bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact assessment of the public health product tax in Hungary
Authors: Zámbó L , Bakacs M , Illés É , Varga A , Sarkadi Nagy E , Zentai A , Feigl E , Biró K
Published: October 2020

Many countries apply fiscal policies to promote healthy diets to reduce the risk factors of NCDs. In 2011, a public health product tax (PHPT) was introduced in Hungary, taxing non-staple food products that carry proven health risks when consumed. The objectives of PHPT were to promote healthier eating habits by increasing the availability of healthy choices; to encourage reformulation; and to increase revenues for public health. With the purpose of evaluating the social and economic effects of PHPT, impact assessments (IAs) were conducted in 2012, 2014, and in 2018. The IA in 2018 was conducted within the framework of an EU-cofunded development project. To measure the awareness of the population on the law; to assess the population's attitude towards PHPT; to map the consumption patterns and to examine the major factors influencing food choices were fundamental parts of the IAs. We aim to present the findings of the latest IA and compare them to the results of the previous studies. Population surveys with questionnaires including the same questions were applied in the three assessments, hence changes during the 6 years could be detected. A sample of the adult population was involved in form of personal interviews in each IA. Based on the results, the awareness of PHPT was less (66%) in 2018 than in 2012 (72%). The adult population's consumption of the taxed products increased in all categories between 2012 and 2018 (except for salty condiments). Sociodemographic factors and awareness of the law correlated with the consumption of certain PHPT products. Taste was the primary determinant of food choice both in 2012 and 2018. The role of the price and the energy content in food choices were decreased significantly by 2018. A higher proportion of people identified the aims of PHPT correctly and agreed with them in 2018. The results draw attention to the importance of further interventions and the need of targeted health communication.

Key messages

The impact of the PHPT should continue to be monitored and evaluated. To achieve the aims of PHPT in the long term, it is needed to use more effective health communication, furthermore harmonized intersectoral actions should be also implied to promote healthy diet.
Implementation level of best practice policies by Italian government for healthier food environments
Authors: Zace D , Specchia M L , Di Pilla A , Carini E , Cacciatore P , Frisicale E , Silano M , Ricciardi W , Sassi F
Published: October 2020

Background

Government actions play a critical role in shaping healthy food environments, which can improve population's diet and decrease the burden of disease. This study aims to determine and compare the level of policy implementation for healthy food environments in Italy with reference to international benchmarks and make prioritized recommendations based on the identified implementation gaps.

Methods

The Healthy Food Environment Policy Index (Food-EPI) tool from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) was adapted for the Italian context. This tool includes two components, thirteen domains and fifty good practice indicators, which were verified with experts from National Health Institute (NHI). Evidence for implementation was gathered and summarized for all fifty indicators from data sources such as governmental websites, non-government organizations publications and websites and via direct contact with government officials. After collecting all evidence, experts from the NHI verified the completeness and accuracy of it. The evidence document will be presented to stakeholders, aiming to seek consensus on the priority actions to be implemented by the Italian Government to improve food environments.

Results

The evidence for policy implementation concerning Italy varied among domains and indicators. We found the highest level of evidence within three domains: Food Composition (2/2 indicators), Food Labelling (3/4 indicators) and Food Promotion (4/5 indicators). The domains with less identified evidence were Food Prices (1/4 indicators), Food Retail (0/4 indicators), Food Trade and Investment (0/2 indicators) and Platforms and Interaction (1/4 indicators).

Conclusions

The evidence summarization and the upcoming stakeholders' meeting to rate the level of implementation for each indicator in Italy, have the potential to improve government commitment to shape healthier food environments.

Key messages

Food environment policies, implemented by the government, play a key role in the health of the population, decreasing the burden of disease. Several food environment policies have been implemented and supported by the Italian government but there are still some priority actions to be taken towards healthier food environments.
Italian multiple sclerosis register as the basis for post-authorization safety studies
Authors: Ponzio M , Trojano M , Capobianco M , Pugliatti M , Ulivelli M , Mosconi P , Patti F , Zaratin P , Lepore V , Battaglia M A
Published: October 2020

While the safety and efficacy of Disease Modifying Therapy (DMT) in multiple sclerosis (MS) are assessed in clinical trials, these are of relatively short duration and always confined to highly selected patient groups. The evaluation of real-world data such as patient registries, is vital as it offers long-term data collection and is patient rather than product-focused during the lifetime of MS, and allows to document a patient's treatment history throughout the disease course. Patient registries can play an important role in monitoring the safety of drus. Regulators and the pharmaceutical industry have shown interest in complementing or even replacing phase 4 clinical studies with data from MS registries.

