bluuebunny/crossref_metadata_2025 huggingface dataset:
HIA and the standard public health licensing control and supervision
Authors: Loosova J
Published: October 2020

The methodology of health risk assessment (HRA) is embedded in Czech legislation; the process is clearly set, those doing HRA need to be licensed. Public health authorities (PHA) use HRA as a basis for assessing negative impacts of various activities, and are obliged to evaluate the quality of an HRA and, if in doubt, to examine it or directly call for the authorizing authority to revise it. HIA does not have this support in Czech legislation. HIA has the same potential for PHA as HRA, but its use is much broader, because it identifies positive effects as well. Is there a need for more legislation? It seems that yes, partly. Czechia at least needs a clear definition of the terms (HRA and HIA are used interchangeably). It is necessary to create a HIA assessment framework. What does HIA mean for public PHA? Identification of the health profile of a community, identification of missing data sources, current research of scientific literature on the given impact, identification of problems in the territory, prioritization of health impacts and their reflection in measures and health policies. It gives the opportunity to open the discussion with stakeholders and set up projects focusing on health. HIA opens the door for problem-solving, promoting positive impacts, protecting vulnerable groups and reducing distribution of inequalities in the population. Is it possible to use HIA without a national law? The Liberec Region has been using a unique way of implementing HIA into its regulations, which can be issued by the Regional Council in delegated powers. The reason for initiating this process was the absence of health assessment in regional policies. PHA requires an HIA and to evaluate the quality of the HIA, PHA uses a checklist. But the time has come for the next step of HIA implementation, to put it into urban planning. The first step has already been taken; we have prepared a project with GIS experts and urban planning.
Knowledge translation and health policy for burden of disease
Authors: Pallari E , Thomsen S T , Hilderink H B M
Published: October 2020

A key goal of most Burden of Disease (BoD) studies is to support public health policies. However, while the concepts of BoD and Disability Adjusted Life years have been introduced more than 25 years, BoD researchers are still struggling to find better ways to translate their findings and communicate them to the relevant decision makers and other stakeholders.

To address this gap, the burden-eu COST Action aims to generate better guidance of the use of BoD metrics in policy-making processes. In collaboration with experts in knowledge translation and risk communication, the Action will compile good practices in knowledge translation and develop a roadmap to integrate knowledge translation in national BOD studies. To support these objectives, collaborations have been established with knowledge translation experts from the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Public Health Association.

During an initial meeting of the “knowledge translation” working group, 29 participants identified elements in the pathway from evidence generation to practice that need to be addressed. Building on the outcomes of this meeting and the inputs from the knowledge translation experts, this presentation will introduce the knowledge translation framework, and address some of the challenges in identifying best routes to reach out to the public and policy-makers. Specific emphasis will be placed in profiling the context, actors and processes of each country within the policy triangle, and drawing on best and worst example case studies. Additionally, the process will be discussed to co-create a toolkit or guide for using BoD evidence in policy and practice. The session will conclude with an interaction with the audience to learn about the perceived barriers for implementing knowledge translation within the BoD framework.
Health, well-being and social relations in a changing neighbourhood
Authors: Lund R , Christensen U , Mathisen J , Srivarathan A , Molbo D , Kristiansen M
Published: October 2020

The main purpose of the study is to examine the development in health, wellbeing and social relations among middle-aged and older residents during a four-year period from 2018-2021 in a Danish multi-ethnic social housing area undergoing large structural changes in the built environment. In addition, to develop two interventions with a focus on ensuring social cohesion in the area during the study period.

This presentation will provide an overview of the study outline. The presentation will include a description of the study area, the political decisions that have led to the structural changes, the study population and a short overview of the aims and planned sub-studies. To prepare for the workshop discussion of the challenges, advantages and possibilities with the multi-methods approach this is followed by a short introduction to the different methods applied (a three-wave survey and qualitative data as well as two co-created interventions). The study is furthermore including a 'natural experiment' (N∼6.000) with a neighbouring non-profit social housing area not undergoing structural changes as the control area based on register data. The user-engagement in the design of study will be shortly described for example by their involvement in intervention development and by the involvement of citizen representatives and representatives from the Municipality and local non-governmental organizations in the design and execution of the study. Finally, the inclusion of graphical facilitation as a communication tool will be introduced.
The Diabetes and WELLbeing programme: protocol of a multi-site European complex intervention study
Authors: Hatzidimitriadou E , Manship S , Morris R , Hulbert S , Webster J , Belmas N , Best A , Averous V , Vanbosseghem R , Gijssel M
Published: October 2020

