bluuebunny/crossref_metadata_2025 huggingface dataset:
Joining two worlds - When academia meets real life and vice versa
Authors: Ese J , Ihlebak C
Published: November 2019

Partnerships between academic institutions and actors outside of academia have for some time been considered a universal remedy for solving complex issues in a wide range of fields; ranging from themes as different as commercial developments in innovation clusters to reducing social inequalities or working against climate change. Such partnerships are strongly encouraged by governing bodies, and are sometimes prerequisites for being eligible as applicants for funding schemes like H2020. A proof of the impact this model of cooperation has had, is the fact that partnership is the only organisational structure that has been elevated to be part of the UN17 goals for sustainable development.

Throughout history, academia has had a complex relationship with the society to which it belongs. On the one hand, academia depends on being seen as valuable, often through visible and concrete impact on society. On the other hand, within academia there is a strong norm of academic freedom stating that such freedom is best accommodated for through a certain degree of insulation between academia and society. This way of understanding academic freedom is an important cornerstone of the Humboltian university ideals as well as in the Mertonian CUDOS norms. Practice and policy actors may also find partnerships with academia complex to navigate. However, such partnerships can be valuable through ensuring that policies and developments are based on research findings and best practices. Furthermore, academics may educate and train practitioners, and evaluate and do research on their initiatives. However, partnerships can also be challenging for practitioners, as academics have to follow strict principles for research design and have little room for holding back results that may put the practitioners in a bad light. In this presentation the complex relationships between academia and practice are presented, both by examining advantages and by taking a critical stance.
Health Equilibrium Methodology (HEM), a digital tool in public health work for health equity
Authors: Hallmyr M , Wretlind K , Magnusson M
Published: November 2019

HEM draws on theories for health behavior and power relations. The methodology contains a structured documentation for formative and summative purposes. Strive for a high level of participation, control and influence from individuals and community members is a foundation pillar. Systematic use of theories allows for answering the fundamental question “in what way do we anticipate the planned intervention to contribute to closing the health gap?” Social Cognitive Theory (SCT) considers social and physical environment. HEM currently involve several SCT determinants in planning and evaluation; self- efficacy, observational learning, facilitating, expectations of outcome, reciprocal determination. The qualitative procedure is described below. Numeric data are also collected.

Step one (before action, e.g. a dialogue-meeting): Consider which determinant(s) may be affected by the planned action, and by what mechanisms.

Step two: Carry out the action.

Step three: Describe what happened, based on input from the participants and the anticipated determinants and mechanisms.

Step four: Systematic self-critical review based on common grounds for discrimination. Examples: Was it difficult to engage or include participants because of language, gender, function variation, national background or other factor? In retrospect, can you identify stereotypes in the examples you used? Did anybody else at the event act to maintain prejudice or exclusion?

Step five: consider implications for methodological development.

Step six: Formative collective evaluation based on reflections from step four and implications from step five.

Stakeholders using HEM gather regularly for workshops based on their HEM-reports, aiming at developing tools for increasing health equity. HEM is implemented in public health work of Angered Hospital and the Dental Public Health, Region Västra Götaland, and is used by 20 different stakeholders. A web-application has been developed to facilitate documentation and spread.
The migrant health workforce in European countries: does anybody care?
Authors: Kuhlmann E , Greer S L , Burau V , Falkenbach M , Jarman H , Pavolini E
Published: November 2019

Background

Data and knowledge on the migrant health workforce are poorly developed, and we do not understand which institutional contexts may foster responsible governance. This introduction seeks to set the scene for critical debate by placing the structure and composition of the migrant health workforce in the context of health systems and policy. The aim is to confront growing nationalism and populism with the important contribution of migrant carers to health system performance and the health of the population.

Methods

A comparative approach was applied and a rapid review of available data and research undertaken. Five EU countries were selected which represent different healthcare systems, health workforce patterns and political contexts in high-income countries, comprising Austria, Denmark, Germany, Italy, UK.

Results

The migrant workforce pattern show high variation. The number of physicians is highest (around 28%) in the UK, and low in Austria, Denmark and Italy (below 5%) while Germany is in a middle position (around 10%). The picture turns when looking at nurses and carers, where Italy and Germany for instance are placed in higher ranks. The results suggest three things: no coherent patterns of health system types and composition of the migrant care workforce can be identified. There is also no clear connection between the size of the migrant health workforce and the relevance of populist movements. And finally, the migrant carers remain largely absent in the policy debates; none of the health systems has develop a comprehensive governance model that ‘cares’ for the migrant carers and that could help to highlight their contribution against the threats of growing nationalism and populism.

