bluuebunny/crossref_metadata_2025 huggingface dataset:
Breatsfeeding supression in a Spanish referral hospital (2011-17): a retrospective cohort study
Authors: Llupià A , Torà I , Cobo T , Sotoca J M , Puig J
Published: November 2019

Background

WHO recommends measuring the role of social determinants in the initiation of breastfeeding, given that they will have an impact on the health of these mothers and babies throughout their lives. The present study, the first in Spain, describes the onset of breastfeeding through maternal and pregnancy characteristics related to breastfeeding suppression with cabergoline.

Methods

We assessed 20965 opportunities of breastfeeding initiation, collecting data of deliveries that had an obstetric clinic history record and resulted with at least one alive baby at the Hospital Clinic of Barcelona (HCB) between January 2011 and December 2017. Adjusted odds ratios for cabergoline use during hospitalization considering maternal, neonatal and pregnancy characteristics were obtained.

Results

Adjusting for the set of variables, inhibition of lactation was significantly higher in women without or primary studies with respect to women with higher education (OR 2.5, CI95% 2.0-3.0) and living in economically more depressed areas (OR 1.08, 1.04-1.2). Breastfeeding was also more inhibited in women who did not express intention of natural birth (OR 2.3, 1.9-2.9), smokers (OR 2.2, 1.9-2.6), with more previous children (OR 1.2 for each sibling,1.1-1.3), in term versus pre-term birth (OR 1.3, 1.2-1.4), in women with multiple births (OR 1.6, 1.2-2.1) and with higher risk pregnancy (OR 1.3 per risk point, 1.2-1.4). According to the mother’s country of birth, and taking Spanish women as a reference, women born in Northern Africa (OR 0.2, 0.1-0.3), in India and Pakistan (0.2, 0.1-0.3), in Eastern Europe (0.4, 0.2-0.6) and Western Europe (0.5, 0.4-0.8) are less likely to inhibit breastfeeding. Chinese women are significantly more likelier to inhibit breastfeeding (OR 7 (5.7-8.6)).

Conclusions

Inequalities have been detected in the inhibition of lactation in puerperal women. Knowing these inequalities in breastfeeding initiation is the first step to address them.

Key messages

This is the first study to describe disparities in breastfeeding inhibition in puerperal women. Factors related to lower socioeconomic status and poor health are more likely associated with breatfeeding suppression.
The Entred 3 study: a national representative sample of people with diabetes, 3rd edition-France-2019
Authors: Henry V , Piffaretti C , Saboni L , Gane J , Fosse-Edorh S
Published: November 2019

Background

In France, more than 3.3 million people are pharmacologically treated for diabetes. The 3rd edition of the Entred study was launched in 2019 in order to establish an overview of the epidemiological situation of diabetes since the last studies performed in 2001 and 2007. The main objectives are to describe and assess trends in characteristics of people pharmacologically treated for diabetes, in cost of care and clinical care pathways, in quality of care, in quality of life and in mortality and to focus on specific populations.

Methods

A sample of 13’000 adults has been randomly selected from the two majors French health insurance systems database. Those patients are invited by their health insurance provider to answer to a short phone-based questionnaire and then to a self-administered questionnaire (mailed or by Internet). With the agreement of those patients, their physicians are suggested to answer a questionnaire to collect information concerning their clinical and biological results. A passive follow-up of the sample is implemented by extraction of participants’ reimbursement and hospital discharge data from the SNDS (Système National des Données de Santé) for 20 years (the 10 years previous to and the 10 years following the sampling).

Results

Results expected will present first rates of participation for patients and their physician. Also, a first feedback on the innovative processes of the study, collaborations between institutions and partners will also be presented.

Conclusions

The expected results of this surveillance system based on a complementary approach (self-questionnaire, medical questionnaires and medico-administrative data) are: health status, therapeutics, economic burden, social and the quality of care pathways, the ways to improve medical practice and the quality of life of people with diabetes. Entred 3 would also be a valuable tool for orientating prevention policies that could be transposed to other countries.

Key messages

Entred combines data from people with diabetes, their care providers and extractions of health insurance data. This is a valuable tool for orientating care and prevention policies in diabetes. Entred 3 is the continuation of two previous editions and should provide important information not available in administrative database, is a major tool for all stakeholders involved in diabetes care.
Education and hypertension in the CONSTANCES cohort: which factors mediate this association?
Authors: Neufcourt L , Deguen S , Bayat S , Zins M , Grimaud O
Published: November 2019

Background

Individual socioeconomic characteristics and in particular education have been shown to be strongly associated with hypertension (HTN). Few studies have examined the mechanisms involved in such associations and understanding them would help to reduce the burden of social inequalities. We aimed to investigate whether specific risk factors of HTN intervene as mediators in the association between individual education and HTN in a large sample of French adults.