A quasi-experimental design evaluation study examines long-term impact of the 12-week DWELL programme, a self-management intervention for people with type 2 diabetes (T2D), based on adult learning and person-centred approaches, delivered in 5 community and hospital sites in 4 European countries. Overall target is 780 people with T2D. Staff are trained in motivational interviewing, group facilitation, diabetes education, and programme approach which consists of core and 'pick and mix' sessions on diabetes education, physical activity, healthy eating and wellbeing. Pre-post measures are taken at baseline (T0), end-of-programme (T1), at 6 months (T2) and 12 months (T3). There is a non-equivalent control group of 190 at T2/T3. Biomedical data are collected by staff and psychosocial data are collected via self-completed validated scales. Metabolic measures include: HbA1c, BMI and waist circumference. Demographics capture: age, gender, ethnicity, household composition, education, employment, income. Psychosocial data are collected on illness perception, patient empowerment, eating behaviours, physical activity, physical/mental health status, health-related quality of life (EQ-5D), use of diabetes-related health services and self-care activities. Participant experiences are recorded via motivational interviews at T0 and T1 and focus groups at T1. Process evaluation data are collected via interviews with staff and patient ambassadors. The DWELL programme started in 2018 and results will be available in 2021.

The study will produce rich data on long-term impact of intervention to allow replication and further development. It will permit cross-border conclusions on sustainability and embeddedness of model in varied service settings, and empowerment-based public health approach to T2D self-management.
GAP REDUCE. A research and development project to promote quality of urban life of adult people with autism spectrum disorder
Authors: Congiu T , Lubrano F , Talu V , Tola G
Published: October 2020

Background

Sensory peculiarities of people with Autism Spectrum Disorder (ASD) significantly affect their lives, making the relationship with the environment difficult to face. Many authors, referring to the urban environment, report that rather more stimuli required to be processed and orientation and navigation are challenging skills at different scales. The growing incidence and prevalence of the disorder and the need to guarantee during adulthood the actual opportunity to exercise the level of autonomy achieved during youth, emphasize the necessity to 'broaden' the research perspective by investigating also how the shape and the organization of the urban environment affect the quality of life of this group of inhabitants. GAP REDUCE is a R&D project aiming at developing a tool to provide support to adult and high-functioning people with ASD to plan, easily and in advance, an urban itinerary towards daily destinations. After the development of a cognitive framework on the relationship between built environment and autism, a survey involving different experts has been conducted to identify the relevant urban spatial features to calculate the most suitable path (in terms of sensory stimuli, accessibility and orientation). A neighbourhood in Sassari (Italy) was selected as pilot study area to test the tool.

Results

The identified urban features were classified into positive and negative points of interest, acting as spatial facilitators or obstacles respectively, and evaluated on the basis on a set of indicators according to their impact on the possibility for the user to reach the selected destination.

Conclusions

GAP REDUCE is an innovative tool that leverages on spatial facilitator to make the urban environment more accessible, inclusive and healthy to people with ASD. Indeed, this principle and tool can be also applied to other groups of inhabitants (elderly, people with dementia, people with other sensory disabilities).
Health benefits of Mediterranean and non-Mediterranean dietary pattern in different cultural contexts
Authors: Iacoviello L , Bonaccio M
Published: October 2020

Description of the problem

The increasing globalization of diet and dietary habits resulting from the large availability and diversity of food poses new questions for the actual health benefits of different dietary patterns in populations not traditionally exposed to a certain dietary model. Consuming a traditional Mediterranean diet (MD) has been found to be associated with lower mortality/disease risk also in non-Mediterranean populations but it is unclear whether healthful non-Mediterranean (non-MD) diets may reflect protective dietary patterns in Mediterranean populations.

Results

Data from the Moli-sani Study showed that participants reporting high adherence to the MD or the DASH diet experienced lower risk of both all-cause and CVD death risks. On the other side, risk reduction associated with the Palaeolithic diet was limited to total and other cause death, whereas the Nordic diet did not alter risk of mortality. Increasing adherence to MD was also associated with higher survival in each stratum of non-MD diets, suggesting that a closer high adherence to a traditional MD may counterbalance the weak effects on CVD mortality risk associated with non-MD diets. Similarly, data form the Swedish Mammography Cohort indicated an advantage to be adherent to the MD as compared to a healthy Nordic diet.