Conclusions

There is a need for comprehensive European monitoring and research to develop more inclusive health workforce governance and to identify institutional conditions that improve capacity and capability for ‘care’ ‘of the migrant health workforce.
“People expect you to work like you don’t have a child but be a mum like you don’t have a job’
Authors: Rush L , Hilton S , McDaid L
Published: November 2019

Background

Recent UK campaigns that aim to increase awareness of sepsis have been accompanied by high profile media reporting about deaths in children resulting from misdiagnosis. Parents have been urged by the Sepsis Trust to have a low threshold for suspecting sepsis when their child is unwell and to follow ‘gut instincts’, challenging health professionals if necessary. This study aims to explore how parents enact this advice in the context of everyday life.

Methods

Thematic analysis of 16 focus groups comprised of parents and carers of pre-school children and 4 groups with individuals affected by sepsis.

Findings

Participants encountered various barriers and conflicts of interest when endeavouring to do the ‘right’ thing in managing acute childhood illness. Gaining access to healthcare was often challenging, with parents weighing up the need for reassurance against fears of over using scarce health care resources. Despite knowledge of recent sepsis awareness campaigns, parents frequently reported that the diverse symptoms described were too non-specific to be of practical use. ‘Knowing your child’ and being able to detect subtle deviations from normal was seen as key to decision-making about the need to escalate care. However, for parents in paid employment, the obligation to be present with their sick child to monitor symptoms closely was often in conflict with their duty to employers. The capacity to work flexibly, while highly valued, was inconsistent and frequently based on discretion of line managers rather than supported by official workplace policies.

Conclusions

Recent awareness campaigns have highlighted the need for parents to be alert to the possibility of sepsis when their child is acutely unwell. However current campaign materials do not enable parents to confidently identify when to seek help. Lack of access to primary care appointments and unsupportive employment policies may act as barriers to acting in accordance with sepsis awareness messages.

Key messages

Recent sepsis awareness campaigns focus on the importance of ‘parental instinct’ in managing risk. Parents often experience conflicting obligations towards their child and employer which can act as a barrier when monitoring risk during episodes of acute illness.
International, inter-university transferability of a student health surveillance system (SuSy) tool
Authors: Reintjes R , Holt M , Kalbus A , Powell S
Published: November 2019

Introduction

While university students are known to face major life transition challenges with the risk to engage in potentially undesirable health-related habits, there are very few attempts to monitor students’ health behaviour on a regular long-term basis. Even in cross-sectional designs, students from the field of Public Health and/or Health Sciences are rarely investigated. Here, a cross-university students’ health behaviour surveillance system is presented.

Methods

A students’ health and health behaviour surveillance system (SuSy) has been implemented in Hamburg University of Applied Sciences in 2014, collecting and analysing data of health sciences students twice a year since. After Manchester Metropolitan University joined the project and adapted SuSy to its specific context in 2016, data of both SuSy settings were compared using logistic regression models. In addition, focus groups were carried out in both universities in order to assess the perception and acceptance of the tool.

Results

After eight elicitations with total sample of 1366 responses, a decreasing trend of smoking and increasing trend of cannabis consumption can be observed among Hamburg students. In comparison, Manchester students tend to smoke significantly more (OR = 3.74, 95%CI 1.95-7.17), but consume less cannabis (OR = 0.51, 95%CI 0.14-0.9). Trends in physical activity and healthy food consumption complete the overview. Focus groups revealed that SuSy is perceived as an appealing, useful and recognisable tool among students from both universities.

Discussion

While being easily adapted in content and delivery, SuSy allows for the provision helpful, comparable information about students’ health behaviours as well as for the observation of time trends. These findings underline SuSy’s potential in promoting university students’ health.

Key messages

The student health surveillance system (SuSy) tool allows comparable information about students’ health behaviours as well as the observation of time trends. SuSy is perceived as an appealing, useful and recognisable tool among students from both universities.
Surveillance of dengue: evolution of surveillance strategies during a large outbreak, Réunion, France
Authors: Menudier L , Vilain P , Robinson E , Balleydier E , Daoudi J , Thébault H , Jaffar-Bandjee M C , Muriel V
Published: November 2019

Issue

After a period of low-level circulation of a few cases per week during 2017, La Réunion experienced an outbreak of dengue in 2018 followed by a second and ongoing larger epidemic wave in 2019. Various surveillance systems have been progressively implemented to monitor and characterize the outbreak.

Methods

All laboratory diagnoses of dengue are routinely notified to the regional health authority (RHA) for investigation. With the outbreak onset additional programmes were implemented including the monitoring of presentations to emergency departments (EDs) and hospitalisations of dengue cases. In addition, all death notifications to the RHA which cite dengue are reviewed by an expert committee and the cause of death classified as directly, indirectly or unrelated to dengue. Finally, weekly data from a sentinel network of general practitioners is used to estimate the number of community consultations with dengue-like illness across the island.

