bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural Experiment on Trade and Investment Liberalization and Soft Drink Consumption
Authors: Tcholakov Y
Published: October 2020

Background

Globalization is recognized to as a contributing factor to a health harming environment through a variety of mechanisms including through changes in food systems and food availability. Sugar-sweetened beverage (SSB) consumption is linked to obesity and diabetes and its regulation is a key priority for public health. The Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) is an international trade agreement between 11 countries.

Methods

This project uses of natural experiment methods to predict the impact of the entry into force of the CPTPP on SSB consumption. These methods allow quantitative inferences to be drawn in the situations where the exposure is not randomly assigned. Soft drink consumption data was collected from the Euromonitor database for 80 countries from all regions. This data was used to estimate the effect of agreements similar to the TPP.

Results

Eleven country trade agreement pairs were identified. In 5 cases out of the 11, the exposed country had a higher soft drink consumption at five years after the trade agreement. The effect of the trade agreement exposure for an average country in the sample in a trade agreement was found to be 1.10 (95% CI: 1.01-1.18; p-value: 0.03) after adjusting for GDP and the involvement of the US. In 7 of the 11 member-countries soft drink consumption is expected to increase yielding an average increase of 9.0% in those countries; the changes did not yield statistically significant differences in others.

Conclusions

This projected extended the use of synthetic methods to the projection of future effects of policy implementation. While it showed that there may be increasing trend of SSB consumption in certain scenarios, this could not be generalized to all cases. This illustrates the wide range of effects of international trade liberalization and highlights that national policy probably plays a strong modulating role on the impact that it has on local food environments.

Key messages

Globalization can lead to health harming environments and its impacts should further be studied by public health professionals and researchers. Many global policies have the potential to lead to significant health impacts but are negotiated without involving public health experts.
Chilean mortality due to STEMI: analysis of a public policy using interrupted time series
Authors: Nuñez Muñoz G
Published: October 2020

Issue

To the end of 1990s, ST-segment elevation myocardial infarction (STEMI), along with other causes, led the causes of death in Chile. Therefore, at the beginning of 2000s, the explicit health guarantees policies were created, including the treatment of STEMI, which was implemented in first quarter of 2005, generating a series of benefits that seek to improve people's survival. However, there are few studies that show the effectiveness of interventions at the level of morbimortality, given the difficulty in database (DB) collection.

Description of the problem

The objective is to determine if the policy implemented was able to reduce the mortality associated for STEMI, evidenced in the number of cases and potential years of life lost (PYLL). The public DB of Hospital Discharges (HD) and Deaths of Chile during the periods 1997-2017 were analyzed. ICD-10 codes were identified for STEMI. An interrupted time series analysis (ITSA) was performed with Newey-West regression adjusted according to autocorrelation, using as intervention the start of the STEMI policy, both in annual and quarterly series. For PYLL calculation, life expectancies by sex, were used, available on the website of the National Institute of Statistics of Chile. The data was analyzed with Stata v15.1.

Results

27807004 HD were recorded, of which 143061 were due to STEMI, 10.9% died at the in-hospital. Regarding deaths, 1586731 occurred, of which 6.37% were secondary to STEMI. When performing ITSA, for deaths it was observed that there was a significant increase in post-intervention cases (p-value <0.05), PYLL increased post intervention (p-value 0.001). HD showed a decrease in post-intervention mortality cases (p-value <0.01) and PYLL showed no significative changes with respect to the pre-intervention time.

Lessons

Globally, the focus on treatment has not allowed to reduce STEMI mortality. Prevention is the key to treat Social Transmission Diseases

Key messages

ITSA is a powerful tool to analyze interventions. Prevent and treat.
Supporting implementation of resilience training among school-aged children – RESCUR in Sweden
Authors: Eriksson C , Skoog T , Kimber B
Published: October 2020

Issue

What is needed to facilitate implementation of an intervention when scaling up and scaling out the program?

Description of the problem

RESCUR: Surfing the Waves (Jag vill, jag kan, jag törs!) is a new resilience curriculum, developed in 2012-2015 by researchers in six European Universities, to foster the psychosocial development of children and give them tools to deal with challenging situations. It aims at increasing children's resilience, i.e. their capacity to cope with disadvantages, crises, changes and stress without breaking down. The RESCUR project in Sweden consists of a Randomized Controlled Trial among children of the ages 6-12 in schools or social services. RESCUR is a pedagogic material, which requires training before getting access to the intervention. The training consists of two days and a follow-up day as well as observation and supervision. The project has been evaluated from two perspectives: implementation and effects. For a theoretically promising method to work at all, the method must be implemented effectively and correctly. Implementation was documented through self-evaluations, reported by group leaders after six months, and observations made according to a formalized checklist. The implementation of the method is fundamental to properly evaluating the effects of the method.

