bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal trend in adolescent mortality from aggression in Brazil, 2000 to 2017
Authors: Pereira V O M , Aquino E C , Corassa R B , Mascarenhas M D M , Ramalho W M , Mello N F , Fagg C W
Published: October 2020

Background

Mortality from aggression in adolescents reflects one of the symptoms of the Brazilian social situation, which makes this population group vulnerable, exposing them to situations that determine their death in an early and violent way. This work contributes to the analysis of the temporal trend of adolescent mortality due to aggression throughout Brazil from 2000 to 2017.

Methods

A ecological design time series was carried out on the mortality rate of adolescents due to aggression in Brazil, from 2000 to 2017. Data from the Mortality Information System (SIM) of the Ministry of Health of Brazil was used. Mortality rates were analyzed according to sex and age groups (10-14 and 15-19 years). The joinpoint regression method was used to calculate the annual trend in mortality rates.

Results

The mortality rate among female adolescents aged 10 to 14 years decreased from 1.81 to 1.74 deaths/100 thousand inhab., and in the group aged 15 to 19, increased from 6.64 to 7.87 deaths/100.000 inhab., from 2000 to 2017. The Average Annual Percentage Change (AAPC) of the rates showed a steady trend of mortality in the groups from 10 to 14 years (AAPC = -0.4; 95% CI -1.4-0.7) and 15 to 19 years (AAPC = 0.7; 95% CI -2.3-3.9). In males, the rate for the 10 to 14-year-old group increased from 4.56 to 6.64 deaths/100.000 inhab., and in the 15 to 19 year old group, increased from 73.06 to 122.78 deaths/100.000 inhab., from 2000 to 2017. The AAPC showed an upward trend in the groups between 10 and 14 years old (AAPC = 2.3; 95% CI % 0.2-4.4) and 15 to 19 years (AAPC = 2.8; 95% CI 2.1-3.5). In the 15 to 19-year-old group, the upward trend of the period between 2009 and 2017 stood out [Annual Percentage Change (APC) = 5.1; 95% CI 4.0-6.3)].

Conclusions

This analysis can contribute with subsidies for the improvement of public policies and intersectoral actions that act on the vulnerabilities to which adolescents are exposed and that reduce the mortality rates due to aggressions.

Key messages

Mortality from aggression in adolescents aged 15-19 showed, in the female sex, an increase from 6.64 to 7.87 deaths/100.000 inhab., and in males, an increase from 73.06 to 122.78 deaths/100.000 inhab. The upward trend in the mortality rate in male adolescents aged 15 to 19 was highlighted in the period from 2009 to 2017 [Annual Percentage Variation (APC) = 5.1; 95% CI 4.0–6.3).
Combining jobs and motherhood: is it worse when growing children alone?
Authors: Roxo L , Porto G , Perelman J
Published: October 2020

Background

Women combining paid job and motherhood may experience a poorer health status than those childless. This risk is expectedly higher among lone mothers due to their greater emotional, social, and economic vulnerability. This study aims to assess the impact of employment characteristics on the health of working mothers and to understand differences between lone and coupled mothers.

Methods

We used data from the 5th Portuguese National Health Survey from employed women (N = 1,649) aged 25-55 living with a child (<16). We modelled depression (assessed by the Personal Health Questionnaire-8) and less-than-good self-reported health as a function of employment variables (part-time job; self-employment; instable job situation; skill level and sector of activity) using logistic regressions, adjusting for age, family variables, socioeconomic status, and social support. Interaction terms assessed differences between lone and coupled mothers.

Results

Women in part-time (OR = 3.04, 95%CI=2.97-3.11), high-skilled jobs (OR = 3.57, 95%CI=1.30-1.38), and self-employed (OR = 1.34, 95%CI=1.30-1.38) had higher odds for depression, compared to those working in low-skilled, full time and not self-employed jobs. Less-than-good health was also more likely among those working part-time (OR = 1.34, 95%CI=1.31-1.36) and self-employed (OR = 1.34, 95%CI=1.31-1.37). Mothers' mental health disadvantage was amplified when alone regarding self-employment and part-time jobs.

Conclusions

Employed mothers' physical and mental health may be harmed by part-time jobs, self-employment, and working in more differentiated jobs. Employed lone mothers may experience greater risks than coupled mothers.

Key messages

Part-time, high-differentiated jobs or self-employment may harm the physical and mental health of working mothers. Lone mothers are disproportionately impacted by these employment characteristics.
Periconceptional folic acid intake in Northwest Russia: a birth registry study
Authors: Postoev V A , Menshikova L I , Usynina A A , Grjibovski A M , Odland J O
Published: October 2020

Introduction

Periconceptional use of folic acid supplementation is an evidence-based measure of birth defects prevention. The study was aimed to assess effect of periconceptual use of folic acid on birth defect prevalence in Arkhangelsk county and to investigate socio-demographic factors, which are associated with adherence to this preventive measure.

