bluuebunny/crossref_metadata_2025 huggingface dataset:
Final clinical practicum of nursing education and transition experience of new nurses
Authors: Kaihlanen A-M , Elovainio M , Salminen L , Haavisto E , Sinervo T
Published: November 2019

Background

Challenges in transitioning from a student to a registered nurse may contribute to new nurses high turnover rates. Final clinical practicum (FCP) before graduation is known for its importance in preparing students for the transition but little is known about the specific elements of FCPs essential for successful transition. We examined the associations between multiple FCP elements and transition experiences in new nurses and whether work characteristics modified these associations.

Methods

The data were collected in 2018 with electronic survey. The sample comprised 712 Finnish nurses graduated within the last two years. Linear regression analyses was used to examine the association of five FCP elements (Preparing for demands; Being part of team; Systematicness of FCP; Teacher involvement; Quality of supervision) with the transition experience that was measured with four scales demonstrating its emotional, physical, socio-developmental and intellectual domains. Work characteristics were defined based on demand-control -model and multiple potential confounders were considered.

Results

Several associations were found between the FCP elements and the four transition indicators (psychological distress, sleep problems, role conflict/ambiguity and perception of transition/educational preparation). Systematicness of FCP was, however, the only element associated with all the transition indicators, whereas quality of supervision was not associated with any. Multiple interactions were also detected between the FCP elements and job demands.

Conclusions

Our results suggest that FCP experiences reflect to new nurses’ first years of employment. Especially systematic planning and implementation of FCP, collegial work atmosphere and an opportunity for students to become an active member of the work community should be ensured for promoting a smoother transition from student to nurse. This could increase the chances to retain new nurses in the health care workforce.

Key messages

Well planned and implemented final clinical practicums with an opportunity to become an active member of professional team could help nursing students to obtain a smoother transition into nurses. The benefits of having a good final clinical practicum experience may be squandered if considerably high level of job demands (e.g. timepressure) is experienced in the first years of employment.
Health Communication needs of health professionals in Europe – the H-COM cross sectional study
Authors: Zota K , Karnaki P , Veloudaki A , Tsiampalis T , Linos A
Published: November 2019

Background

Effective communication between Health Professionals (HP) and patients is crucial for the overall functioning of the healthcare system with positive impacts on readmission rates, treatment outcomes, adherence and costs. However, health communication training is limited especially during medical training. In the framework of the EU H-COM project an exploration of health communication needs and gaps and preferred training methods was performed among HP.

Methods

A cross-sectional online survey was conducted among 702 health professionals (Physicians: n = 315; Nurses: n = 258; Other: n = 129) through a purpose made questionnaire available in English, Greek, Polish, Spanish and German.

Results

Health communication training is considered necessary for physicians (89.8%) and nurses (89.7%), although 42.4% of them never received relevant training in the past. Professional status (p < 0.001), age (p = 0.079), gender (p = 0.090) and years of experience (p = 0.012) affected the likelihood of not having received such training, with physicians, HPs aged 45-54 years old, males and those having 6-10 years of experience being most in need. At least 50.0% reported encountering problems in communicating with their patients and facing several barriers either in primary health care settings and hospitals or in private practice. The ability to listen and answer patients, deliver bad news and obtain medical history were the most important communication skills identified, while the most suitable training method was learning relevant practical skills. The availability of such trainings is reported as being fair or poor at all educational levels by the majority.

Conclusions

Health communication training is considered important although currently not available to the extent needed. This research provides evidence concerning the preferred type, frequency and mode of health communication training providing also insight on differences between various HPs.

Key messages

Health communication training is crucial but inadequate in Europe. There are specific training needs and preferences among HP which need to be considered. Health communication training needs to be adapted and tailored to professionals’ age, experience and status.
Engaging a wider public health workforce: bringing public health into architecture education
Authors: Marsh R , Pilkington P , Marco E , Rice L
Published: November 2019

Background

Current public health challenges necessitate the closer working of public health with built environment professionals. Despite growing evidence of benefits, there remains little progress in practice. Architects can play a key role in ensuring urban and building design is health promoting, however there is no requirement to teach health by architectural accreditation bodies across Europe.

Objectives

In the United Kingdom in 2010, the Public Health Practitioner in Residence programme (PHPiR) was established to address this situation. Public health professionals are embedded within the Faculty of Environment and Technology at the University of the West of England, and contribute to research, pedagogic programme development, teaching and mentoring. The aim was to embed public health concepts and issues into architecture training, to empower the profession as part of the wider workforce, to improve health and wellbeing when designing buildings and places. The PHPiR was evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data was collected (questionnaires, focus group, semi-structured interviews, programme documentation) on a Masters of Architecture cohort (N = 34) at intervals from 2011-2019 to see if the PHPiR has long lasting effects as students enter practice.