Results

The model used to train and support people who implemented the intervention seems to have worked according to the self-reports and the observations of lessons, which noted good implementation quality in the activities that were carried out every week by the majority of teachers and group leaders. The observed implementation was exemplary or very strong among 56 % in schools (n = 41) and 41 % in social services (n = 12).

Lessons

An important challenge in health promotion is ensuring that an intervention is implemented in an efficient way. Recruiting participants and training implementers are basic requirements for successful trials.

Key messages

The implementation of the health promoting method is fundamental to properly evaluating the effects of the method. Therefore, an educational and monitoring component is needed. Different implementers can achieve the high-quality implementation of an intervention. Training, observation, feedback, supervision and educational material all supported the implementation of RESCUR.
Affordable Care Act did not reduce inappropriate use of emergency room services
Authors: DeLellis N , Wilson F , Belsito F , Cunningham W
Published: October 2020

Background

The US Patient Protection and Affordable Care Act of 2010 (ACA) has several provisions to increase access to health insurance among Americans. Prior to ACA, emergency departments (ED) served as a safety net to uninsured as most hospitals are required to provide stabilizing treatment to patients with emergency medical conditions regardless of their ability to pay. The ACA increased the number of insured, improved access to primary care and was expected to reduce high cost ED utilization

Methods

This retrospective cross-sectional study used ED data from a US Midwest suburban medium size hospital (November 2009 - January 2017) to analyze the patterns of ER utilization pre- and post-ACA. The data (n = 423,548) excluded ambulance deliveries; 5-level Emergency Severity Index was re-coded as urgent/non-urgent for each visit. Analysis included age, sex, race, mode of arrival, disposition, insurance, visit day and time as other predictors in binary logistic regression.

Results

Non-urgent visit proportion increased from 34.5% in 2009 to 49.1% in 2016; odds of a visit being urgent are lower after ACA (Exp(B)=0.684; 95%CI 0.675,0.694) with stronger effect for pediatric (age<18) population (Exp(B)=0.487, CI 0.471, 0.503). ACA did not change ED utilization by working population, however, in comparison to people with commercial insurance, patients without recorded insurance are less likely to have a true urgent visit (Exp(B)=0.845; CI 0.83, 0.86). Among other factors predicting ED visit urgency are race and insurance type.

Conclusions

Expensive ER care is still provided for non-urgent care. Access to alternative type of care and public health awareness efforts should focus on subpopulations with high inappropriate ED use.

Key messages

Affordable Care Act (2010) did not improve efficiency of emergency room utilization. Additional effort are needed to increase access to primary care and awareness of ER use for specific subpopulations.
Financial protection against out-of-pocket health expenditure in Poland
Authors: Tambor M , Pavlova M
Published: October 2020

Background

Protecting people against financial hardship associated with using health care, is crucial for achieving universal health coverage. Despite the significant improvement happening in the last two decades, household out-of-pocket payments in Poland account for 23% of current spending on health, which is more than in many European Union countries. This implies an incased risk of financial hardship for Polish households.

Methods

The aim of this study was to assess the extent to which people in Poland experience financial hardship when they use health services. The analysis draws on household budget survey data collected annually by the Central Statistical Office of Poland between 2005 and 2014. It focuses on two indicators of financial protection: catastrophic health spending and impoverishing health spending. The study is a part of WHO country-based studies generating new evidence on financial protection in European health systems.

Results

In 2014, 8.6% of Polish households experienced catastrophic health spending, while 3.8% of households were impoverished or further impoverished due to health spending. Financial hardship is heavily concentrated among the poorest households for whom the incidence of catastrophic spending is 30%. Outpatient medicines are the largest single driver of catastrophic health spending across all consumption quintiles except the richest. For the richest households, payments for medical products and dental care are the main causes of financial hardship. Although financial protection improved between 2005 and 2014, the improvement among the poorest was marginal.

Conclusions

Policy attention should focus on protecting households against high spending on outpatient medicines, e.g. revising patient cost-sharing for prescribed medicines and strengthen regulation for over-the-counter medicines. The protection mechanisms should be targeted at low-income households (people living on social benefits, disability or survivor's pensioners).