Conclusions

From a public health perspective, these data provide further incentive and support to the efforts aimed to preserving a traditional MD in order to prolong survival among Mediterranean populations, and to reduce CVD mortality risk. Evidence on the health effects deriving from classifying participants in joint exposure strata reflecting the combined adherence to different diets is scarce but more efforts should be made to see whether, at a time of food globalization, healthy dietary patterns are possibly interchangeable among populations.
Review of pandemic plans, varying international approaches focusing on medical students’ contribution
Authors: Fundano N , Khan H , Holm S , Ghazal Asswad A , Petráková A
Published: October 2020

A review of pandemic plans and international approaches to pandemics focusing on the responsibilities of medical students should they be called to help in times of need. Are there specific guidelines or competencies in place with respect to medical students? Are medical students being utilised to their maximal capability when compared across different nations on an international basis? These questions were kept in mind during the evaluation and analysis of publicly available pandemic plans and other international systems concerning the approach to pandemics. The main differences, strengths and weaknesses of these responses will be highlighted. The presentation will conclude with proposals of the specific role medical students could play in the pandemic response and the importance of their contribution on an international level.
Panel discussion
Authors: Petráková A
Published: October 2020

Panel discussions

Panellists will discuss the topics mentioned during the presentations, adding their opinions and further elucidating steps which can be undertaken for future progression. Audience participation will be welcomed. The panellists include: A. Petrakova, Faculty of Medicine & Dentistry, Palacký University Olomouc, Chair ASPHER V4 Working GroupM. Raška, Faculty of Medicine & Dentistry, Palacký University Olomouc, representative of AMSER. Otok, ASPHER, Co-chair of the ASPHER V4 Working GroupV. Prikazsky, National Institute of Public Health, Czech RepublicZ. Katreniakova, PJ Safarik University in Kosice, Faculty of Medicine & SAVEZ / Slovak Public Health Association
4.D. Workshop: Health Impact assessment of chemical exposure: state of the art and challenges
Authors:   Organised by: EUPHA Health impact assessment section, EC JRC, ibs.GRANADA (Spain), EASP (Spain),   Chair persons: Piedad Martin-Olmedo - Spain, Stephanie Bopp - Italy
Published: October 2020

Humans worldwide are exposed to a wide range of chemicals through their diets, consumer products and the environment, often changing in concentrations, combinations and over time. Health impact assessment (HIA) for exposure to chemicals is poorly defined and its contribution to the global burden of disease is difficult to quantify and certainly underestimated. The importance of taking actions for reducing deaths and illness associated to hazardous chemicals is reflected in the UN Sustainable Development Goals target 3.9, as well as in the 7th European Environment Action Programme or in the European Green Deal (Communication of the European Commission, COM (2019) 640 final).

Recent discussions suggest that current EU Legislation, while contributing to reducing the overall risks of chemicals in the environment, is protecting mainly against highly toxic chemicals in the workplace. However, the assessment of potential health impacts over the general population is limited by uncertainties related to data collection, health indicators and confounding factors. Concerns have also been reported regarding the increased introduction in the market and the environment of new substances with unknown properties as well as referring to the chronic, low-level exposure to chemical mixtures, which are considered to be poorly characterised and yet to be systematically addressed. Notably, in recent years the European Commission (EC), acknowledging that the assessment and management of mixtures is only partly covered by current legislation, has identified several gaps and areas for action.

With regard to carcinogens, the proportion of non-genotoxic carcinogens in the environment is expected to increase, since industrial chemists are designing compounds without overly reactive moieties. In addition, the manufacture and use of novel types of substances including nanomaterials, new generation pesticides and pharmaceuticals (e.g. biologicals, cell and gene therapies) are expected to increase. This raises new challenges for the assessment and risk management of the carcinogenicity impacts of chemicals.

The present workshop intends to provide an overview of the different initiatives conducted in Europe at different scales (European, national and regional), to address such defies related to the HIA of chemicals. Specifically, we will debate about existing data sets for characterising both human exposure and health effects related to chemicals, new approaches and guidance for the assessment of exposure to mixtures, and the carcinogenicity impacts as well as how all that is being translated to policy actions.

Key messages

Increasing global trend of human exposure to chemicals demands holistic approach for action. Several research/policy initiatives for improving HIA-chemicals are ongoing, with expected strong impacts.
Testing the Mig-HealthCare Algorithm in Greece
Authors: Riza E , Karnaki P , Zota D , Linos A
Published: October 2020

The Mig-HealthCare Algorithm is a tool, comprising a set of questions developed with the aim to (a) guide the user on how to access all the categories and tools that are available through the Roadmap & Toolbox (b) help the user identify the health issues of importance when providing care to a specific migrant/refugee. At the end of a series of questions, a brief report summarizing the main outcomes is generated. The algorithm was tested in Greece in two mainland reception centres and a local hospital in an area serving migrants/refugees. Results discuss the usefulness of the algorithm for improving the delivery of appropriate health services to migrants/refugees and its importance in raising awareness about the health conditions which are crucial for migrants/refugees and are expected to pose a significant burden on the health care systems of host countries unless dealt with adequately at an early stage.
Burden of cancer and human exposure to chemicals
Authors: Carvalho R , Randi G , Martos C , Dyba T , Giusti F , Nicholson N , Neamtiu L , Dimitrova N , Bettio M
Published: October 2020

Cancer has important impacts on the EU's health systems and economies, with around 3 million new patients diagnosed each year. However, up to 40% of cancers are attributed to preventable causes. For these reasons, cancer is one of the main priorities of the EC in the health domain.