Results

Public health concepts including; inequalities, life course approach, and social capital, became embedded into the architecture curriculum. Projects produced had increased reference to wider health promoting issues and participants thinking shifted from the building itself to who would use the building, suggesting the intervention achieved its aims.

Conclusions

The PHPiR offers a novel approach for built environment professions to better understand public health issues and the relevance to their chosen fields. This model could be applied to other courses and replicated in educational institutions and public health training programmes across Europe.

Key messages

The PHPiR influenced the architecture curriculum, improved architects understanding and public health issues and concepts, and empowered them to create more health promoting environments. Embedding public health professionals into training for other disciplines may be an effective, sustainable method for increasing the wider public health workforce.
Human Resources for Health challenges during health emergencies—low number of workers in El Salvador
Authors: Amaya MP Amaya
Published: November 2019

El Salvador is one of the 57 countries considered to be in Human Resources for Health (HRH) crisis according to the World Health Organization (WHO). El Salvador’s healthcare worker density is 1.95 health professionals per 1,000 population, with even lower numbers in certain departments of the country. There have been improvements in the distribution of healthcare workers since 2010; however, on average it has remained “in crisis” based on the 2006 World Report definition. The increase in vector borne diseases in the region, has resulted in an overwhelmed vector control system and public health sector in many Central American countries. This study aims to analyze whether the healthcare workers identify the numbers of HRH as a factor that affects the health system response during health emergencies.

Through an extensive review of scientific literature, country reports, 16 meetings and 34 in depth semi-structured interviews with key stakeholders; this paper explores the challenges healthcare workers faced and how they were influenced by the numbers of available HRH during recent arboviral epidemics in El Salvador, using the recent Zika epidemic as a point of comparison.

The study findings suggest that some of the barriers that the health workforce identified during health emergencies include factors related to the low availability of HRH such as feelings of tiredness, being overwhelmed, as well as a need to rely on doctors in their social year in some areas of the country. Despite this, they also recognize that the recent intersectoral work done by the government and the Ministry of Health, has helped to overcome the obstacles of a low healthcare workforce by involving other sectors of society into the emergency response. Therefore, there is not a clear consensus on how the low number of HRH affect the health emergency response.

Key messages

The study findings suggest that some of the barriers that the health workforce identified during health emergencies include factors related to the low availability of HRH. They also recognize that the recent intersectoral work done by the government and the Ministry of Health, has helped to overcome the obstacles of a low healthcare workforce.
Informal carer in Portugal: moving towards political recognition in Portugal
Authors: Fronteira I , Simoes J , Augusto G
Published: November 2019

Informal care represents around 80% of all long term care provided in EU countries. Nevertheless, the needs for this type of care are expected to increase in the coming years in all OECD countries.

Portugal is among the OECD countries with the highest ageing index (21.5% of the population was older than 65 years in 2017) due to high life expectancy and low fertility rates. As this demographic trend establishes, Portugal is expected to have more than 40% of the population over 65 years in 2037, and the expected prevalence of dementia is 3%, in 2050. In 2015 there were 2.1% of people over 65 receiving long-term care, representing 52% of all long-term care users. Around 38% were receiving care at home. It is estimated that 287,000 people in Portugal depend on informal carers.

The agenda towards the official recognition of informal cares has been push forward in the country. Since 2015, several recommendations have been issued by the Parliament as well as legislative initiatives and a proposal for a Status of the Informal Carer is currently under discussion. We analyse the process of formulation of this policy in terms of sectors and stakeholders involved, definition and scope of informal carer, rights and obligations, role of the person being cared for, formal protection (e.g., labor, social, financial, training) and implementation.

Recognition of the informal carer is a sector wide approach. One of the main features is the economic, social and labor protection mainly through reconciliation between work life and caring activities and promotion of the carer’s well being. Notwithstanding, and from a health system perspective, community health teams are to be the focal point for informal carers, supporting and providing specific training whenever needed. Despite its relevance, informal care should not be professionalized and responsibility of care should not be shifted from health services to informal carers.

Key messages

Needs for informal care are expected to increase in the coming years in OECD countries. Recognition of the informal carer is a sector wide approach.
Attitudes of social welfare professionals of the concept of positive health in the Netherlands
Authors: van der Meer N , Dierx J A J
Published: November 2019

The current definition of health from the World Health Organisation seems to no longer meet the changes in the current Dutch health system. An alternative approach which puts emphasis on health, not disease, is Positive Health. The current and future developments in the health care system in the Netherlands are demanding different mentality and practice methods of social work and welfare professionals. In order to measure the extent to which there is support for positive health among the social welfare professionals, research must be carried out into the attitude of the professionals. In this study, the attitudes towards the concept of Positive Health of social welfare professionals are examined.

