bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic resistances of S. aureus in refugee accommodations – an investigation from the microbiological perspective
Authors: Kiemann I
Published: November 2019

Background

Antimicrobial resistance (AMR) has been added to the list of the “Ten threats to global health” of the WHO. Due to varying rates of AMR persistence in the different countries of the world, there is concern that migration might foster the burden of antibiotic resistance in Europe. As calculated before, prevalence of AMR is elevated in refugees. Refugees are supposed to have higher risk for AMR prevalence, constituted by the conditions in the European host countries and the countries of origin or transit. In European refugee accommodations poor sanitation, overcrowded living conditions and barriers accessing health care services are feasible risk factors. One example for AMR bacteria is the Methicillin-resistant Staphylococcus aureus (MRSA). In the last decades, S. aureus became a global threat for healthcare, through the gain of AMR genes.

Methods

Nasal swabs voluntarily provided by refugees living in accommodations in Bielefeld (Germany) were checked for presence of S. aureus. After identification by 16S rRNA sequencing the isolates were typified and antibiotic resistances were phenotypically detected by broth dilution method. For MRSA, the resistance genes were identified by PCR.

Results

Nasal swabs of participating refugees contain antibiotic resistant S. aureus, including MRSA. Some isolates are resistant against various therapeutic antibiotics, like clindamycin and erytromycin. Nearly all isolates are resistant against penicillins. Resistances against vancomycin and the reserve antibiotic linezolid were not detected.

Conclusions

Efforts to reduce AMR rates in Europe focus on surveillance, screening and antimicrobial stewardship. As the living situation in host countries is expected to be a risk factor for AMR persistence, host countries may also consider improving the accommodation of refugees.
The construction of alliances in the field of health: about addictions
Authors: Josseran L
Published: November 2019

The construction of alliances in the field of addictions is a key topic to develop effectiveness and efficiency public health policies.

The short-term economic stakes can not be the alpha and the omega of public policies. Whether general or sectoral, such as agriculture, they must take into account their impact on the health of populations established by scientific work.
Estonia: Problems created by border-trade for applying high-tax alcohol policy
Authors: Täht T , Laarmann H
Published: November 2019

In early 2000s, Estonia had one of the highest levels of alcohol consumption globally. In 2008, the average salary could buy 62 litres of strong spirits, compared with 28 litres in 2000; the increase of affordability was one of the highest in the EU. Since then, alcohol consumption per capita has been reduced by a third, which has also led to a reduction in related problems: mortality from alcohol-related illnesses has fallen by 40%. This was achieved with the progressive adoption of measures that rely heavily, but not exclusively, on increasing excise taxes. In 2014 a comprehensive alcohol policy document was adopted, paving the way to the measures in all 10 areas of WHO global strategy to reduce harmful use of alcohol. Since then Estonia has launched treatment programme and awareness campaigns, restricted advertising and the exposure of alcohol in the public sphere.

By 2017, the over-exploitation of the tax-based measures backfired. The twofold alcohol price difference between Estonia and Latvia, resulting from doubling the excise tax for beer and raising significantly those for other alcoholic beverages, caused an unintended increase in cross-border trade between the two countries. This, in turn, caused a new wave of public discussion around pricing policies, and a loss of popular support for tax increases. As a first step to address the problem, the government halved the tax increase planned for February 2018, thus increasing beer tax by 9% and spirits tax by 5%. Tax increases scheduled for 2019 and 2020 were cancelled, and taxes on spirits, beer and cider were cut by 25% instead. This resulted in Latvia decreasing their spirits taxes by 15% in turn. This development forces health promoters to seek new ways to reduce harm to public health and win back support to healthy policy choices.
Round table: Applying multidisciplinary sciences to improve paediatric primary care for children in Europe
Authors:   Organised by: EUPHA (CAPH) Chair persons: Danielle Jansen - EUPHA (CAPH), Jochen Ehrich - Germany
Published: November 2019

Considerable progress has been made in improving child health and well-being in Europe over the past 40 years, with great reductions in neonatal, and child deaths, and in deaths from causes such as vaccine-preventable diseases. Paediatric primary care (PPC) has significantly contributed to these advances. However, there are still differences between and within countries regarding the content and organizations of primary care for children that might have an impact on important aspects such as access and availability of primary care. These cross-country and within-country differences together with current and future challenges in child health care, such as increasing prevalence of chronic and long-term conditions, fragmentation of care and shortage of health personnel, pose a complex challenge for European countries. Working towards an approach to tackle these challenges requires the vision, input and collaboration of multidisciplinary sciences.

