,647) were used. Slope and Relative Indices of Inequality (SII and RII respectively) in relation to net household income and self-rated good health were calculated. Analyses were stratified by sex and age, for children, working-age adults, younger old and older old, given age differences in relation to labour market. Time trends of SII and RII were tested during the period of economic stagnation 1992-2013.

In all age groups, prevalence of good health declined slightly from its peak in 1995 but increased after 2007. In 1992 among children, working-age adults and younger old, health inequality based on SII was small, about 10% lower prevalence of good health in those with lowest compared to highest income. Among working-age adults, time trends of health inequalities based on SII narrowed from 1992 and then widened after 2002 (quadratic trends in men and women p < 0.05), resulting in the magnitude of health inequality returning to its level at the beginning of economic stagnation in 1992 but not exceeding it. Time trends in relative inequality (RII) were qualitatively similar to those in absolute inequality (SII).

The long-term low-growth Japanese economy appears compatible with maintaining and improving population health and holding health inequalities at current levels. This evidence is of great significance for sustainable development and the health of current and future generations.
Influenza burden estimates in Portugal: seasons 2013/14 to 2018/19
Authors: Torres A R , Kislaya I , Silva S , Gomez V , Machado A , Nunes B , Guiomar R , Rodrigues A P
Published: October 2020

Background

Reliable influenza burden estimates are essential for a true understanding of the influenza epidemics' impact; informed decision-making and effective risk communication. This study aimed to estimate the influenza burden in Portugal in 2013/14 - 2018/19 seasons.

Methods

We estimated seasonal influenza burden, ranging from medically attended influenza cases in primary care to influenza-attributable deaths, using surveillance data. Data were collected for influenza like illness (ILI) epidemic periods, determined by the Moving Epidemic Method. Medically attended influenza cases were estimated by multiplying the number of ILI cases in primary care by the percentage of influenza-positive samples. Hospitalized severe acute respiratory infections (SARI) positive for influenza estimates were computed, multiplying the number of SARI by the percentage of influenza-positive samples. To determine influenza-attributable deaths, a Poisson regression model was used.

Results

The median number of medically attended influenza cases in primary care was 33,668 (325.8 cases per 10,000 population), ranging between 21,393 in 2017/18, [Influenza B and A(H1) co-dominance] and 61,768 in 2014/15 [Influenza B and A(H3) co-dominance]. The median number of SARI positive for influenza was 8,724 (84.4 cases per 10,000 population), ranging between 7,099 in 2013/14 [A(H1) and A(H3) co-dominance], and 9,125 in 2014/15. The median number of influenza-attributable deaths was 3,311 (32.0 cases per 10,000 population), ranging between 96 in 2015/16 [A(H1) dominance], and 5,224 in 2014/15.

Conclusions

Higher mortality, and higher rate of medically attended influenza cases, were found in seasons with A(H3) circulation. Little variability was observed in the number of influenza-positive SARI. The relationship between the number of SARI and the number of deaths requires further investigation. This work highlights the need of health surveillance systems for a better understanding of the influenza impact.

Key messages

Lower burden of influenza is found in seasons with A(H1) co-dominance. Higher burden of influenza is found in seasons with A(H3) circulation. Health surveillance systems are essential to provide data for a better understanding of the epidemiology and extent of seasonal influenza.
Antipsychotics and mortality among elderly with dementia: a population based study in the Lazio region
Authors: Bargagli A M , Cascini S , Agabiti N , Kirchmayer U , Marino C , Davoli M , Vanacore N , Canevelli M
Published: October 2020

Background

Most dementia patients experience one or more behavioral and psychological symptoms (BPSD) at some time during their illness, in particular in the middle and later stages. Antipsychotic drugs (AP) are often prescribed off-label for treating BPSD, despite concerns about safety and limited efficacy. The impact of AP on short- and long-term mortality has not been fully assessed.

Objective

To assess the association between the use of APs and short- and long-term mortality in a cohort of dementia patients aged ≥ 65 years residing in the Lazio region.

Methods

We use data from regional health information systems to conduct a retrospective age, gender and comorbidity matched cohort study with a 1:3 matching ratio to pair dementia patients new AP users with non-users. For the exposed participants, the index date was defined as the date of the first drug prescription; the same date was used for non-users matched subjects. Patients were enrolled on 31/12/2016 and followed-up from the index date through 2018. Four cohorts were enrolled to analyze mortality at 30, 60, 180 and 65 days from the index date. Adjusted estimates were obtained with propensity score matching using the Greedy Nearest Neighbor Matching algorithm.