Methods

A mixed-method study was used, in which both quantitative and qualitative data were collected. By means of a survey (n = 128) and semi-structured interviews (n = 9), the attitude and working method of social workers were explored.

Results

Social welfare professionals find that the concept Positive health can contribute to an increase in resilience and self-management in citizens and patients. However, social welfare professionals wonder if all citizens and patients have the ability to self-manage skills. In addition, social welfare professionals think all domains of the positive health concept are regarded as important in defining health.

Conclusions

The concept of positive health is in line with the attitude of social welfare professionals and has support for implementation. In order to introduce the concept Positive Health further and to make it stand out in the social welfare domain, more attention needs to be paid to disseminating the concept, broadening the knowledge of the professionals and practical tools for practice.

Key messages

Positive Health concept connects professionals in health care and welfare. The concept of positive health is in line with the perceptions of health of the social welfare professionals.
Parental mental vulnerability and use of healthcare services in infants
Authors: Heuckendorff S , Johansen M B , Overgaard C , Johnsen S P , Fonager K
Published: November 2019

Background

Parental mental illness has been associated with a number of consequences for the health and use of healthcare services of the child. However, most research has focused on maternal depression. Research examining the impact of paternal mental vulnerability (MV) as well as different degrees of MV are needed to plan interventions. Therefore, the aim of this study was to examine the association between different categories of individual and combined parental MV and the child’s use of healthcare services the first year of life.

Methods

A population-based birth cohort study was conducted including all Danish children born from 2000-2016 using the Danish national registers. Exposure was parental MV of three categories according to the degree of MV: Group 1 “minor MV” with mental related contacts to primary healthcare and/or prescribed psychopharmaceuticals, group 2 “moderate MV” and group 3 “severe MV” both with contacts to psychiatric hospital. Outcome was contacts to GP the first year of life expressed as incidence-rate ratios (IRR) using Poission’s regression analyses.

Results

The analyses included 952,709 children. 21% of the mothers and 11% of the fathers were in the MV groups. Parental MV (any parent, any MV-group) was associated with an increased risk of GP contacts daytime and out-of-hour contacts. If both parents were classified as group 1 MV, IRR were 1.21 (CI95 1.20-1.22). IRR were 1.18 (1.17-1.18) resp. IRR 1.05 (1.04-1.06) if only the mother resp. father were in MV group 1. The same pattern were seen for out-of-hour contacts; IRR 1.28 (1.26-1.31) for both parents in group 1 and IRR 1.19 (1.18-1.20) resp. IRR 1.09 (1.08-1.11) for the mother resp. father.

Conclusions

Maternal and paternal MV were associated with an increased risk of GP contacts daytime and out-of-hour contacts although maternal MV had the highest risk. Even minor MV had an impact on healthcare contacts and the risk increased further if both parents were classified as minor MV.

Key messages

Both maternal and paternal mental vulnerability has an impact on the child’s healthcare contacts. Our results indicate the need for a focus also on minor mental vulnerability in the planning of interventions.
The effectiveness of a web-based Dutch parenting program to prevent overweight in children age 9-13
Authors: Ruiter E L M , Molleman G R M , Fransen G A J , van der Velden K , Engels R C M E
Published: November 2019

Background

We developed a web-based parenting program for parents entitled “Making a healthy deal with your child”. This e-learning program can be incorporated into existing prevention programs, thereby improving these interventions by reinforcing the role of parenting and providing parents with practical tools for use in everyday situations in order to stimulate a healthy lifestyle.

Methods

The effectiveness was studied in a two-armed cluster randomized controlled trial. We recruited 548 parent-child dyads of children 9-13 years in the Netherlands who participated in an existing school-based overweight prevention program. Primary outcomes included the child’s dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices (set of rules, modeling, monitoring), and parental self-efficacy. Multilevel multiple regression analyses in Mplus were conducted.

Results

87% of the parent-child dyads participated in the study and 47% of the parents in the intervention group completed 2 or more episodes of the e-learning. The score that parents gave to the e-learning is a 7.Main effect analyses showed in the intention-to-treat analyses that the the parents in the intervention group have more strict rules regarding eating snacks (0.046) and children of parents in the intervention group drink more milk (p = 0.018) and less sugar sweetened beverages (p = 0.024). The completers only analyses showed that the children of parents in the intervention group eat more vegetables and fruit, drink more water and less sugar sweetened beverages, and had less screentime than the children in the control group.

