bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a strategic plan for sustainable health inequality monitoring – the basic step towards tackling health inequalities in long run
Authors: Lesnik T
Published: October 2020

Slovenia has had periodic reporting on health inequalities for almost a decade. The importance of reporting is well recognised and stated in the National strategy on health care 2015-2025. Yet, the assessment of the status of the national health inequality monitoring system (HIMS) conducted within the Joint Action Health Equity Europe project, made the unsystematic nature of current practices obvious. A need for developing a more systematic and sustainable HIMS and to have a long-term monitoring strategic plan in place was acknowledged.

The set-up of systematic and sustainable long-term monitoring of health inequalities will provide reliable and comparable longitudinal data on the direction, magnitude and trend of health inequalities in Slovenia. This is in turn necessary to inform any future policies and/or programmes, thus stimulating action. Furthermore, identifying relevant stakeholders will facilitate formation of a network of partners who take part in tackling health inequalities, thus allowing for a more proactive (i.e. bridging) role in addressing health inequalities in Slovenia.

The aim of this presentation is to demonstrate the process and the steps taken to prepare a document (strategic plan) detailing a systematic approach to long-term monitoring of health inequalities complete with goals, objectives, methodology, a pragmatic set of indicators and an evaluation plan that will inform and facilitate most reporting/monitoring activities
Brief materials and programmes for children and families who have experienced conflict and displacement
Authors: Calam R , El-Khani A
Published: October 2020

This presentation will provide an overview of a set of materials and programmes designed for families who are living through or have escaped conflict and displacement. Delivery formats include i) brief leaflets giving parenting advice for caregivers; ii) a more extensive booklet and format for a Conversation Group, and iii) a programme designed to address post-traumatic stress in children, Teaching Recovery Techniques (TRT), to which a caregiver and parenting skills module was added, to form TRT+Parenting. Each intervention has been tested or trialled with families living in challenged contexts. The leaflet was distributed to 3000 families via bakeries in conflict zones in Syria. The Conversation Group was trialled for feasibility in Palestine. TRT+Parenting was piloted with Syrian families living on the Turkey-Syria border, and then trialled with 120 families in Lebanon, with teachers and social care workers trained as facilitators. In Syria, 59.5% of 3000 parents returned questionnaires and reported satisfaction with the leaflet despite the study being conducted in a conflict zone and in the context of humanitarian intervention. The Conversation Group proved feasible and acceptable, and caregivers in Palestine gave positive feedback. Children and caregivers showed significant improvements across measures of trauma and mental health, with higher levels of improvement seen in the TRT+Parenting group compared to TRT alone or waitlist. Caregivers who took part in the Plus Parenting component also reported improvement in their own mental health. The results demonstrated valuable improvements across all interventions, and indicate that brief programs can and should be widely used as components of preventive strategies.
2.M. Workshop: Strategies on preventing and responding to violence and injuries among refugees and migrants
Authors:   Organised by: WHO/Europe, EUPHA Migrant and ethnic minority health section, NIHMP (Italy),   Chair persons: Santino Severoni – WHO/Europe
Published: October 2020

Violence, injuries, conflicts and natural disasters are experienced more frequently among migrants and refugees than host population.

The objectives of this workshop are to: improve knowledge and understanding among participants on the magnitude and nature of violence, harms and injuries faced by refugees and migrants during their journeys and upon arrival in countries of transit and/or destination in the WHO European Region;raise awareness of the most vulnerable groups across the WHO European Region;discuss strategies and policies to prevent and properly respond to cases of violence;present the new WHO Technical Guidance on Strategies and interventions on preventing and responding to violence and injuries among refugees and migrants and main recommendations from emerging evidence.

While the target audience includes policy-makers across sectors at local, national and regional levels, it will also be of value for health-care practitioners, as well as law enforcement and border protection officials.

Violence and injuries among refugees and migrants are extremely common and they can take place before departure, during transit and at destination and they can occur for several reasons: boating and traffic accidents, sexual and gender-based violence, exploitation, torture, trafficking, self-directed and collective violence.

Member States have promoted many laws and regulations to prevent violence and protect vulnerable groups among refugees and migrants, however the lack of awareness of such legislative mechanisms and the invisibility of many of the form of violence and injury determine serious problems and challenges as well.

The current political rhetoric regarding refugees and migrants in Member States is contributing to increase the cases of violence and punitive attitudes against refugees and migrants.

Key messages

Stakeholders need to strengthen the knowledge base on violence and injury experienced by refugees and migrants and act in accordance with the latest evidence, international norms and standards. States should ensure safe passage, address causes of violence and injuries in transit and destination countries (prevention); identify victims, provide care; investigate and prosecute perpetrators.
How does smokefree policy impact nicotine-related and other prisoner spend (e.g. HFSS foods)?
Authors: Best C , Brown A , Semple S , Hunt K
Published: October 2020

Background

People in custody (PiC) have poor health compared to the general population, in part due to high smoking rates. Scotland's prisons became smokefree in 2018. Rechargeable e-cigarettes became available a few weeks before the removal of tobacco from the 'canteen' (prison shop for PiC).

