bluuebunny/crossref_metadata_2025 huggingface dataset:
Sociodemographic inequalities in lifestyle patterns of the population of a large Brazilian city
Authors: Medina L P B , Barros M B A , Barros Filho A A
Published: October 2020

Knowledge of avoidable exposures to noncommunicable diseases from the analysis of health behaviors or practices, and of attitudes and care related to lifestyle is an important strategy in identifying issues emerging to health and opportunities for the prevention of these problems. It was intended to analyze the combination of behaviors related to health, food and lifestyle, identify behavioral patterns and verify the inequalities present in its association with sociodemographic characteristics of the population of Campinas, São Paulo. This is a cross-sectional study conducted in 2014/15 that evaluated 1,205 people aged 20 years or older. From the behaviors regular consumption of raw and cooked vegetables, fruit and beans, consumption of low-fat milk, concern with salt intake, habit of reading food label, concern with the use of pesticides, consumption of organic foods, practice of leisure-time physical activity, consumption of meat with fat, frequent consumption of sausages and soft drinks, current smoking, alcohol abuse and short sleep duration were extracted through analysis factorial by main components. The association of these patterns with the variables gender, age and income were tested. Three lifestyle patterns were identified and nomined. The 'Healthy Advanced' lifestyle pattern was associated with females, the elderly and the best income groups can be identified; the 'Healthy Prudent' was associated with older adults, with the elderly and with the intermediate income segment. The 'Unhealthy' pattern was associated with males, with young people and did not have an association with income. It can be concluded that healthy lifestyle patterns were more present in female groups, with older age and better income level. The less healthy pattern was found more frequently among men and young people. It is noteworthy that this last pattern did not differ between income strata indicating that unhealthy practices may be equally disseminated in these groups.

Key messages

The better lifestyle patterns were more present in female groups, with older age and better income level. The less healthy pattern was found more frequently among men and young people, and did not differ between income strata.
Geospatial analysis of emergency services use for public health assessment and intervention
Authors: Cassourret G
Published: October 2020

The population is increasingly using emergency care services around the world. The underlying interrogation is whether this increase is a consequence from a dysfunction in healthcare provision, from a deterioration in the health status of the population or from socioeconomic determinants.

We performed geospatial analyses with 3-year 1,081,026 Emergency Medical Services (EMS) responses in Paris and its suburbs. Incidence of calls per population and complaints were compared, at the neighborhood level, with demographic and socioeconomic determinants. Associations with characteristics of the health system such as the density of primary care doctors were also studied. Spatial autocorrelations were searched with Moran's I analyses.

We found a positive correlation between the incidence of EMS calls by population for respiratory problems, and the level of poverty as well as the unemployment rate (p < 0.001). There was no significant correlation between psychiatric complaints and socioeconomic determinants. There was a strong correlation between calls for birth or imminent birth by woman of childbearing age and the unemployment rate among women, the unemployment rate overall and household median household income (p < 0.001). There was no correlation between the density of primary care providers and EMS activity by population.

EMS data allowed us to powerfully identify specific socioeconomic determinants of health for a 7 million-inhabitant population at the district level. Results could be used to design and implement tailored public health interventions for maximum impact. The overuse of emergency services does not seem to stem solely from the decrease in the supply of primary care doctors. Innovatively, monitoring the actual use of emergency services could responsively inform policy makers and agencies responsible for prevention and health promotion about the specific needs of the population and the consequences of decisions on the organization of the provision of care.

Key messages

The use of emergency services is a valid metric to evaluate the health status of the population and identify socioeconomic determinants. It gives specific guidelines for public health interventions. Geospatial analyses can efficiently identify the specific needs of a population at the neighborhood level. It can participate to the evaluation of the organization of healthcare provision.
Are contextual socioeconomic factors associated with diarrhea in Mozambique children under age 5?
Authors: Moreira de Sousa A
Published: October 2020

Background

Diarrhea is still highly prevalent in Mozambique children under age 5, which leads to avoidable morbidity and mortality. Specific socio-economic variables may influence diarrhea prevalence.

Methods

Secondary data analysis with the application of multiple logistic regression models on the data of 10026 living children under age 5 from Mozambique's Demographic Health Survey (DHS) report from 2011. Data were collected from June 2011 to November 2011 and had a household sample size of 13919. RStudio 1.1.442 was chosen as the statistical software to conduct the multiple regression modeling and the graphic representation of the results.

Results

From the 10026 children under age 5, 10.6% of them (1064) had diarrhea in the last 2 weeks. The prevalence of diarrhea during that period was 1.25 times higher in the urban areas in comparison with the rural areas (adjusted OR [95% CI]: 1.25 [1.03-1.52]). Households with a higher number of children had 12% less risk, per children's group (adjusted OR [95% CI]: 0.88 [0.80-0.96]). No increased risk of diarrhea was found for other variables, including sanitation, source of drinking water and refrigerator presence.