The new Europe's Beating Cancer Plan of the EC, to be launched at the end of 2020, aims to support EU Member States to improve cancer control and care, by proposing actions at every key stage of the disease: prevention (lifestyle, pollution, vaccination), diagnosis, treatment and survivorship. Reliable cancer statistics are essential to propel both epidemiological research and political decision making, and provide the supporting evidence to allow assessment of best practices in all those key stages. To this purpose, the European Cancer Information System (ECIS), built on European population-based cancer registries' data, provides the latest information on indicators that quantify the burden of cancer in Europe. It permits the exploration of geographical patterns and temporal trends of incidence, mortality and survival by granting access to harmonised and validated cancer incidence data.

Population-based cancer registries have been essential in many of the epidemiological studies that led to the identification of several carcinogens in the work place as well as those linked to certain lifestyle habits such as tobacco and alcohol consumption. However, In conditions of low exposure, the identification of cancer hazards has remained largely inconclusive, due to the unavailability of sufficient exposure data and appropriate models that can account for multiple exposures over extended periods.

The linkage between cancer registries data and administrative databases, biobanks, environmental data and extensive lifestyle questionnaires could help identifying or consolidate the available information on emerging carcinogens and populations at risk, thus allowing the development of preventable measures.
Data for characterizing human exposure to chemicals and their contribution to human diseases: IPCHEM, HBM4EU
Authors: Bopp S , Martin-Olmedo P
Published: October 2020

Human exposure to chemicals can occur via different sources and routes. Understanding the (combined) exposure to chemicals is often hampered by a lack of data or difficulties in sharing data. This was recognized in the Commission Communication on Chemical Mixtures (252, 2012) and the Information Platform on Chemical Monitoring (IPCHEM) was developed. The aim of IPCHEM is to support a coordinated approach for collecting, storing, sharing and assessing data on the occurrence of chemicals and chemical mixtures in humans and the environment. IPCHEM covers four thematic areas to support a holistic approach to exposure assessment, including human biomonitoring, environmental monitoring, food and feed monitoring and indoor air and consumer products. The shared occurrence data support exposure assessment, the identification of sources and hot spots, the analysis of time trends and can also support the evaluation of the impact of regulatory measures to restrict exposure to specific chemicals. In particular, human biomonitoring data can provide insights into internal combined exposure, integrating across different exposure sources and routes. The ongoing EU funded project HBM4EU generates and uses human biomonitoring to assess human exposure to chemicals in Europe, to better understand the associated health impacts and to improve chemical risk assessment. Associations between chemical exposures and development of disease can be further supported using toxicological/mechanistic information to establish causal links. The presentation will focus on relevant types and sources of data available to support health impact assessments of chemical exposure.
Implementation of Evidence Informed Deliberative Processes and HTA in Emerging Settings: Challenges and Opportunities
Authors: Kahveci R
Published: October 2020

The third speaker will provide the LMIC perspective, including the examination of feasibility in implementing governance mechanisms to ensure fair and transparent deliberation.
Regulatory and legislative frameworks and their role in R&D, HTA and UHC
Authors: Lingri D , Petelos E
Published: October 2020

The fourth speaker will present the role of HTA in reimbursement, as well as existing pricing frameworks and HTA initiatives, and determining overall access. An overview of constraints and opportunities in terms of establishing legislative frameworks to enable deliberation, transparency will be further discussed. Their importance for national healthcare systems, i.e., payers, and for ensuring system sustainability. Affordability will be examined in terms of effect on individuals, on payers, and on systems.
The ASELPH Leadership Fellowship enhancing the performance of healthcare leaders in South Africa
Authors: Cloete S , Olorunju S , Buch E
Published: October 2020

Background

South African healthcare leaders face significant challenges and concerns are raised regarding the competencies of leaders to deal with such challenges. The Albertina Sisulu Executive Leadership Programme in Health (ASELPH) Fellowship was established to equip leaders with skills to perform optimally. The study evaluated the effect of ASELPH in enhancing the performance of leaders. The study proved the benefits of leadership training, established the factors affecting training effectiveness and the contribution of the Fellowship's unique features to training's success. It also contributed to the scant global literature on whether such programmes are effective.

Methods

A quasi-experimental study design was used, with pre-post assessments of ASELPH students at the University of Pretoria. Data were collected from a questionnaire, module assessments and reflective essays. A 360° assessment of 14 competencies and 56 performance indicators were done.

Results

Students improved significantly in 11 competencies and 44 performance indicators, in spite of adverse workplaces. Assessors observed the same improvements, which confirmed performance change at the students' workplaces. Factors influencing the effectiveness were poor leadership, increased workload, time and resource constraints. The unique features of the ASELPH i.e. case-based method, eLearning, group work, real-time assignments, continuous assessments and mentoring contributed to the success of the training.