Results

In 2017, 97 dengue cases were notified, with low level circulation continuing through the austral winter. In 2018, 6,679 cases (exclusively serotype 2) were notified. Western and southern regions of the island were most affected. The supplementary surveillance identified over 500 ED presentations for dengue-like illness and 160 hospitalisations. Three deaths were determined to be directly due to dengue, while 3 were indirectly related. Finally, there was an estimated 26,000 consultations for dengue-like illness in the community. After a second winter of persistent circulation, a second epidemic wave commenced in December 2018, and is still ongoing.

Lessons

The implementation of additional surveillance systems enabled a better understanding of the magnitude and impact of the outbreak. The use of sentinel network allowed the estimation of the number of people affected in the community without a laboratory diagnosis. The ongoing viral circulation since 2017 suggests a high risk of endemisation of dengue on the island.

Key messages

The outbreak has had a significant impact of health and community health services, and on the wider population. The second consecutive austral winter with interrupted transmission suggest a high risk of endemisation.
Influenza-associated morbidity and mortality in Tunisia
Authors: Bouguerra H , Hechaichi A , Bouabid L , Yazidi R , Abdeddaiem N , Maazaoui L , Moussi A , Ben Khelil J , Ben Salah A , Ben Alaya N
Published: November 2019

Background

Influenza is a highly contagious viral infection representing a public health problem worldwide with more than 10% of the population affected each year. In addition, severe complications and deaths may occur especially among high-risk groups. Our objectives was to assess the severity of influenza in Tunisia from 2015 to 2017 and to identify the isolated circulating viruses.

Methods

Basedon the network of ILI (Influenza-like illness) and SARI (Severe acute respiratory infection) Sentinel Sites and the National Influenza Center, we conducted a descriptive analysis of all data collected from 2015 to 2017. The case definitions of ILI and SARI were those recommended by WHO. Data entry was using Epi-Data and data analysis using SPSS-20.

Results

The total number of SARI cases during 2016-17 season was 614. The hospitalization rate was 0.7% which was higher than the 2015-16 season (0.19%). The majority of these severe cases were males (60,3%) and the group aged more than 65 years was the most affected. Comorbidities were reported in 58,7% of the cases, especially cardiovascular diseases, obesity and asthma. In 2016-17, the viruses identified in SARI cases were type A(H3N2) (47,7%), type B (40,9%) and type A (H1N1) pmd09 (4%). The lethality rate was lower than in the previous season (0.32% vs 20%) with two deaths reported in February. These deaths were due to virus B and virus AH3N2, comparing to 77% of deaths due to virus A (H1N1) pmd09 the season before.

Conclusions

Influenza severity vary from a season to another. The 2016-17 season was marked by higher rates of hospitalization but a lower lethality rate. This may be due to a lower circulation of the type A (H1N1) pmd09 virus, which virulence is much discussed. Influenza surveillance remains essential to detect any emerging novel pathogen and to guide decision-makers for future strategies.

Key messages

Seasonal influenza epidemics continue to have significant morbidity and mortality. Epidemiological and virological surveillance are highly essential for an early detection of epidemics and novel strains.
The Public Health Implications of Brexit in Wales: A Health Impact Assessment (HIA) approach
Authors: Green L
Published: November 2019

On March 29th 2019, the United Kingdom was due to exit the European Union (EU) in a process known informally as ‘Brexit’. The 2 years before this time (and ongoing) experienced a period of unprecedented political and social upheaval with many unknowns and much uncertainty attached to the outcomes and future impact of withdrawal and transitionary period.

Public Health Wales commissioned the Wales Health Impact Assessment (HIA) Support Unit to carry out a HIA of Brexit in Wales to assess the potential impact, extent and nature of ‘Brexit’ on health and wellbeing in Wales which would to inform its planning, future work and support other bodies decision-making, planning and policymaking.

A comprehensive HIA was conducted over a 6 month period in 2018/19, steered by a Strategic Advisory Group. Methods included; a literature review; stakeholder workshop; interviews with policy leads, a community health profile, and report with evidence synthesis.

Trade agreements, economic impacts, changing relationships with EU agencies, uncertainty and loss of regulatory alignment were key pathways for health impacts to occur. Potential impacts included; food standards/safety; environmental regulations; working conditions; and health and social care. Many impacts will affect the whole population. Vulnerable populations included; children/young people; those at risk of unemployment;Welsh areas receiving significant EU funding. Potential indirect impacts were identified on mental well-being.

Brexit has the potential to impact significantly on the determinants of health.The HIA has informed and influenced cross-sector planning and policy in response to the short/long-term implications of Brexit to ensure that health and inequalities are considered at every juncture.This unique work demonstrates continued leadership by Wales in the field of impact assessment and ‘health in policies’ and has been positively received. It has transferable learnings for many nation states and health policy leads.

Key messages

Brexit is a major policy change with major health impacts. HIA is an informative and influencing process to support planning and future policy making.
The EU Health Promotion and Disease Prevention Knowledge Gateway
Authors: Bakogianni I
Published: November 2019

Issue/ problem

Unhealthy diets, physical inactivity, alcohol and tobacco use are leading risk factors for non-communicable diseases. They are all modifiable and health promotion policies can support that.