Methods

In this cross-sectional analysis, participants are adults aged between 18 and 69 years old recruited to the CONSTANCES cohort over the period 2012-2015. We included behavioral (poor diet, physical inactivity, alcohol consumption), anthropometric (body mass index) and socioeconomic risk factors (income and longest occupation) as potential mediators. Analyses were stratified by sex. Natural direct and indirect effects of education on HTN were estimated using weighted Poisson regression models with inverse odds weighting.

Results

A total of 62,247 individuals (53% women, mean age 48±13 years) were included. Prevalence of HTN was 37.3% [95%-Confidence Interval (95%-CI) =36.6-38.0] in men and 23.2% [95%-CI=22.7-23.8] in women. We found a steep educational gradient of HTN in both sexes, larger among young adults in relative terms. Low education was strongly associated with HTN: RRTotal Effect=1.16 [95%-CI=1.12-1.21] in men and 1.26 [95%-CI=1.21-1.32] in women. Behavioral, anthropometric and socioeconomic risk factors accounted for 49% and 32% of the total effect in men and women respectively.

Conclusions

This study underlines the importance of education in inequalities in HTN and suggests that behavioral, anthropometric and socioeconomic risk factors substantially mediate the association between education and HTN. Future research using longitudinal data should be done to help understand the causal pathway linking education and HTN.

Key messages

A strong gradient of decreased prevalence of hypertension with higher individual education is observed in both sexes and in early adulthood, suggesting that prevention should start early. Behavioral, anthropometric and socioeconomic characteristics at adulthood substantially mediate the association between education and hypertension.
6.H. Workshop: Quality strategies in European health systems: assessing their nature, use and effectiveness
Authors:   Organised by: Observatory Chair persons: Ewout Van Ginneken - Germany, Niek Klazinga - Netherlands
Published: November 2019

Quality of care is one of the most frequently quoted principles of health policy, and is currently high up on the agenda of policy-makers at national, European, and international levels. However, the understanding of the term and what it encompasses varies. Many organizations and movements, such as evidence-based medicine, health technology assessment, provider accreditation, clinical practice guidelines and patient safety, play an important role in improving quality of health care. However, this broad field of quality-related initiatives is fragmented, and there is often a lack of awareness about parallel activities because of different labels. Evidence on the effectiveness and cost-effectiveness of different quality strategies is not always readily available for policy-makers, who have to struggle with prioritizing initiatives for investment.

To provide a solid foundation for addressing these challenges, the European Observatory on Health Systems and Policies in collaboration with the OECD has put together a comprehensive study on health care quality, its interpretation and the evidence on different strategies aiming to assure or improve it. Drawing on this 2019 study, the workshop has the following objectives: Provide an understanding of the multidimensional concept of quality of care and its relation to health system performance as well as a comprehensive framework for looking at different strategies and their potential contribution to improving health care quality;Introduce key components of international and European governance for quality of care;Highlight the effectiveness, cost-effectiveness and implementation of selected quality strategies, with a focus on the European context:Health professional regulation, including education, licensing and registration, continuous professional development and mechanisms to ensure fitness to practice;External institutional strategies for health care organizations, including accreditation, certification and supervision;“Pay for Quality”, wherein financial incentives are paid to providers or professionals for achieving quality-related targets within a specific timeframe.Discuss and refine lessons learned through audience participation, and identify further areas for research and action.

Key messages

Quality of care is a political priority and an important contributor to population health. Within an overall strategic framework, understanding the potential of different quality strategies is key. Evidence on the (cost-)effectiveness of different quality strategies is variable but largely inconclu-sive. Maintaining an overview and identifying areas for action is paramount for policy-makers.
Key components of international and European governance for quality of care
Authors: Palm W , Peeters M , Garel P , Daval A , Shaw C
Published: November 2019

The legal status and binding nature of various international governance and guidance instruments to foster and support quality strategies in European countries differs substantially. This presentation introduces and discusses the four main elements of an integrated international governance framework for quality in health care: i) raising political awareness of the relevance of health care quality and creating a common vision on how to improve it; ii) implementing this vision into actual policy frameworks by sharing experience and practice between countries; iii) developing and providing standards and models (voluntary or mandatory) that can be transposed into national policy; iv) measuring, assessing and comparing quality by developing better information, better indicators and methodologies as well as dissemination strategies.