Conclusions

The study showed how ASELPH enhanced the performance of public healthcare leaders in SA and their impact on the SA healthcare system. Recommendations include the continuous use of blended learning for training and all SA healthcare leaders to attend ASELPH. The findings of this study combined with the evidence in the literature showed that leadership training, together with ongoing assessment post-training, are necessary for leaders to perform effectively in their workplaces.

Key messages

Leadership training is imperative for optimal performance of leaders. The teaching approaches and pedagogy affect the effectiveness of the training.
The Knowledge Broker Mentoring Program: Developing capacity for evidence-informed decision making
Authors: Howarth C , Steinberg M , Neil-Sztramko S , Dobbins M
Published: October 2020

Background

Evidence-informed decision making (EIDM) is important to ensure that practice is evidence-informed and resources are used efficiently and effectively. However, public health professionals can face barriers to EIDM. Knowledge Brokers can support and champion EIDM within an organization. The National Collaborating Centre for Methods and Tools (NCCMT) developed a Knowledge Broker (KB) Mentoring program, a hands-on mentorship program to develop capacity for evidence-informed decision making.

Objectives

The objectives of the KB Mentoring program are to build individual and organizational capacity for evidence-informed decision making. The program takes place over 20 months and includes an organizational assessment, nine face-to-face workshop days, monthly webinars, completion of a rapid review, and a period post-program to connect with mentors. Participating cohorts are evaluated qualitatively.

Results

To date, two cohorts of five organizations each have completed the program (n = 56 participants). At the individual level, participants reported increased: confidence; EIDM knowledge and skills; and interpersonal connections. At the organizational level, the groups reported conducting rapid reviews, critically appraising evidence, and using evidence in program planning decisions. Additionally, organizations have put in place ongoing supports to build EIDM capacity. Participants noted that they would like more support both before and after the program. This recommendation was put in place for the third cohort, currently in progress.

Conclusions

Participants indicated the KB mentoring program was high quality and increased EIDM capacity and behaviour in their organizations. This innovative program is important across settings and countries as public health continues to face changes to public health practice. In order to scale up the program to diverse geographic settings, an online KB mentoring program is currently in development.

Key messages

Knowledge Broker mentoring supports public health practitioners to use evidence in practice. Knowledge broker mentoring raises the confidence, knowledge, skills, and connections of participants.
Microbiological surveillance in reducing potential infection risk
Authors: Tuvo B , Cristina M L , Spagnolo A M , Totaro M , Baggiani A , Privitera G , Casini B
Published: October 2020

Background

Failure in reprocessing of endoscopes has been reported as one of the top ten most important threats to patient health.

Materials/Methods

The study was conducted in two digestive endoscopy centres of a teaching hospital (29,000 endoscopies/year, of which 550 endoscopic retrograde cholangiopancreatography (ERCP). Following two cases of bacteremia due to KPC-producing Klebsiella pneumoniae temporally related to ERCP and 89% of non-compliance detected on endoscopes subjected to microbiological surveillance, the reprocessing activities were audited and implemented to ensure guideline compliance. Clinical and microbiological surveillance were reinforced and all responsibilities for each phase identified according to UNI/TR11662. Microbiological surveillance was performed according to the 'Duodenoscope Surveillance Sampling and Culturing Protocols' protocol, CDC, 2018.

Results

In the 11 months of surveillance, 47 endoscopes were sampled (13 colonoscopes, 9 gastroscopes, 23 duodenoscopes and 2 echoendoscopes), 19 washer-disinfector machines and 9 medical cabinets. 36% (17/47) of endoscope internal channels resulted non-compliant, 17% (4/23) in duodenoscopes. NDM-producing K. pneumoniae was isolated in 2 gastroscopes always associated with the use on a colonized patient. The inlet and final rinsing water of washer-disinfectors and medical cabinets resulted always conformed. Non-conformities were managed immediately in order to avoid infectious risks for patients.

Conclusions

Microbiological surveillance of endoscopes after reprocessing allowed to prevent infections in patients undergoing endoscopic procedures.

Key messages

Training of health workers followed by strict adherence to guidelines is the most appropriate tool in preventing and controlling infections related to the use of endoscopes. Endoscopy and reprocessing staff should follow a formal recognized endoscopy reprocessing training program, followed by regular practice and periodically updated training to maintain competency.
Medicolegal Alienation in Physicians Practising in Informal Clinics Servicing Undocumented Migrants
Authors: Greenbrook J T V , Reichenberg K
Published: October 2020

Background

Globally, undocumented migrants have relied on informal clinics for their healthcare services. Empirical explorations of physicians' moral, ethical, and legal consciousness surrounding practising within this context remain lacking. The present study sought to contribute to this gap.