Description of the problem

However, information overload, controversies and uncertainties, budget constraints and difficulties in balancing disparate interests are common challenges that can hamper action by policy makers in the field of public health. To support them, the European Commission has created the Health Promotion and Disease Prevention Knowledge Gateway. It is a reference point for independent and reliable information to assist policy making; it summarises both the data and knowledge needed to support prioritisation of public health policies and justify investments in health promotion.

Results

The Knowledge Gateway currently covers the areas of nutrition, physical activity, alcohol, marketing of foods and beverages, and related societal impacts such as disease burden and health inequalities. These topics have been prioritised by Member States representatives and policy makers. The content is organised into concise, well-structured briefs which include definition of each issue, health related effects, and examples of policy recommendations and implemented policies. The high-quality source documents are selected in a tiered approach and are mainly authored or endorsed by authoritative public health organisations.

Lessons

Judging by the positive feedback received, the Knowledge Gateway is being used widely across Member States and stakeholders. The content of the Knowledge Gateway will be further expanded to support other health priorities such as mental health promotion. Policy makers have a unique, trusted “one-stop-shop” with high quality information to support, justify and strengthen the development of public health policies and health promotion.

Key messages

The use of reliable authoritative information for the development of public health policies can support the prevention of major non-communicable disease risk factors. The EU Knowledge Gateway is a unique reference point of reliable, independent information to support policy making in the area of public health.
Impact of sleep and screen times on incidence of overweight in European children and adolescents
Authors: Guzman V , Arvidsson L , Lissner L , Hunsberger M
Published: November 2019

Background

A deeper understanding of the modifiable risk factors leading to excess weight in children and adolescents can provide unique opportunities for preventing the immediate and long-lasting health consequences of overweight. The aim of the study was to explore independent, prospective associations of screen time and sleep duration with incident overweight in a sample of European children.

Methods

Data from 4285 participants of the IDEFICS/I.Family cohort who were followed-up from 2009/2010 to 2013/2014 was analyzed. Hours per day of screen time and sleep duration were collected by parental report at baseline. Logistic regression analyses were carried in separate and mutually adjusted models controlled for sex, age, European country region, parental level of education and baseline BMI z-scores.

Results

At baseline screen time (hours/day) and sleep duration (hours/day) were inversely correlated behaviors (rs= -0.226, p<.001), indicating the necessity of exploring their separate and joint effects on the weight trajectory. In the non-overweight/non-obese population at baseline (N = 3734), separate models suggest that every hour increase on screen time and every hour decrease on sleep duration were associated with higher odds of the child becoming overweight or obese at follow up (OR = 1.156, 95% CI 1.015-1.316 and OR = 1.226, 95% CI 1.053- 1.428 respectively). In the mutually adjusted model, the screen time association was attenuated to non-significance (OR = 1.125, 95% CI 0.986- 1.284), while the association with sleep duration was also attenuated but remained statistically significant (OR = 1.198, 95% CI 1.026-1.398).

Conclusions

Both screen time and sleep duration are significant predictors of incident overweight in children and adolescents. However, according to our results sleep duration plays a stronger role than screen time, suggesting an increased value of overweight prevention strategies that emphasize adequate sleep duration.

Key messages

A holistic and integrated approach is needed to prevent overweight from early age and with a life-course perspective. New strategies for overweight prevention could benefit from prioritizing interventions that promote adequate sleep duration and reduce excessive screen time.
Acute respiratory infection hospitalized in intensive care unit: long-term outcome in Elderly
Authors: Grammatico-Guillon L , Hermetet C , Gaborit C , Laporte L , Guillon A
Published: November 2019

Background

The consequences of the ageing population concerning ICU-hospitalization need to be adequately described, especially acute respiratory infections (ARI) strongly associated with Elderly. The study aimed to assess the long-term outcomes of ARI surviving ICU hospitalization in patients over 80 yo.

Methods

A retrospective multicentre cohort study was performed, based on hospital discharge databases in one French region (2.5 million inhabitants). Patients with ARI in ICU were selected according to specific ICD-10 diagnosis codes recorded and matched with a control population (patient undergoing a cataract surgery), using a propensity score (matching algorithm 1:1 ratio, caliper 0.002) with the matching variables (age, sex, frailty score, chronic heart disease, chronic pulmonary disease and cancer). Analyzes of this matched population were performed to determine their 2-year in-hospital mortality, healthcare utilization and evolution of the frailty score during the 2-year period before/after the inclusion stay.