Methods

Routinely collected weekly 'canteen' purchase data (no of units of given product purchased by an individual by date) were available for 29-7-18 to 31-3-19 (2112638 rows of data, 645 unique products). Products were categorised into: tobacco; e-cigarettes; food/drink; communication; hygiene; NRT; other and graphed as mean/person/week, for 'smokers' and 'non-smokers' (at baseline). Spend by product type pre- and post-implementation was compared in PiC for 31+ weeks over this period, using mixed effects models.

Results

Mean weekly spend for 'smokers' in custody for 31+ weeks over the pre-post ban comparison period (n = 2541) decreased from £21.36 to £19.80; mean weekly nicotine-related spend reduced from £6.64 (pre-) to £5.55 (post-) (p < 0.001), but showed an increasing trend in nicotine-related spend (£0.08/week) post-ban. No changes were seen for 'non-smokers' (n = 342) overall) or in nicotine-related spend. Trends in mean spend for other products remained flat, suggesting positive transfers of spend noted in qualitative interviews over a comparable period were not evident at population level.

Conclusions

Whilst there are benefits of removing tobacco from prisons, for staff and PiC, previously heavy smokers may find (mandated) tobacco abstinence difficult. Some jurisdictions have made e-cigarettes available to support people quitting/managing without tobacco, but long-term implications of e-cigarette use in this population are as yet unknown. When the introduction of smokefree policy is facilitated by the introduction of e-cigarettes, nicotine spend by PiC may remain high; the implications for whether or not PiC return to smoking on release from custody are unclear.
Economic impacts of implementing a national smoke-free prison policy
Authors: McMeekin N , Hunt K , Brown A , Tweed E , Pell J , Craig P , Leyland A , Conaglen P , Boyd K
Published: October 2020

Background

Worldwide, over 600,000 non-smokers are killed annually due to exposure to secondhand smoke (SHS); the UK societal cost of SHS is estimated at £700million per annum. Prior to recent smoke free policy in Scottish prisons smoking rates were very high (70-75%), well above population rates, subjecting people in custody (PiC) and prison staff to high levels of SHS. Eradicating SHS exposure in prisons could lead to improved health in previous smokers and non-smokers alike, and decrease demand on the National Health Service. However, to date, there is little evidence relating to the economic impact of smoking bans in prisons.

Methods

An economic evaluation estimating the short-term and lifetime impacts of smokefree prison policy in Scotland policy used data from the TIPs study (Jun 2016-Nov 2019) for prison staff and PiC. The analyses adopted a public health and personal perspective and key resources included: implementation costs, cessation support services, health service use and personal costs. For the short-term analyses data were sourced from TIPs staff and PiC surveys, and routine data from the Scottish Prison Service and NHS National Services Scotland. Outcomes included SHS exposure, staff sickness absence, violent incidents and quality adjusted life years (QALYs). The life-time analysis used a Markov model to estimate cost per QALY for both staff and PiC.

Results

SHS exposure measures show a median reduction of 91%. Costs and economic outcome results (mean cost pre- and post-ban, cost-consequences balance sheet and incremental cost per QALYs) are confidential until May 2020 due to their sensitivity and will be available to present at EUPHA 2020.

Conclusions

Previous economic evaluations have focussed on smoking bans in public places and raising the smoking age. This is the first economic analysis of a national prison smoking ban and analysis will be of interest to prison services in other jurisdictions which have yet to implement smokefree policy.
Twenty-first century capitalism & commercial determinants of health: what are the connections?
Authors: Freudenberg N
Published: October 2020

21st century capitalism (e.g., globalization, financialization, deregulation, privatization, corporate control and deployment of new technologies, etc.) influences people's daily efforts to get food, health care, education, work, transportation and connections to others and thus challenges the search for well being and a decent life. This presentation will provide a systematic and explicit examination of capitalism and its impact on human and planetary well-being. In so doing it will provide a broader perspective that builds on the more focused commercial determinants of health.
The application of Health Technology Assessment to health apps: what is the evidence?
Authors: de Waure C , Giacchetta I , Violi S , Martini C , Favaretti C
Published: October 2020

Background

In the last years, many health apps have been developed to support citizens' and patients' health management. Nevertheless, a thorough evaluation is necessary to support the decision to incorporate them into healthcare systems. Health technology assessment (HTA) could be considered a valid evaluation tool allowing considering different stakeholders' perspectives. This research aimed to look for studies that applied HTA to health apps and to analyze feasibility and limits of HTA in this field.