In this workshop four perspectives are brought together with the goal to learn from each other’s experiences and to establish a common knowledge base on how to collaborate between different disciplines and sciences to bring PPC to a next level. The first presentation will be from a public health perspective and is about the comparison of actual and desired organization and content of adolescent health services. The second presentation will be a paediatrician’s perspective and stresses the importance of an adequately trained paediatric workforce. The third presentation will be from a sociological perspective and focuses on the societal scale drivers framing health among children and their families. In the final presentation a philosophical perspective will be given on adherence to therapy, resilience and resonance in the treatment triangle of ‘patient-family-therapist’. The presentations will be followed by a round table discussion in which the audience will be involved: the presenters will answer questions and discuss with the audience how we should create better and sustainable PCP by making use of multiple disciplines and sciences.

Key messages

Differences between and within countries regarding the content and organizations of primary care for children might have an impact on important aspects such as access and availability of primary care. Working towards an approach to tackle challenges in paediatric primary care requires the vision, input and collaboration of multidisciplinary sciences.
Children deserve adequately trained doctors
Authors: Illy K
Published: November 2019

Children treated in different European countries continue to have very variable outcomes. Among several factors that might affect these outcomes, organisation of primary care services for children and training programmes for primary care clinicians are likely to be important factors.

Children have an unquestionable right to health, safety, and wellbeing. Children have the right to access the highest possible standards of health-care services and facilities, both in primary health care and when they need specialised care. Any restriction of provision of appropriate care would contradict article 24 of the UN Convention on the Rights of the Child.

Paediatric primary care is an academic and scientific discipline dealing with all issues affecting the health and wellbeing of infants, children, and adolescents from birth to adulthood in the context of their family, community, and culture. The primary clinician, ideally a paediatrician, is the first contact for children until they reach adulthood and is thus responsible for provision of comprehensive and continuing care throughout infancy, childhood, and adolescence.

Paediatric care in both primary care and hospital settings needs special knowledge, ethics, empathic behaviour, and access to services, including disease prevention and health promotion. These aspects are therefore mandatory for all paediatric training both for paediatricians and family doctors.

There should be a structured and accountable paediatric training programme for all doctors providing first-line care to children in primary care. When family doctors provide primary health care close collaboration with paediatricians and adequate continued training in both paediatrics and primary care is advised. Moreover, all children need timely access to professional paediatric advice.
Global trends of chronic non-communicable diseases risk factors
Authors: Di Cesare M
Published: November 2019

Background

One of the global targets for non-communicable diseases is to reduce, by 2025, the rise in global trends of major non-communicable diseases (NCDs). We aimed to estimate worldwide trends in NCD risk factors.

Methods

Data from the NCD Risk Factor Collaboration (NCD-RisC) allowed the analysis of over 128 million children, adolescents, and adults with available information on height and weight, 4.4 million participants with data on diabetes through measurement of its biomarkers, and 19 million adults that had measured the blood pressures.

Results

No changes in age-standardised mean BMI in girls and boys from 1975 to 2016 were registered in eastern Europe, while an increase of up to 1.00 kg/m2 per decade was reported in central Latin America (for girls) and in Polynesia and Micronesia (for boys). Global prevalence of obesity increased from less than 1% in 1975 to 5.6% and 7.8% in 2016 in girls and boys, respectively. In adults, prevalence of obesity increased from 3.2% in 1975 to 10.8% in 2014 in men, and from 6.4% to 14.9% in women. Global diabetes prevalence increased from 4.3% in 1980 to 9.0% in 2014 in men, and from 5.0% to 7.9% in women; the lowest prevalence in 2014 has been recorded in northwestern Europe. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014. Estimation from current trends shows that only a minority of countries (mostly in western Europe) have a 50% or higher probability of halting the rise of diabetes by 2025. Global prevalence of raised blood pressure was more than 20% in both men and women in 2015. Globally, the number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the increase largely in low-income and middle-income countries.

Interpretation

The burden of NCD risk factors is partially due to population growth and ageing. However, lifestyle factors play a crucial role in NCD prevention.
Socio-economic determinants of nutrition transition in Southern European countries
Authors: Iacoviello L
Published: November 2019

Issue/problem

Traditional dietary patterns in southern European countries are changing into less healthy choices, especially among the younger generations.

Description of the problem

There is consistent evidence of a transition from Mediterranean foods preference toward a higher consumption of high-caloric and hyper-processed foods. Potential reasons for the observed nutrition transition or barriers for adopting healthy dietary pattern across the borders of the Mediterranean basin are represented by lifestyle changes, food globalization, economic, and socio-cultural factors.