The presentation will also focus on how quality in health care is addressed through EU policy, first through EU provisions and policies that are meant to ensure free movement of citizens and goods and establish an internal market, and by means of more horizontal and generic EU policies on quality and safety that stem from the mandate to support, coordinate or supplement national policies. It will further highlight how EU integration and policy touch upon quality in health care and how the approach has evolved over time.
Screening for tuberculosis among newly arrived migrants in France. Results from a practice study
Authors: Luan L , Charlois C , Leroy H , Cordel H , Figoni J , Méchaï F , Lachatre M , Mechain M , Vignier N
Published: November 2019

Background

Screening of active and latent tuberculosis among migrants is a public health concern but physicians’ practices are poorly known. The study aimed to evaluate physicians’ practices in France.

Methods

A national survey of physicians’ practices about infectious diseases prevention among migrants was conducted in 2017-2018 and broadcasted by several scientific societies.

Results

In total, 367 physicians answered; 53.1% were primary care physicians, 34.3% “TB involved physicians”, and 85.5% were involved daily with migrants. Screening by chest X ray is recommended by 84.8%, 71.9% and 38.4% of participants for migrants from high- (>100 cases/100,000 p.a.), medium- (> 50/100,000), and low-incidence countries respectively. One physician in two declares considering migration conditions in his/her decision of screening migrants from low incidence countries. Primary care physicians are less likely to offer screening (aOR= 0.21[0.09-0.48], p < 0.001). About screening prescription, only 55.6% consider it their responsibility. TB control centres are designated by 56.7% of respondents. Concerning screening for latent tuberculosis infection (LTBI), 61.8% and 34.0% offered screening for children under the age of 15 and for all migrants (adults and children) from high incidence countries respectively; physicians working in Paris and its region being less likely to offer it (aOR=0.45 [0.28-0.71], p = 0.001 and aOR=0.43 [0.27-0.69] p = 0.001 respectively). Among those screening children, 88.1% recommend treatment if facing a positive result, most often with a 3-month isoniazid rifampicin double therapy, and 11.4% offer follow up alone.

Conclusions

Physicians’ practices in France regarding screening of tuberculosis among migrants are heterogeneous. Which population should be targeted for LTBI screening remains unclear in the context of contradictory national and international recommendations. The results of our study raise the issue of knowledge, and adherence to these guidelines.

Key messages

Physicians’ practices in France concerning active and latent tuberculosis screening among newly arrived migrants are heterogeneous. Many physicians involved in migrants’ care ignore or do not adhere to current national guidelines, especially concerning LTBI screening among newly arrived migrants.
Workshop: Addressing the mental health needs of lesbian, gay, bisexual, and transgender populations
Authors:   Organised by: EUPHA (SGMH) Chair persons: John Pachankis - USA, Arjan Van Der Star - EUPHA (SGMH)
Published: November 2019

Today a large number of studies from different parts of the world clearly show that compared with heterosexuals lesbian, gay, bisexual, and transgender (LGBT) individuals have an increased risk of mental health problems, especially depression, anxiety and suicidal behaviour. To meet this increased risk of mental health problems, many governmental public health agencies call for policy and intervention programs addressing specific needs of LGBT individuals. Despite the clear need for evidence-based care, prevention, and treatment specifically tailored to LGBTQ people, there are currently few such programmes due to lack of sufficient research.

This workshop will give examples of studies on mental health care needs among LGBT individuals and effect of evidence-based training for mental health providers, as well as, studies showing improvements of mental health after treatments. Dr. Corina Lelutiu-Weinberger (Rutgers University, USA) will present results from a newly conducted study of LGBT-affirmative mental health training for health care providers in Romania. Dr. John Pachankis (Yale University, USA), will present results showing improvements in mental health among transgender individuals after receiving gender-affirmative surgical treatment, using a total population dataset from Sweden. Dr. Igor Grabovac (Medical University of Vienna, Austria) will present health and well-being disparities based on sexual orientation among older LGBT individuals in England. The situation for LGBT individuals varies greatly across Europe. The level of acceptance for minority sexual orientations differs greatly by country, and in many countries, LGBT people are also subject to legal discrimination concerning basic civil rights, e.g. regarding recognition of same-sex unions. During the workshop, Dr. Richard Bränström (Karolinska Institutet, Sweden) will present data on experiences of discrimination in health care settings and openness with sexual and gender identity to mental health providers among LGBT populations across all 28 European Union Countries.