Methods

A systematic review was performed considering three databases, namely PubMed, Web of Science (WoS) and University of York-Centre for Reviews and Dissemination database. Being the topic of health app assessment new, articles were considered eligible if they assessed at least two of the domains of the HTA core model suggested by the European network for Health Technology Assessment (EUnetHTA). Furthermore, only articles published in English in the last 5 years were considered.

Results

A total of 850 articles were found: 383 articles from PubMed, 462 from WoS and 5 from York. After removing duplicates, 708 articles remained and 43 were eventually included after the screening process. Seven articles were focused on apps used by healthcare professionals, while 36 dealt with apps aimed to support patients. None of the papers explicitly mentioned HTA as assessment tool. Indeed, not all the domains of the HTA core model were assessed in any article. Apps' technical description, clinical effectiveness and social aspects were the domains considered more often. On the contrary, costs and economic evaluation was clearly faced by one article only.

Conclusions

Even though the scientific literature on health apps is growing, the adoption of standardized methods for their evaluation, such as HTA, is still scant. This might be due to peculiarities of health apps and points out the importance of adapting existing methods in order to let a thorough assessment possible.
Use and impact of smartphone apps in mental health
Authors: Amerio A , Scardoni A , Bellini L , Salvati S , Buttigieg S , Staines A , Odone A
Published: October 2020

As smartphone usage is more and more ubiquitous, the app market is flourishing in all fields, including health. Indeed, the availability and use of smartphone apps (SAs) in health has exponentially grown in recent years. It has been estimated that in 2018 there were over 97,000 health apps available and that, 15% and 8% of US phone users aged 18-29 and 30-49 years respectively had health apps installed on their mobile devices. Health apps might potentially support people health paths in multiple ways: channeling health education, enabling personal health data tracking, self-monitoring and goals setting, facilitating access to health records or compliance to treatment, fostering effective communication with healthcare providers and health services, as well as supporting clinical decision-making.

Despite such large potential, still scant evidence is available on the impact of SAs on clinical outcomes in different fields of medicine, including mental health. With an estimated prevalence of around 450 million people currently suffering from mental disorders and 1 in 4 people in the world affected at some point in own life, mental disorders are a leading cause of ill-health and disability worldwide whose prevention and care might be enhanced by mHealth technology.

The general aim of the presentation is to provide an overview on the use and impact of SAs in the field of mental health. Specific objectives are: i) to present a conceptual framework on how SAs might support mental disorders prevention, diagnosis and treatment, ii) to report on SAs use in mental health in different settings, iii) to collect and pool available evidence from observational and experimental studies on the impact of SAs use on different mental health outcomes, iv) to explore the quality, effectiveness and attributes of top-rated smartphone mental health apps and lastly, v) to suggest gaps in knowledge to be filled by future research.
Global trends of obesity, malnutrition and dietary risk factors
Authors: Grosso G , Di Cesare M
Published: October 2020

Background

The burden of malnutrition across the world remains unacceptably high. Children under five years are facing multiple burdens, including stunting and wasting; conversely, overweight and obesity among adults are at record levels while global trends in chronic non-communicable diseases (NCDs) are rising globally.

Methods

Data from the NCD Risk Factor Collaboration (NCD-RisC) and the Global Burden of Disease (GBD) Study and insights from the Global Nutrition Report will be discussed.

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), with lower but significant variations over time all around the world. There has been some progress in reducing malnutrition at a global level but there are significant disparities in progress at the national and subnational level. Fewer than one in five children aged 6 to 23 months eat a minimally acceptable diet while only half of children aged 6 to 23 months get the recommended minimum number of meals. Regardless of wealth, children, adolescents and adults are eating too many refined grains and sugary foods and drinks, and not enough foods that promote health such as fruits, vegetables, legumes and whole grains. A total of 11 million deaths are attributable to dietary risk factors. High intake of sodium, low intake of whole grains, and low intake of fruits are the leading dietary risk factors for deaths globally. However, important differences between regions and outcome (i.e., cardiovascular disease vs. cancer) have been registered.

Conclusions

Current data allow us to assess what people are eating at global level, but nutrition quality in all countries and wealth groups pose a significant threat to achieving ideal targets. Focus on healthy diets to drive better nutrition everywhere is crucial to prevent NCDs globally.
Mobile Teaching Kitchen Project – eradicating and preventing malnutrition through nutrition education
Authors: Ray S
Published: October 2020

Background

Global malnutrition, affecting over 2.6 billion people globally, represents a triple burden to health in the form of micronutrient deficiencies, under-and over-nutrition. Malnutrition reaches all parts of society, with those undernourished and deficient in vitamins and minerals often thought to be the poorer in society, whilst overnourished those wealthier. NNEdPro, an international think-tank working to develop nutrition capacity, performed a landscaping activity in Kolkata, India and noted significant undernutrition within the slum dwelling population and overnutrition among the inner-city workers.

