bluuebunny/crossref_metadata_2025 huggingface dataset:
Designing and evaluating an information campaign on HPV vaccination in Denmark
Authors: Soborg B , Jaconsen S
Published: November 2019

Vaccinating 12-year-old girls against human papilloma virus (HPV) was included in the Danish vaccination program in 2009. Since 2014 safety concerns resulted in a dramatic decrease in uptake.

In order to nuance the debate, inform parents’ decision-making and increase uptake, we launched a national HPV vaccination information campaign in May 2017.

Before designing the campaign, we investigated parents’ knowledge, attitudes and decision patterns regarding HPV vaccination. Results showed that 34% parents were vaccine hesitant. Mothers were the primary decision makers regarding their daughters’ HPV vaccination, and their primary source of information was online media, particularly Facebook. Finally, parents had a lack of knowledge on several HPV-related facts and a high proportion requested more information before deciding on HPV vaccination for their daughters.

Based on these findings, we designed and launched an information campaign in partnership with the Danish Cancer Society and the Danish Medical Association. The campaign, “Stop HPV - stop cervical cancer”, was given a designated website and a public Facebook page posting infographics, written case stories, short movies with cases and experts, and updates on vaccination uptake. The overall strategy was to bring back focus on preventing cervical cancer and put faces on the cancer statistics.

Following the campaign, the proportion of hesitant parents and parents against HPV vaccination had declined and 70% of parents were now in favor of HPV vaccination. The number of vaccinated girls had doubled in 2017 compared to 2016 with nearly 31000 girls receiving their first doses. However, the remaining proportion of hesitant parents indicated that they still felt a lack of information and continuously worried about adverse events. Henceforward, effort will be put into guiding hesitant parents to the website and to disseminate the campaign throughout the country by organizing information meetings for parents locally.
How to institutionalise health promotion through legislation?
Authors: Hätönen H
Published: November 2019

Legislation is a powerful tool to enhance health promotion practices. The aim of this presentation is to describe legislation related to health promotion in Finland. The Finnish Constitution (1999) and the Local Government Act (2015) stipulate every citizen’s right to health and wellbeing. Concrete duties and tasks as well roles of different actors are stipulated in detail in the Health Care Act (2010) and many specific acts.

General strategic management obligations and tasks of the municipalities have been defined as follows: (1) Municipalities shall assess and take into consideration any effects that their decisions may have on the health and wellbeing of residents. (2) In their strategic plans, municipalities shall identify the objectives and define the measures for health and wellbeing promotion on the basis of local needs. (3) They shall monitor the determinants of health and wellbeing, measures taken and follow-up the health and wellbeing of their residents by population groups. (4) Reports on these shall be drawn up for the municipal council once a year and a more comprehensive review on health and wellbeing shall be produced for the municipal council once during each term of office. (5) They shall assign bodies responsible for health and wellbeing promotion. (6) All departments of the municipality shall work together for health and wellbeing promotion. (7) They shall cooperate with other public local authorities, with private enterprises and non-governmental organisations.

The Health Care Act as well other acts further defines the preventive services that municipalities need to offer. In Finland we have ensured effective implementation of the legislation by number of actions. First, different stakeholders were closely involved to the law-making process from the beginning of the process. Secondly, implementation was, and is still, supported by the National Institute for Health and Wellbeing. Finally, the implementation is systematically monitored.
Public health policy implementation and evaluation in portugal and israel (Project PH.PIE): the intersectoral pledge and the case of health literacy for tobacco control in the building of the Homo Salus
Authors: Saboga-Nunes L , Fernandes A C , Levin-Zamir D
Published: November 2019

Despite the overwhelming accumulated evidence of the negative effects of nicotine intake, the prevalence of tobacco use is not expected to decline in the near future in several countries. Israel and Portugal both signed the WHO Framework Convention on Tobacco Control (WHO FCTC) and implemented several strategies to achieve Positive Public Health Outcomes (PPHO) (e.g. policy making, legislation). Nevertheless during the past 10 years the number of smokers in Israel has decreased from 28% (in 2000) to about 20.6% (in 2017), while in Portugal, the number of smokers has not changed (2002, 19.2%). However, it has increased for women and adolescents.