Key messages

Today a large number of studies from different parts of the world clearly show that compared to heterosexuals LGBT individuals have an increased risk of mental health problems. Access to supportive mental health care for LGBT individuals varies greatly across Europe and dissemination of targeted LGBT-affirmative evidence-based interventions needed.
Web-based training and supervision for LGBT-affirmative mental health practice: A randomized controlled trial
Authors: Lelutiu-Weinberger C , Pacjankis J E
Published: November 2019

Background

Lesbian, gay, bisexual, and transgender (LGBT) individuals in most countries remain stigmatized, requiring culturally sensitive mental health care to foster coping and resilience. This trial tested the efficacy of an LGBT-affirmative mental health training for psychologists and psychiatrists in Romania, where such resources are scarce. The trial compared in-person and web-based training modalities.

Methods

Participants were randomized to a 2-day training either in-person (n = 56) or via web by viewing the live-streamed training (n = 54), and assessed pre- and 5-, 10- and 15-months post-training, with optional monthly web-based supervision (n = 47) after the first follow-up. Generalized linear mixed models were conducted to assess for change across time.

Results

The sample (M age=34.98) was mostly female (88%) and heterosexual (84%). Trainees, regardless of in-person or web-based attendance, reported significant decreases from baseline to 15-month follow-up in explicitly (b = 0.21, 95% CI 0.06 − 0.37, p < 0.01) and implicitly (b = 0.26, 95% CI 0.10 − 0.41, p < 0.001) assessed homonegativity, and significant increases in LGBT-affirmative clinical skills (b = -1.19, 95% CI -1.41− -1.00, p < 0.001), beliefs (b = -0.17, 95% CI -0.31 − -0.03, p < 0.05) and behavior (b = -1.17, 95% CI -1.72 − -0.61, p < 0.05).

Conclusions

Training in LGBT-affirmative mental health can change provider attitudes and practice in high-stigma countries. The fact that web-based trainings were equally efficacious as in-person trainings suggests that such education can have widespread reach. As LGBT individuals represent one of the highest-risk global populations for mental health problems driven by stigma, findings hold strong public health potential. Future research should assess the impact of such trainings across high-need settings and include patient outcomes.
Is problematic Internet use associated with substance use among youth? A systematic review
Authors: Lanthier-Labonté S , Dufour M , Milot D M , Loslier J
Published: November 2019

Background

Problematic Internet use is an important emerging public health problem. Among youth, the link between problematic Internet use and other risky behaviors needs to be define. The National Institute on Drug Abuse was recently questioning if this new problem can explain the downward trend in substance use among young people. The objective of the systematic review is to explore the association between Internet use (with an average time measure and a problematic Internet use measure) and psychoactive substance use (alcohol, cannabis) among youth.

Methods

Empirical studies meeting inclusion criteria were chosen from important databases and then screened. Quality assessment and narrative synthesis were executed giving the high heterogeneity. Forty-three studies were eligible.

Results

A majority of studies found a positive association for the association between Internet problematic use and alcohol use, and between Internet problematic use and cannabis use. High heterogeneity in the assessment of alcohol and cannabis use made the synthesis a great challenge. Studies with substance use assessment that were reflecting a higher risk measure more often found a positive association.

Conclusions

Despite the diversity of the measures used, it seems that Internet use has a potential association with alcohol and cannabis use among youth around the world. When addressing risky behavior such as substance use among youth, professionals should also address problematic Internet use. Further studies are needed to assess the longitudinal impact of Internet use on youth substance use. A golden standard on how to assess alcohol and cannabis use among youth would be welcomed and certainly help future knowledge synthesis.

Key messages

Internet problematic use has a potential positive association with alcohol and cannabis use among youth around the world. Prevention programs for youth addressing risky behavior should include problematic Internet use, an important emerging public health problem.
Whole systems approaches to obesity and other complex public health challenges: a systematic review
Authors: Bagnall A , Radley D , Jones R , Gately P , Nobles J , van Dijk M , Blackshaw4 J , Montel S , Sahota P
Published: November 2019

Background

Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs). We carried out a systematic review of WSAs targeting obesity and other complex public health and societal issues.

Methods

Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken.

Results

65 articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes.

Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance.