The Italian MS Register (IMSR), in collaboration with the Big MS Data initiative, that also includes the national MS registries of Denmark, France, and Sweden and the international database network MSBase, came together with industry to conduct studies on post-authorization safety (PASS) and treatment effectiveness. The IMSR includes the clinical history of approximately 55,000 patients, or approximatively 45% of the estimated cases of MS in Italy. More than 10,000 patients have a follow-up duration of over 10 years.

A Core Protocol outlining principles of PASS projects was created in which aggregated results made available to sponsors and health authorities. The Core Protocol specifies variables, emphasizes improved capture of adverse events, in particular cancer, non-melanoma skin cancers and immunosuppression-related infections, all MedDRA-coded. EUROCAT codes for pregnancy outcomes are also documented.

Regulators, the pharmaceutical industry and national-level registries have jointly identified a format of collaboration on PASS for DMT in MS to benefit patients and the larger society. In this way, we hope to contribute to a framework that will include emerging and existing registries with the common goal of contributing to the advancement of knowledge in MS.

Key messages

The real-world data can contribute to understanding of the impact of disease-modifying therapy on long term. A format of collaboration among clinical research, regulators and pharmaceutical industry could be a winning framework to improve the knowledge on safety and treatment effectiveness in MS.
Appropriate admission to rehabilitation: definition of a set of criteria through the Delphi Method
Authors: Principi N , Carnevali D , Grimoldi L , Merlo A , Rodà F , Auxilia F , Lombardi F , Maini M , Brianti R , Castaldi S
Published: October 2020

Background

Controlling inappropriateness of care, a widespread phenomenon, should be a global target in order to improve the quality of care, save money and ensure system sustainability. Inappropriateness is a relevant issue in public health and in rehabilitation medicine specifically. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. Aim of this study is to define clinical admission criteria and rules in rehabilitation medicine.

Methods

A three-round Delphi survey was conducted on a sample of rehabilitation medicine experts skilled in both rehabilitation and healthcare organization. The two initial rounds consisted of an electronic online questionnaire concerning appropriateness of admission to intensive rehabilitation while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed.

Results

A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions questionnaire. The second round was designed thanks to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, eight criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated.

Conclusions

This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules.

Key messages

Improving appropriateness in healthcare delivery must be a primary goal in public health and in rehabilitation medicine specifically. Delphi method was applied to define shared clinical admission criteria and rules in rehabilitation.
The determinants of non-smokers’ opinions about increased health insurance rates for smokers
Authors: Szulc K , Duplaga M
Published: October 2020

Background

The rates of obligatory health insurance available to Polish citizens do not depend on their health behaviours. However, there are opinions suggesting that the rates should be increased for those who show risky health behaviours. This study aimed at the assessment of determinants of non-smokers' opinions about the introduction of increased health insurance rates for smokers.

Methods

The analysis was carried out on the data originating from the telephone-based survey on the representative sample of 1000 adult Polish citizens. Responses from non-smokers in the moment of the study were retrieved from the data set. A dichotomised variable derived from the item asking about the opinion about increased insurance rates for smokers was used as a dependent variable in uni- and multivariate logistic regression models. Sociodemographic characteristics, health status, prior use of health care resources, and history of smoking were included as independent variables.

Results

The study sample included 779 respondents; of them 60.1% (n = 471) never and 0.39.9% (n = 308) smoked in the past. There were 45.0% and 34.4% of supporters of higher rates in these subgroups. Increased insurance rates were supported by older respondents (OR, 95%CI: 1.01,1,001-1.03) and those with higher income (2.17, 1.27-3.70, and 2.23, 1.34-3.71, for the comparisons of two higher income categories with referential category of net income <1500 PLN). Past smokers (0.51, 0.36-0.74), Internet users (0.49, 0.27-0.90), respondents admitted to hospital in preceding year (0.57, 0.36-0.91), and those who reached higher levels of education (0.49, 0.29-0.84, and 0.50, 0.28-0.90 for comparisons between persons with higher levels of education with those with the lowest level) expressed an opposite view.