Methods

A registry-based study was conducted with data from the Arkhangelsk County Birth Registry for 2012-2015. The study population included 57084 pregnancies to calculate the proportion of women taking folic acid and 53340 pregnancy outcomes without missing data to analyze related socio-demographic characteristics.

Results

The proportion of women followed a folic acid supplementation before pregnancy was 1.3% (95% CI: 1.2-1.4), during pregnancy - 55.8% (95%CI: 54.6-56.4). Such women had less risk to deliver a newborn with any birth defects (OR = 0,84, 95%CI: 0,75 - 0,95). Considering birth defects prevalence of 38,6 per 1000 newborns in Arkhangelsk county, number needed to prevent one case of birth defect was 142,9. Based on multivariate analysis, nulliparous married women with higher education, aged 30 or more, had a higher chance to use folic acid before and during pregnancy. The history of spontaneous abortion in the mother's medical history and the first pregnancy were negatively associated with the probability of folic acid intake both before and during pregnancy.

Conclusions

The compliance to periconceptional intake of folic acid among women in the region was low. A level of compliance was associated with such socio-demographic factors as age, education, marital status, gravidity and parity. The findings have direct applications in improving prenatal care in Arkhangelsk county and establishing targets for prenatal counseling.

Key messages

A level of compliance to primary prevention of birth defects is associated with such socio-demographic factors as age, education, marital status, gravidity and parity. Prenatal counseling in terms of birth defects prevention should be based on socio-demographic characteristics of pregnant women.
Refining insights in SES and other determinants on perceived health; a Positive Health Perspective
Authors: Dierx J A J , Kasper H D P
Published: October 2020

Background

Many studies use dichotomous distinction between high and low SES and overall 'general total health' as outcome variable in studying Socio-Economic Status (SES) as determinant of health. In light of recent views on health and society, this study challenges this approach by proposing a more multidimensional view on both SES as well as health by analyzing four groups of SES and including six dimensions of positive health (PG) next to total general health. This study therefore addresses the impact of SES on the perception of total general health and the six domains distinguishing four instead two SES groups.

Methods

An online questionnaire on health perceptions was performed amongst 1000 respondents age 18 years and older in the Netherlands. Spearman correlations and regression analysis have been performed determining relationships and relative contributions of effects to the main outcome of perceived total general health using IBM SPSS Statistics 24.

Results

It appears that on average total general health is higher with increasing SES scores. Furthermore, distinguishing between four levels of SES instead of two revealed that low and mid low SES group evaluated total general health and all six health domains equal. However, mid low SES group evaluate their general health and 5 out of 6 domains lower than mid high SES group and mid high SES group scored lower on general health and all 6 domains than very high SES group. Variance in people's evaluation of their perceived health was explained for 10% of the impact of SES on total general health using simple regression analysis which remarkably disappeared using multiple regression including other socioeconomic and demographic variables.

Discussion

Results show that a more refined SES score and using the six health domains of positive health seems to give more insight into peoples' perceptions of their health. These findings suggest that health promoting interventions should be tailored to different SES-groups.

Key messages

Using more SES-groups and positive health domains gives more insight in peoples' perception on experienced health. Tailoring health promoting interventions to peoples' perspectives on health and SES might decrease health disparities.
Integrating child’s health promotion in schools – local mechanisms and strategies
Authors: Kerschbaumer L , Gell S , Nesimovic A , Röthlingshofer E , Heiss R , Zoller C
Published: October 2020

Background

Evidence shows the importance of promoting awareness towards healthy nutrition; sports and health literacy in childhood, as early-incorporated behaviour often shape life-long behaviour patterns. Despite the legally formulated mission by the Austrian government to promote children's health, the available support for this purpose is still disproportionate and does not meet the expectations and demands of health care experts, insurances, and teaching staff regarding the pace and consistency of implementing necessary measures. Thus, local and regional stakeholders (e.g., insurances or education departments) are indispensable to accelerate implementation in the federal province of Tyrol. One measure is the “Quality Label Healthy School Program” which contains a strict set of requirements (e.g. healthy snacks/drinks; psychosocial health, sports and so forth) to promote the overall health of children.

Methods

We conducted 11 focus groups with five Participants on average to explore enabling and restricting factors, which may determine the successful implementation of the healthy school program. We recruited schools who joined the quality label and invited directly involved teachers as a source to provide insights into the practices, restricting and enabling factors for various health promotion measures. For processing the data, we used partially content analytical tools and the documentary method.