The goal of PH.PIE project (Public Health Policy Implementation & Evaluation) is to document policy development and implement Health Impact Assessment (HIA) towards a knowledgeable civic society, searching for the real PPHO. Tobacco control is a selective topic because of its high relevance in public health. PH.PIE considers policy making and stakeholder analysis to comprehend HIA of strategic public health issues and PPHO.

The tobacco industry during the last 10 years has invaded the market with a comprehensive new approach, built around the concept of harm reduction and turnaround strategies to counteract WHO FCTC principles. This way, public health has apparently lost its grip from its own argumentative discourse, while several stakeholders have positioned themselves in the co-working facelift of nicotine use with smokeless tobacco, electronic cigarettes, and other forms of use that have not been scrutinized in terms of their real potential on public health terms.

Harm reduction approaches take the front line, in contrast to smoking cessation efforts as a cornerstone of WHO FCTC. We argue in this paper that health literacy can be critical tool in re-making nicotine addiction in the homo salus upbringing.
The WHO support tool: how is it used and what kind of adaptations are needed?
Authors: Rosenkötter N , Ortiz D Novillo
Published: November 2019

Issue and method

In December 2013, the Standing Committee of the Regional Committee for Europe asked the WHO Regional Office for Europe (WHO EURO) to develop a practical tool for Member States that provides assistance in developing and improving national health information systems (HIS) through the development of a national health information strategy.

The developed tool, the Support Tool, was informed by existing tools developed earlier by WHO’s Health Metrics Network and was adapted for the planned assessments in the WHO EURO region. The Support Tool was published in 2015 and was used until now for nine national HIS assessment missions.

Results

By using the Support tool all dimensions of a HIS are assessed: the general resources needed, the indicators used, the data sources available, the applied data management procedures, data quality, and the dissemination process and use of the HIS outputs. The Support Tool structures the assessment process and supports the identification of strength, weaknesses, opportunities, and challenges that inform HIS strategy development in the second stage.

Lessons

So far, the application of the Support Tool had a strong focus on the assessment stage. It turned out that it is necessary to develop a joint understanding of what a HIS entails. The Support Tool offers great potential to start a structured dialogue with all actors linked to the HIS including policy makers. The assessment provides an opportunity for HIS strengthening and the development of a joint understanding. However, it turned also out that further adaptations of the assessment content are needed to better cover topics prevalent in European HISs, like electronic health records, modern IT-resources, modern reporting approaches, and knowledge translation.
The WHO support tool: what can you learn and how have others experienced it?
Authors: Bogaert P , Abboud L A , Calleja N , Zelviene A , Schmidt A , Rösenkotter N , Ortiz D Novillo , Verschuuren M , van Oers H , Van Oyen H
Published: November 2019

Issue and method

Health information systems (HIS) in Europe are complex and involve multiple stakeholders. To strategically assess HIS, a support tool has been developed by the WHO Regional Office for Europe.

It has been applied in nine countries by WHO Europe since October 2015. Additionally, nine countries are using the tool in a peer review format within the context of the Joint Action on Health Information (InfAct) between January and December 2019. What can you expect to find out during such an assessment? What are countries commonly struggling with? In this presentation, the wealth of experiences using the support tool will be shared and participants will learn about common strengths and weaknesses in HIS across Europe.