Conclusions

Not only earlier experience of tobacco smoking but also higher education level, prior hospital admission and Internet use are related to lack of the acceptance for increased health insurance rates.

Key messages

Determinants of opinions about increased insurance rates may be counterintuitive. The use of health services or higher education levels are not associated with the support of higher rates for smokers.
Changes in walkability in three urban neighborhoods of the city of Rome: a comparison 2009-2019
Authors: Appolloni L , Barbaliscia M , D'Alessandro D
Published: October 2020

Introduction

Scientific evidence stresses that more walkable neighborhoods are linked to increased physical activity. Walking Suitability Index of the territory (T-WSI) is an easy method, already validated, to evaluate the walkability on the basis of direct observation. Aim of the study is to compare the walkability indices obtained in three urban neighborhoods of the city of Rome in 2009 and 2019, to evaluate whether the urban redevelopment interventions, performed in the decade, do really promote walkability.

Methods

An audit, through T-WSI, is carried out for each street of a neighborhood. T-WSI audit evaluates 12 indicators subdivided into 4 categories: practicability, safety, urbanity, pleasurableness. The weighted analysis of these indicators gives an overall score of the actual usability of the neighborhood. In this study, 2 different trained surveyors, evaluated T-WSI in three neighborhoods of Rome (San Saba, Sacco Pastore and Tufello-Val Melaina), which differ in socio-economic conditions. Average scores have been compared using t-student.

Results

A considerable improvement was observed in the Sacco Pastore neighborhood final weighted scores (T-WSI scores: from 53.6 in 2009 to 68.3 in 2019, with an increase of 14.7% (p < 0.005). All categories improved, although Safety (T-WSI scores: from 35.0 to 59.3; increase of 24.3% - p < 0.005) and Pleasurableness (T-WSI scores: from 48.5 to 61.4; increase of 12.9% - p < 0.005) show the greatest improvements. It is mainly due to redevelopment works carried out in the neighborhood in the last 10 years, mainly aimed to increase citizen's perceived safety (e.g. signs, crossing protection devices, traffic lights, greenery management) and to remove architectural barriers.

Conclusions

The results show T-WSI is a useful tool in order to measure the effectiveness of the interventions already realized at local level, but it could also contribute to making decisions to develop regeneration projects for degraded areas of the cities.

Key messages

Physical Activity must become a priority and part of a daily routine. Healthy cities, healthy people.
Enhancing efficiency and outcome in cancer care integrating patient's and survivorship perspectives
Authors: Offermanns O , Schweiger A
Published: October 2020

Although the Austrian health care system generally presents the highest standards and excellence structures of cancer care, patient outcomes continue to lag behind in the global comparison with respect to include the patient's perspective in cancer care. Therefore, potential inefficiencies must be considered in future health system development to achieve more efficient processes and higher outcomes for patients suffering from cancer.

The contribution presents the development of the All.Can initiative in Austria, in line with a cancer care framework and derived health targets for patients suffering from cancer including a special focus on the patient's and survivorship perspectives and enhancing the influence of patient organisations in current Austrian cancer care.

The proceeding is based on a systemic and applied approach to embed All.Can Austria in the national health landscape and ensure a strategic orientation with a concept paper including literature review and stakeholder research. One important point was to include health professionals in the process and experts from different political sectors with a strong relationship to health according to the concept of health in all policies, referring to the real needs of e.g. patients and cancer survivors. The next step consisted of the development of a policy framework for all sectors to empower patient organisations to gain more efficient structures that incorporates multi-stakeholder involvement.

The developed cancer care framework and targets of All.Can Austria aiming at new priorities in Austrian cancer care, creating high-level political commitment to patient outcomes and providing a basis for the empowerment of patient organisations, in consequence changing the system step by step and piloting innovations in cancer care. A special tool will support the allocation of resources for projects in prevention and health promotion linked to the developed health policy framework.

Key messages

Establishing the All.Can initiative in Austria to empower patient organisations by building innovative structures in Austrian cancer care. Enhancing efficiencies and patient outcomes in cancer care according to health in all policies.
Analysis of cervical cancer policy documents in East-African countries
Authors: Njuguna D W , Mahrouseh N M , Varga O V
Published: October 2020

Background

Cervical cancer is largely a preventable disease according to data by Global Burden of Disease. Among the 20 countries with the highest incidence of cervical cancer globally, 16 are African countries. Relevant cancer control interventions in most low-income countries are partially developed attributing to unavailability of statistics limiting understanding and approximation of the magnitude of the burden of cancer. In order to evaluate health policies for prevention and management for cervical cancer among East-African countries a legal mapping was carried out.