Results

Influencing factors include: a) lack of resource provision b) creativity in devising strategies for health promotion c) decision-making sovereignty d) support from local authorities & parents e) collaboration & networks f) school-specific needs & circumstances g) Workload & capacity and h) professional ethics.

Conclusions

Despite the lack of national support for required efforts, local authorities, health insurances and education departments developed own mechanisms and creative strategies to implement child health promotion.

Key messages

Local authorities, health insurances and education departments developed own mechanisms to promote child’s health and the teaching staff established creative strategies for its implementation. Despite the existing legally formulated mission to promote children's health in Austria, the national support made available for this purpose is still disproportionate to the required efforts.
Characteristics of patients visiting naturopathic practitioners for maternal and reproductive health
Authors: Steel A , Foley H , Schloss J , Redmond R
Published: October 2020

Background

Naturopathy, recognised by the World Health Organisation as a European traditional medicine system, is practiced in every world region. Patients in countries where naturopathy is practiced visit a naturopathic practitioner for a range of health concerns including maternal and reproductive health; recognised as a global health priority area. This study aims to examine the characteristics of patients visiting naturopathic practitioners for their maternal and reproductive health concerns, and the clinical care provided by naturopathic practitioners to those patients.

Methods

An international cross-sectional survey of typical naturopathic practices and their associated patients, conducted in naturopathic clinics in 14 countries and 4 world regions. Naturopathic practitioners(n = 54) were invited to prospectively complete an online survey for up to 20 consecutive cases within the study period. Univariate relationships were examined through chi-square tests. Backwards stepwise logistic regression was employed to explore the characteristics most likely to be associated with individuals visiting a naturopath for maternal and reproductive health.

Results

Naturopathic practitioners provided data for 852 patients, with 43 (5.0%) visiting a naturopath for maternal and reproductive health concerns such as fertility (54.8%), pregnancy (26.2%), preconception health (11.9%), and lactation, breastfeeding or other postnatal care (7.1%). The regression analysis indicates the practitioners are more likely to prescribe acupuncture (OR 2.71, p<.001) and more likely to identify gynecological (OR 4.31, p<.001) or endocrine (OR 3.30, p=.01) systems as important in the management of the health of these patients.

Conclusions

Individuals are accessing naturopathic practitioners for maternal and reproductive health. An examination of the motivations influencing this population to access naturopathic care and the outcomes of this care is urgently needed.

Key messages

Naturopathic practitioners throughout the world are being visited for assistance with maternal and reproductive health issues including fertility, pregnancy, preconception and postnatal care. Naturopathic practitioners are prescribing acupuncture, as well as a wide range of other treatments, for maternal and reproductive health issues.
When universal health care isn’t truly universal: Beyond filling gaps in access to medicines
Authors: James L , Menezes S , Lawrence S , Aranago M
Published: October 2020

Issue

The Canadian healthcare system is defined by universality, but unfortunately that does not extend to drugs outside of hospitals. Access to medication remains an area of inequity, fragmentation and system failure, with millions struggling with cost related non-adherence. This has created major implications for public health, limiting the health status of populations. Canada's inequitable system and the recent pursuit to fix it, provides an opportunity to examine ways of balancing public health goals and health systems reform in a country with established public and private care services.

Background

The government mandated the creation of a plan to improve access to medications. Stakeholder consultations ran from June -September 2018 and the Heart & Stroke Foundation (H&S) aimed to create policy recommendations that would improve population health outcomes and inequities. Research review and analysis determined the scope of the problem and viable solutions. Questions arose around whether a solution could improve equity and lower health care costs without dismantling the existing private system.

Results

Visionary principles led to the recommendation of a universal pharmacare program, designed to improve access to cost-effective medicines for all people in Canada regardless of geography, age, or ability to pay. A hybrid -program would include a robust common formulary for which the public payer is the first payer creating cost efficiencies. Top-up private insurance would result in less strain on the public system and maintain the presence of the existing private industry.

Lessons

Health charities have a unique role to play in creating innovative policy solutions that also serve patient interests. In order to advance public health, health charities need to maintain focus on equity and avoid policy development that is biased with conflict of interest.