Key messages

Financial protection is fairly weak in Poland compared to many European Union countries. Out-of-pocket payments for medicines (prescribed and over-the-counter) are the main cause of financial hardship for Polish households.
Moving towards people–centered approach in TB Health Care System: Armenia’s Experience
Authors: Sahakyan S , Musheghyan L , Harutyunyan A , Khachadourian V
Published: October 2020

Background

Achieving integrated people-centered care requires interventions at various levels of the system, including policy changes and measures tailored to strengthen skills and competencies of health care providers. The national guidelines for TB care provision in Armenia provide a standardized approach for TB diagnosis and treatment, including systematic implementation of TB care services across the country. Before August 2019, the only option for drug-sensitive TB treatment was facility-based DOT.

Methods

In order to offer an alternative treatment option- family- based DOT, and bring TB services closer to patients' needs and values, the national guideline for TB care provision was updated to institutionalize the new approach. A series of nationwide professional development trainings was launched to assure that health care providers at the inpatient and outpatient settings effectively follow the new updates in the national guideline. These evidence-based trainings specifically aimed to equip healthcare providers with the necessary tools, knowledge, and the skillset for communicating with TB patients and building relationship and trust, offering their professional support. Along with patient counselling skills, the curriculum covered recent updates on TB epidemic, its social-psychological and behavioral risk factors, and advancements in TB diagnosis and treatment. All the participants were provided with a manual and other materials regarding the program.

Results

The Ministry of Health of the RA has approved the national guidelines on TB care (No 2277 - Ô±, August 19). This document includes information on people-centered TB treatment and institutionalizes the family-based DOT in Armenia. More than 90 percent of TB healthcare providers (98 physicians and 134 nurses) throughout Armenia participated in the trainings and received certificates. The RA Ministry of Health accredited the training curriculum with 11 continuing medical education credits for participation.
Integrating psycho–social counselling in TB Services in Armenia
Authors: Musheghyan L , Sahakyan S , Harutyunyan A , Khachadourian V
Published: October 2020

Background

Community or family-based DOT improves clinical outcomes and quality of life of TB patients compared to facility-based DOT. Based on a previously conducted clinical trial and recommended best practice guidelines, Armenia started the institutionalization of the family-based DOT in 2019, as an important component of the integrated people-centered approach in TB treatment. Psycho-social counselling and education played a crucial role in preparing patients/family members for this new model of care.

Methods

To facilitate the family-based DOT, multidisciplinary counseling teams consisting of a TB nurse and a psychologist or a TB nurse and a social worker were formed and further incorporated into the existing TB care system. After a systematic evaluation the strongest applicants were shortlisted, interviewed, and selected. They underwent a three-day training, improving their knowledge on TB disease, its transmission, diagnosis and treatment; patient counseling with an emphasis on motivational interviewing techniques; and people-centered TB care. A comprehensive package of procedural documents was developed to facilitate the counseling teams work process, including a guideline on counseling, reporting forms, and patients' educational materials. At an early stage of TB treatment, the counseling teams provide psycho-social counselling to patients and their families, and educate them on TB risk factors and infection control.

Results

The counselling teams have been based in the National Center of Pulmonology of the RA and provide psycho-social counselling to all drug susceptible TB patients and their family members all over Armenia. The counseling teams prepare patients/family members for the family-based DOT and provide continuous support during the entire treatment. The integration of counselling teams in the TB care system has provided the required human resource and capacity for the successful adoption of a new model of people-centered TB care in Armenia.
Preparedness of outpatient health facilities for ambulatory treatment with all–oral short DR–TB treatment regimens in Zhytomyr, Ukraine: a cross–sectional study
Authors: Malakyan K , Gils T , Laxmeshwar C h , Duka M , Siomak O , Didik V , Lytvynenko N , Terleeva Y , Donchuk D , Isaakidis P
Published: October 2020

Introduction

Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder (AUD), are common comorbidities. As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine.

Methods

This is a cross-sectional study in which routine program data was collected during June 2018 and February 2020. Before discharge of every patient from the hospital, MSF teams assess outpatient facilities available using a standardized checklist. The assessment evaluates access, human-resources, availability of medicines, infection control, laboratory and diagnostic services, and psychosocial support.

Results

We visited 90 outpatient facilities in 23 districts and 1 city between June 2018 and February 2020. Forty health posts, 27 TB-units, 23 ambulatories including two family doctors and one polyclinic were included. All facilities provided DOT, but only nine (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and limited to TB-doctors. TB-medicines and storage space were available in all facilities, but only twenty two (24%) stored ancillary medicines. HIV-patients had to visit a separate facility to access HIV-care. Personal protective equipment for infection control was unavailable in 41 (46%) facilities. Basic laboratory services were available in TB-units, but only 3 (11%) performed audiometry. Only twenty (22%) TB-units had psychosocial support available, and 1 (4%) psychiatric support.