Results

A total of 1,658 hospital stays for ARI after 80 yo were identified, with 438 dead (26%) during the initial stay. After matching with the cataract population, 988 patients were selected in each group without difference in the propensity score. ARI lead to an important increase of healthcare use during the 2 years after discharge. The patients that were discharged from hospital after ARI requiring ICU, had a 23-fold increase of death at 90 days and 4-fold at 2 years and the evolution of the frailty score was 1.6 fold higher than the cataract population.

Conclusions

Elderly patients with severe ARI survived from their ICU stay in 75%, but have a major risk of death in the following months, and an important increase in healthcare consumption. Our findings provide data for more informed goals-of-care discussions and may help target post-ICU discharge services for these high-risk groups.

Key messages

Elderly patients with severe acute respiratory infection survived ICU in 75%, but had a major risk of death in the following months, added to a substantial increase in healthcare consumption. These findings provide data for more informed goals-of-care discussions and may help target interventions for these high-risk groups.
Compulsory vaccination policies: a systematic review about knowledge, attitudes and believes
Authors: Voglino G , Gualano M R , Bert F , Olivero E , Corezzi M , Rossello P , Vicentini C , Siliquini R
Published: November 2019

Background

Vaccine hesitancy is a considerable issue in European Countries and leads to low coverage rates. Consequently, the implementation of national immunization programmes including the introduction of compulsory vaccination are required. It is interesting to determine citizens’ knowledge, attitudes and believes about vaccination policies, in order to more effectively define vaccination programs.

Methods

The present study systematically reviewed published studies evaluating attitudes towards mandatory vaccination programs. PubMed and Scopus scientific databases were searched and 4,198 results were returned, of these 29 met the inclusion criteria. PRISMA statements were followed.

Results

Twenty-two studies assessed attitudes towards mandatory vaccination programs in general, while 9 papers focused specifically on the Human Papilloma Virus (HPV) vaccine. Most of the studies were performed in Europe and North America. According to the assessed studies, the majority of the population seems to be in favour of compulsory vaccinations, from 53% to 97% for different vaccination programs. More resistance has been recorded for the HPV vaccination: the percentage of agreement for mandatory HPV vaccinations ranged from 27% to 63.5%. Furthermore, some studies investigated healthcare workers’ attitudes towards childhood and adult vaccinations. They pointed out that the general population is generally more in favour of mandatory vaccination policies than healthcare workers. The studies highlighted that the support to mandatory policies increased after their implementations.

Conclusions

The results presented in this review could be an important starting point to further understand the issue of vaccine hesitancy and support the implementation of effective vaccination strategies in Europe.

Key messages

Mandatory vaccination policies are generally well accepted among general population. More resistance is recorded for specific vaccination (HPV) or among specific population (healthcare workers).
The assessment of students anxiety and depression symptoms, sense of coherence and suicidal risk
Authors: Žulpaitė G , Žilinskas E , Puteikis K , Jakubauskienė M
Published: November 2019

Background

The study measures and compares the rates of anxiety, depression, sense of coherence, subjective health status, suicidal risk among students from 12 universities of Lithuania.

Methods

Six-hundred-fifty-eight students from different academic fields completed a questionnaire that consisted of 23 questions and included Hospital Anxiety and Depression(HAD), Sence of Coherence(SOC-3) scales, suicide risk and subjective health status assessments. The data was analised by Microsoft Excel, R commander and IBM SPSS programmes.

Results

Males had higher depression(p = 0,025), but lower anxiety prevalence(p < 0,001) than females. The total score of depression symptoms subscale (5,min=0,max=19) indicated no risk of depression, although a mild anxiety level was found (the total score is 10,min=0,max=21). Students scored 3 points out of 6 in SOC-3 and evaluated their health for 2 points out of 5. Weak suicide risk was found in 43,2%(n = 284) of all respondents, moderate - 12%(n = 79) and high - 3,2%(n = 21). Students from the field of arts had the highest depression rate(7), whereas those from social sciences had the lowest rate(3)(p < 0,001). Students who live alone during years of study evaluated their health the worst(p = 0,004), had higher risk of depression(p = 0,038), more often felt sadness and apathy during the last 12 months(p = 0,045).

Conclusions

The respondents have mild anxiety symptoms, low sence of coherence, their subjective health status is good. More than half of students had suicidal thoughts. Male gender, academical field of arts, living alone during studies potentially increase the risk of depression, whereas female gender is related with higher anxiety symptoms. This study motivates the universities of Lithuania to strengthen the psychological support for students.

Key messages

The survey unveiled the need for higher education institutes to put more effort on reducing students‘ anxiety levels and it also highlighted the problem of suicide ideation among students. This study motivates the main universities of Lithuania to strengthen the psychological support for students.
Domain-specific physical activity patterns and cardiorespiratory fitness among adults in Germany
Authors: Zeiher J , Duch M , Kroll L E , Mensink G B M , Finger J D , Keil T
Published: November 2019

Background

Studies show that occupational physical activity (OPA) has less health-enhancing effects than leisure-time physical activity (LTPA). The spare data available suggests that OPA rarely includes aerobic PAs with little or no enhancing effects on cardiorespiratory fitness (CRF) as a possible explanation. This study aims to investigate the associations between patterns of OPA and LTPA and CRF among adults in Germany.