Results

Emerging socioeconomic inequalities in other domains of healthy dietary behaviors such as dietary variety, access to organic foods and food purchasing behavior seems to affect Southern Mediterranean countries while countries in Northern Europe and some other Countries around the world are currently embracing a Mediterranean-like dietary pattern. A potential cause of this downward trend could be the increasing prices of some food items of the Mediterranean diet pyramid. Recent evidence has shown a possible involvement of the economic crisis, as material resources becoming strong determinants of the adherence to the Mediterranean diet just after the recession started in 2007-2008 in part of Europe. Undesirable dietary modifications possibly linked to the current economic crisis were mainly reported by lower socioeconomic groups.

Interpretation

Traditional healthy dietary patterns have become socioeconomically patterned, and the prominent role of financial over cultural resources in determining the adherence to this pattern should be taken into account. The current economic crisis represents a major health threat for the general population but in particular for the most vulnerable socioeconomic groups, possibly leading to wider gaps in terms of risk/protective factors across socioeconomic categories.
Workshop: Access to health services in health systems providing universal coverage
Authors:   Organised by: French National Institute of Health and Medical Research Chair persons: Olivier Grimaud - France, Helmut Brand - Netherlands
Published: November 2019

Universal health coverage (UHC) is part of the global WHO strategy to improve health. UHC and equity in access to care fall within the shared principles and values of EU health systems. However, as reported in 2016 by the Expert panel on effective ways of investing in health (EXPH), significant amount of unmet needs persisted both between and within EU member states. Access to health services encompasses the dimensions of affordability, user experience and availability of services with potential barriers arising at individual, providers or health systems levels. Health needs are constantly evolving as a consequence of population ageing and of health care technology development. Consequently access to care does not simply mean availability of a single component of care, but rather to an array of pertinent, coordinated, cost-effective and timely primary and specialized health and social interventions.

Measuring performance in that respect is beyond the ability of commonly used “national level” indicators of access. Available research suggests that achieving ubiquitous access to optimal care across territories and populations (eg socioeconomic groups) is hard to achieve. This applies to the whole spectrum of health interventions, from preventive care such as immunizations to multidisciplinary interventions required for the management of chronic diseases. In this context, the workshop proposes to present examples of policy initiatives and results from research projects focusing on access and use of health care conducted in a variety of settings. The aims are to share knowledge about methods used in measuring variations of access, to improve understanding of their determinants and to identify avenues for improving performance.

The workshop is proposed by a multidisciplinary and international group of research teams. It will start with a short introduction from the chair (5 minutes, Olivier Grimaud) followed by five presentations (10 minutes) addressing the issues of variations in access and use of care from different research teams and in a variety of settings. The first presentation will report on an innovative policy aiming at improving UHC in India. The following presentations will illustrate the challenges of providing access in high income countries, including, Scotland, France and Australia. In the last part of the workshop (30 minutes) comments from Prof Helmut Brand (former expert panel member of the EXPH) will introduce a general discussion with the audience moderated by the chair.

Key messages

Even when the conditions for universal health coverage are in place, providing equitable access to quality care remains a challenge. Understanding variations in access to care would help improve performance and equity.
Reflections on life-course vaccination: the England experience
Authors: Edelstein M
Published: November 2019

Since the introduction of the expanded programme on immunization in the 1970s, vaccination has evolved from being an intervention of early infancy to being a programme targeting individuals at all stages of life including birth, infancy, childhood, teenage years, pregnancy and adulthood. The UK has been at the forefront of this lifelong approach to vaccination and has introduced vaccines at all stages of life in its national schedule, including vaccination against hepatitis B at birth, Meningococcal disease group B in infancy, influenza in primary school years, Meningococcal disease groups A, C, W and Y in teenage years, pertussis in pregnancy and shingles in older adults. Based on a range of studies conducted by Public Health England, This session will reflect on some of the challenges brought on by the life course approach in the UK including issues of access in different age groups, choosing the right age and settings for vaccinations, age-specific attitudes to vaccination and subsequent communication strategies, and challenges with monitoring a life-course programme.
Striking a balance between accuracy and timeliness in HTA: an elusive task
Authors: Petelos E
Published: November 2019

Issue

HTA is a decision-making tool. Users need high-quality and timely evidence to ensure sound resource allocation and timely access to innovation. High-quality HTA recommendations are time-consuming to generate, requiring high-quality evidence and timely evidence synthesis, as well as mechanisms to ensure timely recommendation release and feasible implementation of guidance.

Description of the problem

HTA submissions, issuing recommendations and implementation guidance oftentimes have no transparent timelines, with high accuracy posing unique challenges for timeliness. We can broadly examine such challenges in the context of methodologies and processes. Accuracy ensures longer-term validity of decision-making, however, HTA should not be used only for new technologies but also revision of previous decisions through timely re-assessment, ensuring obsolete technology disinvestment.