Conclusions

Outpatient facilities in Zhytomyr oblast are not yet fully prepared to provide comprehensive care for DR-TB patients. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential to establish high quality, patient-centered care.
Austria
Authors: Falkenbach M , Heiss R
Published: October 2020

Background

Health policy research tends to focus on medical care practices and disease prevention while the emphasis on political determinants of health is thin at best. Within this case study, we look at Austria's Freedom Party (FPÖ), a Populist Radical Right (PRR) party, and their impact on health policies. Existing conceptualizations suggest three key dimensions of PRR parties: People centrism (nativism), vertical exclusion (ant-political elite), and horizontal exclusion (immigrants). We explore how these conceptualizations are applicable to the health policy choices of the FPÖ.

Methods

We conducted a review of available primary sources (legal and policy documents) and secondary literature (academic, press, and think-tank publications). Resulting data were analysed thematically.

Results

In the years 2000 to 2003 and 2017 to 2019, the FPÖ, in a coalition government with the ÖVP, was in charge of the health ministry. The biggest changes came about in 2017 where 1) the FPÖ reneged on the smoking ban set to have been implemented in May 2018. 2) the FPÖ led the consolidation of the 21 separate health insurance companies to five, stating that it would bring patients €1 billion. However, the current government is now confronted with a budget deficit of the ÖGK. 3) the FPÖ promoted social policies reducing the social benefits for immigrants who showed insufficient language skills.

Conclusions

The case analysis suggests that the FPÖ's health policy choices, described above, may be explained through the people centrist, nativist, and anti-elitist tendencies of PRR parties. 1) reneging on the smoking ban can be interpreted as an anti-scientific and pro “ordinary citizen” action. 2) the health insurance mergers, can be explained as being a strike against the economic and political elites, who allegedly used the complex structure for their own benefit (clientelism). 3) attacking the socio-economic status of immigrants, a social determinant of general health.
Improving Gender Equality & Nutrition Data for Women and Children
Authors: Ferne J
Published: October 2020

Empowerment of women and girls is identified as an important nutrition-sensitive strategy to address malnutrition in low- and middle-income countries. Minimizing the data gaps and advancing knowledge of the relationship of gender equality and women's empowerment and nutrition is relevant to inform local women's groups and host country response to policy and advocacy. Good nutrition and gender equality are mutually reinforcing: improving nutrition is critical to achieving gender equality, and vice versa. Simpler tools to generate timelier and better quality data using gender equality indicators for nutrition program delivery and performance can guide program managers, partner and government access to program monitoring data at reduced cost, leading to strengthened gender responsive services and more effective and time-sensitive decision making. This innovation has developed a framework for measuring and linking gender and nutrition-related outcomes, as well as a predictive model incorporating potential links between gender inequality, increased nutritional needs, and inequitable access to nutrition and health services. Through identifying simple yet appropriate indicators and tools of gender equality, it has tested this model and tools in current nutrition program settings across sub Saharan Africa, to ensure that emerging nutrition experts understand and can apply these models and tools.
Action against environmental pollution through a healthy, green and just recovery in Europe
Authors: Stauffer A
Published: October 2020

Issue

With the COVID-19 pandemic, the European Union (EU) is faced with an unprecedented crisis with huge effects on every aspect of our society. As European countries start easing lockdowns, discussions on recovery and investment plans pick up the pace, but it will be vital not to repeat mistakes of the past but focus on a healthy, green and just recovery to increase overall health preparedness and resilience in the face of future pandemics.

Description of the problem

The recovery from the COVID-19 crisis is the litmus test how serious policy-makers are about the EGD, if they take it as the blueprint for rebuilding or continue investing into yesterday's polluting industries and economies. While at EU level there is a strong commitment for the EGD to be the principle in economic recovery, decisions and bailouts at national level do not necessarily follow suit (yet). One of the actions that are needed is defining conditions for all recovery and investment money being spent.

Results

With EU Commission President's van der Leyen's proposal for a 750 billion EUR recovery fund was presented end of May (1). The European Green Deal (EGD) proposal (2) shows that European Commission has understood the importance of a healthy planet for healthy people. If successfully implemented, this deal has the potential to achieve major health improvements in the near term while reducing the growing health risks from climate change (3,4), air and chemical pollution.

Lessons

Shifting from a polluting to a green and healthy economy, with the European Green Deal at the core is possible. The EGD already foresees a zero pollution ambition for the EU: preventing all pollution in order to protect health is the much needed goal upon which European and national leaders must base all recovery actions.