Results

While each country possesses a unique HIS, common strengths and challenges emerge from across assessments. A few major ones will be presented in this session. In many countries promising e-health developments are ongoing such as electronic health records, e-prescription and cloud solutions for data storage. There is a clear desire to shift towards e-health technologies which is a real opportunity. However, well-developed step-wise approaches in interaction with key players are sometimes lacking and sustainability in financing can be of concern. Central multisectoral coordination mechanisms are often lacking, leading to inefficiencies in bringing together data and information, and in the use of financial and human resources. Finally, in many cases data is available, but legal aspects (e.g. impact of General Data Protection Regulation) are limiting the exchange and linkage possibilities for research and monitoring.

Lessons

HIS assessments help to determine common strength and challenges. By sharing common experiences, participants are better prepared to face common hurdles in their country and will have been exposed to good practices on how to address these.
Workshop: Social-to-biological processes over the lifecourse and social inequalities in health
Authors:   Organised by: French National Institute of Health and Medical Research Chair persons: Michelle Kelly Irving - France, Marc Chadeau-Hyam - France
Published: November 2019

Context

Socioeconomic inequalities in health and ageing are observed across contexts and over time, presenting a challenge for public health. The mechanisms driving associations between social conditions and health include biological responses, which in turn are associated with health outcomes. This workshop aims to describe and discuss evidence on the biological embedding of the social environment from research carried out within a large European consortium, and place it within the context of public health.

Methods

The Lifepath project was funded by the European Commission between 2014-19 and brought together longitudinal datasets from across Europe, as well as an interdisciplinary collective of researchers keen to examine how social inequalities in health are constructed over the lifecourse.

Results

Four separate studies are presented here. First, Carmeli et al examine the relationship between social position and systemic inflammation through the mediating role of gene regulation. Second, Fraga et al describe the social patterning of chronic inflammation observed in early adolescence. Third, Castagné et al analyse the relationship between social position across the lifecourse and systemic inflammation, and the role of inflammation within the allostatic load heuristic. Fourth, Chadeau-Hyam et al describe social gradients in a multi-system biological health score, and its subsequent relationship with a number of major health outcomes.

Discussion

We will coordinate a discussion between the audience and workshop participants. The contribution of the inflammatory system to capturing social inequalities and in its association with chronic disease will be discussed. Is it a key player in the construction of health inequalities, or merely an effective signal for many diverse processes? The role biological markers can play in enhancing our understanding of health inequalities, and how the public health community can respond to the evidence will be discussed.

Conclusions

Socially patterned biological responses begin early in the lifecourse and may be key factors in the construction of social inequalities in health and ageing. As such, they should be taken into account in public health activities and policy.

Key messages

The biological embodiment of social conditions is observed from early life and across the lifecourse. Systemic inflammation appears to be a central mechanism which is socially patterned and associated with many health outcomes.
Social patterning of inflammation over the lifecourse and its relationship with mortality
Authors: Castagné R , Chadeau-Hyam M , Karimi M , Stringhini S , Vineis P , Delpierre C , Kelly-Irving M
Published: November 2019

Background

This study explores (i) the relationship between socioeconomic position (SEP) across the life course and circulating C-reactive protein (CRP), a marker of systemic inflammation, in 6 European cohort studies (in up to N = 23 008) participating in the Lifepath project and (ii) interrogate the hypothesis of a cumulative biological risk (allostatic load, AL) reflecting 4 physiological systems, including inflammation, potentially predicting future risk of death in one of the cohort.

Methods

First, we estimated the association between measures of three time point SEP and adulthood CRP, adjusting for health behaviours and body mass index (BMI). To mimic life course experiences, we sequentially adjusted for the chronologically ordered measures of SEP. Next we used mortality data from the 1958 British birth cohort to operationalise AL from 14 biomarkers collected at age 44. Multivariate Cox proportional hazards regression was used to estimate hazard ratios for the association between AL, biological sub-scores and individual biomarkers with mortality.

Results

Educational attainment was most strongly related to inflammation where low educational attainment was associated with higher log-transformed levels of CRP (β = 0.30, (0.22-0.38)). Higher AL at 44 years old was a significant predictor of mortality 11 years later (HR = 3.56 (2.3 to 5.53)). Among the four physiological systems, only the immune-inflammatory and cardiovascular sub-scores were significantly related to mortality.