Results

We enrolled 34,625 individuals (67% females, mean age 82 years) distributed as follows: 30 days cohort, 4321 users vs 12,960 non-users; 60 days cohort, 4202 users vs 12,606 non-users; 180 days cohort, 3641 users vs 19,923 non-users; 365 days cohort, 2618 users vs 7854 non-users. Multivariate analyses showed a statistically significant excess mortality at 60, 180, and 365 days since the first prescription (HR: 1.83, HR: 1.63, and HR: 1.62, respectively).

Conclusions

This study showed that antipsychotics increase short- and long-term mortality risk in older adults with dementia. The prescription of AP should be carefully evaluated and, if it is the best option for patient and caregiver, stringently monitored.

Key messages

Antipsychotic medication use is associated with an increased all-cause mortality in elderly with dementia. The mortality risk increases in 60 days after starting their use and remains elevated at 1 year.
Public health and multiple sclerosis in Italy
Authors: Bezzini D , Battaglia M A , Ponzio M , Manacorda T , Zaratin P , Bandiera P
Published: October 2020

Background

Multiple Sclerosis (MS) is a complex and progressive disease of the central nervous system. In Italy, prevalence of MS ranges from 198 (continental Regions) to 370 (Sardinia) per 100,000. Despite a National Health System, differences among Regions cause inequalities in access to and quality of care, also involving chronic diseases and disabilities, including MS.

Methods

Interviews and focus groups involving persons with MS, caregivers, institutions, patients association and other stakeholders were conducted in 2019, to evaluate MS policy landscape, existing services, guidelines and care pathways regarding diagnosis, therapy, follow up, strenghts and weaknesses.

Results

600 MS specialized neurologists and 350 MS nurses operate in 240 MS Centers located in hospital neurology departments providing clinical care, disease modifying drugs (DMDs), interdisciplinary care. 13 Regions on 20 approved a PDTA (Diagnosis, Therapy, Care Pathway), other are due by 2020. A reference national PDTA has been already discussed by Regional Health Authorities Conference and Ministry of Health. Regional multistakeholder observatories will be organized. A national MS registry started in 2017, at present involving over 140 Centers and including data of 50% (60.000 patients) of estimated prevalence.

Discussion

MS specialized centers are recognized as the key component of MS care in Italy and the main refererral for 80% of patients, also taking in account that over 60% of patients receive a DMD. Access to rehabilitation is lacking and hospital, community and primary care linkage is needed, also considering transition from early stages to severe disability. Access to psycological support is variable and cost containment strategies restrict drug access and symptomatic care in some areas along with lacking of interdisciplinary management. It is mandatory to integrate health and social care pathways accordingly with the National Plan for Chronicity in which MS has to be included.

Key messages

MS specialized centers are the backbone care network in Italy. Integrated care pathways (PDTA) stated as National Health System rules define the right for the patients to receive the proper care.
Validation of a health promotion leadership self-efficacy measure in Jewish and Palestinian women
Authors: Karjawlly M , Greenberg K , Nubani Husseini M , Agbaria N , leiter E , Zwas D
Published: October 2020

Background

Health promotion (HP) leadership training is necessary to optimize health promotion in all sectors of society, and as in all interventions, there is a need for a measure to assess the effectiveness of leadership training and leadership self-efficacy. The current study aims to validate a 13-item self-report scale for use in health promotion leadership programs. The scale, in Hebrew and Arabic versions, assesses health-promotion leadership skills and self-efficacy (HPLSES).

Methods

Data for the Hebrew scale were collected as part of a leadership training program for women in Jerusalem and Beer Sheva workplaces (n = 38). The Arabic scale was administered as part of a healthy lifestyle and leadership training program conducted in community centers in East Jerusalem (n = 155). Data for both scales were collected at baseline and 6 months post-intervention. Validation of scales included a panel of experts to assess content validity, Cronbach's alpha to assess internal validity, and structural equation modeling (SEM) to assess construct validity. A specific model was designed to test predictive validity for both communities.