Methods

Legal mapping as a qualitative research method is used to determinate existing policies, collect and analyze the information, and ultimately measure the effect of these policies on health outcomes. Legislation was searched from government websites, national cancer institute sites, international and national legal databases in a uniform way. Nvivo 12 software for content analysis of unstructured qualitative data related information was used for analysis. Coding of the data was developed by two researchers. Reliability of policies assessed according to Cohen's Kappa inter-rater reliability.

Results

The sample included 24 policies, plans guidelines, acts and strategic documents from 10 East-African countries. No relevant legislation identified from Somali and Djibouti. Majority of the countries had policy documents related to cervical cancer and touched on the components of cancer control. Majority of the East-African countries have not established screening registries leading to poor or no reliable data for assessing the cancer burden. Prophylactic vaccination against HPV is yet to be included in the national immunization schedules.

Conclusions

Findings show limited coverage of the identified policies, discrepancy to international guides. To reduce the harmful impact of the discordance between scientific evidence and policies, surveillance systems have to be set up/strengthened.

Key messages

Legislation which is brought into force to prevent cervical cancer is a pillar of effective public health efforts. Evidence based policy mapping plays a key role in giving insight on the burden of disease thereby making informed decisions for health.
Maps of Health Needs and their use for policy making
Authors: Olminski J , Koziol M , Bartolik K
Published: October 2020

As the economies transform into data-centered, so does the healthcare system. Responding effectively to the current problems by making right decisions and setting up the adjusted policies, either on national or regional level, requires the evidence-based tool. The one developed in Poland is called 'Maps of Health Needs', which states an unbiased source of information to a broad spectrum of stakeholders.

The project is the answer to the need of evidence based policy making. The process is based on four steps: firstly, the data on demographics, epidemiology, staff, provided services, infrastructure, etc., are gathered,after that, they are analyzed, using the combination of two fields of expertise: advanced programming and statistics with medical knowledge; the qualitative and quantitative indicators are settled, along with its forecast,subsequently, the conclusions for the system are drawn,finally, the recommendations on actions are set up.

First maps were published on 2015. The project is a subject to the constant adjustments, as the maps are upgraded and updated yearly, according to the stakeholders' expectations. Lately the maps for the five most burdening problems have been published in a form of an online app, accompanied by an executive summary.

The spectrum of use of the maps is broad, not only for health priorities and health policy. Project's results are also used to review the legitimacy of financing health investments from public funds. Moreover, the planning and monitoring of the system is enhanced. Recent examples include also geographical distribution of linear accelerators and locations for psychiatric centers.

Key messages

Data is nowadays a key factor in decision making, also in the health system. The tool developed in Poland, called Maps of Health Needs, resulted in some real changes and might be set as an example or inspiration for others.
Development of Learning and Research Health Districts (LRHD) in the DR Congo: results
Authors: Mwembo -Tambwekoy A , Chenge F , Criel B
Published: October 2020

Issue

There is great need in DRCongo for adequate training sites where national public health managers and workers can discover what is means to manage complex district healthcare delivery systems in a perspective of PHC and UHC. The development of such LRHD is coherent with the national policy in DRC advocating for demonstration districts.

Description of the Problem

The RIPSEC has launched three sites called LRHD, two of which are rural and one urban. A specialist in the organization and management of health services, from each of the three schools of public health, supervised the development and monitoring of those LRHDs. The Provincial Supervisor was also involved. Three approaches to solving priority problems have been defined: strengthening leadership at the HD level; transform health services into a learning and research framework. We analyze the transformation process obtained in these HD.

Results

Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research. The results of those LRHD after 4 years were mixed: the leadership of the management teams has improved. A reflexive attitude developed which contributes to more appropriate decision-making,monitoring and evaluation.At least one hospital service and 2 health centers have been transformed according to specific problems,improving the interaction between health structures, in order to quality of care has improved, the results of action research have made it possible to resolve local health problems. RIPSEC support to Provincial Supervisor to develop their working tools to better address their functions and responsibilities. However, the documentation of these changes induced by RIPSEC was not yet systematized. No residential internship could be carried out due to operational constraints.