Conclusions

Socioeconomic circumstances across the life course are associated with higher levels of inflammation in adulthood which in turn predict subsequent risk of death. But our findings also suggest that the cumulative AL measure consisting of all the biomarkers was a better measure for predicting death adding evidence on the biological embodiment in response to chronic stress, suggesting that social-to-biological processes are at play, beyond the impact of health behaviours and BMI.
A socially patterned Biological Health Score and mortality in Understanding Society and UKBiobank
Authors: Chadeau-Hyam M , Karimi M , Castagné R , Bodinier B , Delpierre C , Kelly-Irving M
Published: November 2019

Background

It now established that social factors impact the quality of ageing, through the lifecourse stimulation/dysregulation of key physiological systems. Composite scores such as allostatic load, focusing on the response to stress, can be used to measure individual physiological wear-and-tear.

Methods

Using data from the Understanding Society study, a cross-sectional panel study including 9,088 participants representative of the UK population, we defined a synthetic biological health score (BHS) capturing the wear-and-tear of four physiological systems (endocrine, inflammatory, cardiovascular, and metabolic systems), and of two key organs (liver and kidney). We used 16 established blood-derived biomarkers of these systems to calculate the BHS and explored the relative contribution of socio-economic position to the BHS and its main components across age groups. Using data from UK biobank, including over 400,000 UK participants in whom similar biomarkers have been assayed in blood, we sought validation of our results and investigated the role of the BHS on all-cause and disease specific mortality, and disease incidence.

Results

We identified a systematic decreasing education-related gradient of the BHS (p < 0·001) leading to lower biological risk in participants with higher educational attainment. Education-related differences in the BHS were detected early in life, and were not attributable to lifestyle and behavioural factors. Analyses of the UK biobank data validated these findings and also showed that the BHS contributed in turn, irrespective of established health risk factors, to all-cause and disease specific mortality.

Interpretation

Our findings highlight the social-to-biological processes ultimately leading to health inequalities, and suggest that such disparities can already be detected in the 20-40 year age group.
Using survey data on population health literacy for developing a National Action Plan in Germany
Authors: Berens E , Schaeffer D
Published: November 2019

Promoted by the results of the European Health Literacy survey, the first representative German Health Literacy Survey (HLS-GER) was conducted in 2014. The results showed that every second individual in Germany (54.3 %) has limited health literacy. Thus, a majority of the German population is confronted with difficulties in finding, understanding, appraising, and applying health information. Particularly, vulnerable groups as people with migration background, low education attainment, and in older age as well as chronically ill have even more problems in processing health information and thus are confronted with challenges to maintain health, prevent diseases and use the healthcare system.

Based on the initial research findings of the HLS-GER and the increasing attention and discussions arising with its results, the National Action Plan Health Literacy was developed by a group of experts to systematically improve and strengthen health literacy in Germany. After agreements with representatives of politics and society, health professions and patient and citizen organizations it was published in 2018. It includes 15 specific recommendations in four areas of action and focusses on fostering health literacy in daily life, creating a user-friendly and health literate healthcare system, HL and chronic illness and expanding health literacy research. Five underlying key principles are mentioned to consider in implementing the National Action Plan. The HLS-GER survey data were further used to discuss some recommendations within specialized workshops leading to more detailed strategy papers. The current political and practical developments and discussions initiated by National Action Plan, will be picked up in the second German Health Literacy Survey (HLS-GER2), which is part of HLS19. By repeatedly assessing population HL in Germany the implementation of the National Action Plan can be monitored and further specified, thus survey data help to create policy.
Italian participation to the WHO action network on measuring health literacy: policy implications
Authors: Cadeddu C , Palmieri L , Galeone D , Mastrilli V , D'Elia R , Rosano A
Published: November 2019

Issue

Health literacy (HL) is recognized as a determinant, mediator or moderator of health and of use and results of health care services Inadequate HL is associated with patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates.

