bluuebunny/crossref_metadata_2025 huggingface dataset:
26.B. Skills building seminar: Design thinking in public health
Authors:   Organised by: NOVA National School of Public Health (Portugal),   Chair persons: Juan Rachadell - Portugal, Nuno Do Amparo - Portugal
Published: October 2020

Public Health (PH) is a multidisciplinary area that deals with complex problems. PH professionals from the global to the local level often find themselves faced with new challenges without an obvious solution. PH teams and organizations frequently try to find answers to problems with an experienced-based brainstorming methodology that can lead to solutions that might not be feasible, viable or desirable.

Commonly used in the context of innovation and entrepreneurship, Design Thinking (DT) is a problem-solving methodology that allows teams to arrive at the right questions, instead of just looking for immediate answers. It requires practice in order to be implemented and important changes in the usual workflow of PH teams when presented with a challenge.

This workshop intends to present DT as a valuable tool for problem solving in PH. It will provide an explanation of the concept of DT, its components and practical applications.

The workshop will be in a “Skills building seminar” format with 90 minutes total. It will begin with 2 presentations (25 minutes each, followed by 5 minutes Q&A) and a 30-minute exercise with the audience.

Presentation: Design Thinking and Public Health: importance and applications (Juan Rachadell)

Presentation: How to arrive at good questions and test them (Nuno Do Amparo)

Group exercise: Come up with a design challenge (Juan Rachadell, Nuno Do Amparo)

After the presentations, the audience will be asked to organize in groups of 5 or less people in order to train the DT methodology. Each group will be instructed to choose a theme in accordance with the Conference topics and arrive together at a corresponding design challenge. This process will be guided by both workshop presenters and will include debate between the groups.

Key messages

When tackling Public Health problems, asking the right question is often more important than trying to obtain answers immediately. Using Design Thinking as a process to arrive at the right question, the subsequent answers will be more effective at actually solving the problem.
26.D. Round table: Achieving healthy prosperous lives for all – from evidence to action
Authors:   Organised by: EUPHA, WHO/Europe Investment for Health and Development RHN, Public Health Wales (UK),   Chair persons: Natasha Azzopardi Muscat - EUPHA, Tatjana Buzeti - EUPHA-FN
Published: October 2020

The adoption of the WHO Resolution on Health Equity (EUR/RC69/R5) put equity, gender equality, human rights and social determinants high on the agenda for policy action and priority for all 53 EURO Member States (MS) and partners. It gives new momentum in the European region to accelerate action in achieving healthy and prosperous lives for all, leaving no one behind. The European Health Equity Status Report initiative (HESRi) is connecting European policy makers with the solutions and best practices to accelerate progress towards this goal of healthy prosperous lives for all. The initiative was launched in 2018 by WHO European Office for Investment for Health and Development and uses an innovative five-step approach underpinned by a suite of tools and sophisticated data analyses to: (1) enable countries to identify who is being left behind and why; (2) build political and public support for action; (3) understand which policies and interventions work best; (4) measure and maintain progress; and (5) influence and sustain action. Key tools launched in 2019 include i) An online interactive Health Equity Dataset which provides country specific data on the status and trends of inequities in health, well-being, and five essential underlying conditions for the 53 member states of the WHO European Region, ii) A Health Equity Policy Tool to support countries in efforts to measure the coverage, uptake and effectiveness of policies for health equity, and iii) 30 case studies showing how countries are advancing real world solutions to improve equity in health.

Currently Italy, Slovenia and Wales are developing national and subnational health equity status reports in order to support action for health and well-being for all and measure policy progress. In the USA, practical action for health equity has been rooted in advocacy work reframing the public narrative to focus on social injustices and structural drivers of inequities, a key pillar of the HESRi work.

The round table aims to explore the country impact and uptake of the new innovative methods and tools and their potential for accelerating action on regional, national and global level.

Key messages

WHO Resolution on Health Equity put equity, gender equality, human rights and social determinants high on the agenda for policy action. The European Health Equity Status Report initiative (HESRi) is connecting European policy makers with the solutions and best practices to accelerate progress towards healthy prosperous lives for all.
Online vaccine-related information-seeking in mothers and HPV vaccine uptake in their daughters
Authors: Dib F , Mayaud P , Longfier L , Launay O
Published: October 2020

Background

There is widespread concern about online vaccine misinformation. The aim of this study was to investigate the association between seeking vaccine-related information on the Internet and HPV vaccination uptake.