Key messages

Canada is primed to implement a unique universal pharmacare program that addresses healthy inequities. Varied stakeholder interests can block public health goals.
Challenges Facing the Health System in Somalia and Implications for Achieving the SDGs
Authors: Gele A
Published: October 2020

While Somalia's health system has been slightly progressing over the last 6 years, there has been significant challenges in both the provision of health services and enabling access to the services. The existing health system is essentially privatized, and it is confined to major towns, leaving the poor majority, in the rural areas, out of affordable health care. Moreover, the national health system is fragmented, and the absence of unified health system governance has affected the capacity of national authorities to regulate the private sector and to partner NGO's to deliver services to remote areas. Consequently, less than 30% of the Somali population have access to health services. The neonatal mortality rate is 40 deaths per 1000 live births and the under-5 mortality rate is 137 deaths per 1000 live births. The maternal mortality rate is estimated at 732 per 100 000 live births. The use of family planning remains low, resulting in high fertility rates. The progress, and also the setbacks, of the health sector has been obscured by lack of reliable data at regional and national level. The absence of research institutions and human resources in research are among the obstacles to implementing evidence-based health interventions and the subsequent quality of health policy and practices. Investing health research is prerequisite for evidence-based health interventions that not only save lives, but also are crucial investment in the wider economy and development of the country. Therefore, to achieve the health-related SDGs, Somalia should invest in research by revitalizing essential public health research institutions.
Primary care, cancer and AMR: from prevention and diagnosis to survivorship and advocacy
Authors: Borisch B
Published: October 2020

The speaker will discuss how cancer patients experience the system, with emphasis on primary care settings and survivorship. Highlighting differences across developed and developing settings, and the implications overuse may further represent for sustainable development, elaborating on the role interprofessional approaches and advocacy can play for changing practice and cross-border collaboration.
Disability and social participation in Europe 2002-2016
Authors: Hadfield-Spoor M
Published: October 2020

Background

Social participation is an important aspect of social inclusion and affects health, wellbeing, equality and citizenship. Informal participation is particularly important for the inclusion and wellbeing of disabled people who are a growing demographic across Europe and the world (GBD, 2017). Despite some disability rights progress such as the UNCPRD, increasing foodbank use may reflect rising prevalence of social exclusion and inequality for some disabled people.

Methods

Analysis of data from all countries that participated in the European Social Survey Rounds 1-8, using Stata16, assessed the extent of a relationship between informal social participation and disability (defined as being hampered by disability or ill-health in daily activities), and over time. Logistic regression was used including possible confounding variables e.g. country variation.

Preliminary Findings

In most years, the data showed a significant negative association between disability severity and social participation, after accounting for potential confounders. For example, in 2016 people who reported 'no' disability (OR 1.678, CI 1.102948 - 2.551828) were more likely to socialise and to have higher levels of participation than people disabled 'a lot' (OR 1.253, CI 1.097011 - 1.431516). The association fluctuated slightly over time but no clear trend was yet identifiable.

Conclusions

It is likely that the relationship observed reflects real inequality in social participation among disabled people, suggesting persisting significant barriers to inclusion for disabled people, which can negatively impact on people's wellbeing and broader health systems. Analysis accounted for some personal and socioeconomic barriers but not cultural or environmental barriers. Inclusion and accessibility issues become an even more acute concern (and opportunity) for policy and practice relating to equality and wellbeing when facing climate chaos: more barriers to inclusion and increased disability prevalence.

Key messages

Inequality indicated by lower levels of social participation of people with disabilities remains a significant concern considering personal and social costs of social isolation. Successful social inclusion improves lives of people and communities here and now and can assist in developing resilience to climate change.
Patterns of beverage purchases amongst British households: a latent class analysis
Authors: Berger N , Cummins S , Smith R D , Cornelsen L
Published: October 2020

Background

Policies to tackle obesity have increasingly targeted drinks, in particular sugar-sweetened beverages (SSBs), as a major source of excess sugar and energy. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. To fill this gap, we categorised consumers on the basis of drink purchase behaviour and explored whether they are patterned by socio-demographic characteristics, total food purchasing and weight status.

Methods

We used latent class (LC) analysis to characterise patterns of drink purchases using the 2016 UK Kantar FMCG household purchase panel. We restricted analyses to frequent purchasers of drinks (n = 8,675) and used 6 drink categories: SSB; diet drink; fruit-/milk-based drinks; beer & cider; wine; and water. We used multinomial logistic and linear models to relate household characteristics, BMI and food purchase behaviours to LC membership.

Results

We identified 7 LCs. Disadvantaged households were more frequent in LCs with high volumes of SSBs ('SSB') and diet drinks ('Diet'). Higher BMI was more likely in LCs 'Diet' and 'SSB'. LC 'SSB' obtained higher total energy, relatively less energy from fruits and vegetables, and more energy from less healthy products, compared to others. LCs 'Diet' and 'SSB' obtained relatively more energy from sweet snacks.

Conclusions

Households who mainly purchased high volumes of SSBs or diet drinks were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.