Description of the problem

Few previous studies suggested that inadequate HL is a prevailing problem in Italy. As compared with the European Countries, Italy has peculiar characteristics of socio-demographic determinants of HL levels, which constitute a challenge for policy making. In so far HL has not been considered as a strategic priority for the Italian National Health Service. The Italian National Institute of Health and Ministry of Health are promoting a national program on HL by adhering to the WHO action network on measuring population and organizational health literacy (M-POHL). Main aim of the program is to propose policies that could enable all citizens to share the benefits of improved HL. A national population survey, coordinated at European level, has been planned in each participating country in 2019.

Preliminary results

We are setting up the survey using the questionnaire with 47 specific questions about HL and 32 about lifestyles and demographic characteristics. Updated results of this survey will be analysed in order to define a strategic line for the implementation of actions for the improvement of HL in the next National Prevention Plan. Furthermore, the national survey will be scheduled and repeated to monitor results.

Lesson State

Policies can be implemented at individual, community, organization or system level. Italy is at the beginning of its experience in this field. A national steering committee of experts has also been appointed to support HL policy initiatives. The comparison with existing policies in other countries within the M-POHL action will be another asset to develop HL policies and related activities to benefit citizens, patients and communities.
Step-by-step process of making the case for sustainable investment in wellbeing and health equity
Authors: Dyakova M , Ashton K , Stielke A , Bellis M A
Published: November 2019

Issue

Urgent action is needed to address the growing health, inequity, economic and planetary challenges that threaten the wellbeing of present and future generations. Business as usual has proven unsustainable with high human, social, economic and environmental costs. Coordinated policy action on the determinants of health combined with well-designed and implemented governance and innovative investment approaches can have a dual effect: a) reducing the health gap; and b) improving overall population health.

Description

The WHO Collaborating Centre on Investment for Health and Wellbeing has developed a practical step-by-step guide, outlining the process of how to synthesise, translate and communicate public health and economics evidence into policy and practice, in order to make the case for investment in wellbeing and health equity. It aims to: 1) prevent disinvestment in health; 2) increase investment in prevention / public health; and 3) mainstream cross-sector investment to address the wider determinants of health and equity, driving prosperity for all.

Building on the Knowledge-to-Action framework and an extensive international multi-disciplinary consultation, four key phases are described: 1) Project scoping and planning; 2) Evidence gathering, synthesis and design; 3) Dissemination and communication; and 4) Monitoring and evaluation. Key messages, different products and a number of practical tools and tips are highlighted. An essential element is using health economics approaches and tools to build the case, showing the burden of inaction in parallel with available sustainable solutions, which can bring ‘social return on investment’.

Results/Lessons

The result of the above-described process is the development of evidence-informed, context-tailored advocacy documents and tools, enabling healthy policy- and decision-making across different sectors, levels of government and country settings.
Mobile clinic approach towards hard-to-reach populations’ health in Roman suburban settings
Authors: Corsaro A , Marotta R , Angelone D F , Biagiarelli F S , Terenzi F , Zampa A , Buonuomo E , Galizi M C , Giuffrida F , Giampaolo R
Published: November 2019

Among other vulnerable populations, Sinti and Roma ethnicity people are the ones more likely living in precarious housing conditions such as settlements, especially in Roman suburban and deprived neighbourhood. These hard-to-reach communities usually present poor health outcomes and reduced life expectancy. Since 2016, the project Nontiscordardimé (a partnership of Bambino Gesù Children’s Hospital, OSA Health Workers Cooperative and Vicariatus Urbis) provided 3 outreach per week in two different peripheral settings ensuring to children specialized visits, nutritional screening, growth monitoring and vaccinations by means of a mobile clinic. When necessary, second level examinations have been arranged in the hospital. Personal data, detected pathologies and services provided have been collected from January 2016 to December 2018.