Methods

Data were obtained from the 2015, 2016, 2017 and 2018 Vaccinoscopie® studies, a pluriannual web-based survey conducted on a nationally representative quota sample of mothers to monitor the dynamics of vaccine coverage, perception and attitudes towards vaccination in France. Mothers of girls aged 14-15 years were asked to state all vaccinations reported on the vaccinal pages of their child's healthcare records. We computed univariate and multivariate logistic regression models, with the outcome variable “HPV vaccination” defined as equal to 1 if the daughter received at least one dose of HPV vaccine, and equal to 0 otherwise; and the dependant variable “Internet use” defined as equal to 1 if the mother responded “Internet” (alone or combined with other sources) to the question “When in doubt about a vaccine, what source(s) of information do you turn to to decide whether or not to have your child vaccinated?”, and equal to 0 otherwise.

Results

Over the 4 years, a total of 2038 mothers answered the self-administered online questionnaire. Overall, 96.1% declared their need to search for information, 23.9% of whom used the Internet as a source. Maternal Internet use was associated with lower HPV vaccination uptake in their daughters (Odds Ratio (OR)=0.49, 95%CI: 0.38-0.64). The association remained after adjusting for several potential confounders, including area of residence, household socio-professional category and income, maternal level of education, physician recommendation and use of other sources of information (adjusted OR = 0.68, 95%CI: 0.48-0.96).

Conclusions

Specific information campaigns are required to empower parents to better use online information and guide them to reputable sources when they seek information on vaccination.

Key messages

The findings of this study suggest that the use of online sources on information is negatively associated with HPV vaccination. Action is warranted to direct parents to use more correct online sources of information on vaccination.
Safety of in-neonatal intensive care unit administration of rotavirus vaccination among preterms
Authors: Costantino C , Restivo V , Tramuto F , Casuccio A , Palermo M , Vitale F
Published: October 2020

Background

Rotavirus is among the most common vaccine preventable illness in children under 5 years old. Despite increased severity of rotaviral illness in early infancy, most neonatal intensive care units (NICUs) do not administer rotavirus vaccination. The present project aims to evaluate the safety of in-neonatal intenive care unit administration of the monovalent live, attenuated rotavirus vaccination to preterm newborns in Sicily.

Methods

From the first of March 2018 within the six most important NICUs of Sicily (three located in Palermo, two in Catania and one in Messina), and under the scientific coordination of the University of Palermo and of the Regional Health Department, rotavirus vaccination was administered to preterm newborns with gestational age ≥28 weeks. Vaccine administrations were performed both under hospital and outpatient settings, from 6 weeks of age and in accordance with the Sicilian Vaccination Schedule.

Results

At the end of December 2019, 449 preterm newborns were fully vaccinated (two dose completion) against rotavirus in the six Sicilian NICUs participating to the project. Average gestational age was 31.4 (SD ± 2.7) weeks. First dose of rotavirus vaccination was administered at 6.3 (SD ± 0.6) weeks. Average weight at first dose were 2.890 (SD ± 0.456) grams. Only 8% and 2% of vaccinated newborns reported abdominal colic and fever >38.5 °C in the 15 days after first dose, respectively. No one expected adverse event was observed in the 30 days after vaccination.

Conclusions

First data obtained from this study confirms the absolute safety of monovalent rotavirus vaccination also in preterm newborns with gestational age ≥28 weeks. Results could represent for public health physicians and for neonatologists a key tool for standardize rotavirus vaccination in very Italian NICU.

Key messages

Rotavirus vaccination is extremely safe in preterm newborns with gestational age ≥28 weeks. Rotavirus vaccination should be routinely implemented in Italian and European NICUs.
Rotavirus gastroenteritis hospitalization in children. Trends in Abruzzo Region, 2008-2018
Authors: D'Addezio M , Di Giovanni P , Cedrone F , Di Martino G , Masciarelli M , Meo F , Scampoli P , Staniscia T
Published: October 2020

Background

Rotavirus is the most important cause of hospitalization for gastroenteritis and dehydration in children under 5 years old. In developed countries, it significantly affects public health in terms of costs and morbidity. Despites the availability of an effective vaccine, the coverage remains low in Italy. This study aimed to evaluate the epidemiological impact of rotavirus hospitalizations in Abruzzo, an Italian region, from 2008 to 2018.

Methods

Data were obtained from hospital discharge records of all Abruzzo hospitals. For the study, only the admissions due to rotavirus infection occurring in children aged 0 to 5 over the study period were taken into consideration. For each year, age-adjusted standardized hospitalization rates for rotavirus infection were calculated, and time trends were analyzed by joint point regression models.

Results

A total of 747 admissions were identified. During the study period, a significant increase of admissions was observed among children under 1 year of age (AAPC +9.8%, 95%CI 0.0;20.5, p < 0.001) and a significant decrease was observed among children between 2 and 3 years of age (AAPC -10.6%, 95%CI -20.0; -0.1, p < 0.001). Overall, the standardized rate increased (AAPC +5.2%, 95%CI -3.0;14.1, p = 0.2).