Conclusions

Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

Key messages

Interventions working towards systems approaches are associated with a range of positive health outcomes. Evidence of systems science and systems thinking was less clear, even in the most “joined up” approaches.
Using the WHO EURO checklist for healthy and sustainable meetings
Authors: Zeegers Paget D
Published: November 2019

Following the decision by the EUPHA/EPH Conference Green Club to use the WHO EURO checklist for healthy and sustainable meetings for the EPH Conferences in Ljubljana 2018, the Green Club thought it a good idea to set a baseline on the health-related and sustainability measures for conferences organised in Europe. If we could compare several European conferences on public health related topics with our own EPH Conference, we could formulate objectives for the future, to be included in the next EPH Conference strategy 2020-2025. The ambitious idea of the Green Club was that EPH Conferences should always be above the average of other conferences organised in EUPHA, whilst continuing to strive for being the best in Europe.

The executive director of EUPHA decided to use the WHO EURO checklist for all the meetings and conferences she would attend in 2019. In the planning for 2019 were 20 meetings throughout Europe. It is expected that this would provide a nice baseline.

The WHO EURO checklist includes questions on venue and transport, invitation and conference materials, food, beverages, tobacco-free, physical activity classes and breaks, waste and use of sustainable materials. Special attention was given to people with disabilities.

The interim results (until the end of April) show that a large fraction of the questions can only be answered if you are the conference organiser, not a conference participant. This was true for questions like: ‘Does the venue use energy-efficient practices?’. Some questions address more fundamental issues, e.g.: ‘Is holding a meeting in a virtual format ... an option?’. The issues of travel mode and/or emission offsetting are not included.

Overall, the checklist approach seems useful. Short of supporting benchmarking, it helps collecting qualitative information and model solutions, and may foster networking among associations towards healthy and sustainable meetings.
Differences in stillbirth and infant mortality by maternal country of birth and descent in Denmark
Authors: Damsted Rasmussen T , Villadsen S F , Smith Jervelund S , Nybo Andersen A M
Published: November 2019

International studies have reported inequalities in stillbirth and infant death among ethnic minority groups compared to the host population. The same tendencies have been reported in Denmark. We investigated differences in the risk of stillbirth and infant death among offspring of immigrants and descendants in Denmark, compared to the risk among women of Danish origin.

The population-based register study included all live births and stillbirths with gestational age ≥ 22 weeks delivered by women of Danish origin, immigrant women and descendants in Denmark in the period 2005-2016. The study population was restricted to deliveries by women of Danish origin and country groups of immigrants and descendants with more than 2000 deliveries during the study period (n = 792 705).

Logistic regression analysis adjusted for year of birth was used to estimate odds ratios (OR) with 95 % confidence intervals (CI) of the association between maternal country of birth and country of descent and respectively stillbirth and infant mortality.

Immigrant mothers from Turkey, Iraq, Somalia, Pakistan, Afghanistan, Syria and Iran had a statistically significant elevated OR of stillbirth compared to women of Danish origin; adjusted OR`s ranging 1.45-2.93. Danish-born women with respectively Turkish (OR 1.44, 95 % CI 1.00-2.07) and Pakistani descent (OR 2.32, 95 % CI 1.50-3.60) had an increased risk of stillbirth similar to the one among immigrant women with the same origin. For infant death, we found increased OŔs among immigrant women from Turkey (OR 1.76, 95 % CI 1.28-2.40), Somalia (OR 1.84, 95 % CI 1.31-2.58), Lebanon (OR 1.63, 95 % CI 1.03-2.60) and Pakistan (OR 2.85, 95 % CI 2.05-3.96). Only women of Pakistani descent (2.22, 95 % CI 1.28-3.86) had a statistically significant increased risk of infant death.

These findings show substantial differences in stillbirth and infant death according to maternal country of birth and descent in Denmark during the first decades of the 21st century.
What can we learn from the national implementation of The MAMAACT intervention?
Authors: Johnsen H , Christensen U , Juhl M , Villadsen S F
Published: November 2019

Initiatives to improve maternal and child health among non-Western immigrant populations in Western countries are still sparse. So far, interventions within antenatal care have primarily focused on doula support and group-based antenatal care.

A qualitative evaluation of the implementation of the intervention was undertaken to explore midwives and non-Western immigrant women’s attitudes towards and experiences of using the MAMAACT intervention. The evaluation also investigated key contextual factors impacting the interventions utilization. Data consisted of focus group interviews with midwives (n = 9) and in-depth interviews with non-Western immigrant women (n = 15), as well as observations of midwifery visits (n = 42). Data were collected at five intervention sites across Denmark and it was analyzed using systematic text condensation.