Main diseases detected during 2.226 examinations in Gipsy settlements were respiratory infection (26,3%), skin infection and parasitosis (13.3.%). Moreover 7,5% of visited children had malnutrition and 3,4 % presented oral hygiene related issues. Only 40% of planned second level examination and only 51% of planned hospital admission have been carried out. During outreach in parishes of suburban areas, 1.411 examinations have been performed, encountering mostly respiratory disease (30%), asthmatic bronchitis (8%), dermatitis (5,8%) and allergic rhinitis (3,8%). Adherence to hospital examination and admission reach respectively 72% and 85%.

Poor housing, isolation and overcrowding are significant barriers to prevention and health care even if the national health system provides universal coverage, and free care. Indeed disease prevalence in gipsy settlements was mainly related to socio-economical and housing condition (poor hygiene, overcrowding) whereas others peripheral urban setting, even when deprived, showed an epidemiological framework close to the general population where asthmatic and allergic disorders are prevalent.

Key messages

Mobile clinics can close the gap between health services and disadvantaged children and hard-to-reach populations. Outreach can be a mean of promotion, prevention and health services inclusion.
Refugee Escape Room©: a new gamification tool to deepen learning about Migration and Health
Authors: Ruben Moreno N , Wylie L , Serre-Delcor N
Published: November 2019

Background

The aim of gamification is to provide an experiential exercise that invokes emotions to deepen learning. MyHealth project is interested in developing tools that facilitate healthcare access to newly arrived immigrants in Europe. One important barrier is the low levels of intercultural competency among healthcare professionals and the pervasiveness of negative health-related stereotypes.

Methods

We aim to demonstrate the educational value and social impact of the Refugee Escape Room©, to 1) raise awareness about the social and health challenges faced by vulnerable migrants and 2) provide an effective intercultural competence and self-efficacy training for hosting community. The game was created in 2017 by healthcare professionals and university students with personal migratory experience. It is divided in two parts. The first part addresses knowledge gaps about relevant aspects of Migration and Health. The second part is a fictional border control exercise with multiple bureaucratic challenges that participants, organized as “families”, must overcome to succeed. A pre-post pilot was executed to test for tool effectiveness. The piloting phase involved carrying out multiple instances of the activity for separate target groups. A questionnaire was developed with items related to knowledge, self-efficacy and intercultural competence. The questionnaire was filled by participants at baseline and post intervention to assess for statistically significant changes in all outcomes.

Results

while the piloting phase is still ongoing preliminary results show a high level of acceptability and engagement with the tool.

Conclusions

Refugee Escape Room© is a newly created tool that posits as a promising awareness-raising, competency-building gamification tool that is easily adaptable to multiple settings and participants.

Key messages

Gamification provides an experiential exercise that invokes emotions to deepen learning. Refugee Escape Room© is a promising tool for raising awareness about challenges faced by vulnerable migrants.
Utilization, satisfaction and barriers of medical care among adults of Turkish descent in Germany
Authors: Dornquast C , Solak S , Durak M , Krist L , Jöckel K H , Schramm S , Schmidt B , Keil T , Reinhold T
Published: November 2019

Background

The growing proportion of people with a migration background poses major challenges for public health and the health care system in Germany. People of Turkish descent represent the largest group within this specific population. The aim of this study was therefore to examine the use and satisfaction of medical services and barriers to health care access among adults of Turkish descent in Germany.

Methods

A cohort study of a group of nearly 1200 Turkish adults in Berlin and Essen constitutes the basis of this analysis. The baseline examination was carried out as part of the pretests of the German National Cohort study. This follow-up survey assessed utilization, satisfaction and subjectively perceived barriers in the German health care system, as well as socio-demography, lifestyle, health status and quality of life via self-report (paper based or online) in Turkish or German. Descriptive preliminary results are presented in this abstract.