Methods

1,204 men and 1,303 women (18-64 years), who participated in the German Health Interview and Examination Survey 2008-2011, completed a standardized sub-maximal cycle ergometer test to estimate maximal oxygen consumption (VO2max). Job positions were coded according to the level of physical effort to construct an occupational PA index and categorized as low vs. high OPA. LTPA was assessed via questionnaires and dichotomized in no vs. any LTPA participation. A combined LTPA/OPA variable was used (high OPA/ LTPA, low OPA/LTPA, high OPA/no LTPA, low OPA/no LTPA). Information on potential confounders was obtained via questionnaires (e.g., smoking and education) or physical measurements (e.g., waist circumference). Multi-variable logistic regression was used to analyze associations between OPA/LTPA patterns and VO2max.

Results

Preliminary analyses showed that less-active men were more likely to have a low VO2max with odds ratios (ORs) of 0.80 for low OPA/LTPA, 1.84 for high OPA/no LTPA and 3.46 for low OPA/no LTPA compared to high OPA/LTPA. The corresponding ORs for women were 1.11 for low OPA/LTPA, 3.99 for high OPA/no LTPA and 2.44 for low OPA/no LTPA, indicating the highest likelihood of low fitness for women working in physically demanding jobs and not engaging in LTPA.

Conclusions

Findings confirm a strong association between LTPA and CRF and suggest an interaction between OPA and LTPA patterns on CRF within the workforce in Germany. Women without LTPA are at high risk of having a low CRF, especially if they work in physically demanding jobs.

Key messages

Women not practicing leisure-time physical activity are at risk of having a low cardiorespiratory fitness, especially if they work in physically demanding jobs. Different impact of domains of physical activity should be considered when planning interventions to enhance fitness among the adult population.
Cognitive function and type of physical activity: results from the FRéLE longitudinal study
Authors: Dupré C , Hupin D , Goumou C , Béland F , Roche F , Célarier T , Bongue B
Published: November 2019

Background

Previous cohorts have been notably criticized for not studying the different type of physical activity and not investigating household activities. The objective of this work was to analyse the relation between physical activity and cognitive decline in older people living in community. Impact of type of physical activity on the results has been realised.

Methods

The study used data from the longitudinal and observational study , FrèLE (FRagility: Longitudinal Study of Expressions). The collected data included: socio-demographic variables, lifestyle, and health status (frailty, comorbidities, cognitive status, depression). Cognitive decline was assessed by using: MMSE (Mini-Mental State Examination)and MoCA (Montreal Cognitive Assessment). Physical activity was assessed by the PASE (Physical Activity Scale for the Elderly). This tool is structured in three sections: the leisure activity, the domestic activity and the professional activity. Logistic regressions and proportional hazards regression models (Cox) were used to estimate the risk of cognitive disorders.

Results

At baseline, the prevalence of cognitive disorders was 6.9% according to MMSE. In total, 1326 participants without cognitive disorders were included in the analysis. The mean age was 77.4 years, and 52.1% of the participants were women. After a 2 years long follow-up, we found cognitive disorders on 92 participants (6.9%). Physical activity at baseline is lower in older adults for whom cognitive decline was observed after two years of follow-up. Subclass analyses showed that leisure and domestic activities were associated to cognitive decline, but not professional activities.

Conclusions

Analysis showed a relationship between cognitive disorders and type of physical activity. The current study will be completed by the MoCA for mild cognitive impairment. These findings compared to other ongoing studies will contribute to the debate on the beneficial effects of physical activity on cognition.

Key messages

The work allowed us to analyze the link between the different types of physical activity and mild to severe cognitive disorders. The aim is to put in place preventive policies of aging. The work allowed us to see the effect of the different types of physical activity and the impact of the statistical method on the results.
Effects of a behavioural approach on lifestyle habits: a before-after interventional study
Authors: Guberti E , Navacchia P , Marzocchi R , Bonaccorsi G , Cavallo G , Lorini C
Published: November 2019

The study aimed to offer a path of empowerment to promote adherence to healthy diets and physical activity for cancer prevention,according to the recommendations of the World Cancer Research Fund (2007): 5 servings per day of fruit / vegetables, protective food (EVO, green tea, cruciferous, turmeric, dried fruit), practicing at least 30 minutes of moderate physical activity.

Participants were volunteers between 18 - 70 years old divided in groups of 25/30 people. They followed a course of 7 theoretical and practical meetings (lifestyles, resilience and cooking workshops) and they signed a contract to comply with the promoted habits, which were verified through questionnaires administered during the engagement phase (T0), three months after the beginning of the course (T1) and one year after (T2).