Effects/changes

Through the exploration of models and tools previously implemented across jurisdictions and settings, such as early-warning systems, conditional approvals and horizon scanning, it will be demonstrated that well-defined prioritisation criteria accepted by both doers and users, adequate capacity and sound preparation of stakeholders are all key elements to ensure the highest possible degree of timeliness and accuracy, and to strike a balance between the two. Particular attention will be paid to critical challenges for public health access and delivery, i.e., emerging technologies and complex interventions, highlighting how horizon scanning ought to start at the discovery, rather than development phase and transparency challenges. Technology tracking and mechanisms for standardizing methodologies and processes will also be discussed.

Lessons

Monitoring and evaluating the impact of HTA methodologies and processes in a transparent manner needs to become an inherent part of HTA to ensure existing and future challenges of accuracy and timeliness can be adequately addressed.
Multimodal health promotion – An approach to successful aging
Authors: Gudlaugsson J , Jonsson P , Janusdottir L , Janusson D , Janusson A , Gudmundsson I , Thordarson E , Aspelund T
Published: November 2019

Multimodal health promotion (MHP) is especially relevant for older persons, because of their high rate of disability, functional dependence, and use of healthcare resources. The purpose of this health promotion and research project was to assess the immediate and long-term effects of MHP on functional fitness (FF), body composition (BC), health and quality of live (HQL), and cardio metabolic risk factors (CMRF).

The main objectives of the project are; 1) to promote health of older age groups so they; a) can take part in the future, both better and longer, in the activities of daily life, b) can live longer in an independent residence, c) can prevent or delay entry into residential and nursing homes, d) have the opportunity to work longer in the labor market; 2) to improve the quality of life of older age groups; 3) to reduce government and municipalities expenditures.

The MHP consisted of three 6-month periods with emphasis on daily endurance training and twice-a-week strength training. This was supported by monthly lectures with emphasis on nutrition, use of medicine in connection with training, healthy ageing, mindfulness, goal-settings in old age, endurance, strength and flexibility training, and how to train. The design was a suitable sample with baseline assessment and three 6-month MHP phases.

After each MHP phase, positive improvement was seen in FF, BC, HQL and CMRF. Males and females retained achieved changes and improved further at the end of each 6-month measurement. Our results suggest that regular MHP can improve or prevent decline in functional fitness in older individuals, reduce cardio metabolic risk factors, influence their health and lifestyle and positively affect their ability to stay independent, thus reducing the need for institutional care. MHP is feasible and beneficial in older populations as an integral part of prevention in municipalities and management of chronic age-related disorders.
Early life socioeconomic position and adult systemic inflammation: the role of gene regulation
Authors: Carmeli C , Kutalik Z , Kelly-Irving M , Delpierre C , Bochud M , Kivimaki M , Vineis P , Chadeau-Hyam M , Dermitzakis E , Stringhini S
Published: November 2019

Background

Adverse socioeconomic conditions in childhood affect systemic low-grade inflammation in adulthood. Studies in animals and humans suggest that socioeconomic conditions get under the skin from early life thus contributing to shape pro-inflammatory phenotypes. Although the existence of socioeconomic differences in gene regulation of the immune function have been described previously, no study has so far assessed the extent to which these differences actually explain socioeconomic variations in inflammatory markers.

Methods

First, we ran 2-sample Mendelian Randomization (MR) methods to identify putative genes whose expression drives C-reactive protein (CRP) levels in blood. We used two databases with summary statistics of associations between single nucleotide polymorphisms and gene expression (eQTLGen, N = 31,486 individuals) and CRP (CHARGE, N = 148,164 individuals) in blood. We tested 10,701 genes and retained those with FDR<0.05. Second, we used individual-participant data from a Swiss population-based study (SKIPOGH, N = 723) to estimate the proportion of the effect of paternal occupational position (SEP) on low-grade inflammation in adulthood (CRP>3mg/L) mediated by the selected genes. We estimated odds ratios and mediated proportions through counterfactual-based mediation models.

Results

We identified 426 genes driving CRP levels (robust to unmeasured confounding thanks to MR). They jointly mediated the effect of low father’s occupation on inflammation in adulthood for a proportion up to about 70% [95% confidence intervals (CI) 11-90%] and with an odds ratio of 1.53 [95% CI 1.05-2.15] compared to individuals with high paternal SEP. Analysis of the effects of life-course SEP trajectories (upward, downward and stable low from paternal to adult SEP) on gene regulation revealed trajectory dependent effects.