Key messages

A green recovery can give the necessary financial support for upgrading and modernising our cities and sustainable urban planning. Through the imminent recovery decisions, policy-makers need to seize the historic opportunity to reduce the pressure on the planet’s and people’s health.
Public Health Policies and Global COVID-19 Outbreak
Authors: Komaroff M , Belhouchet A A
Published: October 2020

Background

Was the world prepared to face the pandemic with a standard strategy?

Objectives

To evaluate the association between public health interventions against the COVID-19 outbreak and the outcome.

Methods

The observational study included data on incidence of confirmed COVID-19 cases (outcome) and public health non-pharmaceutical interventions (exposure) from five countries: France, Italy, Japan, South Korea, and the USA, December 31, 2019 through April 12, 2020. The public health measures were grouped into five categories: lockdown, movement restrictions, public health measures, social (including social distancing) and economic measures, and use of facial mask. The multiple linear regressions were utilized to test the hypothesis that implementation of some public health measures was associated with the change in the incident number of COVID-19 cases, 2-sided, α = 0.05.

Results

The incidence of COVID-19 would be significantly greater without lockdown (1.89 times, p-value <.0001), public health and economic measures (25.17, p-value <.0001), and using masks (11.93, p-value=0.002), assuming that all other public health policies are the same. The effectiveness increases with earlier time of implementation. Among considered countries, South Korea was the most efficacious, where all measures were statistically significantly efficacious (p-value <0.05).

Conclusions

The findings demonstrate an association between public health measures and the outcome. The experience from South Korea should be studied further as the most effective non-pharmacological approach to fight the disease. This paper is the first step to develop the standardized approach utilizing the public health interventions to be applied effectively to the globe population.

Key messages

the most effective measures to control the COVID-19, and future outbreaks. The effect of particular measure varied by country and time of implementation.
Associations of ultra-processed food and its consumption patterns with incident type 2 diabetes
Authors: Duan M , Vinke P C , Navis G J , Corpeleijn E , Dekker L H
Published: October 2020

Background

To study the associations of the consumption of ultra-processed food (UPF) and its underlying habitual consumption patterns with incident type 2 diabetes (T2D) in a large population-based cohort.

Methods

In 70 421 participants (35-70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. Principal component analysis (PCA) was performed to derive UPF consumption patterns. UPF was related to incident diabetes with adjustments for confounders, including overall diet quality.

Results

During a median follow-up of 41 months, the intake of UPF was associated with higher risk of type 2 diabetes (1128 cases, OR for a 10% increment in UPF intake 1.33 [95% CI 1.26, 1.41]), and remained significant after adjustment for confounders. PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased diabetes risk; a pattern high in traditional Dutch cuisine was not associated with diabetes risk (OR 1.05 [95% CI 0.97, 1.14]); while a pattern high in sweet snacks and pastries was inversely associated with diabetes risk (OR 0.82 [95% CI 0.76, 0.89]). There was a clear inverse association between diabetes risk at baseline and the sweet snacks and pastries pattern (β = -0.104 [95% CI -0.113, -0.094]).

Conclusions

A higher consumption of UPF was associated with higher risk of type 2 diabetes. For consumption patterns, this association was most pronounced for the patterns that were high in savory snacks. Our findings emphasize that in addition to promoting the consumption of healthy food products, discouraging the consumption of UPF, specifically savory snacks, should be considered as part of future diabetes prevention strategies.

Key messages

Ultra-processed foods intake was associated with increased risk of type 2 diabetes. Consumption patterns of ultra-processed foods should be the focus for future policies.
Digital epidemiology supported by GIS as a way for effective communication of the epidemic situation
Authors: Smida J , Loosova J , Prattingerova J , Zabka V , Vrbik D , Harman J , Vaclavikova L , Sembera J
Published: October 2020

There is no central information system supporting epidemiological surveillance in the case of the Czech Republic. For efficient management of epidemiological data, it is advisable to use a Geographic Information System (GIS), in which data can be managed based on their geographical component. The advantages of GIS are not only all tools for managing an ordinary database but also functions typical for geographic data. Technical University of Liberec (Czech Republic) with the support of the Technology Agency of the Czech Republic guarantees the design and building of an information system with GIS features designed for the solution of epidemics within the chosen region of the Czech Republic (Regional Hygiene Station of the Liberec Region). The concept of the information system is based on the requirement to use Open Source tools without the need for future license fees. A substantial part of the system is programmed (R language). Data input will be provided by forms and questionnaires (pre-prepared, editable). The database will be based on demographic data along with multiple time and geographical data (useful for the construction of epidemiological curves and data representation in maps).