Key messages

The effects of fiscal policies on SSB consumption is likely to vary across types of beverage consumers. Fiscal policies should be extended to sweet snacks as a major source of excess energy.
Public health risk factors at music festivals: “Be Safe Lab” initiative
Authors: Beržanskytė A
Published: October 2020

Background

At large public events such as music festivals there is an increased exposure to the risk factors as alcohol, tobacco and narcotics, unprotected sex, trauma and violence. Non-governmental organizations engage in prevention and support activities at such events. An initiative “Be Safe Lab” has developed in Lithuania to reduce the likelihood of adverse events due to harmful behavior at public festivals.

Study Aim

To investigate the experience of operating the “Be Safe Lab” initiative at Lithuanian music festivals.

Methods

In this qualitative study the data were collected from five “Be Safe Lab” volunteer staff using semi-structured interviews lasting in average of 50 minutes. The main guidelines were prepared and informants were asked to tell in general about the initiative, motives and reasons to develop the initiative, its goals and tasks, the questions that visitors apply to them, challenges and obstacles, personal experience in the initiative. Data were analysed using inductive thematic analysis according to Braun and Clarke (2013).

Results

The analysis revealed 6 main themes: principles of the initiative, variety of services, substance use harm reduction, changes of volunteers' perspectives, the role of teamwork, and initiative challenges.

Conclusions

The initiative has a number of strengths and challenges. Integrated services are provided not just to drug users, but also to other festival visitors who seek help or advice. The volunteer staff must have special skills, competencies and medical knowledge. The harm reduction measures for drugs and psychoactive substances used in the initiative are believed to be effective and attract music festival visitors. Initiative volunteers benefit both personally and professionally from providing services. However, further success of the initiative requires additional financial support, training, and collaboration with institutions providing emergency medical services at music festivals.

Key messages

Integrated services are provided to any festival visitor who seek help from “Be Safe Lab” specialists. The initiative volunteers benefit both personally and professionally from providing services.
Using population register data for health services research – the Finnish experience
Authors: Keskimäki I , Lumme S
Published: October 2020

The personal identification number was introduced in Finland in the mid-1960s. By 1970, it was universally used in administrative databases including population census, causes of death, cancer, hospital discharge, and health insurance registries. Early on data protection regulations recognised the use of registries and ID numbers for research and register linkages which allowed expanding the use of register data in population health and health services research. The possibility to analyse electronic health records (eHRs) linked to individual whole-population sociodemographic data has allowed the use of a wide range of study designs from cross-sectional to longitudinal studies and to various hierarchical designs. Some registers extend follow-up time up to over 50 years with detailed mapping of individual event histories. Data also allow detailed disentangling of individual and contextual factors, such as socioeconomics and comorbidities vs. provider characteristics. While some data items draw on administrative decisions or clinical discretion, such as granting insurance benefits or decisions on surgery, the research use of the data requires understanding of processes used to construct data items. The use of population registers in health services research is clearly cost-effective. However, the lack of a high-performance computing capacity and environment suitable for processing large sensitive data, as well as inadequate information on the use of primary health care and eHRs has limited efficient use of extensive and complex linkage schemes and the utilisation of machine learning. The Finnish register authorities have improved computing facilities for research use and the legislative reform on secondary use of health care data is opening eHRs for research use granting higher granularity in describing content and quality of care. These developments enable big-data methods to be an essential part of the future methodological toolbox for health service research.
The STOP project
Authors: Sassi F
Published: October 2020

The STOP project aims at expanding and consolidating the multi-disciplinary evidence base upon which effective and sustainable policies can be built to prevent and manage childhood obesity. STOP also aims at creating the conditions for evidence to translate into policy and for policy to translate into impacts on the ground. The primary focus of STOP is on the cumulative impacts of multiple and synergistic exposures in vulnerable and socially disadvantaged children and their families, which must be a priority target for the fight against childhood obesity in Europe to reach a tipping point and succeed. STOP will identify critical stages in childhood at which interventions can be most effective and efficient.

STOP is covering the whole umbrella of different research disciplines, to be able to understand and produce useful policy recommendations for complex issues such as childhood obesity. It is providing basic clinic research insights, comprehensive epidemiological data, study and overview of different public health-oriented measurements, understanding of stakeholders networking and effective communication. It builds on the observation that many interventions deployed by governments have failed to improve health-related behaviours in a sustained way over the life cycle. Little has been done to combine and triangulate different sources of biological, socio-economic and behavioural data to look at the overall, long-term consequences of an intervention on nutrition and metabolic health. Therefore, among other things, STOP focuses on the core idea that obesity has multiple and diverse characterisations, and therefore that one-size-fits-all policy approaches to childhood obesity are bound to fail, and the scientific component of the project is designed to recognise diversity and support the development of tailored solutions.
A first long-term evaluation of the Council of Coaches application: An observational cohort study
Authors: Op den Akker H , Hurmuz M , Jansen-Kosterink S M
Published: October 2020