Conclusions

The e-learning program showed small indications to be effective. A second effectiveness study is currently being investigated. If the e-learning proves to be effective it can be easily incorporated into existing overweight prevention programs for children, as well as activities regarding Youth Health Care.

Key messages

The e-learning can easily incorporated into existing overweight prevention programs for children. www.gezondeafsprakenmetjekind.nl
Early socioeconomic circumstances and cardiometabolic health in 10-year-old children
Authors: Soares S , Santos A C , Peres F Soares , Barros H , Fraga S
Published: November 2019

Background

Social adversity is thought to become biologically embedded during sensitive periods of development, setting children on a trajectory of increased risk for later chronic diseases. Thus, social differences are expected to be expressed as biological alterations and might have their origins in early life. Therefore, we aim to estimate the association between early socioeconomic position (SEP) and cardiometabolic health during childhood.

Methods

Data from 2962 participants in the population-based birth cohort Generation XXI, from Porto, Portugal, was collected following standardized procedures at all study waves. Early SEP definition included household income, parental education and occupation at child’s birth. Cardiometabolic health was characterized at the age of 7 and 10, considering the triglycerides, cholesterol, fasting glucose, body mass index, systolic and diastolic blood pressure. Logistic regression was used to estimate the association between early SEP and a favorable cardiometabolic health profile.

Results

A favorable cardiometabolic profile was observed in almost half of participants at both ages, particularly among high SEP children who remain more frequently without alterations. For girls, higher paternal education at 7 years (OR:1.49;95%CI:1.03-2.15) and higher SEP at 10 were associated with better cardiometabolic health profile. In boys, a better cardiometabolic health profile was observed with increasing levels in maternal and paternal education and occupation, but at the age of 10, social differences were more evident according to parental education.

Conclusions

We provide evidence that children from more advantaged SEP at birth have an increased likelihood of presenting better cardiometabolic health at early ages. Social differences in cardiometabolic health biomarkers are already found in childhood, suggesting that the short-term impact of early life SEP on the physiology dysregulation takes place already in the first decade of life.

Key messages

Social differences in cardiometabolic health are already established in the first decade of life, with children from higher SEP presenting a better cardiometabolic health. Cardiovascular events are not expected to develop during childhood, however the underlying atherosclerotic process might already be in course as social differences appear to widen with age.
Social-emotional problems among Swedish three-year-olds: an Item Response Theory Analysis
Authors: Vaezghasemi M , Eurenius E , Sundberg L R , Ivarsson A , Silfverdal S-A , Lindkvist M
Published: November 2019

Background

Young children’s social-emotional problems can have a long-term effect if not treated early. In order to deepen our knowledge about children’s social and emotional functioning, we utilized the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) among 3-year-olds in Sweden aiming: 1) to identify ASQ:SE items that are most commonly endorsed by children with high level of social-emotional problems; and 2) to assess whether certain ASQ:SE items differs between boys and girls at the same level of social-emotional problems.

Methods

During 2014-2017 data was collected from 7179 three-year-old children through Child Health Care in a northern county of Sweden within the Salut Child Health Promotion Programme. Item Characteristic Curve (ICC) and Differential Item Functioning (DIF) were used to identify the characteristics of children with high social-emotional problems and to determine whether an item exhibit uniform between boys and girls at the same level of social-emotional problems.

Results

Items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury were more commonly endorsed by children with high levels of social-emotional problems. Additionally, on the same level of social-emotional problem girls were more likely to score high in items regarding difficulties to occupy herself, clinging behaviour and repetitive behaviour while boys were more likely to score high in items regarding difficulty to name friends, difficulty to express feelings and destruction of things on purpose.

Conclusions

This study has increased our knowledge about Swedish young children’s social emotional functioning already at the age of three by detecting which items are most closely connected to high level of social-emotional problems and differences between boys and girls. However, whether the results detected in this analysis are reflecting their parents’ expectations more than child behaviour requires further investigations.

Key messages

Children with high level of social-emotional problems were rated high on items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury. On equal levels of social-emotional problems, girls were more often reported with internalizing problematic behaviours and boys were more often reported with externalizing problematic behaviours.
Study on Children’s Health Program and Maternity Health Program, Bulgaria
Authors: Stefanov S
Published: November 2019

Introduction

The survey was conducted to establish the level access to the Children’s Health Program and the Maternal Health Program of the National Health Insurance Fund by marginalized groups. The survey was conducted in the period September-December, 2018 and covered 315 women from Nadezhda neighbourhood (Roma community),Sliven.The methodology used is social accountability and legal empowerment.

Methods

The survey was conducted through a face-to-face survey. A questionnaire was used with closed and open questions. Consultation with those people was anonymous. We used a “cold contact’ and a “snowball’ method.