Results

The first 287 participants interviewed until December 31, 2018 were on average 49 years old, with 64% being female. 90% of the participants had a family doctor and in the last 12 months, 17% were in a hospital for in-patient treatment and 23% in an emergency room. The use of screening programs varied from 15% (skin cancer screening) to 87% (mammography). The most frequently visited physician was the general practitioner (86%). The participants were satisfied regarding many aspects, with the best values for the communication with their doctor. However, 22% reported problems or barriers in the context of medical care in the last five years.

Conclusions

These preliminary results provide a first insight into the utilization behaviour among adults of Turkish descent, their satisfaction as well as barriers with the German health care system. However, possible consequences of our study should only be discussed after all analyses have been completed.

Key messages

This is one of the few cohort studies in a migrant population in Germany. Knowledge of barriers could provide indications of problems of adults of Turkish descent in the German health care system.
Transnational medication management by elderly migrants – a mixed-methods approach
Authors: Tezcan-Güntekin H , Akbulut N , Stern A , Özer-Erdogdu I , Razum O
Published: November 2019

Background

Many elderly people of Turkish origin choose a transnational lifestyle and commute between Germany and Turkey every few months. These circular migrants often suffer from chronic diseases. The transnational lifestyle can lead to discontinuities in long-term medication and irregular check-ups. If continuity of care is not ensured transnationally, health risks arise.

Methods

In a mixed-methods study 8 expert-interviews with general practitioners and 25 guideline interviews were conducted with circular migrants to analyze their medication adherence. Additional quantitative analyses were conducted based on data from a German statutory health insurance popular with migrants to investigate discontinuities of prescribed medication.

Results

Cross-border care involves different health risks with regard to medication adherence. For example, patients in Germany rarely receive the amount of medication they need for their stay in Turkey and there are discontinuities in medication delivery. The multi-perspective insight into the patients’ experiences of medical care and the view of general practitioners shows strong variations of preferred strategies to handle the challenges of transnational medication management. Single strategies, such as leaving the health insurance card in one state for prescription and sending of medication through family members or asking for higher amounts of medication to store before travel, lead to frustration both at GPs’ and patients’ sides. GPs experience high pressure by the health system’s structure in providing good care for the patients, especially in providing enough time for information transfer between GPs and patients.

Conclusions

Transnational solutions for health care, and in particular medication care, such as an interprofessional collaborative care across borders or transnational e-health records need to be developed.

Key messages

A transnational lifestyle can lead to discontinuities in the provision of medication. Transnational, inter-professional cooperation is needed to ensure continuity of health care for circular migrants.
A mixed-method evaluation study of a comprehensive cross-cultural training program in Stockholm
Authors: Tewelde J , Dahlin M , Bäärnhielm S
Published: November 2019

Background

Global migration and increasingly diverse populations poses new challenges to mental health services. Cultural differences between refugees and mental health professionals and lack of cultural competency is described as challenging. Cross-cultural training has been proposed as one way to reduce these problems. There are few evaluations on cross-cultural mental health training outcomes. Between 2016-2018, 13 one-day cross-cultural training interventions was implemented in Stockholm to equip mental health professionals to respond to mental health needs in a time of high influx of refugees.

Objectives

To evaluate a comprehensive cross-cultural training program regarding participant’s knowledge development, their experiences and views of the training - and their perceptions about their capacity to deliver mental care to refugee patients. An embedded mixed-method design was applied. We used before and after training questionnaires (n = 248) and conducted six focus group discussions (FGD) with mental health professionals. Quantitative data were analyzed by paired t-test and factor analysis, qualitative data were analyzed by thematic content analysis.

Preliminary results

Before the training, significant differences of mean knowledge was found (p = 0.004) among participants. Principle axis Factoring resulted in 3 factors before and 4 factors after the training, explaining 78% of the covariance. Findings from the after training FGDs, revealed that refugee patients were described as different and challenging, and little was known about the reality they live in. The training contributed to a better understanding of migration, integration and refugee health- as well as the role of culture. Further, it promoted empathy and professional self-reflections.