Findings show that midwives found the MAMAACT intervention to be a relevant tool, which was easy to implement in antenatal care. Several organizational factors such as task load, interpreter services and lack of cooperation with general practitioners impacted the implementation of the intervention. Non-Western immigrant women found the leaflet and app to be useful tools in distinguishing between normal and abnormal pregnancy symptoms. The degree to which the intervention was used by the women varied between the participants, and women also used other sources of information during their pregnancy. Contextual factors such as lack of social network and material resources as well as language proficiency impacted how women responded to their pregnancy symptoms. Findings show that in addition to targeting the intervention to midwives and non-Western immigrant women’s informational needs, structural factors such as the organization of antenatal care and women’s socioeconomic conditions need to be addressed in order to reduce ethnic disparity in reproductive health.
Health literacy and ehealth tools to improve quality of life
Authors: Saboga-Nunes L , Pereira A , Picado A , Moraes Filho E
Published: November 2019

Introdution

The use of smartphones and apps to achieve numerous goals, has reached a vast number of citizens today in the world. Health related apps (HAPPS) (estimated to be 318.500 in 2017) have become popular, but little is known about their real impact in public health. The goal of this research is to understand what are the most common used HAPPS, how health literacy (HL) mediates their use and to what extent do they contribute to quality of life.

Metods

The study is observational, cross-sectional and includes both quantitative and qualitative data from an adult population working in the financial corporation. By the means of a survey (CAWI) data was collected about HL (using the European Health Literacy Survey validated to Portugal ((HLS-EU-PT), the use of apps and their influence on quality of life. The sample (n = 748) includes participants from the different offices of the company in Portugal main land and its autonomous territories.

Results

In this study (58.7% males) 40% of the individuals have between 36 and 45 years old, and 9.2% refer the use of health promotion apps. Of the participants, 7.1% have inadequate, 39.0% problematic, 36.6% sufficient and 17.3% excellent HL (HLS-EU-PT). Content analysis showed the categories most common in this sample were apps for running 44.9% (58.1% males) and health monitoring 26.1% (with 55.6% males). Those who use apps have a slightly higher value of HL than those who don’t use, but this difference is not statistically significant.

Conclusions

In this sample not more than 10% of individuals are using apps to promote their wellbeing. Implementing research focusing HL, quality of life and the use of mhealth tools is a new field in public health and allow researchers to identify trends that may trigger strategies to implement health promoting strategies in the work setting. More research is needed to understand how mhealth shape the everyday lives of prosumers in their quest for wellbeing.
Communicating with migrants: children’s health literacy, digital technology, health promotion tools
Authors: Reis A , Saboga-Nunes L , Spínola A , Santos I , Santiago C
Published: November 2019

Background

Being a migrant can enact road blocks in the process of integration, if language barriers persist in the communication between health professionals and migrants. Moreover, health literacy levels (HL) can differ, based on different cultural contexts or conceptions of health and illness. This research aims at exploring migrants (digital) HL and the mediating role of migrant’s children in primary health care setting. Health professionals’ resort to migrants’ children as interpreters and mediators has been highlighted with the younger generations’ digital literacy, as critical tools to overcome such barriers. Assessing and promoting migrant’s HL is a public health mandate in the promotion of individual and family health to establish a common ground base for communication.

Methods

A qualitative and ethnographic study based on narratives, participant observation, focus group and ethno biographic interviews with nurses, migrants, medical doctors and intercultural mediators, involved 52 participants in a primary health care setting in Santarém district, Portugal. Partnership with the Observatory for Migration, the High Commission for Migration (ACM) and with migrant associations, enabled the completion by migrants of an online questionnaire focusing on digital HL.

Results

Migrants’ children were identified as facilitators in the clinical setting at three levels: the communication, HL promotion and adherence to continuity of care.

Conclusions

Improve migrant’s HL and health decisions is feasible when considering several strategies to overcome cultural barriers. Migrants’ children are potential mediators in the process of communication between health professionals and adults. Awareness of their potential allows adjustments in the primary health care sector. The need to further investigate migrants’ HL and digital HL (e.g. telephone translation services, Internet-based tools for scheduling health appointments) are some tasks that need further research.
Dissemination of the capacity building results - tools adapted to the local context
Authors: Kallel K , Zakraoui L , Othman Y Ben , Jouini M , Selaouati F
Published: November 2019

Introduction

The Centres for Evidence into Health Policy created by the CONFIDE project are multidisciplinary; they are dedicated not only to health professionals but also to researchers, policy makers as well as other social, environmental and economic stakeholders. Good dissemination and awareness among all stakeholders are the basis of the success and sustainability of the project results.