Conclusions

We suggest that adverse childhood SEP affects systemic inflammation in adulthood through a long-lasting effect on gene regulation.
A methodology for monitoring population health literacy in Europe – the HLS19 project
Authors: Pelikan J , Nowak P , Bobek J
Published: November 2019

Health literacy (HL) matters for health of people and for use and results of health care. Therefore knowledge on HL is relevant for evidence based health policy. But there is evidence on considerable variation of distributions and associations of HL between European countries. Furthermore HL is impacted by health promotion and health care policy interventions. Therefore it makes sense to monitor HL in each European country on a regular basis in a standardized form that allows for benchmarking between countries. A first European Health Literacy Survey (HLS-EU) in 2011 in eight member states supported by the European Commission introduced measurement of population HL in Europe. Based on the results of this survey WHO-Europés “The Solid Facts - Health Literacy” (2013) recommended institutionalized regular measurement and monitoring of HL.

To implement this recommendation in 2017 the Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was initiated under the umbrella of the European Health Information Initiative (EHII) by WHO-Europe, with already 25 countries participating. From its beginning M-POHL combined a policy with a research agenda and developed a documents on it vision and mission: The Vienna Statement on the measurement of population and organizational health literacy in Europe (2018).

As a first project the European Health Literacy Survey 2019 (HLS19) has been planned and implemented. Based on the comprehensive concept and definition of population HL and the design and questionnaire of the HLS-EU study a common study design and a further developed instrument has been developed by representatives of 15 participating countries. Most import measurement of digital HL has been included into the HLS19 study and a new short form HLS-Q12 of the HLS-EU47 has been constructed. The presentation will give an overview on the research questions, the design and the instruments, the pretesting and the data collection of HLS19.
ED visits and hospital admissions of foreigners for psychiatric disorders in Rome from 2007 to 2018
Authors: Nardi A , Migliara G , Angelozzi A , Caminada S , Giffi M , Isonne C , Pirro F A , Bertazzoni G , Villari P , Vito C De
Published: November 2019

Background

First generation immigrants are at high risk of psychiatric disorders (PD). Moreover, cultural and migration related factors can act as barriers in the access to care. The aim of this study was to analyze the emergency department (ED) visits and the subsequent admissions to Umberto I, a large teaching hospital in Rome, for PD from 2007 to 2018 and to highlight the differences between Italian citizens and foreigners.

Methods

Adult patients were divided in 11 Nationality Groups (NGs). Basing on ICD9 codes, PD were classified in 5 categories: psychotic, mood, anxiety, personality and substance abuse disorders. Descriptive statistics were conducted for gender, age, educational level and triage. Poisson regression models, adjusted for sociodemographic variables, were used to estimate incidence rate ratios (IRRs) of different NGs, both for visits and hospital admissions, for the five psychiatric categories and for PD as a whole.

Results

In the period of interest there were 11,965 ED visits for PD, of which 19.2% made by foreigners. Compared to Italians, all NGs showed higher percentages of ED visits for PDs, except for Southern Asian (SA) and East-Southern east Asian (ESA); SA and ESA, together with Other Africa population, showed also higher proportion of psychosis. Regarding admissions, ESA had the highest percentage overall, while more than half of foreigner nationality groups had higher percentages of admissions for psychosis than Italians. Poisson regressions showed that only EU citizens have greater risk of ED visit (IRR 1.69, IC95% 1.46-1.96) and of hospital admission for PD (IRR 1.23, IC95% 1.02-1.49) than Italians, while Romanians, SA and ESA have lower risk.

Conclusions

Different risk in ED visits for PDs among NGs can be due to heterogeneity in psychopathology, cultural factors, barriers, and migrant status. More studies are necessary to better understand the needs of foreigners and to enhance their mental health service use.

Key messages

The risk of ED visit and hospital admission for psychiatric disorders differ among foreign populations. Different study design are needed to understand which cultural and migration related factors influence the risks, in order to provide more tailored mental health services for high risk populations.
Risk of macrosomia and low birthweight among immigrants in Belgium, a perfect mirror?
Authors: Racape J , Sow M , Schoenborn C , Spiegelaere M De
Published: November 2019

Background

Both low birthweight (LBW) and macrosomia are associated with increased risk health conditions but risk factors of macrosomia among immigrant are understudied. One hypothesis is that some migrant groups at high risk for LBW have correspondingly low risk for macrosomia, and vice-versa. Our objective was to analyze LBW and macrosomia among immigrants according to naturalization, time since naturalization and socioeconomic status in Belgium.

Methods

The data came from the linkage between the Brussels birth and death registers, the national register of migrant trajectories and the social security register for the years 2004-2010. We used logistic regression to estimate the odds ratios of the associations between LBW and macrosomia according to maternal nationality and time since naturalization, taking into account socioeconomic status (SES), parity and maternal age.