Results

Content validity was confirmed by a panel of experts. Preliminary correlation analysis between the instrument items showed high correlations for both time periods, which suggested difficulties in building distinct dimensions. Preliminary confirmatory models using exploratory/confirmatory models for the13 items showed reasonable loadings (Loading>0.65). We obtained acceptable goodness-of-fit to the empirical data (Cronbach's alpha=0.90).

Conclusions

This scale demonstrated acceptable content, internal and construct validity for addressing leadership self-efficacy. It can be used in the evaluation of HP leadership training. Caution is advised in generalizing the results for the Jewish sample given the small sample size.

Key messages

This scale has been validated as a measure for assessing leadership self-efficacy. The scale can be used in evaluation of health promotion leadership trainings for the same population.
Challenges and leverages to strengthen vaccination in south American countries
Authors: Souza L
Published: October 2020

L. De Sousa will provide examples of challenges and leverages to strengthen vaccination in South American countries
'I smoke and drink alcohol during pregnancy, but I'm a good enough mom': a mixed methods study
Authors: Satran C , Bord S , Sassoni- Bar-Lev O , Berkovich E , Madjar B
Published: October 2020

Background

Smoking and alcohol consumption during pregnancy is a major public health concern. The aims of this study were: 1) to examine smoking and alcohol consumption during pregnancy and to investigate their association with maternal attitudes and socio-demographic characteristics; 2) to explore maternal attitudes regarding smoking and alcohol consumption during pregnancy among pregnant and postpartum women in Israel.

Methods

This mixed methods study is comprised of a self-reported questionnaire for measuring attitudes and behaviors regarding smoking and alcohol consumption among 676 Jewish women, up to 9 months postpartum; and semi-structured interviews with 17 women who smoked cigarettes and/or consumed alcohol during their pregnancy.

Results

Sixty-four women (9.6%) reported drinking alcohol during pregnancy, and 30 (4.8%) reported smoking. Women with a fewer children (OR 2.25; 99% CI: 1.30, 3.92) and those whose attitudes supported alcohol avoidance (OR 0.52; 99.9% CI: 0.36, 0.74) consumed less alcohol while pregnant. Educated women (OR 0.31; 99% CI: 0.14- 0.71) and women with anti-smoking attitudes (OR 0.50; 99% CI: 0.30, 0.82) were more likely to avoid smoking during pregnancy. Qualitative analyses reveals three major themes: 1) 'A good enough mom': The mothers presented risk-management practices in line with the conflict between their perception of ideal motherhood and that of being an independent person; 2) 'Social acceptance of smoking and alcohol consumption during pregnancy': Social attitudes of spouses, family and friends; 3) 'Lack of reliable information' from healthcare professionals.

Conclusions

Women's attitudes have a significant impact on their decision to drink alcohol and/or smoke during pregnancy. These attitudes may be a result of their risk management practices and the social acceptance of risk behaviors during pregnancy, and information provided (or not) by healthcare professionals.

Key messages

The results highlight the importance of creating a supportive environment and shaping health promoting attitudes among pregnant women. Reliable information given by healthcare professionals regarding risk behaviors during pregnancy is needed.
Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal
Authors: Dharel D , Bhattarai A , Paudel Y R , Acharya P , Acharya K
Published: October 2020

Background

Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal.

Methods

We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates.

Results

The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods.

Conclusions

Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery.

Key messages

The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.
Gaining political will for actions to achieve health equity: lessons from Australia for advocates
Authors: Baum F , Townsend B , Fisher M , Freeman T , Harris P , Browne-Yung K , Friel S
Published: October 2020

Background

There has been an accumulation of evidence on the importance of action on the social determinants of health to reduce global and national health equity. Yet there has been little effective systematic action by governments. This is commonly attributed to the absence of political will. Despite its importance, however, little research has examined how political will might be created or prevented.

Methods

This paper reports on the results of eight case studies of the extent to which Australian public policy is likely to contribute to reducing health inequities. 192 participants were interviewed including public servants, politicians and their staff, non-government organisation workers and community members. The transcripts were interrogated with the assistance of NVivo software to determine lessons about the creation or destruction of political will. The case studies were of: national primary health care policy, crucial determinants of health (work conditions, internet access, urban planning, social welfare, trade) and an automotive plant closure.