Lessons

Mentoring, through its intellectual inputs, has contributed to a dynamic of change in the HD.

Key messages

The basis of the strategy is the improvement of the leadership of the HD management team,reinforced by mentoring and systematic documentation of complex decisions. This program could be continued to perpetuate these fragile achievements. This experience can be used elsewhere in different contexts. But,the residential internship requires other resources.
Participatory systems mapping for localised evidence and decision-making: helminth control, SSA
Authors: Pearson G , Parker M , Storer E , Allen T , Fergus C
Published: October 2020

Background

Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making.

Methods

We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts.

Results

Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented.

Conclusions

An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

Key messages

Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.
Evidence-based governance: the role of epidemiological indicators in negotiation with stakeholders
Authors: Gattoni M E , Russo A G
Published: October 2020

Following the enactment of Regional Law 23/2015 in Lombardy, Agencies for Health Protection (AHP) were set up with programming, monitoring and control tasks on all areas of public health, including hospital performances. It was therefore necessary to develop a new efficient system of negotiation with stakeholders. A summary document has been created for each hospital that highlight the areas to be improved. This report is based on the use of updated indicators validated nationally and internationally, relating to average hospital stays, volumes and outcomes. Main sources were the National Outcome Program, the Ministerial Decree 70/2015 and the Network of Regions.

As comparison values, the thresholds from international literature or Italian legislation. The report was sent to the stakeholders in advance, initially in paper format then through a dedicated portal, before the discussion of the contractual objectives with Executive Board, Epidemiology Unit and the Department of Planning, Purchase and Control. The achievement of the objectives entails a substantial economic benefit, from year to year more and more conspicuous.

The results accomplished were twofold. On one hand there was the improvement of several indicators: for AHP as a whole, such as the fracture of the femur operated within 48 hours went from 50% in 2015 to 74% in 2019; for individual hospitals, for example, some hospitals that did not perform cholecystectomies in day surgery have started to do them. On the other hand, it was possible to detect system critical issues that made it difficult to achieve the objectives for the stakeholders.

Linking the contractual objectives to epidemiological indicators discussed collectively was productive to both AHP and stakeholders and allows objective and constant monitoring of the progresses and difficulties encountered.

Key messages

Internal cooperation in the AHP and direct dialogue with stakeholders are necessary to achieve ambitious objectives. The use of validated epidemiological indicators as contractual objectives makes the assessment and contracting process of hospitals more transparent and objective.
Epidemiological aspects of human exposure cases to rabies by in the central west region of Tunisia
Authors: Ben Fredj M , Dhouib W , Bennasrallah C , Abroug H , Zemni I , Kacem M , Bannour R , Mhamdi M , Belguith Sriha A
Published: October 2020

Introduction

Rabies is a major public health problem in several countries in the South and East of the Mediterranean and in the Middle East. The objectives of this study were to describe the epidemiological profile of human exposures to rabies by a dog, as well as the profile of aggressive dogs during a period of 15 years in a region in the central west region of Tunisia.

Methods

We have included all cases of human exposure to a dog, reported between 2004 and 2018 in the Kasserine area. The source of the data was the directorate of primary health care in Kasserine.

Results

A total of 41,850 human exposure cases to a dog have been reported over the fifteen year study period with an annual average of 1937.5 cases. Among them, 29,062 cases (69.4%) were attacked by a bite. The crude incidence of dog bite cases was 441 per 100,000 population. The vaccination status of attacking dogs was unknown in 15.4% of the cases (n = 6423). Among all attacking dogs with a known vaccination status (n = 35427), 45.2% were vaccinated (n = 16017) and 54.7% (n = 19392) were unvaccinated. A significant increase in human exposure cases to dogs was noted from 2004 to 2018 (β = 11.7, p = <10-3). The number of exposures by an unknown dog or a known unvaccinated dog increased significantly (β = 28.02; p = <10-3 and b = 69.9, p = <10-3; respectively). However, the number of cases attacked by a known vaccinated dog decreased significantly (β = -86.4, p = <10-3). During the study period, five cases of human rabies were identified in the study area.

Conclusions

In Tunisia, human exposure to rabies by a dog has been on the rise. It could be linked to the period of popular and political movement that the country is going through.