Conclusions

These results confirm that Rotavirus gastroenteritis has a heavy impact on pediatric hospitalization in Abruzzo Region. Subsequently, the study gives evidence of the need to improve vaccination coverage, in order to reduce morbidity and costs for the Italian healthcare system.

Key messages

In Abruzzo region, rotavirus gastroenteritis is a very important cause of morbidity and hospitalization in children under 5 years old. This study confirms the need of an improvement in vaccination coverage, that is the most effective mean to reduce the high morbidity, as well as the social and health costs.
Adherence to the new WCRF cancer prevention recommendations associates with a decreased cancer risk
Authors: Deschasaux M , Bourhis L , Chazelas E , Debras C , Hercberg S , Latino-Martel P , Julia C , Kesse-Guyot E , Srour B , Touvier M
Published: October 2020

Background

Cancer remains one of the leading causes of death worldwide. In 2018, following its summary report, the World Cancer Research Fund (WCRF) issued its recommendations for cancer prevention based on the nutritional risk factors with a sufficient level of evidence. Our objective was to study whether adherence to these new recommendations leads to a reduced risk of cancer.

Methods

This study included 80,604 participants from the NutriNet-Santé population-based cohort study (2009-2019). Adherence to the 2018 WCRF recommendations was assessed using the operationalized score on a 7-point scale, proposed by Shams-White et al (Nutrients 2019), including: weight, physical activity, fruit and vegetables, dietary fibers, ultra-processed foods, red and processed meat, sugary drinks and alcohol. Usual dietary intakes were assessed using repeated 24h-dietary records and physical activity level using the IPAQ questionnaire. Multi-adjusted Cox proportional hazard models were used for the analyses.

Results

A total of 2,438 incident cancer cases were diagnosed during follow-up (median: 7.4 years). The median WCRF 2018 adherence score was 3.75 (IQR: 3.25-4.50). An increase of 1-point increment in the score was associated with a decreased risk of cancer overall (HR = 0.90; 95%CI 0.86-0.90; P<.0001), and of obesity-related cancers (n = 1549 cases, HR = 0.89; 0.84-0.94; P<.0001), aerodigestive cancers (n = 390, HR = 0.83; 0.74-0.93; P = 0.001), breast cancer (n = 749, HR = 0.92; 0.85-1.00; P = 0.04) and a non-significant trends for prostate (n = 332, HR = 0.89; 0.79-1.01; P = 0.07) and colorectal (n = 218, HR = 0.88; 0.76-1.03; P = 0.1) cancers.

Conclusions

Our results suggest that a higher adherence to the WCRF 2018 recommendations for cancer prevention is associated to a decreased risk of cancer. Given the consistency between overall food-based dietary guidelines and the WCRF cancer recommendations, our result support their general promotion to the general public and transposition as public health actions.

Key messages

Following the recommendations for cancer prevention issued by the WCRF in 2018 can contribute to decrease the burden of cancer. The WCRF cancer recommendations are consistent with overall food-based dietary guidelines and should be promoted to the general public and transposed as public health actions.
An exploration of cancer-related mortality attributable to infections in Italy
Authors: Ferrara P , Agüero F , Conti S , Masuet-Aumatell C , Mantovani L , Ramon-Torrell J M
Published: October 2020

Background

Previous attempts estimated the impact of infectious agents on cancer incidence in Italy, but the burden of carcinogenic infections on cancer mortality remains unknown. Therefore, we aimed to conduct a preliminary analysis in order to estimate this burden at country level.

Methods

We applied the global, regional, or national population attributable fractions for Helicobacter pylori, hepatitis B virus (HBV), hepatitis C virus (HCV), high-risk human papillomavirus (HPV) types, Epstein-Barr virus (EBV), human herpesvirus type 8 (HHV-8), and human T-cell lymphotropic virus type 1 (HTLV-1) - all microorganisms ranked as group 1 carcinogenic agents in human beings by the International Agency for Research on Cancer - to 2015 cancer-related deaths recorded according to the 10th International Classification of Diseases coding system in Italy.

Results

We estimated a total of 14,120 deaths attributable to carcinogenic infections, being 8.3% of the total of cancer-related deaths (n = 170,339). 58.8% of those occurred in men. H. pylori, HCV, HBC, and HPV accounted for 96.4% of the whole mortality burden attributable to carcinogenic infections in both sexes. H. pylori was responsible for 8,116 (57.5%) deaths due to gastric carcinoma (non-cardia and non-Hodgkin lymphoma). Hepatitis-related liver cancer accounted for a total 4,372 deaths: 3,812 due to HCV infection and 560 to HBV. Cancers related to HPV infection represented the third most frequent cause of deaths due to carcinogenic infections in women.