Results

We found the following factors to be important in determining the extent of political will for health equity, whether: path dependency was present; the issue would impact on staying in or winning government; political philosophies stressed collectivism or individualism; there were negative or positive social constructions of groups affected by the policies; economic and/or biomedical framings were dominant; elites (especially business interests) lobbied against the policies; and there was effective civil society and policy advocacy in favour of the policies.

Conclusions

Building on our insights from our case studies of action for political will, we conclude with a series of questions to guide the work of public health activists and policy advocates working to support existing and to create new political will in multiple contexts.

Key messages

The creation of political will is vital to the adoption of policies supportive of health equity. Analysis of 8 policy case studies points to how advocacy can most effectively create political will.
Systematic review examining the evidence for impact of school policies on physical activity
Authors: Volf K , Kelly L , García Bengoechea E , Gobis A , Lakerveld J , Zukowska J , Gelius P , Messing S , Forberger S , Woods C
Published: October 2020

Background

Epidemiological evidence has demonstrated that physical activity can have substantive health benefits for children and young people. The 'Policy Evaluation Network' is a multi-disciplinary research network across 7 European countries and New Zealand aimed at building capacity and evaluating the level of impact of policy interventions for promoting healthy lifestyles. The Toronto Charter identified 'whole-of-school' programmes as one of seven key investments for promotion of PA. This paper presents results of a SLR, designed to assess the level of evidence for policies within the school setting that contribute directly or indirectly to increasing PA.

Methods

Researchers searched six online databases for scientific literature regarding PA policy interventions in the school setting using key concepts of policy, school, PA and evaluation. Risk of bias will be assessed with tools appropriate to the design of the studies considered. Evidence of actual or potential positive PA outcomes arising directly or indirectly from policy actions will be catalogued.

Results

Preliminary searches identified 2327 unique scientific articles. 1938 (83.3%) were excluded on first reading and 189 (8.8%) were included for full text analysis. Initial findings suggest that organisational policies, for example avoiding overcrowding in playgrounds during school breaks, may be a promising policy action. Detailed analysis revealing other potential policy actions supported by evidence will be presented (SLR in progress).

Conclusions

Preliminary findings suggest that few studies link policy actions in the school setting to PA outcomes. However, studies that have investigated the effects of changes to the school environment on PA levels may provide evidence for policy actions. Preliminary recommendations include strengthening the evidence base for school-based PA policy by supporting studies into the effects of particular policy or legislative changes on PA outcomes.

Key messages

School physical activity policies are an underappreciated public health intervention. More studies should link policy changes to physical activity outcomes.
Healthy choices in New South Wales health facilities for staff and visitors: a policy evaluation
Authors: Trevena H , Munn E , King L , Thomas M , Shepherd L , Cranney L , Crino M , O'Connell T , Cobcroft M
Published: October 2020

Issue

Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018).

Results

The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability.

Key messages

Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.
24.G. Workshop: Reconstructing public health institutions in Somalia
Authors:   Organised by: Public Health Agency (Sweden),   Chair persons: Khalif Bile - Sweden, Kassim Abdi Jimale - Somalia
Published: October 2020

The overall aim of this workshop is to present the ongoing efforts to restore central national public health institutions in Somalia like The National Institute of Health Somalia (NIHS), and to discuss critical factors to rebuild the health system and restore health institutions in fragile states using Somalia as an example. The workshop will focus on how to accelerate this process in order to reach the sustainable development goals and to help Somalia to achieve universal health coverage by 2020. The Public Health Agency of Sweden and The Norwegian Institute of Public Health organize this joint workshop in order to commemorate our late colleague and co-worker Mohamed Guled Farah, whós hard and tireless work was pivotal in the reestablishment of NIHS, with the ultimate goal of improving the health of the Somali people. The workshop will be chaired by Khalif Bile, who is a Senior Advisor to the Federal Ministry of Health Somalia. Bile has an outstanding experience in global public health in general and is very knowledgeable about the challenges and opportunities of the health system in Somalia and of the general health status of the population. Highly relevant presentations will be made by prominent key players and researchers in the field, followed by ample time for audience interaction. Kassim Abdi Jimale, Lecturer, Somali National University, will give an introduction and background to the restoration of the National Reference Laboratory and the process to establish the National Institute of Health Somalia. Somalia is a country that is affected by complex emergencies resulting from prolonged conflict, climate change, outbreaks of communicable diseases and a dysfunctional health system. The Public Health Agency Sweden, with the support of Sida (Swedish International Development Cooperation Agency), supports the Federal Ministry of Health Somalia to restore vital health institutions such as the National Institute of Health Somalia (NIHS) to provide effective public health services within a country disrupted by conflict. There are several partners involved in this process, and a great deal of effort is put in coordination of activities. Joining hands, finding synergies and coordination of efforts is another key function of this workshop.