Conclusions

Urban areas and Households with fewer children are more likely to have a higher diarrhea risk while adjusting for other variables. It is important to notice that WASH variables such as sanitation and source of drinking didn't seem to lower diarrhea risk in Mozambique's context. Further research should take into consideration a greater sample and identify other possible reasons that may explain the high prevalence of diarrhea.

Key messages

Several factors may influence the prevalence of diarrhea in Mozambique. Beside the existence of sanitation infrastructure, there maybe be the need to improve its quality.
The Girls Active Project: a school-based intervention to increase adolescent girls’ physical activity
Authors: Mc Quinn S , Belton S , Staines A , Sweeney M
Published: October 2020

Background

National and international evidence indicate that adolescent's physical activity (PA) participation rates are low. In Ireland, 93% of adolescent girls (vs 86% boys) do not reach recommended PA guidelines for health. Literature indicates that socio-economic status is a predictor of PA participation. The aim of this study was to work with a socio-economically disadvantaged school in Dublin (Ireland) and, using the behaviour change wheel (BCW) framework, design the components of a school-based intervention to increase adolescent girls' PA levels.

Methods

A circular development process was undertaken to collectively design the intervention in accordance with the steps recommended by the BCW. One all-girl, socio-economically disadvantaged post-primary school was invited to take part. Public and Patient Involvement (PPI), alongside a cross-sectional, mixed-methods study design, was used to identify the barriers and facilitators to PA using both quantitative questionnaires, and three semi-structured focus groups.

Results

Girls (n = 287) felt they would be more active in school if they had 'more time to do it' and they 'developed a habit of doing it'. The qualitative data identified influence of their peers, beliefs about their capabilities, setting goals and lack of reinforcement as additional themes. Just 1.4% of students in this sample self-reported meeting the recommended PA guidelines. The BCW design process, informed by the data, PPI members and research team resulted in the selection of specific intervention functions and behaviour change techniques.

Conclusions

The PA levels of adolescent girls are far below recommended guidelines for optimum health. Helping schools to fulfil their PA promoting role should be a public health priority. The BCW provided a systematic framework for developing a PA school-based intervention. The feasibility and preliminary efficacy of the Girls Active Project will be examined.

Key messages

Physical activity levels of adolescent girls in Ireland are far below recommended guidelines for health. Using Public and Patient Involvement, and the Behaviour Change Wheel provided a well-founded framework with which to develop a school-based intervention to improve Physical Activity levels.
Health promotion program in regular primary school “We Learn to Accept Diversity”
Authors: Skes M , Polić-Vižintin M , Šostar Z , Hladki Z
Published: October 2020

Background

One of the main goals of National Strategy of Equal Opportunities for People with Disabilities from 2017 to 2020 is the encouragement of their full participation in education, family and community life. According to Croatian Register of People with Disabilities, 86,274 people with disabilities live in the City of Zagreb in 2019. That accounts for 10.8% of the total population of the city, of which 10.1 % is under the age of 19. In the school year 2019/2020 in 110 regular primary schools, 4,035 children with disability were included.

Objectives

The aim of this project is to educate students, parents, staff and experts in education system in health literacy skills about the categories of disability types, how to appropriate communicate and support them to realize their opportunities, to reduce of stereotypes regarding children with disabilities, fight against discrimination and stigma.

Results

Andrija Stampar Teaching Institute of Public Health in partnership with City office for Social Protection and People with Disabilities carries out the project “We Learn to Accept Diversity” - Creating a Healthier life for Children with Disabilities in elementary school in the City of Zagreb. In the period from 2018 to 2019, a total of 24 health workshops were conducted through which 525 pupils were educated. The results of students’ creative expression are integrated into the educational brochure “How can I help You?”.

Conclusions

A disabling condition or diagnosis of impairment does not define individuals, their abilities and talents, or health status and health behaviors. The final evaluation with extremely positive reactions of professionals and students in these primary schools, indicated that the program should become an integral part of school prevention programs and implement expend to the other primary schools.

Key messages

It is important to expand the knowledge base and raise awareness of health determinants for children with disabilities in health promotion activities. Health sector should promote, analysis, advocate and continue educate for healthier lifestyle children with disability, but community and policy are to support and complement the actions.
The epidemiology of polypharmacy in a large cohort with linked health records in Scotland
Authors: Khezrian M , Murray A D , McNeil C , Johnston M , Myint P K
Published: October 2020

Background

Our understanding of the potential harm of taking multiple medications in older, multi-morbid populations is limited. We aimed to investigate the prevalence of polypharmacy and its association with hospitalisation in a large cohort with linked health data.

Methods

Prescription data and hospital admission records of the Aberdeen Children of the 1950s (ACONF) Cohort were extracted from the National Health Services Scotland database and linked from 2011-2016. We estimated polypharmacy by measuring monthly drug exposure for 1) total number of prescribed medications and 2) total number of defined daily doses (DDDs). Cox proportional hazard models (adjusted for demographics, socioeconomic circumstances and health conditions) were used to examine the association of polypharmacy and hospitalisation.