Six editions (2014-2017) were made for a total of 153 subjects involved (75% women, average age 54 years old). Of these, 116 eligible subjects (76%) were also evaluated at T1 and 63 volunteers (41.7%) at T2. With respect to the dropped out rate, 24% of the subjects left the study prior T1, while 45% of volunteers left it prior T2. The established goal (40% expected target) was accomplished and excided the expectation, since more than 80% of the subjects involved at T1 achieved an improvement in healthy diet (increased consumption of vegetables and fruit, daily consumption of at least one food with antioxidant action) and physical activity (at least 30 minutes a day).

Furthermore the 77% of T1 compliants (50% expected goal) retained healthy eating and healthy motor behaviors even after a year (T2).

The proposed path of empowerment positively affected nutrition and promotion of physical activity at 3 months after the intervention (T1) and were maintained even after a year. The latter result was partly scale down by a high drop out. The path of empowerment, appropriately adapted, can complete the diagnostic therapeutic pathways for breast cancer and colon cancer survivors.

Key messages

People are easier involved in empowerment paths aimed at fighting a single disease, for example cancer, but good results can be achieved simultaneously for all non-communicable diseases. Motivational communication for healthy eating, physical activity and stress prevention must become an integral part of the therapeutic diagnostic pathways of cancers and non-communicable diseases.
Solidarity in genomic healthcare? Results of the Belgian citizen forum (2018)
Authors: Mayeur C , Van Hoof W
Published: November 2019

Genomic medicine requires to collect and use a huge amount of patient and citizen data. Therefore, the Belgian Minister of Public Health decided to organize a citizen forum on the ethical, legal and societal issues (ELSI) surrounding the use of genomic information in healthcare. This initiative follows the trend of public involvement in Europe regarding ELSI in genomics.

During three weekends, a panel of 32 citizens, informed by experts of different backgrounds, produced political recommendations. We will focus on their conception of solidarity, which is crucial to take into account when considering policies on data sharing in genomics.

Citizens of the panel consider their genome simultaneously as the individual’s property and as something to be shared for the common good. As a consequence, the panel agrees to support solidarity provided individual interests, such as privacy protection, are respected. By solidarity, the panel means supporting genomic data sharing for the common good, which they define as scientific research that improves knowledge (on both prevention and diagnostics) to build a fair society where everyone has an equal opportunity to live healthy.

According to the panel, the government should actively encourage citizens to share their genomic data, but no one can be forced to do it. For instance, the government could motivate citizens to share their genomic data by partially reimbursing genomic tests undertaken without medical prescription. However, because everyone has an equal right to live healthy, the panel esteems that genomic tests for medical needs should be accessible for all, thanks to a well-thought-out and sustainable refund system.

Key messages

Citizens support solidarity in genomic medicine, but demand proportional individual protection. As citizens become increasingly important stakeholders in genomic medicine, all public authorities should actively engage citizens in relevant healthcare policies.
Skills building seminar: Environmental Burden of Disease: methods and applications
Authors:   Organised by: Sciensano Chair persons: Brecht Devleesschauwer - Belgium
Published: November 2019

There is an increasing body of evidence showing that environmental risk factors can cause illness and death. For example, particulate matter triggers lung cancer and noise increases the risk of heart attack. Consequently, governments worldwide should aim to mitigate the negative health effects of environmental exposures. The concept of Environmental Burden of Disease (EBD) aims to quantify the number of illnesses and deaths associated with various environmental risk factors, as well as the health benefits of potential prevention and mitigation measures. Current EBD studies commonly use the Disability-Adjusted Life Year (DALY) metric as a common currency for integrating the effects of ill health and premature death, thereby facilitating the comparison of the burden of various environmental risk factors amongst each other and with other risk factors.

The EBD approach has been used since the 1990s, spearheaded by the World Health Organization. However, even today, the approach is not yet commonly adopted across Europe, mainly because of a lack of capacity. At the same time, the EBD approach remains in full development, trying to adapt to the current state of research. The overall aim of this skills building seminar is therefore to a) create awareness of the EBD approach, and b) to present and discuss current methodologies and future developments.

The skills building seminar consists of four presentations. In the first presentation, the history and general methodological framework of the EBD approach will be outlined. Next, three presentations will present EBD case studies. These presentations will explain in a didactic, step-by-step way how the estimates were produced, and how technical challenges were addressed. Finally, ample time will be foreseen to discuss methodologies, challenges, possible solutions, and future collaborations to increase EBD capacity within Europe.