Key messages

In this study, human exposures cases to rabies by unvaccinated dog is significantly increasing. It is crucial to strengthen appropriate preventive measures, such as mass vaccination and dog castration programs.
Response patterns in the Belgian health interview survey: web versus face-to-face mode
Authors: Braekman E , Demarest S , Charafeddine R , Berete F , Drieskens S , Van der Heyden J , Van Hal G
Published: October 2020

Background

Potential is seen in web data collection for population health surveys due to a combination of its cost-effectiveness and ease of implementation and the increased internet penetration rates. Nonetheless, web modes may lead to lower and more selective unit response rates than traditional modes such as face-to-face (F2F) interviewing and hence may increase bias in the measured indicators. This research assesses the response patterns of a web versus F2F study.

Methods

A Belgian health interview survey by web (BHISWEB; net sample=1010) was organized parallel to the traditional F2F BHIS 2018 (BHIS2018; net sample=11611; subsample used in this study=2748). Socio-demographic data on invited individuals were obtained from the national register and census linkages. To address the high item-missingness on education level deriving from the census, multiple imputation (m = 20) was applied. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the impact of mode (web vs. F2F) and interactions between mode and socio-demographic characteristics on unit response.

Results

The unit response rate was significantly lower in the BHISWEB (18.0% (95% CI: 17.0-19.1)) than in the BHIS2018 (43.1% (95% CI: 41.5-44.7)). A lower web versus F2F response rate was found among all socio-demographic groups, however, this lower web response was less pronounced among youngsters, people cohabiting with household members, higher educated people and native Belgians.

Conclusions

The F2F unit response rate was generally higher, yet for certain groups the difference between web versus F2F was smaller. It is therefore worthwhile to experiment with adaptive mixed-mode designs to optimize resources without increasing selection bias; e.g. only inviting socio-demographic groups more eager to participate online for web surveys (e.g. youngsters) while remaining to focus on increasing the F2F response rates for other groups.

Key messages

The advantages of web versus F2F interviewing come against its considerable lower unit response rate. Differences in unit non-response between web and F2F vary between socio-demographic groups.
Resident co-created urban redesign to improve health in post-war neighbourhoods: an exploration
Authors: Koene M , Reijneveld S A , Tuinstra J , Broekhuis H , Wagenaar C , van der Spek S C
Published: October 2020

Urban interventions in the built environment can improve the health of residents by impacting daily living patterns and lifestyles. Co-creation of these interventions with residents enhances their effectiveness. This pilot study investigates how the co-creation process can be developed, with elderly as a target group. The setting of the pilot is the area around a shopping centre in a post-war neighbourhood.

Residents were recruited via the neighbourhood council and existing networks, via student-recruiters and via door-to-door flyers. They were asked to participate in the evaluation of proposed interventions, which aimed to increase physical activity. Virtual reality (VR) techniques were used as a tool to communicate current and redesigned environments. We organised three meetings for residents, where VR was used to: 1) collect data on current urban issues, 2) evaluate the different redesigns of the project location, and 3) present a final redesign. During meeting 1 and 2, VR was supported by questionnaires to collect data.

We recruited 31 residents with an average age of 65, mostly through the neighbourhood council and existing networks. Recruitment with flyers resulted in only 1 participant (<1% response). The data collected from the combination of VR and questionnaires showed that participants were likely to walk more often in the redesigned interventions. Moreover, participants indicated that the differences between current and redesigned environments were very clear (score 4.8 out of 5) and that they could imagine very well what the designs would look like in real-life (score 4.6/5). The VR-experience was scored an 8/10 and 28 participants were willing to participate in future activities.

Recruiting residents through existing networks, including the neighbourhood council, was most effective. VR technology is a very useful tool to communicate urban interventions and the residents were very capable of evaluating them while providing valuable input for the redesigns.

Key messages

Co-creating urban redesigns with residents to improve health is feasible, and virtual reality is of great added value as a co-creation supporting and communication tool. Urban interventions impact daily living patterns and lifestyles of residents and thereby public health.
Comparability of questionnaire and interview responses on health among people with foreign origin
Authors: Lilja E , Seppänen A , Kuusio H
Published: October 2020

Background

In health surveys, self-administered questionnaires are a good way to collect data most cost-effectively. For some population groups, a mixture of methods might be necessary in order to reach the desired response rate. If the collection methods vary, the comparability of data might become an issue when evaluating differences between two population groups or changes over time. This study examines the comparability between questionnaire and phone interview responses in a survey on migrants in Finland.