Results

Prescription records were linked for 8,713 cohort members. Mean age at baseline was 58.5 years (SD = 1.5) and 50% were female. 1,994 individuals (23%) had at least one health condition and 8% of population had multimorbidity. The proportion of cohort with polypharmacy assessed using taking 5+ medications and taking 5+ DDDs at baseline were 12.7% (female=12.6% vs male=12.7%, P = 0.179), and 15.5% (female=13.8% vs male=17.1%, P < 0.001) respectively. Of all the cohort, 4,365 admitted to hospital (mean follow-up of 3.5 years, total 30,269 person-years). Adjusted hazard ratios for hospitalisation were 1.51 (95 % CI 1.39,1.64, P < 0.001) for polypharmacy measured by number of medications and 1.40 (95 % CI 1.29,1.51 P < 0.001) for polypharmacy estimated by number of daily doses.

Conclusions

Polypharmacy is independently associated with increased risk of hospitalisation. This association could signify polypharmacy as a risk factor and a marker of poor outcome. Data linkage can generate evidence-based information for future policy and health services to improve polypharmacy measurement and management.

Key messages

Data linkage is a cost effective and contemporary return on the investment in data collection and research in public health. Improvement in evidence to better understand the relationship between polypharmacy and health outcomes should be a priority to optimise treatment in older people with various chronic conditions.
The opioid crisis: 18 years of opioid prescriptions in spine patients
Authors: Calvachi P , Mezzalira E , Boaro A , Duey A , Bolivar F , Mekary R , Smith T R , Aglio L , Gormley W
Published: October 2020

Background

The US opioid epidemic continues to afflict patients and the healthcare system. Surgery remains a risk factor for opioid misuse, and treatment of low back pain in orthopedics and neurosurgery is one of the largest introductions of opioids into the community. The objective of the study is to understand how opioid prescribing practices for spinal surgery have evolved in two academic hospital in the last 18 years.

Methods

Data were obtained from the Research Patient Data Registry for Brigham and Women's and Massachusetts General Hospital from January 2000 to December 2018. Patients included had a primary diagnosis of degenerative diseases, trauma, spinal infection, spinal deformities, or spinal pain symptoms/syndromes; were aged > 18 years; and had an opioid prescription. Covariates included demographics, diagnoses, comorbidities, procedures, opioid type, number of prescriptions, route of administration, doses and length of prescription.

Results

A total of 38,250 patients with spine-related diagnoses received an opioid prescription. The median age was 63 years (18-107), 50% male and 86% white. A total of 32,304 patients (84.4%) received at least one opioid prescription during their hospitalization. The sum of opioid prescriptions filled (inpatient and outpatient) were 889,868 between 2000 and 2018 (55.2% oral, 41.7% intravenous). Oxycodone was the most prescribed. The dose of ≥ 50 morphine milligram equivalents MME/day was reduced from 65.0% in 2000 to 17.3% in 2018, and doses ≥ 90 MME/day dropped from 26.9% in 2000 to 6.4% in 2018. However, the duration of prescription has increased from 4.1% having an opioid prescription for >7 days in 2000, to 21.7% in 2018.

Conclusions

Opioid prescription rates for spinal surgery patients have increased since 2000, declined temporarily in 2016, but are rising again. Physicians are prescribing fewer MMEs per day but have increased longitudinal dosing, which still leaves patients at risk for misuse and opioid use disorder.

Key messages

Between 2000 and 2016 there was an increase of 140 times the number of opioid prescriptions for spine patients. More interventions and non-pharmacological solutions are needed to reduce this public health epidemic.
Health Alliance for Digital Development and Action (HADDA)
Authors: Elmi M
Published: October 2020

SPIDER's Digital Health Programme in Somalia - HADDA - supports Somalia's National Plan for health system strengthening through the use of digital tools for data and knowledge sharing. By deploying and tailoring a Health Information Management System for the country's health system, the programme will enhance the capacity of healthcare workers, whilst enabling policy makers to analyse public health data, plan, manage and deliver quality healthcare for all in Somalia. To realise this, a number of Maternal and Child Health Clinics and referral services will be selected that will connect the entire care pathway in Puntland and Galmudug linking them to the Federal Ministry of Health. Based on the outcome of a needs-assessment in the selected regions, the evidence will determine the required digital infrastructure and human resources and skills necessary for the programme to succeed. SPIDER, in alliance with the Somali government authorities, will engage and mobilise key stakeholders, practically adhering to the digital principles for development for the strengthening of the health system. In tandem with the implementation of project activities, SPIDER will support an independent and ongoing research programme to monitor the outcomes of programme. This will help to improve the methods of application, manage risks, and sustain the results.
WFPHA Immunisation position paper: advocating together for equitable and effective immunisation
Authors: Moore M
Published: October 2020