Results

NNEdPro' s Mobile Teaching Kitchen (MTK) project was developed as a nutritional education tool to improve awareness of diet diversity and disease prevention amongst marginalised communities by using locally sourced foods and cooking skills. Local volunteers trained in healthy cooking transfers core principles through cooking demonstrations of sustainable, nutritional, and affordable meals. They follow a 'See One, Do One, Teach One' (S1D1T1) model to transfer knowledge to their peers. This model aims to create a sustainable solution that will enable the rural-urban slum dwellers across regions of the world to challenge food insecurity and malnutrition.

Conclusions

The potential of the Teaching Kitchen can extend beyond creating powerful behavior change for improved health and nutrition within local communities of both developing and developed countries. In addition to improving the wellbeing of the community, the project can also potentially create livelihood opportunities through empowering women with catering skills and having a positive impact on the health and nutritional status of the wider community. After successful impacts in India, the Mobile Teaching Kitchen model has been proposed to other 8 existing regional networks of NNEdPro such as Australia & New Zealand, Brazil, Italy, Mexico, Morocco, Switzerland, USA, and UK.
The Pappa di Parma project: promoting better health and social condition in developing countries
Authors: Scazzina F
Published: October 2020

Background

Malnutrition is the primary cause of death in infants and children. Malnutrition is very common in individuals aged from 6 to 60 months due to the lack of high-quality protein and to deficiencies in the intake of vitamin A, D, thiamine, riboflavin, niacin, calcium and iron. In low-income countries, the nutritional approach to treat child malnutrition is mainly based on RUTFs (Ready-to-Use Therapeutic Foods). Being produced by donor countries, RUTFs do not solve the problem of malnutrition at source: RUTFs are expensive for low-income communities and are distant from their local tradition. The use of ingredients not locally available and the passive participation of the community are the main cause of RUTFs failure among mothers of malnourished children. Community engagement and educating the local populations represent a key element in addressing the causes and treatment of malnutrition.

Results

Based on these concepts, the Pappa di Parma project, developed at Department of Food and Drug of University of Parma, aims to create a hyper-energetic and nutritional balanced meal, tailored on children from 6 to 60 months suffering from severe/moderate malnutrition, including only affordable local ingredients and technologies, providing in this way a potential long-term solution to decrease malnutrition.

Conclusions

The Pappa di Parma approach has been applied in Sierra Leone, Zambia, Tanzania, Burundi, Senegal, Togo from 2009 adapting to the different context. The Pappa di Parma approach consists in: (a) identifying the local food and creating a nutritional database; (b) developing recipes with accessible-to-family ingredients and with local technologies; (c) testing in loco the recipes in the real setting; (d) creating educational materials aiming to enhance awareness about the importance of a balanced nutrition.
Gaps in coverage and access in the European Union
Authors: Webb E , Palm W , van Ginneken E , Lessof S , Siciliani L , Hernandez-Quevedo C , Scarpetti G
Published: October 2020

Background

At the request of the European Commission, the Observatory on Health Systems and Policies and the HSPM network have undertaken a study to explore gaps in universal health coverage in the European Union and increase the level of granularity in terms of areas or groups where accessibility is sub-optimal.

Methods

To explore these gaps more systematically a survey was developed based on the so-called cube model that comprises different dimensions determining health coverage, including population coverage, service coverage and cost coverage. In addition, access can also be hampered by other factors, which relate more to the physical availability of care, a person's ability to obtain necessary care or the attitude of the provider. The survey was sent to country contacts from the Health Systems and Policy Monitor network.

Results

Within the diversity of country cases found in the survey, the most significant barriers for accessing health care still seem to be associated with social and income status, rather than specific medical conditions. However, groups like mentally ill, homeless, frail elderly, undocumented migrants are more likely to face multiple layers of exclusion and complex barriers to access.

Conclusions

Health system interventions can close access gaps for these vulnerable groups and address inequities in access to care. Through detailed coverage design countries can indeed determine the extent to which financial hardship and catastrophic out-of-pocket spending can be prevented. Furthermore, scope exists to improve current data collection practice.
Differences in Colorectal Cancer (CRC) patients who did and did not undergo screening
Authors: Thompson J , Ng J , Armstrong B , Feletto E , Ha T
Published: October 2020

Background

The Australian National Bowel Cancer Screening Program (NBSCP) is a free population-based screening program which aims to identify precancerous lesions and early colorectal cancer (CRC) using an immunochemical faecal occult blood test in average risk Australians. Formally commencing in 2006, NBCSP participation rate in eligible 50-74-year-old people was 42% in 2018. The barriers and facilitators of participation in the NBCSP have been explored for the general, at-risk population but not in a population of CRC patients. This is the first study to assess a population of CRC patients, post diagnosis, who would have been eligible for CRC screening to determine the barriers and facilitators to screening.