Results

Data relate to all singleton births among Belgian, Maghrebi, Sub-Saharan African and Turkish women (n = 76 312). Compared to Belgians, we observed lower risk of LBW but higher risk of macrosomia among Maghrebi women (p < 0.0001). Among Turkish and Sub-Saharan African mothers the risk of LBW is higher than the Belgian (p < 0.001) but the risk of macrosomia is similar to Belgian mother. The results show a U-shaped increase of LBW and decrease of macrosomia with time since naturalization for all migrant groups. Results did not change after adjustment with maternal characteristics and SES. In parallel, we observe an improvement of SES among all migrant groups.

Conclusions

Our results show an increase of LBW rates and a decrease of macrosomia among Maghrebi, Sub-Saharan African and Turkish women with time since naturalization. The risk of macrosomia completely mirrors the risk of LBW for Maghrebi mother but not for Sub-Saharan African and Turkish women. Further studies would help to better explain risk factor and social determinants of macrosomia among immigrant.

Key messages

We observed an increase of LBW but a decrease of macrosomia with time since naturalization among immigrants. Patterns of macrosomia do not completely mirror those of LBW among different migrant groups.
The health situation of children and adolescents with migration background in Germany
Authors: Santos-Hövener C , Kuntz B , Frank L , Koschollek C , Ellert U , Hölling H , Thamm R , Schienkiewitz A , Lampert T
Published: November 2019

Introduction

Although more than one third of minors living in Germany have a migration background (MB), valid data on the health of this population are still lacking. The German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS wave 2, 2014-2017) provides population-based data to make reliable statements on the health of adolescents with and without MB.

Methods

Survey data from KiGGS wave 2 are used to describe the general health status, mental health and the prevalence of allergic diseases in 3-to 17-year-old children and adolescents (n = 13,568). To determine overweight, body height and weight are measured (n = 3,463). In addition to MB (without/one-sided/two-sided), the socio-economic status (SES) and the length of stay of the parents in Germany are taken into account.

Results

Children and adolescents with two-sided MB show a physician-diagnosed atopic dermatitis (3.5%vs.6.9%) and attention deficit hyperactivity disorder (ADHD) (1.5%vs.5.1%) less frequently than their peers without MB, but more often a moderate or poor general health status (6.1%vs.3.9%). Adolescents with two-sided MB are also more often affected by overweight than those without MB (22.1%vs.12.2%). If only participants with MB are considered, their health situation is often associated with the SES and partly also with the length of stay of the parents.

Discussion

Health differences between children and adolescents with and without MB vary by the observed indicator. The heterogeneity of children and adolescents with MB, which can be partly determined by the SES or the length of stay of the parents, should be considered in target-group-specific interventions.

Main messages

The vast majority of children and adolescents in Germany grow up healthy and a MB is not per se associated with a poorer health status. Our results suggest that considering MB as the sole determinant of health to reflect the impact of migration on health is insufficient.

Key messages

Migration background is not per se associated with a poorer health status. Socioeconomic status and parents’ length of stay are derminants associated with poorer health outcomes among children and adolescents with migration background.
Cloud-computing and precision medicine: Big data offers big opportunities
Authors: April A
Published: November 2019

Research on large shared medical datasets and data-driven research are gaining fast momentum and provide major opportunities for improving health systems as well as individual care. Such Open Data can shed light on the causes of disease and effects of treatment including adverse reactions side-effects of treatments, while also facilitating analyses tailored to an individual’s characteristics, known as personalized or precision medicine. Precision medicine treatments will take personalization to the next level and be effective for individual patients based on their genomic, environmental, and lifestyle factors. High-throughput sequencing technologies and open databases have made precision medicine possible but up to now only large research centres could handle the large scale technology needed for its processing. Aside from issues such as user trust, data privacy, transparency over the control of data ownership, and the implications of data analytics for personal privacy with potentially intrusive inferences, recent advances by Berkeley using open source Big Data technologies and Cloud Computing Services has allowed precision medicine studies to be conducted by small and agile research labs and researchers around the world.
Association between legal status, prenatal care utilization, severe perinatal and maternal morbidity
Authors: Eslier M , Schmitz T , Luton D , Mandelbrot L , Estellat C , Azria E
Published: November 2019

Background

Some groups of migrant women have a higher risk of inadequate prenatal care utilization (PCU), severe maternal morbidity (SMM) and severe perinatal morbidity (SPM). To better understand this association, our aim was to assess the association between the legal status and PCU, SMM and SPM during pregnancy.

Methods

The analysis was performed in the database of the multicenter prospective PreCARE cohort. All pregnant women registered for delivery in 4 university hospital maternity units in Paris north area from October 2010 to May 2012 were included (N = 10 419). Women whose pregnancies ended before 22 weeks of gestation or who delivered in another maternity unit were excluded (N = 820). Women were distributed according to legal status in 4 groups: non-migrants, migrants with French or European nationality, legal migrants and undocumented migrants. The associations between the legal status and the composite variables of prenatal care utilization, SMM and SPM were tested through multivariate logistic regressions also adjusted for maternal characteristics.