Conclusions

We estimated that one out of 12 cancer deaths in Italy was attributable to an infection sustained by carcinogenic agents. Such mortality burden is potentially avoidable, given that these infections are both potentially preventable and treatable. Thus, these estimates provide actionable metric of the burden for the implementation of specific public health measures. Further analyses will provide more accurate estimates of this disease burden.

Key messages

In Italy, one out of 12 cancer-related deaths is attributable to infections sustained by preventable or treatable carcinogenic agents. These estimates provide metric of carcinogenic infections for the implementation of specific public health measures to avert the related mortality burden.
Strategies to facilitate access to physical activity on a basic health unit: A participatory design
Authors: Cury de Carvalho A , Russo Rodrigues B , Maria Braga Edmundo K , Taiar R , Bittencourt Machado C
Published: October 2020

Background

sedentary lifestyle has been decreasing physical activity (PA) practice, accentuating the prevalence of overweight and obesity. Participatory methods in healthcare (including Design Thinking) have been proposed to obtain input from users, creating critical strategies for patients and physicians. The aim of this study was to elaborate strategies to facilitate access to PA for users from a basic health unit (BHU) by means of a participatory design.

Methods

a qualitative, participatory design with Design Thinking was carried out in a BHU at Nova Friburgo (Brazil), serving a community with 1,131 families. Semi-structured interviews were conducted with 32 users, and four health community agents (CHAs). Immersion and ideation (Design Thinking) were applied: (1) to gather information about PA; (2) to map free PA sites; (3) to develop generation sessions with users and CHAs, gathering information about needs, barriers and desires, and creating strategies to provide free PA.

Results

data showed that 59% of the users do not regularly practice PA. They reported lack of time, laziness, health problems, location and cost. CHAs said that they are not prepared to give information to users about PA. CHAs and users declared that they use mobile apps, and an app about PA would be helpful. According to them, the access for PA would be facilitated with: free offering, places near the community, CHA capacitation, professional advisement for exercise at home, and a mobile app with maps and transportation options, schedules, exercise programs and health education.

Conclusions

it was possible to propose strategies to facilitate access to PA by means of a participatory process (Design Thinking) with CHAs and HBU users. As a consequence, there is already a private financing support for a mobile app, as well as the preparation of a report to be presented to the city's secretary of health. It is expected to further benefit not only the local community, but the entire city.

Key messages

A participatory design with Design Thinking provided strategies to facilitate access to physical activity for users from a health basic unit. The development of a mobile app with information about PA access for underserved community seems to be an interesting option to foster exercise practice on a regular basis.
Mental health services utilization after Mariana dam burst
Authors: Dell'Aringa M F , Corrêa-Oliveira G E , Della Corte F , Ragazzoni L , Miranda E S , Murray V , Barone-Adesi F
Published: October 2020

Background

The global burden of mental health conditions is increasing, especially in middle- and low-income countries and frequently the quality of mental health services is lower than the quality of services for other conditions. Disasters may increase this burden through their direct impact or due to secondary stressors, such as the preclusion of access to essential services. The aim of this study is to assess the impact of Mariana dam burst (Brazil) in November 2015, in the utilization of public mental health services by the population that experienced an interruption of water supply after the event.

Methods

We used data from DATASUS, the database of the Brazilian public health system, analyzing data from 34 months before to 36 months after the event. We defined as affected the population living in the municipalities of Minas Gerais state that had an interruption of water supply after the event and the rest of the state population as the comparison group. We designed an Interrupted time-series analysis to evaluate both immediate and gradual changes in use of mental health services after the accident.

Results

The affected population included 381,749 inhabitants and the comparison group 20,487,352 inhabitants. The monthly rate of mental health visits in the affected population in the beginning of the series was 296 (CI 182 to 409, p < 0.001) per 100.000 person-month. Comparing the groups after the event, we observed a non-statistically significant higher increase in the rate of visits immediately after the event of 115.96 (CI -30.00 to 261.92, p = 0.118) and a significant increase in the monthly rate of visits (change in slope) of 15.55 (CI 8.19 to 22.92, p < 0.001) in the affected group.

Discussion

The results suggest that the event translated in a long-term increase in mental health services utilization. We believe that this study presents an innovative methodology on the assessment of mental health services after disasters and that it could be adapted to other contexts.

Key messages

Indirect impacts of disasters may be associated with long-term changes in the utilization of mental health services. Interrupted time series using routine data are useful tools for the assessment of health services utilization following disasters.
Implementing research and best practice for the development of community mental health facilities
Authors: Chrysikou E , Savvopoulou E , Cox E , Mc Frederick M
Published: October 2020

Healthcare is a sociotechnical system in which the technical system is interrelated to a social system of people and organization, including users, staff, carers, equipment, medication. Emphasis remaining on the latter, contributes to stigma. Outpatient services provide for the public health key components of early detection and support. This project was initiated by an NHS Mental Health Trust at a stage of building redevelopment. It aimed at gathering state of the art, best practice, innovative and challenging approaches on psychiatric buildings to inform an extensive multi-stakeholder and patient inclusive co-design process, useful for both the UK and other settings.