M. Moore will present the solutions and next steps highlighted in WFPHA position paper to create a sense of ownership by all health professionals to align their efforts and advocacy for equitable and effective immunization.
A model for the capacity building of Somalia midwifery educators through a blended, web-based Master Programme
Authors: Osman E
Published: October 2020

In most low-resource settings maternal and child mortality and morbidity are major public health concerns and closely related to sub-optimal care, and the most cost-effective response is to scale up women's access to quality midwifery care (Renfrew et al., 2014). It is further recognized that midwives educated per international standards, integrated in the health care system, and working in interdisciplinary teams in providing midwifery care could decrease maternal deaths (Renfrew et al., 2014). Somaliregion suffers from a shortage of qualified health care professionals, including midwives, the training of health care professionals is essential for the situation to improve. In this workshop, we will present the implementation of the Master Programme in Sexual and Reproductive Health and Rights in three universities in Somaliland and Puntland as well as the impacts that a net-based program can have on individuals' professional development.
The Roadmap for Action on AMR
Authors: Berg A
Published: October 2020

The speaker will present the perspective of civil society, as well as its extensive work to raise awareness and bring together stakeholders committed to tackling AMR across Europe. The Stakeholder Network on AMR, hosted within the European Commission's Healthcare Policy Platform, along with the resulting Roadmap for Action on AMR will be presented. The speaker will explain how the Roadmap and the key strategies and targets identified encompass a 'One-Health' approach, emphasising that AMR can only be addressed through concerted cross-sectoral actions, ranging from infection prevention, better diagnostics and supporting Member States in implementing National Action Plans. The links between AMR and other EU initiatives such as the emerging Cancer Plan, the Farm to Fork Strategy and the European Green Deal will also be elaborated on. Finally, the role of the European Parliament in ensuring that AMR stays high on the agenda and mobilising Member States to act, will be discussed in the context of a newly established MEP Interest Group on AMR with an ambitious strategic work programme for the Parliamentary term 2019 - 2024.
Factors predicting physical activity and healthy nutrition habits among students in Israel
Authors: Beck H , Tesler R , Moran D , Kolobov T , Harel Fisch Y
Published: October 2020

Background

The World Health Organization has defined school systems as the significant framework for health promotion, because it enables accessibility to most of the child population.

Objectives

To examine the association between health promotion policies of school principals and student-level factors that predict health behaviour patterns: physical activity and proper nutrition.

Methods

This cross-sectional study is based on data from the HBSC (Health Behaviour in School-Aged Children) survey that included 7,000 students in grades 6, 8, and 10 in secular and religious public schools and in Arab schools, and about 126 principals.

Results

The findings of the study indicate: at the student level boys perform physical activity more frequently than girls (B = 0.80, p < 0.01); with increasing age students from a high socio-economic background are more physically active (B=-0.34, p < 0.01); and students in religious public schools perform less physical activity compared to students in secular public schools (B=-0.37, p < 0.01). At the multi-level, implementation of a policy that encourages physical activity is a predictor of physical activity habits at the student level (B = 0.09, p < 0.05). Moreover, findings show that school nutrition policies (OR = 0.89, p < 0.05) and principals' commitment to health promotion (OR = 1.13, p < 0.01) predict healthy eating habits among students. Findings also indicate that students in the Arab sector consume less healthy food compared to students in public schools (OR = 0.54, p < 0.05).

Conclusions

The results of the current study emphasize the importance of implementing health promotion policies in schools among principals to improve students' physical activity and healthy eating habits.
Roma child participation in public health policy and practice across Europe
Authors: Larkins C , Jovanovic M , Milkova R
Published: October 2020

Roma teenagers are often excluded from participation opportunities, when they could be informing a wide range of law, policy and practice. CoE and EU recommendations make it clear that improvements in living conditions can only be achieved through active participation of Roma people. The 2018 Roma Civil Society Monitoring report reinforces that 'it is essential for Roma to be involved not only in narrowly defined 'Roma issues', but also in a wider range of topics and policies'. We address the question of what methods enable Roma children to become involved in influencing health policy and service design, focusing on the case of Bulgaria. A qualitative European survey (Feb - June 2020) in English, French, Spanish and Bulgarian identified professional perspectives on the impact of COVID-19 on children, with a focus on Roma families. Case studies of Roma children's experiences, and examples of their participation, were analysed of these case studies was conducted by the authors (combining sociological, public health and community perspectives). Accuracy of emergent findings were assessed through dialogue with survey participants. Preliminary results indicate that participatory practices that enable Roma children's participation in designing public health policy, services and responses are limited and pre-existing inequalities are deepening. However relevant isolated examples of inclusive participation were identified: information design, peer-administered questionnaires, arts-based activities, dialogue events, and campaigning in Bulgaria and beyond. Inclusive methods that enable Roma teenagers' engagement in health policy and service design are closely tied to methods used with other communities facing discrimination. However, significant structural barriers, related to economic inequalities and anti-gypsyism are additional barriers faced by some Roma children. International exchange of examples of such practices could inform future health promotion practice.
Needs-based decision-making for municipal health promotion – an analysis across 13 European countries
Authors: Quilling E , Kuchler M , Leimann J , Dieterich S , Plantz C
Published: October 2020