Methods

A cross sectional study nested within a cohort study. Data from CRC patients who participated in the 45 and Up Study; the largest cohort study in Australia and southern hemisphere, were analysed to compare those who had and had not participated in CRC screening. Logistic regression analyses were conducted using RStudio (version 3.5.2, Boston, Massachusetts, USA.). Multiple Imputation (MI), was used to handle missing values assumed to be missing at random.

Results

A total of 339 CRC patients were included. Patients who were female, overweight (≥25kg/m2), consumed less than the recommended five servings of vegetables per day, consumed less than or equal to fourteen standard drinks per week (compared to non-drinkers) or did not meet physical activity guidelines were significantly less likely to have participated in screening.

Conclusions

Our study has taken a unique approach to identifying a high-risk group by exploring factors to screening participation in CRC patients. CRC patients with less healthy lifestyles were less likely to participate in screening. In contrast to previous studies, female patients were less likely to participate in screening than males were. This was an unexpected finding and should be replicated.

Key messages

Not surprising that those with less healthy lifestyle practices also reflected less than ideal screening practices. Surprising that female patients participated less in screening than males. Future interventions to improve CRC screening participation rates should consider specialised messaging for average-risk females who are overweight not meeting dietary or physical activity guidelines.
Invitation of non-attenders to colorectal cancer screening: impact on coverage by examination
Authors: Majek O , Ngo O , Seifert B , Suchanek S , Zavoral M , Jung T , Dusek L
Published: October 2020

Issue

Colorectal cancer (CRC) has been among the most important cancer causes of death globally. CRC screening and early detection can decrease CRC incidence and mortality through timely removal of colorectal neoplasia or early CRC treatment. CRC screening has been initiated in the Czech Republic in 2000 for individuals over 50, with GPs having a key role in recruiting individuals to screening, offering faecal occult blood test (FOBT). Screening colonoscopy (CS) was added for individuals over 55 since 2009.

Description of the problem

To increase uptake of CRC screening, personal invitation of non-attenders under 70 was implemented in 2014, along with temporary mass-media campaign. Health insurance companies have been sending invitations to those individuals without record of recent FOBT, CS or CRC treatment.

The aim of our study was to evaluate impact of this policy on complete coverage by examination over 2013-2018. We defined the complete coverage by examination as the proportion of individuals aged 50-69 undergoing examination with CRC early detection potential (FOBT or CS for any indication) during past 3 years. We used newly established National Registry of Reimbursed Health Services as the source of data.

Results

Complete coverage of the target population (2.7 million individuals aged 50-69) was 44.8 % in 2013. By 2016, the coverage increased to 54.6%. Therefore, almost 300,000 individuals were newly covered by the relevant examinations. By 2018, the coverage decreased to 51.2%. When we consider only screening FOBT examinations, the coverage was 36.9 % in 2013, 45.2% in 2016, and 42.0% in 2018.

Lessons

In the health system with accessible CS facilities, the policy of non-attenders' invitation for CRC screening resulted not only in increase in coverage by screening examinations; complete coverage also increased. Unfortunately, the positive effect has been fading out, and further actions to sustain high coverage are therefore warranted.

Key messages

Invitation of non-attenders to colorectal cancer screening increased complete coverage of the target population by examination. Initial increase was followed by a slow decrease in coverage by examination, underlying the need for other actions to increase participation.
Passive smoking and knowledge of its health hazards in the Kingdom of Saudi Arabia
Authors: Algabbani A , Bin Dhim N
Published: October 2020

Introduction

Exposure to secondhand smoke is a major public health issue that requires assessing its magnitude. This study assesses the current status of passive smoking and its determinates in the Kingdom of Saudi Arabia.

Methods

This national study conducted in the 13 regions of Saudi Arabia through web-based-computer assisted telephone interviews. The two main measurements were passive smoking among nonsmokers and smoking behaviors in microenvironments among smokers. Data on socio-economic and demographical data, smoking status, attitude, and knowledge on passive smoking impacts were also collected. Data was weighted by age, gender, and region to account for the different probabilities of selection.

Results

Exposure to secondhand smoke among non-smokers was 44%. Smoking at home with the presence of children in the same room was prevalent (25% cigarettes smokers, 30% waterpipe smokers). About 18% of smokers smoke inside their cars while children on-board. Only 34.4% of smokers perceived, “to a very large extent”, the harms of their smoking might be doing to others. As the knowledge on secondhand smoking exposure health risks increases the smokers were less likely to smoke in microenvironment (R= -0.16, p value< 0.01). Almost half of the population (49.1wt.%) were “extremely concerned” about the effect of passive smoking on their health in the future.