Key messages

Reaching UHC and the SDGs in Somalia require support to the re-establishment of strong, sustainable public health institutions like the National Institute of Health Somalia. Strengthening the public health system of Somalia requires coordinated, long-term, sustainable commitments and partnerships.
Challenges and leverages to strengthen vaccination in Asia-Pacific countries
Authors: Macartney K
Published: October 2020

K. Macartney will provide examples of challenges and leverages to strengthen vaccination in Asia-Pacific countries.
The patients’ perspective on coordinated action for cancer and AMR
Authors: Apostolidis K
Published: October 2020

The speaker will present the perspective of the cancer patients, and the challenges they encounter across the spectrum of care and what measures they consider relevant in terms of prevention, diagnosis, treatment and, indeed, to raise awareness of the impact of AMR on rendering cancer treatments ineffective. She will elaborate on survivorship, and on the impact of AMR on the quality of life of patients, their carers, and families. Emphasis will be given on the implications of modern therapies, such as immunotherapy, representing a unique challenge in terms of better understanding the effect on overall health of patients, with the effect they have the immune system, further weakening the patient and leaving him/her exposed to infections potentially of higher risk than cancer itself.
The emergency to tackle tobacco smoking by Lebanese adolescents
Authors: Akel M , Salameh P , Ehlinger V , Godeau E
Published: October 2020

In Lebanon, tobacco use by adolescents remains a problem and is higher than among adults. This study sought to assess the experimentation of tobacco smoking practices among adolescents in Lebanon, and further to link health promotion at school-level (measured with the Hat Questionnaire) to the smoking behaviour at students-level (measured with the HBSC questionnaire). We relied on a cross-sectional observational study, conducted in 50 schools across Lebanon. The students' ages ranged from 11 to 18 years old (6th to 12th grade). They filled-in a confidential, anonymous self-questionnaire in class. In parallel, the school administration filled in the assessment questionnaire for health promotion. STATA Software was used for statistical analysis.7133 students were included (mean age 15.24±2.00 years). Overall, 24.5% had ever experimented cigarette smoking alone, boys more than girls (31.95% vs. 19.14%; p < 0.001), mainly from Beirut (33.62%; p < 0.001) and with poor health perception (29.12% vs. 19.87%; p < 0.001). Overall, 33.98% had ever used water-pipe alone, again more boys (40.34% vs. 29.88%; p < 0.001), from Beirut (39.55%, p < 0.001), and with poor health perception (39.48% vs. 28.93%; p < 0.001). Finally, 22.28% experimented both cigarettes and water-pipe. Around 70% of the involved schools offered health-related courses in their curricula. 72 % of them included interventions on the harm of smoking but not as an integral part of the curriculum. Less than half of them had developed plans to improve health promotion and review data to ensure the effectiveness of their programs. This alarming rate of use of tobacco products constitutes a major public health issue for Lebanese adolescents that needs urgent intervention. Further analysis will focus on the school-level questionnaires. Already our results will serve to foster the reinforcement of health promoting schools in Lebanon by the ministry of Education, in line with international recommendations.
Strengthening local impact on maternal health for the most vulnerable populations
Authors: Faillat V , Mortiz A , Vouiger S , Liska J
Published: October 2020

Sanofi Espoir Foundation evaluated impact of its decade long investments, in the amount of over 5 million Euros, on addressing health inequalities globally. Focusing on Saint-Louis department in Senegal, they have mapped specific profiles' experience like pregnant teenager suffering from community stigma, and finally linked each key moment with the health determinants, actors and initiatives. This study puts into perspective the impact the health system, including healthcare practitioners, can have on the pregnancy experience in regards of the influence of other determinants such as religion, culture, education, transportation, labor conditions, physical environment, health habits as well as local actors and initiatives. Each social determinant is highly and quite equally influencing the ante- and post-natal experience of the women, whereas the health system is the key factor during childbirth experience. If social determinants in health are well known, they are not reflected as such into health programs and funding processes. Maternal and newborn health in vulnerable situations is not simply a technical concern but a complex social issue that needs to be managed with an integrated, specifically “local” approach, transforming the objective 17 of the Sustainable Development Goals about partnering and breaking down silos, from an abstract paradigm into a daily process, thanks to community engagement and global accompaniment.
Migration, adolescents and health
Authors: Devakumar D
Published: October 2020