Methods

This study uses the data collected in Survey on Well-Being Among Foreign Born Population (FinMonik), conducted in 2018-19. There were 6 836 respondents, out of which 6 505 filled the questionnaire and 331 were interviewed by phone. The survey included questions 'Do you ever feel lonely?' and 'Do you find that your current state of health is:'. Both were answered using a five-point Likert scale ranging from 'never'/'good' to 'all the time'/'bad'. Logistic regression was used to assess statistical differences.

Results

Among those interviewed by phone, the distributions were more skewed than among those who had filled the questionnaire. In the phone interviews, the emphasis was on the socially more desirable options: regarding loneliness, 'never' was selected 1.7 times more often in the phone interview compared to the questionnaire while 'good' was used to describe the state of health 1.3 times more often. On the common binary indicator 'fairly often or all the time', those who had filled the questionnaire appeared lonelier than those interviewed by phone (14.5% vs 10.4%, p = 0.032), and the difference remained significant when adjusted with a range of sociodemographic variables. However, there was no significant difference on the binary indicator of perceived health ('good or fairly good').

Conclusions

The distributions differed considerably between questionnaire and interview responses, but the level of impact varied between indicators.

Key messages

The data collection methods should be examined carefully when comparing results from different surveys. Instruments designed for questionnaires may yield different results when asked by an interviewer.
The food environment in school’s vicinities of Sao Paulo, Brazil
Authors: Barata M F , Leite M A , Levy R B
Published: October 2020

The school environment plays an important role in the eating patterns of students. The quality of food available in the school vicinities can influence the health and diet outcomes of this population. The study aims to analyze the food environment in the school vicinity of the city of Sao Paulo, focusing on stores selling ultra-processed products. The association between presence and characteristics of schools and density of stores will be investigated. Schools information was obtained from the 2016 School Census, provided by the National Institute of Educational Studies and Research Anísio Teixeira (INEP). The 2016 Annual Social Information List (RAIS) database was used to characterize the school vicinity. Eleven types of stores selling ultra-processed products were identified through the National Classification of Economic Activities (CNAE). Initially, schools and stores were georeferenced by the Postal Address Code in the city street map; this information was attached to the Human Development Units (UDH). Descriptive analyzes (absolute numbers and density per 10.000 inhabitants) were carried out to investigate the distribution of food stores by each category of Municipal Human Development Index (IDHM) present in the city. The influence of the schools on the presence of stores was verified by comparing stores densities in areas with and without schools, considering IDHM categories. The results show that food stores densities are smaller in areas with lower IDHM (8.79/10.000 inhabitants) and bigger in areas with higher IDHM (79.19/10.000 inhabitants). Comparing areas with and without schools, areas with schools present higher food stores densities in every category of IDHM. Furthermore, the study results are relevant and necessary to fill gaps in current literature and may support the formulation of recommendations and intervention proposals for promoting healthy food environments for children and adolescents.

Key messages

The results assist in the understanding of how different determinants can modulate food choices and practices of children and adolescents. Food environments investigations and monitoring provide important subsidies for designing and directing accurate public policies that promote healthier food environments and choices.
Occupational Eye Trauma: a major public health issue in France
Authors: El Harrak Y , Naoum S , Khawaja O , Salhi Y , Laib S , El Sanharawi M
Published: October 2020

Occupational Eye Trauma (OET) is a global cause of visual morbidity. According to the WHO, 55 million ocular lesions occur each year, and 1.6 million cases of total blindness caused by trauma. The objective of our work is to evaluate the frequency of OET per projectile in France, to compare results to other similar studies, and therefore to encourage the reinforcement of safety measures. This is a cross-sectional descriptive study, carried out in the Ophthalmic Emergency Department, at the Intercommunal Hospital of Villeneuve-Saint-Georges, France, including all patients who presented to the same doctor's consultation, between June 2019 and December 2019.

The study involved 1730 patients, 700 women and 1030 men, with an average age of 40. In 7 months, 600 are victims of ocular trauma and 346 are victims of projectile during professional practice, a prevalence of 20% of all emergencies, or 57% of all trauma. The prevalence is higher within males, reaching 33% of all emergencies. The average age was 39, 99% of males. The average consultation time was 3 days after the accident. Besides, 66% of consultants already have a previous history of OET; and 59% were not using a safety protection.