Background

Due to the aging population, more and more older adults are living with chronic conditions. Adopting a healthy lifestyle can reduce the impact of these conditions. To address this issue, Council of Coaches (COUCH) has been developed within the Council of Coaches project (European Union's Horizon 2020 research and innovation program under grant agreement No. 769553). COUCH is a web application (TRL6), in which users can have virtual conversations with a group of embodied virtual coaches. These coaches give users information, feedback and tips on adopting a healthy lifestyle primarily in the areas of physical activity and nutrition. The aim of this evaluation is to assess the use, user experience, and potential health effects.

Methods

Use will be assessed by the log data of COUCH, and user experience and potential health effects will be assessed by questionnaires. The target population (older adults, 55 years or older) will participate in an observational cohort study with a pre-test/post-test design. Subjects will complete multiple questionnaires: before the baseline phase, after the implementation phase and, after the follow-up phase. Each participant will sign an informed consent form.

Results

The COUCH evaluation consists of two rounds. The first round started in February 2020, the second round will start in May 2020, with 25 subjects planned in each round. For the first round, 26 subjects are already recruited and included. For the second round, 12 subjects are already recruited. In August 2020, the results of the evaluation will be available. During this presentation, these results will be presented. This will consist of user demographics, use, user experience, and of the results on potential health effect.

Conclusions

This evaluation will give us a broad overview of the use, user experience and effectiveness of COUCH in a real-life setting, leading to further development of COUCH.
HESRi country impact and uptake in Wales
Authors: Dyakova M
Published: October 2020

Establishing a Welsh Health Equity Status Report Initiative (WHESRi) strengthens Wales' international influencer role and enables a healthier, more equal, prosperous and globally responsible Wales. WHESRi aims to inform and support policy solutions, innovation and sustainable investment towards healthy, prosperous lives for all, leaving no one behind. There are four objectives: Gather and analyse data and policies, providing a benchmark dynamic picture of health inequities, their determinants, economic burden and relevant existing policy interventions in Wales;Develop an interactive digital platform and information gateway to host the Welsh health equity dataset and related WHESRi products, tools and resources;To monitor, review, explore, assess, model and forecast the effect of policy changes and investment decisions on wellbeing and health equity; andTo facilitate cross-sector whole-of-government, whole-of-society policy dialogue, commitment and action, embedding and progressing health and equity, as part of the sustainable development agenda.

The WHESRi consists of two work streams: Developing WHESRi, including data, policy and economic analyses, aiming to inform solutions and investment to improve wellbeing and reduce health inequities; andDeveloping a digital Health Equity Solutions Platform for Wales, including an interactive dashboard and a suite of policy, investment and other tools and resources.
Health literacy and increasing level of health knowledge: Ethnographic analysis of the role of school children / young people in the development of health literacy in families
Authors: Wamba A , Soh G , Ngoumou R D , Matchika Megaptche M
Published: October 2020

Background

The contribution of school children and young people to the development of health literacy (HL) within families is little studied in Cameroon, where the majority of parents have low level of literacy skills. Also, they are the most exposed to the risks of poor health status (OMS 2019), because they experience enormous difficulties in terms of ability to seek and access health information, understand, interpret, evaluate it critically, and to use it in a way that promotes health. While it is known that school children and young people bring information into their families that can improve their parents' quality of life and health knowledge, they are rarely involved in actions of development and promotion of health literacy.

Methods

This study combines a quantitative approach apprehending the contribution of Cameroonians school children and young people to the promotion of HL within families, as regards the methods and means used, and a qualitative design research targeting the experience of this contribution. The study concerned 150 families with school children and young people attending primary and secondary school.

Results

The results show the specific actions, means and practical methods that school children and young people use to develop and promote HL in their families. Also, the results indicate that school children and youth help parents to increase their level of health knowledge, and to improve their level of HL skills, while reducing social inequalities in health.

Conclusions

The study suggests a recognition, at the level of health policies, of the importance of involving school children and young people in the development of HL in families exposed to literacy without schooling; the need to lay special emphasis in schools on knowledge related to HL, in order to better equip school children with useful skills beneficial to them and their families.
“Take care of yourself”: a psychoeducational tool for adolescents for the mental health promotion (MHP) in the pediatric primary care (PPC)
Authors: Passalacqua S , Crameri A , Zysset A , Wieber F , Wyl A
Published: October 2020

Background

Worldwide 10-20% of children and adolescents experience mental disorders (MD). Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. As adolescents move from child to adult-centered care, they should be encouraged to implement a proactive mental health strategy. Pediatrician have the potential to be an important gateway to MHP. The healthcare coordination may be affected by contextual constraints such as lack of time and the reluctance of the adolescents to seek help for MD. Adopting a resilience framework, we aimed to develop a psychoeducational toolkit to optimize the contact between the adolescents and their pediatrician.