The progress

Since the start of the project in October 2017 and after developing a dissemination plan, the first and large-scale dissemination action was the creation of a communication platform and a website. Subsequently, we have setup Facebook, Twitter and LinkedIn pages targeting people more involved in the project. These pages are regularly updated (progress of the project, actions carried out). Two press conferences have taken place in order to reach all targeted audiences in Tunisia. Indeed, our press conferences attracted journalists as well as representatives of NGOs, and health decision-makers in the ministry. A poster and a portfolio were designed in order to introduce the project to partner organizations that provide the students` internships and field trainings. The project also includes a policy game as a tool to bring to the same table the policymakers, researchers and other stakeholders in the community that will further contribute to the dissemination of the CONFIDE project results. Due to the dissemination activities of the Tunisian partners, the academic community in Tunisia has been exposed to a different approach and understanding of public health. The dissemination activities of the CONFIDE results have shed a new light on public health in Tunisia.

Conclusions

A good diffusion of the project, using tools adapted to the various audiences, will make it possible to reach a large and multidisciplinary target public and to associate them with the project. This is a key success factor for the sustainability of the Centres for Evidence into Health Policy.
A new strategy for screening infectious diseases amongst migrants: the STRADA study
Authors: Thonon F , Rousset Torrente O , Lert F , Zucman D , Dimi S , Chassany O
Published: November 2019

Background

In France, the prevalence of HIV, HBV and HCV is high amongst migrants and widespread testing is recommended. All legal migrants in France undergo a mandatory medical check-up at the immigration center (OFII). This check-up is an opportunity to offer rapid HIV and hepatitis testing. A screening questionnaire for risk factors (TROD screen) has been developed and could help target the screening offer. The objective of the STRADA study is to evaluate the efficacy of a screening strategy for infectious diseases (Tuberculosis, HIV, HBV and HCV) based on risk-factor questionnaires amongst migrants during the medical check-up.

Methods

STRADA is a prospective, multicenter, observational study with two parts: tuberculosis screening (evaluation of a screening questionnaire) and HIV, HBV and HCV screening. For that part we have created a risk-based questionnaire for those three infections. In the first phase of the study, all migrants eligible are offered a screening, the TROD screen questionnaire. In the second phase, the screening offered on the basis of country of origin will be compared to the screening offered on the basis of the risk factor questionnaire. Finally, a cost-effectiveness study will be performed. During the informed consent process, participants are informed that the study is voluntary and independent from the residence permit.

Preliminary results

A risk-based questionnaire has been created and translated in 10 languages. The screening has been implemented in 20 immigration centers in France. In April 2019, 35,000 participants have answered the TB screen and 8,250 have been screened for at least one of the three virus.

Discussion

This study will determine the acceptability, performance, utility, costs and impact of a targeted optimized screening strategy for migrants in France. The presence of infectious diseases amongst migrants is a major public health issue. STRADA is an innovative initiative that has the potential to improve screening.
The good practice portal in Germany and considerations towards integrating best evidence
Authors: Shajanian Zarneh Y
Published: November 2019

The good practice portal of the Federal Centre for Health Education / BZgA consists of a nationwide collection of projects and interventions to promote the health of socially disadvantaged groups at the community/setting level. Currently the portal includes 3067 practices, out of them 124 fulfil the good practice criteria and have been identified as such.

The portal aims to disseminate (good) practice in Germany, promote its translation into action, create transparency in terms of quality criteria and make the diversity of practice more visible. A secondary aim is to promote regional networking and the exchange of experience. To this end, an exchange platform (inforo) is also offered via the operating agency, which however is still limited in use.

The portal does not intend to identify the most effective practices, but to be a database of well-described interventions that were feasible to implement in Germany. Therefore, the evaluation process was designed as a mutual advisory process: Standardized description of project owners according to 12 good practice criteria- review by experts from the responsible coordinating offices of Equity in Health - peer evaluation by another coordinating body in another federal state - and finally evaluation by an expert from the nationwide working group at the BZgA. Thus, the evaluation process is also set up to promote mutual learning with the goal of in turn increasing quality of the practice nationwide, with the advantage of being close to the implementation needs and the potential disadvantage of lacking objectivity.