Data input is possible via any platform (desktop, smartphones, mobile GIS for fieldwork). The output console is designed to work with data organized in maps. After the necessary anonymization and aggregation of data, some of the data is designed to be made available to the general public. Emphasis is placed on the communication role of the information system in providing information from and to the public.

The research team is multidisciplinary (epidemiologists, geographers, programmers, sociologists). The development of the information system has been started in 2019 on the example of alimentary diseases. A part of it has been used since March 2020 for monitoring COVID-19 within the Liberec Region. Full completion and commissioning are set for 2021.

Key messages

Geographic Information System is an effective database, analytical and communication tool for epidemilogy. The information system must enable communication with experts and the general public.
Each reading is a seed – prescribing books and links at the School of Patients DF
Authors: Cubas-Rolim E , Yung F R , Gripp M R , Oliveira C L A , Marques L A , Fagundes M C , Souza B V , Ribeiro L , Tostes-Faria E , Santana F
Published: October 2020

Issue

The fragile reading habit is a common feature in Brazil, having wide negative impacts in Health and Education areas. Itapoã-DF presents important social vulnerabilities with challenges about the reading habit. Stimulating individual reading from early childhood to elderly, associated with positive reinforcement during doctor appointments, is a way to provide health education.

Description of the problem

In October of 2016, the “Prescreva um Livro” (prescribe a book) project began from childcare doctor appointments, by encouraging children with books and the borrowing of material, in addition to positive reinforcement in consultations. In 2019, book references for adults were incorporated into the chapters of the School of Patients DF - especially for prenatal care and chronic conditions such as hypertension. It highlights the potencial of primary care as point of encouragement for reading and community support, reading coordinator.

Results

The Reading stimulus brought, since 2016, a change in the relationship of young people with the service, making it a space of curiosity and fun instead of “fear of needles”. The importance of primary care in constructive stimuli to reading is reinforced even more considering the difficulties of education in Brazil.

Lessons

Initially focused on children and adolescents, the practice was incorporated into the health education strategy of the School of Patients, grouping prevalent comorbidities and printed guidelines delivered at each consultation. The participating children reported the stories they had read at subsequent visits. This feedback reinforces the influence that the primary care environment can have in several areas of the user's life, including reading

Key messages

Waiting rooms and home visits are opportunities to exchange information also of a literary nature. The stimulus to reading is vital for the full exercise of citizenship, and health services can be a reference for reading.
Positive Choices: Addressing the evidence-practice gap in alcohol and other drug prevention
Authors: Nepal S , Stapinski L , Newton N , Grummitt L , Lawler S , Guckel T , Lynch S , Chapman C , Teesson M
Published: October 2020

Issue

Alcohol and other drug (AOD) use during adolescence puts young people at risk of juvenile offending, poor educational outcomes, school dropout, and mental health issues. Since parents and school teachers are the primary source of contact for adolescents, it is important that they are equipped with accurate and up-to-date response strategies. There are a number of effective drug prevention strategies, however, they are not widely implemented.

Description of the practice

To address this evidence-practice gap, the Positive Choices initiative was launched in 2015. Positive Choices supports implementation of evidence-based and prevention strategies through provision of training and a centralised information and resources portal for young people, their parents and teachers. The portal contains information factsheets and webinars and was developed in consultation with AOD experts and target users. Drug education resources and curriculum programs meeting pre-specified criteria for relevance, quality and evidence-base are listed in the resources database.

Results

Positive Choices has been accessed by one-million Australian and international users. The most popular resources are videos, factsheets, webinars. In 2019, 71% parents and 65% teachers said that they would continue using the website. Half (54%) of school staff were not currently implementing evidence-based prevention strategies, of these 89% intended to shift to evidence-based practice after using Positive Choices. The majority of the users have said they would recommend the website to their colleagues and friends.

Lessons

Positive Choices is effective in changing users' intentions to implement evidence-based strategies. Drug education programs need to engage parents and teachers if they are to be effective.

Key messages

Positive Choices has increased users’ awareness of evidence-based prevention strategies. Positive Choices has increased users’ intentions to implement evidence-based prevention strategies.
Multidisciplinary community approach to reduce cardiovascular risk factors in a neighborhood in Rome
Authors: D'Ambrosio F , Tamburrano A , Galletti C , Mazza E , Gambioli S , Galasso V , Mingarelli A , Rubei F , Gambioli C , Laurenti P
Published: October 2020

Cardiovascular Diseases (CVDs) are one of the main causes of death and morbidity worldwide. To reduce the risk of occurrence it is necessary to promote a healthy lifestyle and consider health as a collective benefit. This study aims to evaluate how the implementation of preventive interventions and health promotion could reduce the impact of CVDs on the involved population.