Methods

Constructivist grounded theory was applied to qualitative interviews with 16 physicians working in informal humanitarian clinics in Sweden.

Results

Physicians' experiences were synthesised into three categories: Ambiguity in navigating illegality, due to awareness of vulnerabilities surrounding patient-safety and own involvement, whilst simultaneously feeling enriched through interactions in the clinic; Being exposed to patients' accounts of structural violence and social injustice; Experiencing isolation in practice, when discovering professional limitations and feeling severed from the conventional medical institution. In navigating the threshold between their societally commended role and structurally condemned undocumentedness, differing processes of alienation synthesised in physicians in medical, ethical, and legal terms; identified as a novel dimension of legal consciousness theory, a process coined medicolegal alienation.

Conclusions

The process of medicolegal alienation occurs when, functioning as arbiters of patients' rights within the conventional medical institution, questions surrounding undocumented migrants' deservingness force physicians into a position of moral, ethical, and professional dissonance. Struggling to dictate their own practice, they are propelled out into informal clinics, in search for congruence. Through this process, physicians become alienated from both their profession and from legality. Though able to navigate freely between the medical institution and humanitarian clinics, the burden of insight into the threshold between legal realms and the plight of the undocumented patient is heavily ambiguous, being both transformative and isolating.

Key messages

In navigating the threshold between their societally commended role and structurally condemned undocumentedness, differing processes of medical, ethical, and legal alienation synthesised in physicians. When undocumented migrants’ deservingness is questtioned, physicians are forced into a position of moral, ethical, and professional dissonance, giving rise to the process of medicolegal alienation.
Implementation of the German Prevention Act: Municipal Public Health Units as a Bottleneck?
Authors: Arnold L , Starke D , Szagun B
Published: October 2020

Background

The German Prevention Act (PrävG) came into force in 2015. As a federal law, it remains vague with regard to municipal structure. The municipalities, as those public health units that have direct access to the living environment, play a central role in the implementation of health promotion and prevention. The evaluation by the National Prevention Conference in 2019 showed that the involvement of the municipal public health services (ÖGD) has not yet been sufficiently achieved. A major problem is the heterogeneity of ÖGD units in Germany's federal structure, about which little information is available.

Methods

In order to fully capture this heterogeneity for the first time, a systematic online screening was carried out. For this purpose, the websites of all 358 ÖGD units were screened independently of two researchers according to structural conditions.

Results

70% of all municipal ÖGD units are located at district level, 18% at city district level and 12% cumulatively. Population varies from 35,000 to about 1.5 million inhabitants. The allocation of the ÖGD units to youth service planning and social welfare varies in the federal states from 18.7% to 94.4%, within regulatory agency and veterinary office from 27.8% to 79.2%.

Conclusions

The heterogeneity makes the establishment of municipal standards difficult. Due to the diverse administrative allocation, different levels of policy-making must be considered on the way to health in all policies. The political classification reflects in roughly equal parts an ÖGD orientation towards health protection or social determinants of health, as recommended for the PrävG. A one-sided orientation towards health protection was shown by the temporary suspension of the use of financial resources for prevention in the course of the 2nd pandemic law to combat the COVID-19 pandemic. For the announced reform of the German ÖGD it is necessary to homogenize essential structural characteristics and to prevent a one-sided orientation.

Key messages

The heterogeneity of municipal health services makes it difficult to implement the German Prevention Act. In the course of the upcoming ÖGD reform, essential structural characteristics should be homogenized and a one-sided orientation of the municipal ÖGD units towards health protection should be avoided.
Knowledge and behaviors regarding salt intake according to urinary Na excretion and blood pressure
Authors: Silva-Santos T , Moreira P , Padrão P , Abreu S , Pinho O , Gonçalves C
Published: October 2020

Background

Understanding salt-related knowledge, attitudes and behaviors can help the design of effective health interventions. Therefore, our objective was to describe knowledge and behaviors related to salt intake according to urinary sodium excretion and blood pressure in University workers.

Methods

We performed our study in a subsample of the participants of the iMC Salt project (n = 60 subjects, 60.5% women, mean age 48±9.5 years). Sodium excretion were measured by one 24-h urinary collection, validated by creatinine excretion and participants were grouped according to the WHO sodium recommendations (<2.0 g/day; high, ≥2.0 g/day). Subjects were classified as hypertensive if the systolic blood pressure was ≥130 mmHg and/or diastolic blood pressure was ≥80mmHg. Knowledge and behaviors regarding salt intake were assessed by the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance.