In low- and middle-income countries, migration for work is common but the health consequences on adolescents is poorly understood. Particularly in low-resource settings, when children enter their adolescent years, their lives change dramatically as they take on adult roles. Young girls may get married and forced to move to their husband's home where they conduct domestic work and are exposed to high levels of air pollution from cooking. They are also more likely to become parents themselves. Many girls and boys drop out of school to work near their home or migrate within the country or abroad. They face risks throughout the journey and often work in precarious forms of labour. Among them, the unaccompanied adolescents face even greater risks than those who move with their parents. When parents migrate, despite increases in wealth from remittances, child and adolescent mental and physical health tends to worsen. With evidence mostly from the South Asian context, Dr Devakumar will explain detrimental impact of parental migration on left-adolescents and raise the importance of policy makers and health-care professionals on taking action to improve the health planning targeting of these young people.
Case-control study of risk factors for adolescent fertility and premature birth in Bulgaria
Authors: Kamburova M , Georgieva S L , Tsanova D K , Karadzhova P
Published: October 2020

The significant positive correlation between share of Roma population and adolescent live birth in EU member states (r = 0.804, with 2-tailed significance p = 0.000) was found. The highest level of proportion of live births to mothers aged less than 20 years was found in Romania (9.8%) and Bulgaria (9.5%). At the same tame proportion of Roma population in those countries is highest: Bulgaria (4.7%) and Romania (2.5%). The study found that two thirds (66%) of children born to mothers under the age of 19 are born prematurely OR = 2.10 95% CI (1.13-3.91). Among the newborns studied, the proportion of prematurely born children living in rural areas is significantly higher than those living in the city (p = 0.0001; r = 0.26). Later registration (after the first trimester) and monitoring of pregnancy is a significant risk factor and increases more than four times the risk of having a premature baby OR = 4.23 95% CI (1.41-12.69). A holistic approach is needed in which socio-economic development and education of Roma girls leads to further reduction of adolescent childbirth and premature delivery in Bulgaria.
Early years pathways to inequalities in childhood asthma? A causal mediation analysis
Authors: Creese H , Mason K , Schlüter D K , Taylor-Robinson D , Saxena S
Published: October 2020

Background

Asthma affects one in five children in the United Kingdom (UK). Children in deprived areas have twice as many unplanned admissions for wheeze but mediating pathways between socioeconomic circumstances and asthma remain unclear. We aimed to quantify which early years pathways explain inequalities in childhood asthma in the UK.

Methods

We analysed data on 10650 children from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life socioeconomic circumstance (SEC) was measured by maternal education at birth. Our outcome was parent-reported asthma at 5 years of age categorised as none, diagnosed asthma and diagnosed asthma with wheeze symptoms in the preceding year. Mediators were grouped into perinatal characteristics (maternal BMI, breastfeeding duration, birthweight, gestation, maternal smoking and alcohol use during pregnancy), neighbourhood features (pollution, grime and environment issues, traffic volume, housing quality) and the home environment (damp/condensation, tenure, pets, tobacco smoke). We used multinomial regression to examine the total effect of SEC on childhood asthma, then adjusted for all potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators.

Results

Children whose mothers had no qualifications were more than twice as likely to have asthma by the age of 5 years with a wheeze episode in the preceding year compared with those whose mothers had degree-level qualifications (relative risk (RR) 2.21, 95% CI 1.44 to 3.40). After adjustment for all mediators, there was a 69% reduction to aRR 1.38 (95% CI 0.89 to 2.14).

Conclusions

Perinatal characteristics and early years neighbourhood features and measures of the home environment partially contribute to inequalities in childhood asthma.