Conclusions

Passive smoking is prevalent in the Saudi population and a proportion of smokers smokes in microenvironments with the presence of children. Further preventive and promotion strategies are needed to protect the public from the hazards of passive smoking with special attention to vulnerable populations.

Key messages

Identify the association between knowledge of the associated health risks with exposure to passive smoking and smoker behaviors that expose nonsmokers to tobacco smoke in private micro-environments. Assess the impact of individual knowledge of passive smoking associated health risks and vulnerability to passive tobacco smoke exposure.
Women offenders in Europe: drug problems and drug offences and/or gender-based violence
Authors: Montanari L
Published: October 2020

Worldwide the proportion of women in prison for drug-related offences is higher than that of men. In Europe (27 Member States, Norway, United Kingdom and Turkey) it varies considerably, between 5 % in Bulgaria, approximately 25 % in Denmark, Finland and Sweden, 33 % in Italy and 40 % in Spain. Women are reported to have less dominant roles in drug trafficking, often occupying the lowest level of the drug supply chain. There are, however, recent indications of involvement of women in higher levels of supply chains

The prevalence of illicit drug use before incarceration is much higher among prison population as compared to the general population. This excess is substantially higher among women. The patterns of drug use among women in prison are similar to those reported by men, with majority reporting having used cannabis in their lifetime. Prevalence is also high for other illicit substance use, such as heroin (19% - 49%), cocaine (21% - 41%), and amphetamines (17% -64%). Inside prison drug use is often reduced, but exists. The reduction in drug use is in many countries smaller among women then among men.

Reasons for this high prevalence of drug use among women in prison are likely to be related to the high proportion of women incarcerated for drug related offences and their high level of vulnerability. Targeted interventions for women with drug related problems who experience imprisonment are needed and should be implemented with a comprehensive and multidisciplinary approach to tackle their physical, mental health and social needs.

The presentation will discuss the latest European data on drug related problems among women in prison and available targeted interventions.
4.B. Skills building seminar: Participatory action research: sharing power to improve public health research outcomes
Authors:   Organised by: Maastricht University (Netherlands),   Chair persons: Elisabeth Dorant - Netherlands, Theresia Krieger - Netherlands
Published: October 2020

This skills building seminar addresses the use of Participatory Action Research (PAR) as strategy to involve professionals and practitioners from (non-academic) health organizations in public health research. These so-called stakeholders possess external -experiential practice-based- knowledge important for a successful realization of a public health research project. After a short introduction on the why and when of PAR as a suitable strategy in public health research, and the why and when in a project's life cycle stakeholders can or must join, levels of participatory practices will be discussed, as well as consequences of transfer of power from academic researchers to professionals and practitioners in the field.

The first part of the seminar will be followed by two real life examples from two projects in Germany: 1) a psycho-oncological care project -hospital-based-, where alarm bells went off during the external prospective evaluation of the new care programme. In the development phase of this new programme,key stakeholders had not been involved yet; and 2) the optimization, by inserting PAR cycles, of a stroke family caregiver support programme before implementation in a public health care system.

The audience is invited to discuss research dilemmas, as well as pros and cons of the PAR strategy

Key messages

Participatory action research is about active collaboration between academics and health professionals to bring transformative change through the process of taking action and doing research. Sharing power between academics and health professionals is vital to improve public health research.
Health impact assessment in Portugal
Authors: Almeida T , Costa L
Published: October 2020

HIA can act as a catalyst for intersectoral involvement and embody the concept of Health in All Policies and the whole-of-governance approach. The National Institute of Health (INSA), with technical support of WHO, designed an HIA capacity-building program, to develop technical skills and instruments for HIA implementation. As products of this Training Program, two policy dialogues were held with stakeholders from various sectors to discuss the difficulties, barriers and opportunities for HIA institutionalization in Portugal. The absence of a common glossary was point out. In fact, different sectors, namely Health and Environment, have different languages that are reflected in the approaches, planning and methods used, which can be competing instead of complementary. To overcome this issue, it was highlighted the need for an intersectoral committee to define a common strategy for HIA. Other suggestion was the creation of a technical unit in the Ministry of Health in order to assume the coordination and quality of the Public Health response in this subject. The experts also recognized the importance of the adoption of common guidelines including a glossary, the definition of dedicated structures, the studies' scale and level of depth, the resources and technical skills required and a set of tools to support the development of studies. As an opportunity, it was identified the transposition of the European Directive 2014/24/EU, which made mandatory that EIA must assess the significant effects of a project in 'population and human health'. This requisite implies intersectoral dialogue and strait work in order to respond to legal demands. In addition, the new Law on Health Bases (2019) determines that the approval of national legislative measures, with relevant impact in Health, must be preceded by previous studies. These elements constitute a new impulse and an opportunity for intersectoral dialogue and HIA implementation in Portugal.
Unscattering the burden of disease landscape: supporting interaction between existing burden of disease efforts
Authors: Haagsma J , Majdan M , Pires S M , Assunção R
Published: October 2020