Results

About 74.6% of the participants reported that reducing salt in their diet was very important and 93.2% think that salt is harmful to health. However, 76.3% always add salt during cooking, 42.4% said that they always or often consume processed foods high in salt, 79.7% reported that they don't look at the salt on food labels, 50.8% don't buy low salt alternatives and 30.5% don't use spices as one substitute for salt when cooking. Hypertensive subjects had a higher mean sodium excretion (3710±1508mg/day vs 2478±871mg/day, p = 0.002) and reported a significant higher frequency of consumption of processed foods high in salt (53.1% vs 29.6%, p = 0.024). No significant differences were found with the other variables.

Conclusions

Most university workers were aware that high salt intake can cause health problems, but they reported low adherence to behaviors to control their salt intake. Hypertensive subjects recognized that frequently consume processed foods high in salt, so reduce salt content on those products could have important impact on their daily salt consumption.

Key messages

This study provides evidence on knowledge and behaviors regarding salt intake to guide salt reduction policies. Hypertensive participants reported a higher frequency of eating processed foods rich in salt.
Coping strategies predicting quality of life in diabetic and obese NAFLD patients
Authors: Funuyet-Salas J , Martín-Rodríguez A , Pérez-San-Gregorio M A , Romero-Gómez M
Published: October 2020

Background

To date, coping strategies have not been studied in patients with nonalcoholic fatty liver disease (NAFLD), despite evidence of their relevance in chronic liver pathology, Type 2 diabetes mellitus (T2DM) and obesity (OB). We therefore analyzed which coping strategies predicted quality of life in diabetic and obese NAFLD patients.

Methods

Four hundred and ninety-two biopsy-proven NAFLD patients (290 men and 202 women, mean age 54.90±11.74) were evaluated using The Brief COPE, 12-Item Short-Form Health Survey (SF-12) and Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease (CLDQ-NAFLD). A stepwise multiple linear regression analysis was performed on four groups (G1, n = 335, absence of T2DM; G2, n = 157, presence of T2DM; G3, n = 249, absence of OB; and G4, n = 243, presence of OB) to analyze which coping strategies predicted patient quality of life (physical component summary SF-12, mental component summary SF-12, and total CLDQ-NAFLD).

Results

In both diabetic and obese patients, active coping (T2DM, p = 0.003, β = 0.26; OB, p = 0.000, β = 0.33) and denial (T2DM, p = 0.027, β=-0.19; OB, p = 0.004, β=-0.18) predicted the physical component summary. Denial (T2DM, p = 0.000, β=-0.30; OB, p = 0.001, β=-0.19), positive reframing (T2DM, p = 0.000, β = 0.28; OB, p = 0.000, β = 0.29), self-blame (T2DM, p = 0.000, β=-0.24; OB, p = 0.000, β=-0.26) and self-distraction (T2DM, p = 0.033, β=-0.13; OB, p = 0.023, β=-0.11) predicted the mental component summary. Denial (T2DM, p = 0.000, β=-0.34; OB, p = 0.000, β=-0.31), positive reframing (T2DM, p = 0.000, β = 0.30; OB, p = 0.005, β = 0.15) and self-blame (T2DM, p = 0.000, β=-0.26; OB, p = 0.000, β=-0.28) also predicted the total CLDQ-NAFLD in both groups.

Conclusions

Active coping and positive reframing predicted better quality of life, while denial, self-blame and self-distraction predicted worse quality of life in diabetic and obese NAFLD patients, suggesting the inclusion of coping strategies in future multidisciplinary NAFLD treatments.

Key messages

Importance of coping strategies for NAFLD patients: active coping and positive reframing predicted better quality of life, while denial, self-blame and self-distraction predicted worse quality. This study shows the need to design multidisciplinary strategies for managing NAFLD and improving patient quality of life, in which intervention in coping strategies should be a major element.
Risk stratification for the safety of patients and hospital health workers during Covid-19 emergency
Authors: Zilli E , Madia A , Giuriato P , Bonaldo D , Napolitano R C , Callegaro R G , Fioretto M , Arseni A , Benini P , Scibetta D
Published: October 2020

Covid-19 emergency has forced hospitals to face enormous organizational challenges in order to implement solutions to minimize the impact of the infection and guarantee at the same time the quality of health services provided and the safety of patients and health workers. ULSS 6 Euganea - Health Trust (District of Padua) has defined four levels of risk for Hospital Units (from the highest to the lowest risk: Red, Yellow, Green and White) based on the following parameters: type of patients hospitalized (SARS-CoV-2 positive, Covid-like, negative), type of health services provided, time of assistance and care for hospitalized patient.

This risk stratification in the Hospital of Cittadella - ULSS 6 Euganea has been applied to different contexts, such as distribution of personal protective equipment, health surveillance, frequency of cleaning and sanitation. Since February 21 (first confirmed case in Veneto Region), in the Hospital of Cittadella personal protective equipment has been delivered daily to health workers; the quantity and quality of devices provided have been carefully monitored, with particular regard to high-risk settings (Red Areas: Intensive Care Unit, Emergency Room, Covid Wards, Operating Room, Radiology, swab samples Area, Morgue).