Results

The illegal status was associated with increased risk of inadequate prenatal care utilization [adjusted odds ratio (aOR) 2,52 (2,10 - 3,01)]. Overall, the prevalence of SMM was 3,2 % and SPM 7,0 %. The illegal status was associated with higher risk of SMM [aOR 1,84 (1,21 - 2,79)], especially severe hypertensive disorder of pregnancy [aOR 2,29 (1,19 - 4,40)]. However, no significant association with SPM was found [aOR 1,29 (0,95 - 1,74)]. The sensitivity analysis demonstrates that results do not change after exclusion of women who arrived less than 12 months before delivery and those who started their follow-up after 14 weeks of gestation.

Conclusions

The illegal status was associated with an inadequate prenatal care utilization and a higher risk of SMM, especially severe hypertensive disorder of pregnancy.

Key messages

The illegal status was associated with increased risk of inadequate prenatal care utilization. The illegal status was associated with higher risk of severe maternal morbidity during pregnancy.
Degree of consistency of parental dietary and sedentary behavior rules as indicators for overweight
Authors: Ruiter E L M , Fransen G A J , Kleinjan M , Molleman G R M , van der Velden K , Engels R C M E
Published: November 2019

Background

To increase our understanding of the effect of parenting on the child’s likelihood of becoming overweight, we attempted to identify typologies based on how consistently parents apply dietary and sedentary behavior rules, and we examined whether these typologies are associated with energy balance-related behaviors in children and/or with the prevalence of overweight children.

Methods

Data were obtained from a cross-sectional survey of the Community Health Service in Nijmegen, the Netherlands in which a total of 4,865 parents of children aged 4-12 years participated. Data were collected using validated self-report questionnaires. To identify typologies based on how consistently parents apply dietary and sedentary behavior rules, we performed latent class analyses. We then performed regression analyses to examine the correlation between these typologies and socio-demographic characteristics, dietary and sedentary behaviors, and overweight.

Results

Latent class analyses revealed the existence of the following four distinct, stable classes/typologies; parents who have: (1) no dietary behavior rules, plus indulgent sedentary behavior rules; (2) indulgent dietary behavior rules, plus no sedentary behavior rules; (3) overall indulgent rules; (4) overall strict rules. Children of parents with overall strict rules (class 4) had significantly healthier dietary and sedentary behaviors compared to the children of parents in the other three classes. Children 8-12 years of age with parents in class 2 were the most likely to be overweight; compared to the children of parents in classes 1, 3, and 4, the parents in class 2 had the lowest level of education and the higher number of Turkish and Moroccan immigrants.

Conclusions

These results underscore the need for parents to establish strict rules for their children, particularly regarding sedentary behaviour in order to minimize the child’s likelihood of becoming overweight.

Key messages

The results underscore the need for parents to establish strict rules for their children, particularly regarding sedentary behaviour in order to minimize the child’s likelihood of becoming overweight. These results may contribute to making healthcare professionals aware that children of parents who do not apply sedentary behavior rules are more likely to become overweight.
Development of ethical governance framework for an mHealth platform for the management of Parkison’s
Authors: Timotijevic L , Peacock M , Hodgkins C , Egan B M
Published: November 2019

Background

The ubiquity of mobile devices promises to address the need for continuous management of chronic conditions at lower costs. Its rapid expansion, particularly in public health, is currently largely consumer-driven and lacking in acceptable frameworks for its wider adoption into the healthcare systems. The aim of this study is to identify the key parameters to consider in developing a governance framework for a Parkinson’s Disease Management MHealth platform. The Parkinson’s Disease Manager (PDM) system was developed to gather symptom information from patients with PD via wearable devices and a specially designed app and stored securely in a cloud, for use by clinicians, health researchers and policy makers.

Methodology

Twelve stakeholders were interviewed in the UK including clinicians, data managers, the public. First, the participants’ existing views about sharing personal and then specifically health data online were explored. Secondly, participants were introduced to PDM via a diagram and encouraged to explore the risks and benefits of the system with a minimum of guidance. Finally, they were asked what risks they thought might be posed by a series of specific scenarios presented through vignettes and how such issues might be addressed.

Results

Thematic analysis identified eight emerging themes which clustered around two overarching categories: 1. The key challenges of the system identified included: Establishing appropriate governance; Protecting the data; Ensuring sustainability; Building trust; 2. The proposed solutions included: Ethically informed governance; Embedded data custodians; Sustainable funding and engagement; Trust through transparency.

Conclusions

The patient’s heuristic assessment of risks and benefits is mediated by trust, which can be initially gained by association with individuals and organisations already deemed trustworthy and then consolidated and sustained through transparency and delivering on promises.