Research followed a qualitative methodology gathering data on best practice in community mental health facilities globally. First, a literature review was conducted with focus on built environment. Additionally, best practice case studies were analysed. In parallel, interviews with international experts were conducted. How can we incorporate out of the box design thinking, as a means to challenge the culture of psychiatric provision? How can we enable integration with non-psychiatric health systems and potentially inverse-integration practices? Data were evaluated using the SCP model, a tool developed for the evaluation of psychiatric buildings.

Results were organised under 32 key themes. These were further digested in two sections - the first comprising a set of design learnings and the second presenting visual material. Findings from the key themes were then organised in a matrix of design recommendations for wards and community mental health hubs to support patient, staff and community consultations with food for thought.

By treating design and place-making as a therapeutic tool we could challenge the way people view mental health buildings. Creating the means -review and inclusive consultation structure - to disrupt a normally segregated architectural dialogue - was essential to this process.

Key messages

Feedback methods for patient staff-consultation for capital planning: supporting staff and patients into the dialogue, increasing design and planning literacy. Evidence base, best practice and experimental design together for extracting meaningful feedback during capital planning consultation processes: we could learn from all three.
Engaging general population: Vaccine confidence, communication and mandatory law
Authors: Lopalco P L
Published: October 2020

Hesitancy is defined as the reluctance or refusal to be vaccinated even in case of vaccine availability and is included by the WHO among the top ten threats to global health. Vaccine confidence is an essential component of the hesitancy. Fear of adverse events and lack of trust in vaccine efficacy discourage the public and drive them toward the choice of refusal. Misinformation and lack of effective communication strategies may seriously jeopardize vaccination programmes. Providing effective communication requires specific competencies that often are not part of the common core competencies of those involved in vaccination programmes. In particular, the rapid evolution of the communication environment due to novel technologies makes the task even more difficult.

The general population in order to comply with the official vaccine recommendation throughout the life course is therefore a complex task. In the presence of worrying signals of lack of vaccine confidence, public health decision can be driven by emergency decisions rather than investing in mid-terms communication programmes. Vaccination mandates are public health measures that are proven to be effective in increasing vaccine uptake. Increasing anti-vaccine sentiment may be a potential negative trade-off. For this reason, the introduction of vaccination mandates should be combined with a structured communication strategy. In addition, vaccine sentiment should be actively monitored when any change in vaccine offer policy is implemented.
The impact of parental mental health and socioeconomic position on child preschool health
Authors: Heuckendorff S , Johansen M N , Overgaard C , Johnsen S P , Fonager K
Published: October 2020

Background

Many children, approximately one out of four to five, live in families with parental mental health problems. Knowledge on the impact of other mental health problems than depression or anxiety is sparse as well as the impact of the father. Therefore, we aimed to examine the effect of maternal and paternal mental health on child respiratory illness.

Methods

A population-based birth cohort study was conducted including all Danish children born from 2000-2012 using the Danish nationwide registers. Two follow-up periods were created: From age 1-2 and age 3-5. Mental health was categorised in three: No mental health problems, minor mental health condition if handled in solely primary healthcare; and moderate-severe if handled in psychiatric healthcare settings. Child respiratory illness was identified by prescribed medication or hospital-based diagnoses. Incidence rate ratios (IRR) were calculated using Poisson regression analysis.

Results

The analyses included 810,243 children. 26% of the mothers and 17% of the fathers were classified with mental health conditions. Children of parents with mental health conditions were more likely to have respiratory illness (10-12% vs. 7.7%). Adjusted IRRs revealed higher risks for children of mothers with minor (IRR 1.32 (CI95% 1.30-1.34)) and moderate-severe mental health conditions (IRR 1.48 (CI95% 1.44-1.51)). For paternal mental health, the IRRs were 1.14 (CI95% 1.12-1.16) for minor and IRR 1.14 (CI95% 1.11-1.17) for moderate-severe mental health conditions. The IRRs were a little higher for the children aged 1-2 years compared to 3-5-years.

Conclusions

Children of parents with mental health conditions were at greater risk of respiratory illness. This was evident for the mental health of both parents, most pronounced for the mother. Not only moderate-severe, but also minor mental health conditions increased the risk of respiratory illness.
Labour market marginalisation in young refugees with and without common mental disorders
Authors: De Montgomery C , Norredam M , Krasnik A , Petersen J H , Björkenstam E , Berg L , Hjern A , Sijbrandij M , Klimek P , Mittendorfer-Rutz E
Published: October 2020

Background

This study explored how inequality in labour market marginalisation (LMM) between refugees and their peers developed during early adulthood in Denmark and Sweden (DK/SE), and the role of common mental disorders (CMD) in these trends.