Results

Almost all respondents - 97.7% - have a GP.All (who have the contact of their GP) can easily contact their doctor, although only 7 (2.3%) have the phone number of their GPs. Almost 90% pay part of the cost of treatment, few are cases of full payment or no payment.Quite low - 40.9% - are the rates of visits to the GP in the first month after birth and the appointed (mandatory and due) examinations. Only 45% were examined in the first month after birth by the testimonies of the respondents. It is imperative to take steps to raise the percentage of mothers who visit doctor’s office and receive an examinations.74.2% say they adhere to the children’s food-hygiene regime. The remaining 20.95% point out the lack of funds and the poor living conditions in the neighborhood (noise, stopping water, etc.) as reasons for not adhering to the regime. While only about 20% claim to have faced discriminatory treatment (just over 30% say they have not experienced it, and nearly half do not respond), there are indicative responses to discriminatory treatment - division in the maternity ward, offensive speech, etc.

Conclusions

The study achieves its goals - to provide an adequate picture of maternal access to prenatal and pediatric medical care, as well as the difficulties to ensure maximum care for children.

Key messages

Roma children are not treated equally under the Children’s Health. Roma mothers do not have equal access to the Maternity Health Program.
Diabetes care in individuals with severe mental Illnesses in Israel
Authors: Sagy Y Wolff , Krieger M , Horwitz E , Paltiel O , Ravel-Vilk S , Ben-Yehuda A , Manor O , Calderon-Margalit R
Published: November 2019

Background

Cardiovascular disease and risk factors are more common in people with severe mental illness (SMI; schizophrenia, schizoaffective disorders, and bi-polar disorders). For instance, diabetes mellitus (DM) prevalence was reported to be 2-3 times higher, with higher incidence and severity of complications. In 2015, following a reform in mental health services in Israel, services were transferred to the responsibility of the health plans, allowing a comprehensive healthcare. We aimed to compare quality of care indicators and intermediate DM outcomes in individuals with SMI compared to the general population.

Methods

The Israel national program for quality indicators in community healthcare obtains data from electronic medical records from the four health plans, covering the entire civilian population. In 2017, n = 74,226 individuals aged ≥18 years had a registered diagnosis of SMI (prevalence 1.37%). DM prevalence, hemoglobin A1c (HbA1c) testing yearly, and DM control in individuals with SMI were compared with the general population.

Results

DM prevalence in adults with SMI in 2017 was 14.3%, compared with 9.7% among all Israeli adults (RR of 1.5). rates of HbA1c testing and control (HbA1c<7-8%, depending on age and duration of disease) were similar among DM patients with SMI and the general population (testing: 90.1% and 90.9%; Control: 70.8% and 69.7%, SMI and general population, respectively); Similarly, uncontrolled DM (HbA1c>9%) was observed in 10.8% of individuals with SMI and in 10.0% of the general population.

Conclusions

Along with the expected excess of DM prevalence in individuals with SMI, quality of care DM indicators rates were alike among those with SMI as in the general population, suggesting non-inferior quality of care. This is consistent with results reported by the British national diabetes audit for England and Wales. However, our results are limited by a possible under-registration or diagnosis of SMI in the Israeli population.

Key messages

Higher diabetes mellitus prevalence is observed in individuals with severe mental illness. Hemoglobin A1c testing and diabetes mellitus control rates are alike in individuals with severe mental illness compared with the general population, suggesting non-inferior quality of care.
Social capital and mental health status among the residents of a neighborhood in Istanbul, Turkey
Authors: Kayi I , Ozgulnar N
Published: November 2019

There has been an increasing policy making and research for social determinants of health and inequalities in health. In such a framework social capital functions as an intermediate factor at the and it is increasingly investigated in health research. Social capital is defined as a resource that individuals may access through membership in a structure of network with certain values and through sharing these resources reciprocally. The objective of this study is to investigate the association between social capital and mental health status among residents of a small neighborhood on Istanbul.

This is a cross-sectional study that has been carried out in Istanbul with individuals of age 18-65 years old. The study sample included 629 individuals selected by a stratified and systematic sampling process. Data was collected via a self-reported questionnaire including items for sociodemographic information, social capital and General Health Questionnaire. We applied Mann-Whitney U and Kruskal-Wallis Tests subsequent to the normality tests of the distribution, and Chi Square Test for the categorical data. Linear and logistic regression models were used for multivariable analysis.

Men constitute 51.7% of the people. Mean age was 40.1 (sd: 12.7). There was a significant association between social capital and being a woman and deprived neighborhood. In addition higher level of mental distress was significantly associated with lower level of neighborhood trust, social support and the higher level of perception that neighbors would take advantage of the participants when they got the chance. However national level trust and sense of people taking advantage of their neighbors were not significantly associated with mental health status.