Key messages

Participants will gain insights in the use, strengths and weaknesses of the Environmental Burden of Disease approach. Participants will develop an understanding of current Environmental Burden of Disease methodology.
Time to use of primary health care after being informed about increased health risk in HUNT
Authors: Toch-Marquardt M , Pape K , Carlsen F , Bjørngaard J H
Published: November 2019

Background

Seeing a general practitioner (GP) after first discovering conditions related to ill health is important for the prevention or timely treatment of major diseases. Receiving information about increased health risk, e.g. from participating in a health study, might increase awareness and trigger a visit to the GP. The question is: Do people allocated in different socioeconomic (SE) groups respond differently to receiving information about increased health risk? This could indirectly increase socioeconomic inequalities in health. In this study we are aiming to analyse patterns of GP contact after being informed that measurements from the HUNT study had deviant values suggesting increased health risk.

Methods

We use data from several Norwegian national registries which were linked to the HUNT study (The Nord-Trøndelag Health Study). Cox-proportional hazard models as well as repeated measurement models are estimated in order to explore patterns of GP contact. Health exposures are: measured high blood pressure (BP) (systolic and diastolic), high blood glucose, high serum cholesterol. SE status is measured through educational attainment (low, medium, high).

Preliminary results

In the analysis for GP contact within a year after HUNT, we had information on 42,581 persons, with 295,188 contacts with primary health service. In our data 8% had clinical measurements indicating high BP (160/100), 60% had high serum cholesterol levels (5,2 mmol/L) and 3% had high blood glucose levels ( > =9 mmol/L). Women in the lowest social group generally used less time to see their GP than both higher educational groups. For men this was less clear cut.

Conclusions

We aimed to analyse SE differences in response to receiving information about increased health risk. The analysis thus far suggests that women in lower SE groups see their GP a relatively short time after being informed. This is less clear cut for men. Further analysis will shed further light on utilisation patterns.

Key messages

Women in lower SE groups take less time to see a GP after being informed of increased health risk. SE differences in primary health care utilisation might be less clear cut than previously suggested.
Migration intentions among Polish physicians - the profile of a potential migrant
Authors: Domagała A , Dubas-Jakóbczyk K
Published: November 2019

Background

Polish physicians migration has become a subject of interest in the context of current shortage of medical staff. The exact scale of migration is unknown due to insufficient data. The main goals of the study were to: 1) evaluate the scale of migration intentions among doctors working in Polish hospitals, 2) identify the key predictors and barriers of migration, 3) investigate an association between doctors satisfaction and their tendency to migrate.

Methods

A quantitative, on-line survey of doctors working in Polish hospitals was conducted between March and June, 2018. 15 cross-nationally distributed hospitals (7 general, 5 specialist, 3 university) were included in the study. The statistical analyses included: associations between the intention to migrate and demographic characteristics as well as work-related variables and overall satisfaction. Simple and multivariable logistic regression analysis was conducted to determine which variables are significant predictors of the intention to migrate.

Results

1.003 questionnaires were analyzed (response rate: 38%). 273 respondents declared the intention to migrate, including 45 (4.5%) answering ‘definitely yes’ and 228 (22.7%) ‘probably yes’. Men more often considered the option to migrate: 5.2% answered ‘definitely yes’ and 26.3% ‘probably yes’ in comparison to 3.7% and 19.0% respectively for females (p = 0.02). Childless physicians more often considered the option to migrate than those with kids (9.0% answered ‘definitely yes’ and 33.1% ‘rather yes’ vs 2.4% and 17.8%, respectively, p < 0.001). Almost 62% of doctors with the intention to migrate considered a temporary stay abroad. 70% of respondents indicated ‘leaving family’ as main migration barrier.

Conclusions

The intention to migrate is related to socio-demographic factors (gender, age, marital status, having children) and work-related factors (work experience, working hours). The intention to migrate is negatively related to physician satisfaction.

Key messages

The main reasons for the intention to migrate are: higher earnings abroad, better working conditions, the ability to achieve better work-life balance and better training opportunities. In Poland a holistic, systemic approach to health workforce planning should be implemented, including monitoring migration trends and improving working conditions.
Case study: HCV micro-elimination in prison
Authors: Meroueh F
Published: November 2019

The presentation will explore the concept of HCV micro-elimination in prison settings end its application in the context of French prisons. Hepatitis C is a chronic pathology of the liver and can significantly affect quality of life, with significant mortality rates. Hepatitis C is of great relevance for prison population due to the overlap of risk factors for both incarceration and HCV infection, including substance use disorders. Historically, HCV interferon-based therapy has not always been offered to people in prison due to various factors, including homelessness, active injecting drug use, and liver disease. With the advent of direct-acting antivirals, almost 100% of patients are experiencing successful HCV treatment, with no medical contra-indication for incarcerated individuals, drug users and/or individuals on opioid substitution treatment. Approaches based on HCV test and treat have proven to be successful in prison settings to achieve micro-elimination and to offer HCV appropriate care to individuals belonging to socially-deprived groups and characterised by limited access to care when in the community. The elimination of hepatitis C in prison, among people who use drugs, also requires effective Harm Reduction programmes, an important tool to prevent re-infections.