The burden of disease landscape in Europe is currently scattered with experts from diverse professional backgrounds, ranging from experts in infectious diseases, non-communicable diseases, injuries and risk factors, to experts in more comprehensive national, regional and global burden of disease studies. Currently there is little interaction between these experts and existing burden of disease efforts. The European burden of disease network (burden-eu) COST Action aims to bring together expertise across different domains and professional backgrounds. During the course of the burden-eu COST Action, several steps will be taken to facilitate interaction between existing burden of disease efforts. First, a survey has been sent around to all members of the EU burden of disease network to map burden of disease studies that have been carried out in their country. Apart from general details about the year of the study and cause of disease categories, items of the survey included data sources, methodological approach and collaborations with institutes of other countries. In the first month, the survey has been completed for over 70 studies that have been carried out in twelve countries. Second, comparison of existing burden of disease initiatives allows for the identification of the various domains for which burden of disease has been assessed, highlight methodological differences as well as similarities, and

facilitate improvements and harmonization of methods and approaches. Furthermore, the data collected from the survey will be included in a continuously updated burden of disease database that lists all past and current burden of disease activities. Lastly, burden-eu will facilitate regular meetings and workshops. Each of these steps will make it possible to move beyond the currently scattered burden of disease landscape and increase interaction between professionals and burden of disease efforts.
A difference-in-difference analysis comparing a control and an intervention social housing area
Authors: Nygaard S , Srivarathan A , Mathisen J , Lund R
Published: October 2020

Often an intervention is applied in an area (e.g. community, municipality) without it being an experiment and without a control group, this can be categorized as a natural experiment. Such a situation offers the opportunity to exploit exposure contrasts between areas regarding the specific intervention for evaluation. In the present study, we will employ the difference-in-difference approach to evaluate the natural experiment (the structural intervention) comparing measures of health and social factors retrieved from registers in the two social housing areas before and after the intervention. A 'natural experiment' study comparing individual and aggregated level differences in register-based information on health and social variables across time including the entire study period is included in the research project. The population includes all residents with an address in the study area and the control area at any point during the years 2015-2025 (∼3,000 residents in each area). All residents are linked to the Danish social and health registers by the unique personal identification number, which makes it possible to follow all permanent and former residents over time. Hereby we plan to study if the structural changes (the structural intervention, the 'natural experiment') give rise to differences in health (such as use of general practitioner, hospitalizations, use of selected medications) and social factors (e.g. divorces, income levels, unemployment) compared to the control area. The control area is representing a similar social housing area in the same municipality, which will not undergo structural changes until 2023. Findings will be evaluated drawing upon knowledge gained from the entire study from surveys and qualitative interviews as well experiences from the interventions. In this presentation, we wish to discuss how best to include the knowledge based on other methodologies in the register-based analyses.
Patient empowerment, eating behaviours and illness control: pre-post outcomes from DWELL delivery in UK and France
Authors: Morris R , Hatzidimitriadou E , Manship S , Hulbert S , Webster J , Teke J , Belmas N , Best A , Averous V , Cazier J
Published: October 2020

Diabetes self-management programmes can improve clinical and healthy lifestyle outcomes. Research has demonstrated that improved engagement with type 2 diabetes (T2D) care is associated with greater empowerment beliefs and a perceived internal control over their illness. As part of the DWELL evaluation study, an interim subset of 139 participants in the UK and 53 participants in France were assessed pre- and post-intervention on measures of weight, BMI, waist circumference and glycated haemoglobin (HbA1c), as well as self-efficacy beliefs (DES-SF), healthy eating behaviours (DEBQ) and perceptions of illness (IPQ-R). Pre-post comparisons in both countries demonstrated statistically significant decreases in weight (UK: Z = 6.71, p<.001, FR: Z = 3.33, p<.05), BMI (UK: Z = 6.70, p<.001, FR: Z = 3.21, p<.05), waist circumference (UK: Z = 6.71, p<.001, FR: Z = 3.24, p<.05),and HbA1c (UK: Z = 6.29, p<.001, FR: Z = 4.18, p <.001). Importantly, participation in the DWELL programme was associated with increased self-efficacy beliefs (UK: Z = 5.63, p<.001, FR: Z = 5.54, p<.001), greater perceived personal control over their diabetes (UK: Z = 3.17, p<.05, FR: Z = 2.20, p<.05), reduced negative feelings about their illness (UK: Z = 3.01, p <.05, FR: Z = 2.19, p<.05) and decreased eating in response to external food cues (UK: Z = 3.79, p<.001, FR: Z = 2.34, p<.05). In the UK, participants also reported an increased optimism for treatment control of their diabetes (Z = 3.06, p <.05) and for their long-term prognosis (Z = 1.99, p<.05).These preliminary findings support the efficacy of the DWELL programme in improving diabetes-related biomedical outcomes, as well as improvements in patient empowerment, healthy eating habits and increased perceived illness control. Further analysis, available at a later date, will include a larger sample of participants, including longitudinal data with follow-ups six- and 12- months post participation in the DWELL programme.
Does participation matter? Prospectively evaluating a German psycho-oncological care programme
Authors: Cecon N , Salm S , Krieger T , Dresen A
Published: October 2020