Social capital measured via trust and social support at the neighborhood level has been a determinant of mental health status. Efforts for decreasing socioeconomic inequalities should also include efforts to promote social capital.

Key messages

Social capital measured via trust and social support at the neighborhood level has been a determinant of mental health status. Efforts for decreasing socioeconomic inequalities should also include efforts to promote social capital.
Changing criteria of access to gamete donation: the views of donors and recipients
Authors: Baía I , de Freitas C , Silva S
Published: November 2019

Background

Differences on the use of sexual orientation and marital status as criteria to define access to gamete donation persist in Europe, contributing to the search of cross border reproductive care (CBRC). The lack of international policy and norms on CBRC highlight the need for surveillance to ensure quality and equitable access to reproductive care, namely by assessing donors’ and recipients’ views. This study aims to analyze the opinion of donors and recipients about the use of marital status and sexual orientation as priority criteria for accessing gamete donation, and its associated factors.

Methods

Between July 2017 and June 2018, 72 donors and 171 recipients completed a self-report questionnaire at the Portuguese Public Bank of Gametes. Opinion about the use of marital status and sexual orientation as priority criteria was assessed through a 5-point Likert scale of agreement, ranging from “totally disagree” to “totally agree”. Descriptive statistics and multinomial logistic regression were used.

Results

Most participants disagreed with a priority of access to gamete donation for heterosexual couples (61%) and married women (60%). Participants who agreed with priority to heterosexual couples were more likely to be males (OR = 2.5, CI95% 1.2-5.3) and married or living with a partner (OR = 3.5, CI95% 1.1-10.8). Males (OR = 3.18, CI95% 1.5-6.9) and those with lower white collar (OR = 3.0, CI95% 1.2-7.4) or blue collar occupations (OR = 4.3, CI95% 1.4-13.1) were more likely to agree with priority for married women.

Conclusions

Donors and recipients agree with equitable access to gamete donation, independently of sexual orientation and marital status. However, a heterosexual marriage hierarchy is particularly observed on male, married/living with a partner, and with lower white or blue collar occupations participants. Policy on reproductive care needs to be especially mindful of equity in access to gamete donation.

Key messages

Donors and recipients agree with access to gamete donation independent of sexual orientation and marital status. Policy on reproductive care needs to be mindful of equity in access to gamete donation.
Health promotion with older informal caregivers: a demand-oriented organization of support
Authors: Hassel H , Foitzik E , Langner S
Published: November 2019

Background

Older informal caregivers are considered to be a growing, vulnerable group with multiple burdens. Existing support programs are rarely used which indicates a lack in meeting the specific demands of the target group. This study was to examine the need for support and the preferred design of support programs for informal caregivers aged 65 years and older.

Methods

A mixed-methods approach was used to identify types of current support programs and demands regarding health promotion and self-management of older informal caregivers. Therefore, two systematic literature researches and a qualitative survey of German program providers were performed. Furthermore, 16 focus group discussions (FGD) with older informal caregivers as well as three FGD with disseminators in three German cities were accomplished.

Results

Most support programs found focus on caregiving instead of health promotion. Most FGD participants preferred: social interaction with health promotion activities, programs thematically focusing on relaxation and physical activity as well as consultation meetings. One of the crucial factors of the utilization of support programs is the guaranteed care of the person who requires it simultaneous to an intervention. In general, it was found that informal caregivers prioritize the health of the person in need of care over their own which indicates low self-awareness.

Conclusions

Support programs combining social interaction with guided health promotion activities seem to be more attractive to informal caregivers than common programs. Those units should especially focus on the low self-awareness the target group shows. Local network structures need to be strengthened to facilitate the development and utilization of support programs.

Key messages

Networks of disseminators could facilitate support programs for informal caregivers. These programs should contain social interaction, health promotion activities and ensured care of the person who needs it.
Use of medical care in the 7 years before dementia in the French health insurance database in 2016
Authors: Rachas A , Gallini A , Gombault E , Carcaillon-Bentata L , Gardette V , Gastaldi-Ménager C h
Published: November 2019

Background

The entry into dementia is a period of growing interest for clinical trials and public health policies. We described the frequency of medical care use in the 7 years prior to the first dementia identification (index date).

Methods

All French health insurance general scheme beneficiaries aged 65 or more with an incident dementia in 2016 (identified through long-term disease registry, hospitalization diagnoses, or specific drug delivery), were matched with beneficiaries without dementia of same age, gender, area of residence. The annual cumulative incidences (ACI) of visits (GP and specialists, including outpatient hospital visits) and hospitalizations were estimated over 7 years (Y-7 to Y-1 before index date), by age (65-74, 75-84, 85-89, 90+).