This prospective study started 1 year ago and will last 18 months (July 2020). Participants have been recruited in General Practice clinic in Torresina neighbourhood in Rome. The intervention was a full year of multidisciplinary meetings scheduled with general practitioners, community nurses, dedicated professionals (nutritionist, physiotherapist, psychologist) and outdoor events with a coach to promote group physical activity, assisted by the use of social networks. Anthropometric data, blood chemistry tests and information about lifestyle, nutritional habits and physical activity were collected at time 0 and every 2-month follow-up and, additionally, the individual cardiovascular risk score (CVRS) was calculated. After 12 and up to 18 months, instead, the self-management ability of a correct lifestyle will be evaluated on the basis of the measured outcomes. Statistical analysis was performed using a paired t test with Jamovi software.

The sample size was 62 patients, 50% male with an average age of 54.6 years (±7.8). During the analyzed period there was a reduction in the percentage of smokers from 30.6% at baseline to 22.6% after 12 months. The baseline CVRS was 4.9% (±6.3). At 12 months the CVRS significantly decreased to 3.8% (±4.0) (p < 0.01). Total cholesterol level was 211.1 mg/dl (±32.8) at baseline, with a significant reduction at 12 months (202.5 ± 37.8) (p = 0.01). The results are preliminary.

Multidisciplinary interventions resulted in a significant reduction of CVRS and cholesterol levels during the study period. Further studies are necessary to evaluate our approach.

Key messages

Cardiovascular Diseases are the main causes of deaths among the population, so primary prevention through tailored educational interventions is fundamental. A multidisciplinary approach has proven to be effective in reducing the risk of cardiovascular disease and the level of cholesterol.
New competences to manage Urban Health: Health City Manager core curriculum
Authors: Capolongo S , Rebecchi A , Napier D , Ricciardi G , Signorelli C , Serra F , Dotta F , Pella R , Lenzi A
Published: October 2020

Health as a common good is a prior essential objective to be pursued by an alliance including citizens and local administrations. Role of cities in health promotion is emphasized by urbanization, entailing 70% of the global population living in urban areas. Cities are therefore perfect laboratories within which to act: studying and monitoring dimensions that determine the level of quality of life in cities, improving their sustainability and capacity for growth, is fundamental for a new governance model able of managing this complexity. Under the premises, the Health City Manager (HCM) has been launched, a professional gaining skills in PH management, sociology of communities, urban design and control in reducing health inequalities. A course lasting 80 hours gives then the opportunity to put into practice, at municipal level, knowledge, competences and abilities achieved. In the background, both the former EU Commissioner for Health and the Committee of the Regions warmly supported the establishment of HCMs, who would coordinate a process ensuring alignment of policies on a macro and micro scale. During G7 in 2017, Ministry for Health and Presidency of Italian Municipalities signed the Urban Health Rome Declaration, underlining the need for a stronger synergy facilitated by HCMs. In 2019, Ministry of Youth and Sport approved and financed the project. On the basis of a core curriculum, validated by a group of experts, the course is starting in 2020 for the first 120 HCMs. Innovation lies in the holistic approach, a multidisciplinary project managing method overcoming silos logic. Customization of public policies and participatory process make the figure ideal to be applied in all countries. Sustainability is ensured by a relatively high return on investment. Main impact relates to improvement of the quality of life through a full involvement and accountability of local administrations; contrast of climate change identifying strategies of urban resilience.

Key messages

Improvement of the quality of life through a full involvement and accountability of local administrations. Contrast of climate change identifying strategies of urban resilience.
Poor oral health and incidence of disability: results from studies of older people in the UK and USA
Authors: Kotronia E , Wannamethee S G , Papacosta O A , Whincup P H , Lennon L T , Visser M , Weyant R J , Ramsay S E
Published: October 2020

Background

To examine the association between oral health markers and disability 4 years later in two population-based studies of older people in the UK and USA.

Methods

Analyses were conducted in the British Regional Heart Study (BRHS) comprising older men (n = 2147) and the Health, Aging and Body Composition (HABC) Study comprising American older men and women (n = 3075). Data from a 4-year follow up period were used. Oral health measures included tooth loss, periodontal disease, dry mouth, and self-rated oral health. Mobility limitations and Activities of Daily Living (ADL) were markers of disability. Logistic regression was performed and analyses were adjusted for confounders (age, socioeconomic position, lifestyle factors, and chronic diseases).