Key messages

The antenatal period and early years of development are important for targeting interventions to reduce inequalities in asthma. About two-thirds of the social inequality in childhood asthma was explained by perinatal characteristics, early years neighbourhood features and the home environment.
How healthy is a ‘healthy economy’? Incompatibility between current pathways towards SDG3 and SDG8
Authors: Koutsoumpa M , Meurs M , Seidelmann L , Fienieg B , Kramer K , Bemelmans M
Published: October 2020

Background

The link between health and the economy is well known. However, economic growth as measured in SDG8, continues to leave people behind and the funding gap for realizing SDG3 for good health and well-being remains vast. International financial institutions, i.e. the IMF, influence national policies in ways that may undermine the SDGs. We examine incoherencies between economic growth and health goals in Malawi, Uganda, and Tanzania.

Methods

We conducted qualitative research based on policy analysis. To analyse IMF policy advice in the three countries we reviewed relevant program documents, article IV consultation reports (2016-18) and literature on structural adjustment. We accessed health information from WHO and World Bank databases, and national policies.

Results

In all three countries, some indicators, e.g. infant and child mortality, improved, but others lag behind. Underfunding is a major cause for poor health and inequities. GDP increases (as a measure of economic growth) do not automatically translate to increases in health spending. Health expenditure from domestic public resources remains much lower than international thresholds. To achieve this level of spending domestically, GDP in these countries would require an unrealistic manifold increase. IMF policy advice and loan conditionality that focus on GDP growth and tight monetary and fiscal targets impair social spending, while suggested taxation measures are generally regressive.

Conclusions

The GDP-focused SDG8 can delay efforts towards the SDG3 if governments opt to focus on GDP growth without measures to equally distribute wealth and invest in social sectors, often under IMF's influence. Although the IMF has acknowledged the importance of social development, its policy advice still adheres to austerity, harming population health. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective, strive for equitable economic development and emphasise global co-operation.

Key messages

GDP increases do not automatically translate to an increase of health spending, partly a result of IMF structural adjustment programs and policy advice. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective and place more emphasis on SDG17 on global co-operation.
The frequent user’s decision-making process when contacting urgent and/or emergency services
Authors: Worrillow N , South J , Cole A , Collin S , Briggs M
Published: October 2020

Background

There is a lack of qualitative research that has been undertaken which has captured the perspective of frequent users to urgent and emergency healthcare services. Previous research has viewed and studied this population largely by using retrospective routine data, which focuses on the patient's demographic, presenting symptom or demand implication. Current research now advocates that these vulnerable and complex individuals are using these services due to their unmet needs or multiple comorbidities. The aim of this research was to explore the patient's decision-making process and their motivations for repeatedly contacting urgent and emergency services.

Methods

Semi-structured interviews were undertaken with a small cohort of six previously identified frequent users to urgent and emergency healthcare services. These participants were recruited into the study by a third sector organisation, due to the vulnerabilities and complexities of these individuals' lifestyles. A framework analysis was used to code and extract relevant themes and concepts from the interviews.

Results

Social prescribing through a named support worker enables navigation and re-engagement into a range of services that benefits this population and reduces their demand upon other services. The support given through social prescribing organisations can counteract the lack of personal support networks and resilience factors that these individuals experience. In addition, individuals who have been re-referred into substance misuse services should be offered alternative engagement programmes, which differ from their initial programme.

Conclusions

Current inequities of outcomes and access to services should be examined, in relation to vulnerable and complex individuals who have reduced support networks and limited resilience factors. Future research should be undertaken regarding the benefits for frequent users of social prescribing to support patient outcomes and re-integration into services.

Key messages

Social prescribing is the link that enables complex and vulnerable frequent users to navigate and re-engage into a range of health and social care services. Examining the inequities faced by frequent users to urgent and emergency healthcare services.
Minimizing health inequalities in rural population through pilot integrated medico-social centres
Authors: Furtunescu F L , Dragoescu A , Pana B C , Minca D G
Published: October 2020

Problem

In Romania about 45% of the population (about 9 million people) still live in rural settings, having more detrimental health indicators and a poorer access to medical and social services compared to population living in urban.