Methods

We first collected pediatricians needs in a focus group and systematically searched in the literature for components of interventions that are effective in the MHP. We selected a previously developed toolkit, that we aimed to optimize and adapt culturally. The adapted toolkit was then evaluated by adolescents in two focus groups. We took their feedback into account when finalizing the toolkit.

Results

The psychoeducational toolkit “Take care of yourself” is a resource for adolescents to recognize risks for MD. It comprises ten topics that are central to MHP: myths and facts about MD, dealing with stress, love and loss, unhealthy relationships, separation, grief, online addiction, drugs, helping others, confidentiality, rights and obligations and useful websites. Analyses of the focus groups showed that adolescents and pediatricians evaluated the toolkit as appealing and helpful.

Conclusions

This toolkit provides a resource for adolescents to address mental health problems. It aims to increase MHP in PPC and to contribute to the destigmatization of MD. In a next step, we plan to test the effectiveness of this psychoeducational tool.
Evaluating mobile conditional cash transfers for improving immunization coverage in Pakistan
Authors: Chandir S , Siddiqi D A , Khan A A , Abdullah S , Dharma V K , Shah M T , Khan A J
Published: October 2020

Background

Despite progress in increasing immunization coverage, poor uptake of vaccines remains a challenge, particularly in LMICs. In part, this is due to the poor socio-economic status of caregivers, lack of motivation, and parental procrastination. While there is evidence that large (≥100 USD) incentives can overcome these problems, research on small incentives that are more appropriate for an LMIC setting is sparse. Our study addresses this gap by evaluating the impact of small (≤12 USD) CCTs in increasing immunization coverage for children under the age of two.

Methods

A 2-year program utilizing two small incentive schemes of different amounts (high: USD9; low: USD5) was implemented in Shikarpur District, Pakistan. Caregivers (with children 0-24 months) visiting any of the 33 study immunization centers were given the opportunity to enroll. All consenting parent-child pairs were randomized in one of the two incentive schemes and incentives were disbursed following each immunization visit, using mobile money. A baseline and end-line survey was conducted to evaluate changes in pre-post coverage.

Results

A total of 63,336 participants were enrolled between March 2016 - April 2018, of which 41,483 were randomized in the high or low incentive schemes (remaining caregivers were enrolled in the no-incentive group). Results show a 13% and 28% increase in age-appropriate coverage for Measles-1 (M1) and fully immunized children (FIC) compared to the baseline (FIC:16%, M1: 38%). There was no difference in M1 coverage between the high and low incentive schemes.

Discussion

Small CCTs have induced positive behavioral change and are a powerful tool for improving immunization coverage and compliance within LMICs.

Key messages

Small mobile conditional cash transfers (USD<12) can serve as nudges to parents and lead to behavioral shifts resulting in improved immunization outcomes for children. There was no significant difference in outcomes between high and low incentives, indicating that small mobile conditional cash transfers were equally effective in improving immunization coverage.
Geographical inequalities in breast cancer incidence, mortality and late stage at diagnosis in Cyprus
Authors: Demetriou C A , Quattrocchi A , Heraclides A , Constantinou C , Marcou Y , Demetriou A , Scoutellas V , Kolokotroni O
Published: October 2020

Background

A national breast cancer (BC) screening programme, targeting women 50-69 years old, was introduced in Cyprus in 2007. This study aims to assess rural/urban differences in BC incidence, tumour stage at diagnosis (TSD) and mortality, since 2004 and since the introduction of the screening programme.

Methods

Data were obtained for 6589 new cases of BC (diagnosis 2004-2016) from a national population-based cancer registry (1998-today) in Cyprus. TSD was recorded according to the Surveillance, Epidemiology, and End Results categories. We defined late TSD as regional or distant stage. Unknown stages were excluded. We linked cases to the population census data and place of residence (rural/urban) and calculated incidence and mortality rate ratios (RR) by place of residence. We conducted logistic regression to measure the association between place of residence and TSD or mortality, adjusting for sex, age, ethnicity, smoking and marital status. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results

Since 2004, 54.7% of BC cases were diagnosed at localised stage, 40.6% at regional stage and 4.7% at distant stage. Incidence, but not mortality, rate for all BC was higher in urban than in rural areas (RRincidece=1.22;95%CI=1.51-1.28 and RRmortality=1.10;95%CI=0.97-1.24). Rural place of residence was associated with higher odds of late TSD (aOR=1.34; 95%CI=1.15-1.58) and death (aOR=1.36; 95%CI=1.11-1.68). After the introduction of the screening programme, for the targeted age group, rural place of residence was still associated with higher odds of late TSD (aOR=1.31; 95%C= 1.03-1.67), but not with death (p > 0.05).