The study shows that 58% of patients had a corneal foreign body; 25% a corneal ulcer; 10% a conjunctival foreign body; while 2 cases (0.5%) presented a corneal wound requiring surgical management. Therefore, eye trauma is a real public health problem. They account for 35% of consultations, half of which are associated with professional activities, mainly affecting young and active men. The high rate of recidivism and non-respect of safety measures highlights the lack of awareness of the target population. Compared to the findings of a previous study lead in Morocco, the outcomes are almost identical, 20/18% in prevalence, 66/75% in recidivism.

Results of this work shows that OET, avoidable circumstances, are however frequent, causing potential severe lesions, with a reserved prognosis.

Key messages

The results of this work prove that occupational ocular trauma, avoidable circumstances, are however frequent. Workplaces with a high risk of eye trauma should strengthen their protective measures and training programs should be put in place for both workers and occupational physicians.
Free Health Care in Niger
Authors: Genovese E , Beck L B , Ganflef M G
Published: October 2020

Issue

To reduce financial barriers to accessing health care, Niger introduced Free Health Care for: family planning, antenatal care, caesarian section, extra uterine pregnancy, uterine rupture, treatment of gynecological cancers, all preventive and therapeutic care for children <5.

Description of the Problem

Implementation has been challenging due to limited funding for pre-payment reimbursements, stock-out of medicines and other pharmaceutical products, and limited traceability up to the end-users. Health Sector partners have provided stock support.

Results

Relevance: stock-outs of medicines and other pharmaceutical products were mitigated, but challenges related to limited funding and traceability up to the end-users were not addressed. Effectiveness: utilization of first antenatal care consultations increased with stock support (88% Intermittent Presumptive Treatment; (50% iron/folic acid supplementation). Utilization of health services for children <5 did not increase despite stock support (reported cases: malaria 35%, diarrhea 60%, pneumonia 20%). Efficiency: not measurable due to lack of reporting on stock support utilization, though representing 16,5% of all expenses for Free Health Care. Equity: not measurable due to lack of information on stock support utilization. Traceability: stock support was received in conformity with delivery bills (in 100%-97%). Cost-effectiveness: not measurable, as health sector partners had to put in place their own logistics, due to weakness of the national procurement and supply management system, and information to compare the two systems is not available. Externality: stock support was deemed not sustainable, as dependent on parallel systems for financing as well as procurement and supply management.

Lessons

Utilization of antenatal care increased, but attribution to stock support is challenging, due to multiple confounding factors and limited measures to support Free Health Care management.

Key messages

Supporting Free Health Care through procurement and supply management of medicines and other pharmaceutical products alone may provide a partial mitigation to stock-outs, yet effects are limited. Free Health Care requires a comprehensive approach: governance (resource planning, management), pharmaceutical stock availability, human resources performance, and control systems up to the end-users.
Heat, heatwaves and cardiorespiratory hospital admissions in Helsinki, Finland
Authors: Sohail H , Tiittanen P , Kollanus V , Lanki T
Published: October 2020

Background

There is a lack of knowledge concerning the effects of heat on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summer-time temperature and heatwaves with cardiorespiratory hospital admissions in Helsinki, Finland.

Methods

Time-series models adjusted for potential confounders such as air pollution were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions, during the summer months of 2000-2017. Daily number of hospitalizations was obtained from the national hospital discharge register, weather information from the Finnish meteorological institute.

Results

Heatwave-days were associated with an increased risk of pneumonia (RR: 1.17, 95%CI: 1.04-1.31), any respiratory disease in some age groups, and myocardial infarction (RR: 1.54, 95% CI: 1.12-2.12) among person 65-74 years of age. In addition, high effect estimates were observed for many types of cardiorespiratory diseases in association with heatwaves in some age-groups. In contrast, risk of arrhythmia was decreased during heatwaves (RR: 0.81, 95% CI: 0.70-0.93).

Conclusions

We found no associations and even protective associations between daily mean temperature and cardiorespiratory hospital admissions. However, our results suggest that heatwaves are a serious health threat affecting the morbidity even in the Northern climate

Key messages

Heatwaves are associated with increased risk of cardio-respiratory hospital admissions. There is a need to adapt to climate change in the public health sector also in Northern Europe to protect vulnerable population groups.