Introduction

In contradiction to many recommendations, municipal health promotion often does not address identified needs. In order to create healthy living environments, all the 13 countries participating in Work package 6 - healthy living environments (WP6) of the EU Joint Action Health Equity Europe have been implementing feasible actions since autumn 2019 based on a country-specific needs analysis. They were supported on a theoretical level by the contents of the WP6 Implementation Template. The aim is to find out if and how the decision-making process from needs-based planning to the implementation of these measures in municipal health promotion was successful.

Methods

In order to gain an insight into the process 'from needs to action' and to obtain information about the methodological approach to implementation, guideline-based interviews were conducted with the project partners of WP6. These, as well as accompanying questionnaire-based interim reports, were evaluated comparatively in terms of content analysis according to Mayring and with regard to concrete evaluation criteria, obstacles and success factors during individual steps that can be transferred to the Public Health Action Cycle.

Results

The interim reports of the participating countries show that the step from an identified problem and related needs to a concrete, tailored action is often difficult. The relevant aspects mentioned above will be analysed more detailed during the interviews. It is to be expected that further insights can be gained from this, especially on successful implementation processes.

Conclusions

The mix of reports and interviews with participants from different European countries offers a broad view of the decision-making process in local health promotion and makes obstacles and success factors transparent for other actors in this field.
How can corporate HIA help shape regulatory environments for Trans-National Corporations?
Authors: Baum F , Anaf J , Fisher M
Published: October 2020

Background

Transnational Corporations (TNCs) exercise considerable sway over population health. They now comprise 157 of the 200 largest economies in the world and shape our food choices and degree of exploitation of our natural environment. This paper will analyse data from two corporate health impact assessments exercise (food and extractive industries) to determine what government and international agency regulatory actions are required to minimize the health harm causes by the actions of TNCs.

Methods

We used a Corporate Health Impact Assessment (CHIA) framework, data sourced through document and media analyses, and semi-structured interviews to examine the practices of McDonalds in Australia and Rio Tinto in Australia and South Africa. Data were mapped against the CHIA framework's three sections which are: i) the impact of regulatory environments ii) How TNC practices and products impact on health and equity ii) the direct impact of TNCs practices on daily living conditions.

Results

The CHIA exercise indicated an absence of effective international regulation on the actions of TNCs and that national regulatory regimes can encourage more responsible behavior from TNCs, for example in occupational health and safety. We identified the need for a much higher level of global and national regulation to: i) prevent the many conflicts of interest we found ii) reduce the extent to which TNC products are unhealthy iii) enforce healthy employment practices iv) prevent externalization of the costs of TNCs v) prevent taxation minimization.

Conclusions

The study highlighted the ways in which TNCs can use their power and size to maintain a de-regulated environment. Concerted global and national action is required to regulate in favour of human health and safety and that of the environment. Our findings support the need for an enforceable international treaty.

Key messages

Transnational corporations have a massive impact on population health. A health impact assessment can identify the pathways of impact and be used to inform regulatory action to promote health.
Health as an asset: Enhancing personal, social and economic life
Authors: Downward P , Rasciute S
Published: October 2020

Background

Health policy in the UK increasingly advocates health as an asset (Baker, 2014; NHS England, 2019) focussing on the holistic capacity of health to support the wider flourishing of individuals (Hanlon et al., 2011). This research illuminates the cross-cutting impacts of public health investment for the personal social and economic life of individuals.

Methods

An observational longitudinal study based on data from the British Household Panel and Understanding Society Surveys covering 25 years from 1991 is undertaken. Satisfaction with partners, subjective financial situation and levels of structural social capital are regressed on measures of general subjective health and the GHQ12 score of mental health and confounders. A fixed effects instrumental variable panel data estimation identifies causal effects.

Results

With a significance level of at least p < 0.05, mental illness reduces satisfaction with personal relationships for males (n = 115,273). For males and females, both greater general subjective health and mental health improve feelings of coping financially (n = 329,282) and social capital (n = 150,298).

Conclusions

Changes in sets of health conditions, acting through general and mental health, produce cross-cutting impacts on personal, social and economic outcomes. These findings support the proposition that health is an asset and that both further analysis and prioritisation of greater coordinated deployment of health care assets in communities is needed.

References

Baker, D. (2014). Developing and implementing a robust asset-based approach to public health. Perspectives in Public Health, 134(3), 129-130.

Hanlon, P., Carlisle, S., Hannah, M., Reilly, D., & Lyon, A. (2011). Making the case for a “fifth wave” in public Health. Public Health, 125(1), 30-36.

NHS England. (2019). The NHS Long Term Plan - a summary, 2.