Methods

Using registry data, all refugees living in DK/SE in 2009-2012 who were born 1986-1993 and who immigrated as children (aged 0-17) were included (N = 13,390/45,687) and 1:5 matched on age, sex and municipality size to individuals born in DK/SE with at least one parent also born in DK/SE (N = 69,650/227,287). Information on psychiatric care (hospital and medicine) during 2009-2011 indicated CMD, while LMM was measured during 2012-2015 using income-based indicators. Probabilities of LMM were standardized by multiplying the estimated parameters of linear probability models in SE (adjusted for age, sex, municipality size, age of arrival, origin country, and accompanying family) onto the mean of the covariates in DK.

Results

The risk of LMM was 2-2.5 times higher for refugees across ages 20-29 in DK/SE. The risk tended to decrease in SE but increased in DK for refugees. The increase was accentuated for youth with CMD. However, CMD did not explain the inequality between refugee and majority youth. The increase in DK was driven by birth-cohort differences, while the trend in SE was consistent across birth cohorts.

Conclusions

CMD did not capture the vulnerability that sets refugees apart from their peers. While immigration and integration policy differences between DK and SE increased, the integration outcomes diminished, suggesting the importance of factors other than national level policies.

Key messages

Young refugees in DK/SE were more at risk of labour market marginalization than their majority peers. Healthcare contact for common mental disorders raised levels, but did not reduce inequalities. Labour market marginalisation decreased with age in Sweden but increased for refugees in Denmark, driven by birth cohort difference.
Opinions and experiences of a national smokefree prison policy: evidence from the TIPs study
Authors: Brown A , Eadie D , Purves R , Demou E , Mitchell D , O'Donnell R , Ford A , Bauld L , Sweeting H , Hunt K
Published: October 2020

Background

Removal of tobacco from prisons poses distinct challenges, as prisons are 'homes' and smoking rates are high. TIPs is unique in comprehensively studying a smoking ban using data collected before, during and after the ban. This paper presents opinions and experiences of people in custody (PiC) and staff in Scotland, and identifies implementation success factors and lessons that are highly relevant for other jurisdictions and areas of public health.

Methods

Surveys of staff and PiC (response rates) were conducted in Nov-Dec 2016 (27%, 34%), May-Jul 2018 (31%, 26%) and May-Jul 2019 (16%, 18%), with questions on smoking, smoking cessation/abstinence and smoking restrictions in the prison context. Topics were also explored qualitatively with staff/PiC at similar time points (34 focus groups, 99 interviews). Survey responses were analysed using descriptive statistics and logistic regression analyses. Qualitative data were thematically analysed to identify the diversity of views and experiences.

Results

Smokefree policy is widely accepted as the new 'norm', but support was higher among staff than PiC before, during and after implementation. Surveys and qualitative data suggest perceptions of some of the potential difficulties (e.g. 'hard to enforce') and negative consequences (e.g. 'cause a lot of trouble') of smokefree policy reduced post implementation. Participants identified several implementation success factors relating to: planning and communication, smoking abstinence/cessation products/services, and partnership working.

Conclusions

Smokefree prison polices can be successfully implemented, providing the removal of tobacco is well managed and support measures are available for smokers. Some factors shaping the successful introduction of smokefree prisons in Scotland are relevant to other areas of public health transformation e.g. setting clear objectives and timescales; collaboration and teamwork; and involving staff at all levels and end-users.
29.B. Workshop: Moving upstream to advance understanding of & ways to address the commercial determinants of health
Authors:   Organised by: University of Bath (UK),   Chair persons: Mark Petticrew - UK, Lucinda Westerman - UK
Published: October 2020

Poor health is increasingly determined not only by the products but by the behaviours of major corporations, notably but not exclusively, unhealthy commodity industries. Models of the determinants of health have been successfully used to advance understanding of the broad range of factors that affect health, and guide policy-makers to entry points for public health interventions. However, the existing and widely used models of social determinants insufficiently address the pervasive influence of commercial actors, such as transnational corporations, within their conceptual frameworks. While conceptual models of the commercial determinants of health and taxonomies of unhealthy commodity industry political activity have been proposed and now applied to diverse industries, there remains a need for such work to fully reflect the extent of private sector political activity. In particular, such models must recognise the corporate sector's upstream influence in shaping, for example, the overarching political environment, trade and governance structures which have both facilitated the spread of NCDs and hindered policy progress in addressing them. Going further still there is a need to recognise that these corporate practices are both enabled by and drive the modern capitalist system which in turn poses threats to human and planetary wellbeing. It is increasingly important, and indeed urgent, for public health professionals to recognise and address these issues.