At the moment, BZgA is assessing different possibilities to integrate evidence as criteria into its good practice portal. Therefore, this presentation will end with a discussion on possibilities to integrate the identification and selection of evidence-based/evidence-informed preventive interventions, including the use of evidence criteria and quality of evidence.
EUPHA strategy 2020-2025: Achieving a triple A rating for health in Europe
Authors: Azzopardi Muscat N , Zeegers Paget D , McKee M , Verschuuren M , Nagyova I
Published: November 2019

The challenges we face are complex in nature, and require multidisciplinary and intersectoral action at different governance levels. Therefore, EUPHA will reinforce its two-tier approach. On the one hand, we will support our members in providing high quality and efficient public health and health care services in European countries, regions and local communities. On the other hand, we will advocate for health and support evidence-informed health policy-making at the international level. Stimulating and facilitating mutual learning and the exchange of knowledge and experiences across experts, members and countries will be an essential element of EUPHA’s approach. Not only with a focus on optimal support for our members, but also with an explicit focus on overcoming health inequalities within and between European countries.

Our new vision is to enable everyone in Europe to achieve the highest possible level of health by providing independent and authoritative analysis of the evidence, combined with targeted advocacy to achieve co-ordinated action by all key stakeholders. Our vision: builds on the commitments of our governments and international agencies to achieve the health-related Sustainable Development Goals;recognises the importance of placing Health in All Policies;draws on the Vienna Declaration to embrace the entire range of health determinants, including the biological, social, environmental, occupational, political, and commercial, the health care system, and everything that influences the health of our planet.

Our mission will be: To ensure that there is a strong evidence base, built on sustained investments in data, research capacity, and knowledge translation in all parts of Europe that can inform policies that impact on health;To identify, develop, and advocate for actionable policy recommendations to improve health;andTo support capacity-building and collaborations that can achieve public health action.
Biosocial perspectives on adolescent wellbeing: time trends and cross-national patterns
Authors: Morgan A
Published: November 2019

Since 1985, the HBSC Study has conducted 9 quadrennial surveys. There has been a growing number of HBSC participating countries over the 3.5 decades - from 5 to almost 50, in Europe and North America. In total there have been 298 national HBSC surveys and data collected from more than 1.5 million 11, 13 and 15 year olds. This paper asks - ‘What have we found out about adolescent mental health’ from this enormous research endeavour?

1000 papers have been published from HBSC and of these, just over 10% (120) have a primary focus on mental health. Notwithstanding the complexity of how mental health is conceptualized in each case, the 120 abstracts were scanned and empirical evidence was organised according to Bronfenbrenner’s bio-ecological model in order to synthesise key findings, in order to evaluate: where there were significant contributions to knowledge/understanding of mental health; where this was limited and where real gaps existed.

A vast array of topics was explored on adolescent mental health with a strong focus on the effects of bullying, the school environment and social and economic inequalities. There was a lack of attention to the importance of friendship and prosocial behaviour. Apart from parents, the role of family members, including grandparents and siblings, in supporting or negatively impacting mental health, was neglected. It was concluded that a deeper investigation is needed into behaviours and social contexts that support positive mental health. The use of the bio-ecological model helped to systematise the evidence to provide an overview of what HBSC has achieved in terms of progressing our understanding of adolescent mental health and where gaps exist.

The implications of this review for HBSC’s future development are considered in addition to reflection on what contribution the research to date can make to policy development to improve adolescent health internationally.
TEAviisari – benchmarking health promotion capacity-building in Finnish municipalities
Authors: Saaristo V , Hakamäki P E S , Ikonen J K , Saukko N S , Wiss K K , Ståhl T P
Published: November 2019

Issue

In Finland, municipalities are responsible for promoting public health on local level. However, there hasn’t been comparable nationwide information on health promotion processes and resources in different municipalities available. In order to enhance evidence-based management, a nationwide online database and user interface called TEAviisari (http://teaviisari.fi/en/) was released in 2010.

Description

TEAviisari is based on a generic health promotion capacity-building framework consisting of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation, and other core functions. Each dimension consists of several indicators. TEAviisari aims to make measures taken by local authorities visible and to provide comparable and objective indicators for the management, planning, and evaluation of health promotion activities in different sectors of administration in all municipalities.

Results

Most of the data are collected biennially with an electronic form by municipal informants, and complemented with register data. Sectors covered are primary health care; comprehensive, upper secondary and vocational education; sport and physical activity; culture; and municipal management. Exceptionally high coverage (76%-97%) supports the quality of the follow-up data. In order to simplify the interpretation, all data are displayed as summary scores ranging from zero to 100, where 100 stands for a desirable quality. It is possible to drill down into more detailed information, all the way down to single indicators.

Lessons

Our work shows that it is possible to collect comparable data on health promotion practices and resources in municipalities. TEAviisari offers access to relevant, interpreted information for decision-makers on all levels, serving as an assessment and planning tool for the local government, making their actions transparent to the residents, and providing information for national policy-making.