The `integrated cross-sectoral Psycho-Oncologý (isPO) programme is a new and complex care programme. It aims to reduce anxiety and depression in newly diagnosed cancer patients. Patients are offered psycho-oncological care after diagnosis for twelve months by psycho-oncological care professionals and specially trained cancer survivors according to their individual needs. Its development, implementation and evaluation is financed by the German Federal Innovation Fund (2017-2021).

During its 15 months lasting development phase, multitude programme components needed to be designed, such as the care concept, care pathways and indicators, quality management or contracts and agreements. The development was conducted with a top-down approach by the programme designers. Key stakeholders, e.g. end-users or service providers, were not actively involved. isPO was implemented in four newly established care networks of certified oncological center hospitals cooperating with local oncological practices in North-Rhine Westphalia, Germany.

All project phases are being externally evaluated, which results in a tripartite evaluation design containing a prospective, formative and summative evaluation.

In this session we refer to the prospective evaluation that aimed to assess the relevance and transferability of the new care programme before implementation. It became visible that the low participation level of key stakeholders, e.g. service providers or end-users, in the development phase might hinder its implementation, e.g. lack of contextual fitting of the programme. This was confirmed during the implementation.

Therefore, by inviting key stakeholders to participate in the development of a new care programme, challenges during the implementation process might be prevented or reduced.

After introducing isPO, the workshop audience is invited to interactively discuss how, when and how much to involve stakeholders in the development of an intervention in a public health context.
Participant experiences of the DWELL programme: focus group findings on motivation, experiences, facilitators and barriers
Authors: Manship S , Hatzidimitriadou E , Morris R , Hulbert S , Webster J , Belmas N , Best A
Published: October 2020

Initiatives to increase effective, low-cost self-management are essential to the sustainability of care for type 2 diabetes (T2D), however research shows that there is currently no standard approach. The DWELL programme seeks to motivate and empower people with T2D to better self-manage their condition through focussed content underpinned by motivational interviewing. As part of the DWELL evaluation study, end-of-programme focus groups were conducted to elicit participant experiences. 33 focus groups with 153 participants (including a small number of partners) took place in the two UK DWELL delivery sites. The focus group data was subjected to thematic content analysis to elicit key themes. Findings indicate that DWELL participants are motivated through a desire for better knowledge and management of their diabetes. Facilitating factors of the programme include: facilitator and peer support; the holistic and autonomous approach which provides participants with the opportunity to better understand the condition and its impact on their whole lives; and a tailored individual approach. Barriers and suggested improvements include content and operational changes, which are fed back to DWELL facilitators as part of the process evaluation in order that they can continually update the programme. Participants report positive outcomes in terms of wellbeing, social and mental health, enhanced knowledge and positive lifestyle changes. These themes align with quantitative outcome measures for participants, including weight loss, reduced BMI and glycated haemoglobin (HbA1c), enhanced empowerment and improved eating behaviours and illness perceptions and control. Interim findings suggest that DWELL outcomes include improved health literacy, participant empowerment and self-management. These findings underscore the need to incorporate a holistic, tailored approach to structured patient education for T2D.
Determinants of autism – an update on knowledge and open questions
Authors: Lindert J , Tola G
Published: October 2020

Background

Early intervention is a critical component to any autism service system. Despite the increasing prevalence of autism, many children do not receive early intervention due to delayed diagnoses and various other factors. Community-based autism early interventions can better identify children and provide interventions in more naturalistic environments for young children and their families. In this talk, we will investigate barriers and potential opportunities facing the dissemination and uptake of community-based early autism interventions.

Methods

We aim to provide an overview on results of intervention and support models for children and their parents with autism based on a narrative review.

Results

The approaches identified in the literature were classified into six complementary categories (Comprehensive approaches, structured teaching, targeted skills-based intervention, targeted behavioural intervention for anxiety and aggression, changes in the built environment).

Conclusions

To respond to need of children, youth and adults with autism, effective interventions for the whole lifespan need to be established. Key environmental factors that interact with the complex pathology of autism need to be identified. Furthermore, how autism affects individuals in different environmental contexts needs to be understood. Finally, built and social environments should be made more autism friendly.