Key messages

Health can be viewed as an asset comprising of a range of conditions that can have causal impacts on the personal, social and economic lives of individuals and their wider flourishing. Harnessing health as an asset requires the development of greater integrated health care, social and individual support to capitalise on the cross-cutting impacts of health.
Conceptualization of Othering in public health
Authors: Akbulut N , Zick A , Razum O
Published: October 2020

Background

Othering refers to various constructed notions of belonging and creates boundaries between Us and Them, which is embedded in power relations. Othering, thus, provides an essential contribution to understanding the link between minority status and health inequalities. So far, Othering is not considered in explanatory models on health inequalities; one reason for this is that Othering for this field of research has not yet been sufficiently investigated either theoretically or empirically. Also, there is no systematic concept that provides well-founded knowledge of the mechanisms of Othering.

Methods

A theoretical-analytical investigation was carried out to establish Othering as an analytical concept in public health research. The use of the term Othering varies among research areas. A theoretical framework was developed by drawing insights from a socio-psychological, postcolonial, and intersectional theory. After fundamental differences and similarities of the different theoretical approaches have been worked out, Othering was conceptualized as a multidimensional construct.

Results

Othering affects health in different ways as it occurs in multiple dimensions and forms that vary according to marginalized groups and institutional as well as social contexts. Othering takes place as a semantic differentiation between Us and Them and constitutes a material hierarchy within a dominant order of belonging. On this basis, Othering has an inclusive effect by treating Others as a particularly vulnerable group and then offering support to them. Othering also creates social exclusion and reinforces disparity in material resources of othered groups. Exclusions of the Other affect access to material resources such as health, for example, by legitimizing restrictions and access barriers in health care.

Conclusions

The developed conceptual framework provides an analytical lens through which the relationship between Othering and public health can be further explored.

Key messages

Othering refers to various constructed notions of belonging and difference that engender marginality and structural inequality. Othering can be considered as an essential social determinant of health.
Sustainable Development Goal 3.4: Regional disparities in cancer premature mortality in Brazil
Authors: De Camargo Cancela M , Borges Lopes de Souza L , Leite Martins L F , Correa Schilithz A , Bezerra de Souza D L , Hanly P , Barchuk A , Soerjomataram I , Sharp L , Pearce A
Published: October 2020

Background

The Sustainable Development Goal 3.4 has a target of 1/3 reduction in premature mortality (30-69 years) from chronic noncommunicable diseases. Although cancer is a chronic disease, it comprises more than 100 different conditions, with different risk factors and prognosis. This study aimed to calculate current and predicted premature mortality by 2030 for Brazil and regions, compare with SDG 3.4 target and identify regional progress and future needs.

Methods

Mortality data were extracted from the National Mortality Information System of Brazil (SIM) and subsequently corrected for ill-defined causes. Crude and age-standardized mortality rates per 100,000 inhabitants were calculated. NordPred package by software R was used to calculate predictions up to 2030 and compared with the goal of 1/3 reduction of premature deaths.

Results

Comparison of observed (2011-2015) and predicted (2016-2030) mortality rates show a 12.0% reduction in the likelihood of death among men and 4.6% among women nationally. Although predicted rates for 2026-2030 are lower than those observed in 2011-2015 predicted number of deaths increases by 75,341 for men and 90,513 for women. Lung cancer mortality rates are predicted to decrease more among men than women, while colorectal cancer mortality will increase for both sexes, in all regions (except in the Southeast).

Conclusions

The profile of premature cancer mortality is diverse in Brazil. Nationally, only male lung cancer will be close to reaching SDG 3.4 target, endorsing government's long-term efforts to reduce tobacco consumption. The increase in colorectal cancer mortality reflects the epidemiological transition. Despite progress in cervical cancer control, it will continue to be a major challenge. Our results provide a baseline for public policies for both prevention and access to treatment to reduce premature mortality in Brazil. Differences in mortality patterns highlight the need to adapt cancer prevention policies regionally.

Key messages

Cancer premature mortality decrease in Brazil is expected to occur, but far from the SDG 3.4 target – including preventable cancers as cervical cancer. An increase is expected to occur in colorectal premature cancer mortality rates and strategies to face it need to be developed regionally.
Are we on track reaching SDG3 in 2030? Gap analyses for African & European countries including Russia
Authors: Laaser U , Bjegovic-Mikanovic V
Published: October 2020

Background

To reach the targets of SDG3 not more than a decade is left. How do the Low and Middle-Income Countries in Northern Africa - in the immediate neighborhood to Europe - compare to the 15 members of the Economic Community of West African States (ECOWAS), and well-developed European countries around the Baltic Sea (the “Northern Dimension”) incl. Russia?