This workshop therefore aims to: identify limitations in existing models of the determinants of health;present new models and taxonomies which can be used to better understand and address the commercial determinants of health;present evidence on the behaviour and practices of unhealthy commodity industries that inform these latest models and taxonomies, pulling together the “silos” of evidence across, for example, tobacco, food and alcohol;examine the corporate sector's, often neglected, upstream influences over policy infrastructure, trade and governance;thereby advance understanding of how unhealthy commodity industries drive ill health and the range and nature of interventions required to address such behaviours and practices;explore how we go further still in understanding and addressing the health challenges posed by the modern capitalist system.

The workshop brings together leading scholars in the field and will involve 4 overview presentations followed by detailed discussion where audience participation will be actively invited.

Key messages

Health is increasingly determined by the products, behaviours and practices of major corporations. We urgently need to understand and address these if we are to improve health and reduce inequalities. This workshop will propose new models for understanding how corporations influence health, focusing particularly on upstream influences on politics, trade & governance & how these can be addressed.
29.E. Workshop: Data analysis, advocacy activities, and actions to counteract the double burden of malnutrition
Authors:   Organised by: EUPHA Food and nutrition section, EUPHA Chronic diseases section, EUPHA Health promotion section, WHO/Europe,   Chair persons: Iveta Nagyova - EUPHA, Luís Saboga-Nunes – EUPHA-HP
Published: October 2020

The burden of non-communicable chronic diseases (NCDs) represents a public health issue of gigantic proportion at global level. Among others, diet has been demonstrated to be a key element to maintain health and prevent NCDs. Today's world is facing the so-called “double burden of malnutrition”, characterized by the coexistence of undernutrition along with overweight, obesity or diet-related NCDs due to a substantial shift toward unhealthy diet high in sugars and ultra-processed foods and concomitant inadequate accessibility of nutritious foods. While interventions to improve diet quality and nutrition knowledge are of paramount importance in order to decrease the burden of NCDs over the next decades, the international policy framework should aim to develop evidence-based policy approaches to reduce such burden globally.

In this context, the EUPHA Food and nutrition section, the EUPHA Chronic diseases section, the EUPHA Health promotion section, in collaboration with the World Health Organization (WHO), aim to propose a joint workshop to provide the latest updates from leading scientists and experts involved in global health research, with a special focus on NCDs, obesity and nutrition-related risk factors as well as ongoing interventions aimed to reduce the double burden of malnutrition.

The objectives of the present workshop are the following: To quantify the global burden and temporal trends of NCDs risk factors; To assess the impact of nutrition-related risk factors on NCDs; To provide examples of advocacy activities and actions at global level to improve nutrition education and dietary behaviors; To promote translatable information at global level and drive implementation of knowledge into policy and practice.

Organizing the present workshop would provide an important occasion for gathering experts in the field and sharing opinions with the audience in light of the presented results. Given the many actors involved, the workshop will provide a unique occasion to discuss about potential policy approaches in the context of the conference.

Key messages

There is science-based evidence demonstrating that healthy nutrition is a key factor to maintain global health and prevent chronic non-communicable diseases. Governmental and non-governmental efforts are currently working to counteract malnutrition worldwide.
The WHO Childhood Obesity Surveillance Initiative (COSI) and the CLICK framework
Authors: Breda J
Published: October 2020

The WHO European Childhood Obesity Surveillance Initiative (COSI) is a well-established system that measures trends in overweight and obesity in over 300,000 primary school aged children from over 40 countries across the WHO European Region. The COSI collects important information related to child anthropometrics, school and family characteristics and child lifestyle behaviors. Major determinants covered by COSI include physical activity, dietary habits and school environments. COSI data has revealed substantial differences in physical activity estimates between countries. However, studies based on COSI data show that 40% of children spend at least two hours watching TV or using electronic devices per day. To prevent increased childhood obesity, policymakers should simultaneously increase opportunities for children to engage in physical activity and act to reduce the amount of time spent on sedentary activities. As children are increasingly online and connected to mobile devices, an emerging concern relates to digital marketing of unhealthy products, which can be effectively targeted at children using advanced persuasive techniques. The WHO CLICK report suggests the need to integrate information such as children's time spent online, device, app and social media usage with outcomes such as child obesity. One future possibility may be to integrate such questions into future COSI questionnaires, which would provide important information at minimal cost and could generate extensive, high quality data. The monitoring and surveillance advocated by the CLICK report is necessary to provide data on whether and how far WHO recommendations in online settings are adopted by governments and public health institutions. The WHO CLICK report acts on consultation with experts to provide a tool to support Member States in monitoring the digital marketing of unhealthy products to children and suggests policy options.
Strengthening primary care through patient registration: a review of 10 countries
Authors: Marchildon G , Allin S , Quentin W
Published: October 2020

Background

Effective primary care requires continuity in the patient-provider relationship so that the primary care provider can act as the central coordinator of services. For this reason, some high-income countries have insisted on patient registration with a primary care team as part of different reform efforts. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of high-income countries that have introduced registration; and identifies challenges related to registration and ongoing reform efforts.