Results

Among 274166 subjects (median age 84, 65% women), the ACI of GP visit was stable and similar between cases and controls, around 95%. The ACI of neurologist, psychiatrist and internist visit and of hospitalization in a psychiatric unit increased in cases, especially in Y-1. They were higher than in controls in the youngest age classes. The ACI of visits to a dermatologist, a rheumatologist, an ophthalmologist, a dentist and for women a gynecologist, were lower in cases than in controls, with an increasing difference in the last years before dementia care. Similar patterns were observed in the oldest exclusively (generally ≥85 yo) for pneumologist, cardiologist, nephrologist, and in a lesser extent, endocrinologist visit. The ACI of hospitalizations increased with time in both groups, with a peak in Y-1 in cases. They were higher in cases than in controls in the youngest age classes.

Conclusions

The increase in hospitalization rate in Y-1 suggests a decline in clinical status leading to the diagnosis or a weakening at the time of entry into dementia. The lesser use of a specialist other than neurologist or psychiatrist suggests a focus of care around dementia, possibly to the detriment of the care of comorbidities.

Key messages

As most patients visit their GP at least yearly, specific GPs training could help to make a timely diagnosis of major neurocognitive disorders. The lesser use of a specialist other than neurologist or psychiatrist suggests a focus of care around dementia, possibly to the detriment of the care of comorbidities.
Predictors of in-hospital mortality post hip fracture in Ireland 2013-2017
Authors: Ferris H , Brent L , Martin J , Crowley P , Coughlan T
Published: November 2019

Background

Hip fractures are associated with considerable mortality, morbidity and healthcare expenditure. There are approximately 3,500 hip fractures in Ireland per annum with this figure set to increase considerably over the coming years due to the ageing population. Internationally, mortality following hip fracture is approximately 10% at 1 month and 30% at 1 year, with less than half of survivors regaining their preoperative level of function. The authors aimed to identify the determinants of in-hospital mortality post hip fracture in the Republic of Ireland 2013-2017, with specific reference to the Irish Hip Fracture Standards.

Methods

A secondary analysis of 15,603 patients in the Irish hip fracture database was conducted.

Results

31% (n = 4,769) were male and 69% (n = 10,807) were female. Mean age for males was 75 years (SD 13.5) and 79 years for females (SD 10.5). The largest proportion of hip fractures occurred in the 80-89 age category, with 72.3% (n = 4,600) of these being female. Median in-hospital mortality was 4.7% (n = 711) (Range 2.7-6.2). Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality; however, only 4 remained statistically significant on multivariate analysis [mobilised day of/after surgery (OR 1.46, 95% CI 1.25-1.70, p < 0.000), pre-fracture mobility (OR 0.84, 95% CI 0.79-0.89, p < 0.000), gender (OR 0.56, 95% CI 0.41-0.76, p < 0.000) and age (OR 1.05, 95% CI 1.03-1.06, p < 0.000)].

Conclusions

Older males with poor pre-fracture mobility who were not mobilised the day of/after surgery had the highest risk of in-hospital mortality. The ability to be mobilised on the day of/after surgery is a good composite measure of both patient and organisational factors in hip fracture care. This research supports the inclusion of mobilisation on the day of/after surgery as a new formal best practice standard.

Key messages

Patients not mobilised on the day of/after surgery are 46% more likely to die in hospital. In-hospital mortality of 4.7% in Ireland is comparable internationally. None of the IHFSs significantly influenced in-hospital mortality after multivariate analysis, but may well affect other outcomes such as ability to return home.
Taxonomic and functional insights into rock varnish microbiome using shotgun metagenomics
Authors: Esposito Alfonso , Borruso Luigimaria , Rattray Jayne E , Brusetti Lorenzo , Ahmed Engy
Published: November 2019

Rock varnish is a microbial habitat, characterised by thin (5–500 μm) and shiny coatings of iron (Fe) and manganese (Mn) oxides associated with clay minerals. This structure is well studied by geologists, and recently there have been reports about the taxonomical composition of its microbiome. In this study, we investigated the rock varnish microbiome using shotgun metagenomics together with analyses of elemental composition, lipid and small molecule biomarkers, and rock surface analyses to explore the biogeography of microbial communities and their functional features. We report taxa and encoded functions represented in metagenomes retrieved from varnish or non-varnish samples, additionally, eight nearly complete genomes have been reconstructed spanning four phyla (Acidobacteria, Actinobacteria, Chloroflexi and TM7). The functional and taxonomic analyses presented in this study provide new insights into the ecosystem dynamics and survival strategies of microbial communities inhabiting varnish and non-varnish rock surfaces.
Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study
Authors: Crimmins Eileen M , Zhang Yuan S , Kim Jung Ki , Levine Morgan E
Published: November 2019

Background

This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.