Conclusions

Even though BC incidence is higher in urban than in rural areas, women residing in rural areas had higher odds of late TSD and death. The introduction of the national BC screening programme only slightly reduced geographical inequalities in TSD. Further studies are needed to understand and reduce the role of inequalities in TSD.

Key messages

Rural/Urban inequalities in TSD are evident among BC cases in Cyprus, diagnosed between 2004 and 2016. The introduction of the national BC screening programme reduced but did not overcome geographical inequalities in TSD.
Cancer care for the homeless population: a literature review
Authors: Gil-Salmerón A , Gutiérrez-Schiavon C
Published: October 2020

Background

The last global survey in 2005 of the United Nations estimated that 100 million people were homeless. Cancer is becoming one of the most important public health problems worldwide, but specifically, the prevalence of cancer-related mortality for the homeless population has been reported to be double compared to the average adult population. To date, health research pays insufficient attention to studying cancer and improving the delivery of cancer care for the homeless population.

Methods

A systematic literature review of relevant databases was employed to identify all the quantitative studies addressing cancer care for the homeless population in English, Spanish, French and Portuguese. A total of 11,740 publications were identified.

Results

A total of 17 studies were included in this literature review. The majority of the studies were based on the United States (n = 13; 76.5%). Nearly half of the studies targeted the general homeless population (n = 9; 52.9%), and most studies specifically targeted homeless women (n = 6; 35.3%). The majority of studies examined specific types of cancer (n = 13; 76,5%). By type of cancer explored, breast cancer (n = 4; 23.5%) and cervical cancer (n = 4; 23.5%) were the most researched. Screening is the most prevalent topic investigated (n = 14; 82.4%). Studies report unequal access and utilization of cancer screening services as well as advanced stages of cancer when diagnosed. Additionally, longer delays to treatment have been reported. On the other hand, community-based screening strategies have proven to be effective in increasing screening rates.

Conclusions

Currently, American researchers appear to be leading exponents of cancer research on the homeless population and most of the research is focused on cancer screening. In this regard, community-based screening strategies have proven to be effective in reducing health inequalities for this vulnerable group but less is known when a positive case is diagnosed for this population.

Key messages

Cancer is a major disease burden worldwide and evidence shows higher mortality rates among the homeless population but unequal access and utilization of cancer screening and treatment services. Community cancer screening programmes for the homeless population should be internationally adopted and specific cancer care pathways meeting their needs after cancer diagnose should be provided.
When is a cancer patient cured? (Results from the EUROCARE-5 study)
Authors: Dal Maso L , Panato C , Tavilla A , Guzzinati S , Serraino D , De Angelis R , Francisci S
Published: October 2020

Background

Although heterogenous risks of recurrence or late effects according to cancer type and host factors exist, increasing evidence of cure has emerged for some cancers. This leads, among other important topics, to the so-called “right to be forgotten” law, adopted in France and Belgium to help cancer survivors access loans and insurance. The aim of the study was to estimate population-based indicators of cancer cure in Europe by type, sex, age, and period.

Methods

Data from 7.2 million cancer patients, aged 15-74 years, from 42 population-based cancer registries in 17 countries were extracted from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: a) median life expectancy of fatal cases (LEF); b) cure fraction (CF) as a proportion of patients with death rates similar to the general population; and c) time to cure (TTC) as the time to reach five-year conditional relative survival (CRS)>95%.

Results

LEF ranged from 10 years for patients with chronic lymphocytic leukemia to < 6 months for those with liver, pancreas, brain, gallbladder, and lung cancers. The CF was 94% for testis, 87% for thyroid cancer in women (70% in men), 86% for skin melanoma in women (76% in men), 66% for breast, 63% for prostate, and <10% for liver, lung, and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri, and melanoma patients of all ages. For breast and prostate cancers, a small excess remained for at least 15 years.

Conclusions

In a context of increasing number of people living after a cancer diagnosis, these results may help to reduce unneeded medicalization (e.g., follow-up) and resources needed for their care, and they further document that there is already a cure for some cancers.

Fundings

This work was supported by the Italian Association of Cancer Research (AIRC) and the European Commission (IPAAC).

Key messages

Cancer cure indicators are provided for European patients and 32 cancer type. Recognizing cancer patients as cured has relevant clinical and social implications.