Results

Over a 4-year follow-up, 15% of subjects in the BRHS and 19% in the HABC Study developed mobility limitations. In both studies, 12% of participants developed ADL problems. In the BRHS, tooth loss (complete and partial), periodontal disease, dry mouth and accumulation of oral health problems were associated with an increased risk of developing mobility limitations after adjustment for confounders (partial tooth loss, OR = 1.86, 95% CI 1.18-2.94, ≥3 dry mouth symptoms, OR = 1.97, 95%CI 1.25-3.09). Similar results were observed for the risk of developing ADL problems. In the HABC Study, complete tooth loss and accumulation of oral health problems were associated with greater risk of incident mobility limitations (OR = 1.77, 95%CI 1.13-2.76; OR = 1.18, 95% CI 1.02-1.37, respectively). Moreover, self-rated oral health was associated with increased risk of ADL problems, after adjustment for confounders.

Conclusions

Poor oral health was associated with increased risk of developing disability in community-dwelling older people. Screening tools of oral health may be helpful in identifying oral health problems, improving oral health status and promoting health and good quality of life.

Key messages

Poor oral health is associated with a higher risk of developing disability in later life. This highlights the importance of oral health on maintaining independence in older people.
Is psychiatric hospitalization an opportunity to deal with oral health issues in France?
Authors: Couatarmanach A , Sherlaw W , Harpet C , Bertaud V
Published: October 2020

Background

People with severe mental health diseases appear to suffer from poor oral health compared with the general population. Specific strategies, including prevention tools and improved access to oral care, should be implemented to tackle this issue. The aim of this study was to investigate whether or not psychiatric hospitalization may constitute a favorable environment to develop such strategies.

Methods

Data were collected from an ethnographic study conducted over 3 months in two different wards in a French psychiatric hospital: an admissions unit for acute cases and a unit for long-term hospitalization. In addition, 16 semi-structured interviews were conducted with different professionals (psychiatrist, general practitioners, nurses and auxiliaries).

Results

Most professionals described their goal as making patients more autonomous in order to go back to the community. Oral health issues were acknowledged by the professionals and increased oral health literacy was perceived as a part of this autonomy improvement objective. However, especially in the admission unit, shortened length of hospitalization in the deinstitutionalization context was seen as a major barrier to both implementation of oral health education programs and oral care treatments (related to the on-site dental clinic waiting list). In the long-term unit, direct assistance for oral hygiene and oral treatments request was perceived as potentially contrary to patients' intimacy and autonomy. In addition, professionals from both units pointed out the lack of oral health practices formalization and the weakness of the relationships with the dental team.

Conclusions

Oral health issue in psychiatry seemed to be well identified by the professionals, but its management remains challenging. Systemic (deinstitutionalization), ethical (intimacy and autonomy) and organizational aspects have to be considered in the implementation of oral health improvement strategies in psychiatric hospitals.

Key messages

Ethnographic study in a French psychiatric hospital identified systemic, ethical and organizational barriers to oral health care for in-patients. Oral care needs in psychiatric hospitals are acknowledged by the professionals but strategies to satisfy these needs are still to be implemented.
Primary care organizational model mix and avoidable hospitalization: an ecological study in Portugal
Authors: Pinto A , Santos J V , Lobo M , Viana J , Souza J , Ramalho A , Pereira A , Freitas A
Published: October 2020

Background

In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patients within USF-B model and the rate of avoidable hospitalizations, as proxy of primary care quality.

Methods

We conducted a cross-sectional study considering the 55 ACES from mainland Portugal, in 2017. We used data from public hospitalizations to calculate the prevention quality indicator (avoidable hospitalizations) adjusted for age and sex, using direct standardization. The main independent variable was the proportion of patients in one ACES registered in the USF-B model. Unemployment rate, proportion of patients with family doctor and presence of Local Health Unit (different organization model) within ACES were also considered. The association was assessed by means of a linear regression model.

Results

Age-sex adjusted PQI value varied between 490 and 1715 hospitalizations per 100,000 inhabitants across ACES. We observed a significant effect of the proportion of patients within USF-B in the crude PQI rate (p = 0.001). However, using the age-sex adjusted PQI, there was not a statistical significant association (p = 0.504). This last model was also adjusted for confounding variables and the association remains non-significant (p = 0.865).

Conclusions

Our findings suggest that, when adjusting for age and sex, there is no evidence that ACES with more patients enrolled in a pay-for-performance model is associated with higher quality of PHC (using avoidable hospitalizations as proxy). Further studies addressing individual data should be performed.

This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.

Key messages

Adjusting PQI to sex and age seems to influence its value more than the type of organizational model of primary health care. Groups of primary healthcare centres with more units under the pay-for-performance scheme was not associated with different rate of avoidable hospitalizations.