Methods

We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.

Results

The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.

Discussion

While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.
The European Court of Human Rights, Transitional Justice and Historical Abuse in Consolidated Democracies
Authors: Gallen James
Published: November 2019

In recent years, both transitional justice and the role of the European Court of Human Rights in dealing with historical abuses have evolved. Transitional justice has begun to address widespread or systemic human rights abuses outside of the contexts of armed conflict and authoritarian regimes. In three key recent judgments, El-Masri v Macedonia, Janowiec v Russia and O’Keeffe v Ireland, the Court has clarified and expanded its approach to addressing historical human rights violations relevant to transitional justice in significant, if inconsistent, ways. To date, there is no exploration of the relationship between transitional justice, historical abuse outside the contexts of armed conflict or authoritarian rule and the European Convention of Human Rights. This article seeks to address that gap by considering the potential opportunities and obstacles for the use of the Convention to address historical abuse in consolidated democracies as a part of transitional justice.
Determinants of physical, mental and social well-being: a longitudinal environment-wide association study
Authors: Ni Michael Y , Yao Xiaoxin I , Cheung Felix , Wu Joseph T , Schooling C Mary , Pang Herbert , Leung Gabriel M
Published: November 2019

Background

Although the World Health Organization (WHO) has defined health as a state of physical, mental and social well-being, public health strategies have primarily focused on one domain of well-being. We sought to systematically and simultaneously identify and validate associations of behavioural patterns, psychosocial factors, mental and physical health conditions, access to and utilization of health care and anthropometrics with physical, mental and social well-being.

Methods

We conducted a longitudinal environment-wide association study (EWAS) with a training and testing set approach, accounting for multiple testing using a false discovery rate control. We used multivariate multilevel regression to examine the association of each exposure at wave 1 with the three outcomes at wave 2 in the Hong Kong FAMILY Cohort (n = 10 484).

Results

Out of 194 exposures, we identified and validated 14, 5 and 5 exposures that were individually associated with physical, mental and social well-being, respectively. We discovered three factors, namely depressive symptoms, life satisfaction and happiness, that were simultaneously associated with the three domains that define health.

Conclusions

These associations, if verified to be causal, could become intervention targets to holistically improve population health. Our findings provide empirical support for placing mental health at the forefront of the public health agenda, and also support recent calls to use life satisfaction and happiness to guide public policy.
Modified Vaccinia Ankara–Vectored Vaccine Expressing Nucleoprotein and Matrix Protein 1 (M1) Activates Mucosal M1-Specific T-Cell Immunity and Tissue-Resident Memory T Cells in Human Nasopharynx-Associated Lymphoid Tissue
Authors: Puksuriwong Suttida , Ahmed Muhammad S , Sharma Ravi , Krishnan Madhan , Leong Sam , Lambe Teresa , McNamara Paul S , Gilbert Sarah C , Zhang Qibo
Published: November 2019

Background

Increasing evidence supports a critical role of CD8+ T-cell immunity against influenza. Activation of mucosal CD8+ T cells, particularly tissue-resident memory T (TRM) cells recognizing conserved epitopes would mediate rapid and broad protection. Matrix protein 1 (M1) is a well-conserved internal protein.

Methods

We studied the capacity of modified vaccinia Ankara (MVA)–vectored vaccine expressing nucleoprotein (NP) and M1 (MVA-NP+M1) to activate M1-specific CD8+ T-cell response, including TRM cells, in nasopharynx-associated lymphoid tissue from children and adults.

Results

After MVA-NP+M1 stimulation, M1 was abundantly expressed in adenotonsillar epithelial cells and B cells. MVA-NP+M1 activated a marked interferon γ–secreting T-cell response to M1 peptides. Using tetramer staining, we showed the vaccine activated a marked increase in M158–66 peptide-specific CD8+ T cells in tonsillar mononuclear cells of HLA-matched individuals. We also demonstrated MVA-NP+M1 activated a substantial increase in TRM cells exhibiting effector memory T-cell phenotype. On recall antigen recognition, M1-specific T cells rapidly undergo cytotoxic degranulation, release granzyme B and proinflammatory cytokines, leading to target cell killing.

Conclusions

MVA-NP+M1 elicits a substantial M1-specific T-cell response, including TRM cells, in nasopharynx-associated lymphoid tissue, demonstrating its strong capacity to expand memory T-cell pool exhibiting effector memory T-cell phenotype, therefore offering great potential for rapid and broad protection against influenza reinfection.