Key messages

The effective system design, must ensure that standards of transparency, data protection and informed consent are upheld if the coming eHealth revolution is ever to realise its true potential. The use of diagrams and vignettes to support qualitative interviews helped elucidate the importance of balancing protection, utility and sustainability to build and maintain trust.
A cross sectional survey to estimate prevalence of asthma in Reunion Island, Indian Ocean
Authors: Solet J L S , Raherison-Semjen C R S , Mariotti E M , Le Strat Y L S , Gallay A G , Bertrand E B , Jahaly N J , Filleul L F
Published: November 2019

Background

Previous studies on asthma mortality and hospitalizations in Reunion Island indicate that this French territory is particularly affected by this pathology. However, no estimates are provided on the prevalence of asthma among adults. In 2016, a cross-sectional survey was conducted to estimate the prevalence of asthma and to identify its associated factors in the adult population of Reunion Island.

Methods

A random sample of 2,419 individuals, aged 18-44 years, was interviewed by telephone using a standardized, nationally validated questionnaire. Information was collected on the respiratory symptoms, description of asthma attacks and triggering factors for declared asthmatics, as well as data on the indoor and outdoor home environment. “Current asthma” was defined as an individual declaring, at the time of the survey, having already suffered from asthma at some point during his/her life, whose asthma was confirmed by a doctor, and who had experienced an asthma attack in the last 12 months or had been treated for asthma in the last 12 months. “Current suspected asthma” was defined as an individual presenting, in the 12 months preceding the study, groups of symptoms suggestive of asthma consistent with the literature.

Results

The estimated prevalence of asthma was 5.4% [4.3-6.5]. After adjustment, women, obesity, a family member with asthma, tenure in current residence and presence of indoor home heating were associated with asthma. The prevalence of symptoms suggestive of asthma was 12.0% [10.2-13.8]. After adjustment, marital status, passive smoking, use of insecticide sprays, presence of mold in the home and external sources of atmospheric nuisance were associated with the prevalence of suspected asthma.

Conclusions

Preventive actions including asthma diagnosis, promotion of individual measures to reduce risk exposure as well as the development of study to improve knowledge on indoor air allergens are recommended.

Key messages

Individuals with suspected asthma who have not been medically diagnosed have been identified. Consequently, the development of a strategy to improve the diagnosis of asthma on Reunion is recommended. Aerating homes to reduce indoor moisture and mould growth, maintaining hygiene standards through cleaning, limiting the use of spray insecticides and household cleaning sprays at home.
Round table: Toward a better living with schizophrenia
Authors:   Organised by: EUPHA (PMH) Chair persons: Jutta Lindert - EUPHA (PMH)
Published: November 2019

According to the Global Burden of Disease Study, schizophrenia causes a high degree of disability, which accounts for 1.1% of the total DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). In the World Health Report [The WHO World Health Report: new understanding, new hope, 2001. Geneva]. In addition to the direct burden, there is considerable burden on the relatives who care for the sufferers.

The workshop aimed to present and discuss different facets of what could be done for these persons and their families’ members in the light of what has been done in some European countries, which have conducted reforms.

The round table will be introduced by presentations from two countries very much involved in psychiatric reforms which will present their attempts and results: first Italy with its emblematic radical deinstitutionalization model setting up a law to close down the psychiatric hospitals. The to-day situation will be presented underlying the huge diversity across Italian provinces and the dramatic lack of resources in some of them. Second the Portuguese reform will be described with a shift of psychiatric care toward general hospitals and its complete integration into health care catchment areas resulting in a increase of out patient acts among them home visits and a decrease of full time hospital admissions.

Then a French three-year research program that focused on themes that aims to improve the every day well-being of people living with schizophrenia will be presented. This program aimed to provid new insights on their integration from different angles: information about the disease by doctors at diagnostic annoucement, on internet and actions to take on health administrator training against stigmatisation that could be extended to a larger public.

Lastly the program allowed to interviewed face to face up to 67 people: 20 persons with schizophrenia, 20 person with bipolar disorders and 27 close ones to schizophrenic patients. A semi-structured interview collected information on the different aspects of care experiences plus “The Brief Illness Perception Questionnaire” allowed to measure and compare perceptions of the disease. This will allow to present the very positive effects of a program toward family members and patients themselves: “psychoeducation” that is a structured educationnal intervention which provides information and guidelines on how to react with their family member and influences positively the patient’s outcome as the well being of both patient and family members.

Each presentation will extensively be discussed with the attendance and followed by some recommandations

Key messages

Although schizophrenia is a severe disorder much could be done to alleviate the burden on the patients and their family members. Reorganising the care systems trough adequate policies, setting up policies against stigmatisation and providing educational intervention should promote patients and families empowerment.