Description of the problem

Under the Swiss-Romanian Cooperation Programme, a public health intervention was implemented in seven rural remote communities from Romania, aiming to increase access to basic medical and social services for the people living in those communities, with focus on the most vulnerable ones and to facilitate integration between medical and social services at the community, county and national level. In the first phase a decentralized training in health projects has been provided for local teams coming from eighteen rural remote communities which expressed their interest to be involved in the intervention. after the training, each local team developed its own pilot project for building a local model of integrated medico-social services. In the second phase, best projects were selected for implementation and received financing. All local teams were supported in the implementation of the model by a central coaching team, which had the role to provide technical advice and to facilitate mediation with the county and central authorities from the medical and social protection sector. The third phase aimed to capitalize the experience from the field and the lessons learned on three layers: local community, county level and central authorities.

Results

Seven medico-social centres were founded in the rural communities and continued to operate after the project end, serving around 20000 inhabitants, among which around half have medical and/or social vulnerabilities.

Lessons

Using a bottom up strategy in building medico-social integrated models of care in rural and remote communities is a key premise for the success and sustainability of the model.

Key messages

Involvement of local actors is essential when trying to increase access to medical and social care for rural, underserved communities. Facilitating access to general health and social protection systems is a key element for sustainability, instead of building new or specific models of services.
Suicide Prevention Pathways: linking risk and behaviour within the Maltese context
Authors: Cachia J
Published: October 2020

Background

People engage in suicidal behaviour as a result of several risk factors, such as acute stress, severe depression, violence, sexual abuse, etc. Beyond such evidence from literature, a mental public health approach to suicide prevention needs also to take into account specific country characteristics and to look beyond the demographic characteristics of deaths by suicide. Available clinical information can help identify and quantify risk, analyse patterns of behaviour, explore links between risk and behaviour and provide possible suicide prevention pathways.

Methods

In this study, the 128 deaths by suicide for the period 2015-2019 in Malta are analysed against available clinical information. Major sources of detailed clinical information include obligatory notifications to the Commissioner for Mental Health of all cases involuntarily admitted to acute psychiatric services and other medical records held within the Maltese public mental health system.

Results

84% of 128 deaths by suicide for the period 2015-2019 were males, two-thirds of them between 25 and 54 years. The preliminary findings have confirmed that less than 50% of these deaths had previous contact with the public health system. The two main diagnostic criteria among deaths with recent psychiatric admission/s were acute stress reaction to personal life events and very severe mood disturbances, particularly depression. There seems to be increased risk among migrants and foreign workers residing and working in Malta. The frequency of prior admissions, age-related issues, the time-event relationships and relevance of elicited clinical findings are still being evaluated, and will be presented in more detail in the workshop.

Conclusions

Exploring risk factors within the history of cases of suicide and attempted suicide through available clinical information can contribute to the development of suicide prevention pathways, relevant to the specific context of local communities.
Comprehensive health literacy in general populations – An international comparison
Authors: Pelikan J , Link T , Berens E , Pettersen K , Le C , Sørensen K , Vogt D , Gibney S , Aringazina A , Vrbovsek S
Published: October 2020

Background

The HLS-EU study in 2011 demonstrated for 8 EU Member States that there exists limited comprehensive health literacy for considerable proportions of the general population, that there is a social gradient for health literacy and that limited health literacy has problematic consequences for healthy lifestyles, self-reported health and utilization of professional health services. It was also shown that distributions and associations of health literacy differ considerable between countries. WHO-Europe started the Acton Network on Measuring Population and Organizational Health Literacy (M-POHL) to measure health literacy regularly with the Health Literacy Survey 2019 (HLS19).

Methods

Based on the design and instrument of the HLS-EU study (to allow comparisons for countries participating in both surveys) a core questionnaire was developed for measuring comprehensive health literacy and its relevant correlates. Optional packages were created to measure, among others, digital health literacy and its most relevant correlates. Data were collected from probability samples of at least 1.000 respondents per country for the general population 18+ by personal interviews, telephone interviews or internet surveys in at least 15 member states of the WHO-Europe region.

Results

Distributions for indices, scales and levels of comprehensive health literacy will be presented as well as correlations and regressions for associations of health literacy with social determinants and with consequences for selected life style indicators, indicators for self-reported health and use of professional health care services.

Conclusions

Preliminary results show that the general trends of the HLS-EU study concerning health literacy hold true for HLS19 and that there are considerable differences between participating countries. Health literacy is relevant for health policy in all countries, but to understand the differences between countries a more detailed analysis is necessary.