Methods

We used quantifiable mortality indicators and targeted reductions until 2030, as published for SDG3.1/2/3 by the United Nations in 2015. To estimate progress or delay we used the methodology of the United Nations Development Program (UNDP) based on the target year 2030, a year of observation, and a year at baseline. For the comparison between Northern Africa/Northern Europe we calculated for indicator 3.3 the Premature Years of Life Lost (PYLL) and for the comparison of Northern/Western Africa the more sensitive indicators 3.1 and 2, the Maternal Mortality Ratio (MMR), the Neonatal Mortality Rate NMR, and the under-five Mortality Rate (<5MR).

Results

In Northern Africa, only Algerian and Morocco will achieve the 2030 target 3.4 in time i.e., 2.5 and 7 years in advance, whereas Egypt, Libya and Tunisia are in delay Mauretania even by 14.5 years. The countries around the Baltic Sea likely will achieve the targeted reduction before 2030, Estonia on top already 2025, followed by Latvia and Finland in 2026, and the Russian Federation in 2027. Among the 15 West African states, Capo Verde has reached the targets 3.1 and 2 already, followed by Senegal (e.g., 4.0 years in advance for <5MR) and Ghana, whereas Guinea Bissau is positioned at the end with a delay of 4,2 years for MMR. The countries of Northern Africa are on track except for Algeria, with 6.2 years in delay for MMR and Mauretania for all indicators.

Conclusions

Whereas the European countries are well in advance of the SDG targets, Northern Africa shows a mixed picture and the countries of Western Africa with a few exceptions are in delay.

Key messages

European countries around the Baltic Sea and Russia are well on track for SDG3, reducing their premature mortality by one third until 2030. Whereas the European countries are well in advance of the SDG targets, Northern Africa shows a mixed picture and the countries of Western Africa with a few exceptions are in delay.
Does the NHS Diabetes Prevention Programme prevent diabetes? A population-based matched cohort study
Authors: Nguyen V , Aldridge R , Blackburn R , Hayward A , Greaves F , Flowers J
Published: October 2020

Background

To reduce the incidence of type 2 diabetes (T2DM) in England, the National Health Service piloted the Diabetes Prevention Programme (DPP). The DPP aims to prevent T2DM by providing high-risk adults with access to 13 face-to-face sessions over nine months that focus on diet and weight management. The DPP has been shown to improve intermediate outcomes for T2DM prevention (weight loss and glycated haemoglobin (HbA1c) reduction). However, there is a lack of evidence examining incident T2DM as the outcome.

Methods

We conducted a retrospective observational cohort study using linked electronic health records from primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care for June 2016 to January 2019. We compared rates of new T2DM diagnoses among eligible adults who were referred to the DPP with rates for propensity score-matched (ratio of 1:4) controls who were eligible for the DPP but were not invited. DPP eligibility was defined as having HbA1c levels of 42-47 mmol/mol or fasting plasma glucose (FPG) levels of 5.5-6.9 mmol/L. Adults with pre-existing T2DM were excluded. Time to the first record of T2DM was modelled using Cox regression with age, alcohol intake, body mass index, ethnicity, sex, HbA1c, index of multiple deprivation and smoking status included as covariates.

Results

We identified 2205 individuals who participated in the DPP and 8820 matched controls with a similar breakdown in age, sex, HbA1c and FPG. During the 2.5-year study period, 4.13% of DPP individuals developed T2DM vs 6.42% of controls. Our results indicate that DPP referrals were associated with a 59% reduction T2DM incidence rates [adjusted hazard ratio=0.41;95%CI=0.38-0.44].

Conclusions

This is the first study to investigate the impact of the DPP on T2DM, relative to usual care. Our results provide support for the effectiveness of DPP in preventing T2DM onset and are compatible with findings for similar interventions in other settings.

Key messages

The evidence suggests that providing consistent face-to-face sessions which concentrate on diet and weight management can reduce short-term T2DM incidences in high-risk adults. With a 59% reduction in T2DM rates in DPP referees relative to eligible adults who were not referred, the DPP is effective in reducing short-term T2DM incidences in high-risk adults.
Healthy lifestyles survey in schoolchildren 'Conta Peso e Medida'
Authors: Ferreira J D , Sá A R
Published: October 2020

Background

A healthy lifestyle should be followed since childhood. To do so a healthy diet and to be physically active are mandatory. To measure and improve that the School Health Project “Com Peso e Medida” was applied throughout schools from the ARS Centro region.

Methods

In the context of School Health questionnaires were given out to school children. The questions pertained to health habit. Questions about socioeconomic characteristics were also included. 464 responses were collected. The responses were collected in a database in MS Excel. The database was then run in SPSS to provide a statistical analysis.

Results

All the students were attending the 5th grade. Median age was 10 years old. There was a similar sex distribution with 50.6% males. Mother education was higher than fathers with 24.7% and 15.7% college education respectively. There was a significative association between the parents' education degree (p < 0.01). In terms of meal frequency, the students had a median of 5 meals a day. 93.3% of them had breakfast every day, 66.4% had a morning snack, 83.4% had an afternoon snack and 30.2% had a late-night snack. Considering the ingredients consumed daily only 41.7% ate the recommended amount of daily vegetables and 30.4% the daily amount of fruit. On a different note 28.6% ate candies more than once a week, and 41.5% drank soft drinks more than once a week.