The performance of nasopharyngeal swabs has been periodically organized for every health worker, according to the level of risk of their Unit: every 10 days for Red Areas, every 20 days for Yellow and Green Areas, every 30 days for White Areas. The frequency of cleaning and sanitation has been intensified in Red and Yellow Areas, following the guidelines released by the World Health Organization.

The definition of four levels of risk for Hospital Units is proving to be a useful and flexible tool in the management of Covid-19 emergency; further research in the next months needs to be made to assess the impact of risk stratification on the different aspects covered (ex. number of health workers infected).

Key messages

Covid-19 emergency has forced hospital to face enormous organizational challenges to minimize the impact of the infection and guarantee the safety of patients and health workers. The definition of four levels of risk for Hospital Units is proving to be a useful and flexible tool in the management of Covid-19 emergency.
Deindustrialisation and health: mapping the mechanism of impact in the Hungarian rust belt
Authors: Scheiring G
Published: October 2020

Background

Industrial countries are undergoing a prolonged period of deindustrialisation, characterised by declining labour in manufacturing and extractive industries. Considering the urgent need to decrease humanity's overall environmental footprint, industrial transformation is imperative. Research showed that deindustrialisation correlates with worsening ill health; yet, little attention has been paid to mapping the complexity of the mechanism of impact.

Methods

Hungary experienced significant deindustrialisation in the 1990s and a parallel decline in life expectancy. Four medium-sized towns were identified in the Hungarian rustbelt: two moderately (25-50%), and two severely (>50%) deindustrialised. Between September 2016 and January 2017, 82 semi-structured interviews were conducted in these towns with subjects who were working-age adults in 1989 and who lived and worked in the interview towns in the following decades. The 816,118 words-long interview-corpus was analysed with qualitative thematic analysis using NVivo.

Findings

The interviews revealed that deindustrialisation affects health through multiple channels. Short-term mechanisms impact individuals directly, such as unemployment, deprivation and increased work-related stress. Medium-term mechanisms impact health through disrupting social hierarchies, social capital, local services, and workplace identities. Long-term impacts are latent, and influence health through territorial stigma, loss of working-class culture, and accumulated perceptions of injustice.

Conclusions

Deindustrialisation is a crucial contextual factor affecting ill health over the short, medium and long term. Going beyond the direct individual channel, involving communities and localities, the health effect of deindustrialisation represents a complex and layered mechanism with multiple explicit and latent components. Complex research approaches and policy responses are needed to address explicit and latent structural mechanisms alike.

Key messages

The study maps the mechanism of impact that links deindustrialisation and ill health in four Hungarian towns using thematic analysis of 82 qualitative interviews. Deindustrialisation affects health over the short, medium and long term going beyond the direct individual channel, necessitating complex research approaches and policy responses.
Implementation of telemedicine project in Bhutanese refugee camp in Nepal
Authors: Khatoon S
Published: October 2020

While working with UNHCR (UN Refugee Agency) in Nepal, I faced the challenge of managing Bhutanese refugee health care programme with limited resources. Since 1993, UNHCR was providing health services to Bhutanese refugees living in seven camps. UNHCR Nepal had received limited budget due to emerging refugee crisis in other parts of the world in 2016. As a health focal person, I was assigned to look for new approaches to provide health services to refugees. After exploring several possibilities, telemedicine project was introduced in the camp in 2016 with the collaboration of tertiary hospital, B. P. Koirala Institute of Health Sciences.

The main objective of the project was to reduce medical referral, which consumed most of the resources. From testing and prototyping, videoconference was considered as the most appropriate method to perform telemedicine in the camp. Telemedicine helped camp clinical staff to directly communicate with consultants in the tertiary hospital at distant and address the refugee health issue at camp level.

After implementation of telemedicine, medical referral from camp clinic to hospitals in 2016 was reduced by 54.8 % in comparison to previous year 2015. Telemedicine project also enhanced the coordination and linkage of refugee and UNHCR with tertiary referral hospital.

Regular monitoring visit from the expert helped to improve the telemedicine project significantly. The most important lesson learnt was that beneficiaries and camp health staff should be involved from beginning. Camp health workers must be trained on using telecommunications equipment.

Telemedicine is cost-effective in refugee setting where internet access is strong. Regular monitoring and technical support from the expert, learning attitude of camp health workers and acceptance from refugee are vital for the success of the project. Telemedicine increased access of essential healthcare to the most disadvantaged communities and ultimately facilitated universal health coverage.

Key messages

Telemedicine is cost-effective way of providing health services to refugee at remote area where access to hospitals is challenging due to certain limitation such as distance, budget, transportation. Telemedicine not only save the cost of medical referral but also save opportunity cost, time and energy of refugees, which are invested while visiting hospital.