Methods

Based on a literature review, 10 countries - Canada, Denmark, England, France, Germany, Israel, Norway, Sweden Switzerland, and the Netherlands - were selected for analysis. Information was collected using a standardized questionnaire completed by national researchers who reviewed relevant literature and policy documents to report on the establishment and evolution of the policy, the requirements for providers and patients, the benefits for patients, providers and payers, and its connection to primary care reform.

Results

Patient registration establishes a triangular accountability relationship between patients, providers and payers that many reform advocates claim is the key to achieving better continuity and coordination of care. Results will provide information about the introduction of patient registration in the included countries; the characteristics of patient registration agreements; quantitative indicators, such as the proportion of patients registered, the proportion of primary care providers registering patients, and the average list size of providers. Recent reform experiences and ongoing challenges will also be reviewed.

Conclusions

This study will allow us to assess patient registration in terms of its key characteristics and outcomes. A preliminary evaluation of the policy's strengths and weaknesses based on key reform criteria is also presented.
Grassroots innovations as salutogenic practices in a slum of Medellín
Authors: Martinez-Herrera E , Molina J C
Published: October 2020

Background

WHO pointed out urbanization as one of the main troubles and defiances for public health in the 21st century because of the increasing urban health inequalities. The United Nations SDGs 11 promotes local strategies to create environments that expand the resources of a healthier, sustainable, livable for life. Basically, grassroots innovation practices (GIP) are shown as boosters and leading figures of urban social transformation in Slums. On average, 20% in Medellin live in Slums with poverty conditions extremely high.

Methods

In 2018, a qualitative case study focused on urban health and salutogenesis was carried out using an interpretative scope by communitarian narrative explanation building analysis. 32 participants, inhabitants and founders of the Slum, mainly adults, were involved in semi-structured Interviews, Photovoice and Mapping of Community Assets. All ethical aspects were conceived to respect the voices on the struggles for being renowned as part of the city.

Results

El Faro built on a settlement space by its residents through a process which they have called 'dignity and resistance' has transform as a consequence of a set of drivers of four GIP developed around the community. Among them, water management, creation of public space and artistic training. GIP have mobilized community health assets, allowing the development of an important sense of community coherence (SoC-C), with which the community faces their situation of poverty, modifying the conditions that reproduce it and setting up coherent experiences.

Conclusions

GIP are configured as an alternative response to local needs and structural limitations and confrontations. SOC-C has contributed to generate health and well-being, through a process of empowerment that promotes a critical, reflective and proactive citizenship in front of its environment. New research based on salutogenesis is needed as a spotlight institutional governance strategy to bottom up housing public policies.

Key messages

SOC-C generates mobilization of own community health assets to face the local situation of poverty in a bottom up process; alluring meaningful processes and raising social cohesion experiences. Social and urban transformation from the community are possible and attributable to a result of grassroots innovation practices.
Strategies for reaching vulnerable groups in municipal health promotion
Authors: Quilling E , Kuchler M , Leimann J , Dieterich S , Plantz C
Published: October 2020

Background

Contrary to the actual goal of health promotion, which is to reach all population groups equally, groups with an already better state of health are reached by such health services whereas vulnerable or socially disadvantaged groups are often not reached. Specific offers for the latter, however, can lead to stigmatization by reducing them on certain risk factors. This results in a further increase of health inequalities.

Methods

As part of the Joint Action Health Equity Europe (Work Package 6), 13 participating countries have initiated individual projects since autumn 2019 to promote community health and health equity. These projects are based on previously systematically identified country-specific needs. Through content analysis according to Mayring of interim reports and interviews with the project partners, it will now be investigated which strategies have been used to reach vulnerable groups. Recommendations for other countries will be derived from this comprehensive experience.

Results

At this stage, the observations indicate that different strategies are chosen to reach different vulnerable groups. It can be assumed that direct connection to existing networks, which enable low-threshold access to these groups in their everyday life and participatory approaches that involve the target group in planning and implementation, seem to be promising.

Conclusions

The diversity, uniquely portrayed by the various projects from different European countries, provides an overview of the differences and similarities in the strategies used for reaching vulnerable groups from which approaches can be generated that are internationally relevant and transferable.

Key messages

Gaining access to vulnerable groups requires special consideration in health promotion. The results of the JAHEE project (WP6) show promising and diverse strategies for dealing with vulnerable groups.