Questions about the physical activity habits revealed that 50.8% watched more than one hour of television every day and 29.1% played videogames more than one hour. 39.2% had no sport activity outside school. There was a positive association between the mother education level and sports practice (p < 0.01) and fruit consumption (p = 0.19).

Conclusions

A healthy diet and regular physical activity are cornerstones in a Health promoting lifestyle. With this study was possible to ascertain the lifestyle of young schoolchildren. With those results it's possible to set futures measures to best improve health.

Key messages

Healthy habits should be developed since early on to give way to a healthy life. To better prepare the future we need to know what health choices the children are taking today.
High to low, low to high: neighbourhood socioeconomic trajectories and birth outcomes
Authors: Burgos Ochoa L , Bertens L C M , Steegers E A P , Been J V
Published: October 2020

Background

A growing body of literature has consistently linked neighbourhood socioeconomic status (SES) with adverse birth outcomes. However, the available evidence is based on cross-sectional indicators of neighbourhood SES, which fail to reflect neighbourhoods' dynamic nature. The objective of this study was to explore the relationship between temporal trajectories of neighbourhood socioeconomic change and adverse birth outcomes.

Methods

The study population consisted of registered singleton births occurred in the Netherlands 2003-2017 between 24 and 41 weeks of gestation (N = 2,335,449). Based on neighbourhood socioeconomic data from The Netherlands Institute for Social Research, we categorized neighbourhoods into longitudinal SES trajectories (e.g. stable, declining, ascending). Multilevel logistic regression models were used to estimate the relationship between neighbourhood SES trajectories and birth outcomes, i.e., preterm birth and small-for-gestational-age (SGA).

Results

Living in a Stable Low SES neighbourhood was associated with higher odds of preterm birth (OR[CI]=1.10[1.06; 1.14]), and SGA (OR[CI]=1.15[1.12; 1.18]), compared to living in Stable High SES areas. Also, women living in a Declining (Middle to Low SES) neighbourhood had higher odds for preterm birth (OR = 1.08[1.03; 1.14]) and SGA (OR = 1.10 [1.06; 1.15]), compared to Stable High SES areas.

Conclusions

Women from neighbourhoods with long-term low or declining SES were more likely to experience adverse birth outcomes. Policies aimed at mitigating the effect of long-term neighbourhood disadvantage or preventing neighbourhoods' decline have potential to benefit early life health outcomes.

Key messages

Women living in long-term low or declining socioeconomic status neighbourhoods were more likely to experience adverse birth outcomes. Our results can provide guidance to policies aimed at improving early life health outcomes.
Age-dependency in mortality of Finnish family caregivers: a nationwide register-based study
Authors: Mikkola T M , Kautiainen H , Mänty M , von Bonsdorff M B , Kröger T , Eriksson J G
Published: October 2020

Purpose

Mortality appears to be lower in family caregivers than in the general population. However, there is lack of knowledge whether the difference in mortality between family caregivers and the general population is dependent on age. The purpose of this study was to analyze all-cause mortality in relation to age in family caregivers and to study their cause-specific mortality using data from multiple Finnish national registers.

Methods

The data included all individuals, who received family caregiver's allowance in Finland in 2012 (n = 42 256, mean age 67 years, 71% women) and a control population matched for age, sex, and municipality of residence (n = 83 618). Information on dates and causes of death between 2012 and 2017 were obtained from the Finnish Causes of Death Register. Flexible parametric survival modeling and competing risk regression adjusted for socioeconomic status were used.

Results

The total follow-up time was 717 877 person-years. Family caregivers had lower all-cause mortality than the controls over the follow-up (8.1% vs. 11.6%) both among women (hazard ratio [HR]: 0.64, 95% CI: 0.61-0.68) and men (HR: 0.73, 95% CI: 0.70-0.77). Younger adult caregivers had equal or only slightly lower mortality than their controls, but after age 60, the difference increased markedly resulting in over 10% lower mortality in favor of the caregivers in the oldest age groups. Caregivers had lower mortality for all the causes of death studied, namely cardiovascular, cancer, neurological, external, respiratory, gastrointestinal and dementia than the controls. Of these, the lowest was the risk for dementia (subhazard ratio=0.29, 95%CI: 0.25-0.34).

Conclusions

Older family caregivers have lower mortality than the age-matched controls from the general population while younger caregivers have similar mortality to their peers. This age-dependent advantage in mortality is likely to reflect selection of healthier individuals into the family caregiver role.

Key messages

The difference in mortality between family caregivers and the age-matched general population varies considerably with age. Advantage in mortality observed in family caregiver studies is likely to reflect the selection of healthier individuals into the caregiver role, which underestimates the adverse effects of caregiving.