Conclusions

Cross-cultural training can contribute to knowledge development, attitude changes and also be valuable for care provider’s professional role.

Key messages

Training mental health professional in cross-cultural issues may facilitate improved quality of care to refugee groups. The training can also strengthen participants in their professional role.
The importance of ensuring artificial intelligence and machine learning can be understood at the human level
Authors: Ram S
Published: November 2019

With rapid developments in big data technology and the prevalence of large-scale datasets from diverse sources, the healthcare predictive analytics (HPA) field is witnessing a dramatic surge in interest. In healthcare, it is not only important to provide accurate predictions, but also critical to provide reliable explanations to the underlying black-box models making the predictions. Such explanations can play a crucial role in not only supporting clinical decision-making but also facilitating user engagement and patient safety. If users and decision makers do not have faith in the HPA model, it is highly likely that they will reject its use. Furthermore, it is extremely risky to blindly accept and apply the results derived from black-box models, which might lead to undesirable consequences or life-threatening outcomes in domains with high stakes such as healthcare. As machine learning and artificial intelligence systems are becoming more capable and ubiquitous, explainable artificial intelligence and machine learning interpretability are garnering significant attention among practitioners and researchers. The introduction of policies such as the General Data Protection Regulation (GDPR), has amplified the need for ensuring human interpretability of prediction models. In this talk I will discuss methods and applications for developing local as well as global explanations from machine learning and the value they can provide for healthcare prediction.
Analysis of needs, expectations and capacities of health and social care professionals in order to provide culturally adapted care
Authors: Lebano A , Hamed S , Bradby H , Gil-Salmerón A , Garcés-Ferrer J , Karnaki P , Zota D , Riza E , Tsiampalis T , Linos A
Published: November 2019

The Mig-HealthCare consortium conducted a qualitative study of the health care needs of vulnerable migrants/refugees in Europe. The research was conducted between Fall 2017 and Spring 2018. In total, 20 focus group discussions or, where necessary individual interviews (19), were organised with health care professionals and service providers; policymakers; and representatives from Non-Governmental Organisations - NGOs. Thematic qualitative analysis was employed. The main results of the analysis show that:

Health care provision for migrants is uneven throughout the EU and variations exist even within the same country. Health care providers and NGOs agree that health care for migrants is inadequate and biased in favour of particular conditions and cases (minors, pregnant women and acute conditions). Challenges faced by different countries vary; while in some countries the main issue is legal access, in other basic needs such as sanitation and basic infrastructure were emphasised. Austerity measures following the 2008 financial crisis have negatively affected the health care system in general, which in turn has negatively affected the provision of health care for migrants/refugees. Discrimination linked to socio-economic and ethnic conditions is reported as a barrier to equal health care access. Knowledge, language and communication on both the demand and the supply side of health care provision emerge as crucial to ensure equal access for migrants/refugees. Gender may act as a barrier with women tending to be more marginalised in the host country, in terms of language proficiency and health literacy, lowering health care access. One of the main challenges for providing equal health care access for migrants has to do with the ability to balance a universal right to health with the particular means of achieving it. The evidence collected here shows how this tension between end and means is at work in different moments of the provision of health care for migrants/refugees.
Best practices addressing healthcare care access of migrants and refugees in European countries
Authors: Riza E , Kalkman S , Karnaki P , Zota D , Gil-Salmerón A , Durá-Ferrandis E , Garcés-Ferrer J , Linos A
Published: November 2019

Mig-healthCare has identified sources in the countries and languages of the consortium providing guidance for community-based healthcare for migrants and refugees. A total of 54 sources that refer to best practices in seven European countries were identified. Results were categorized along with the themes: organization, communication, training, education and facilities & services. Successful organizational measures were a close collaboration with different governmental authorities, NGOs, community organizations and various local service providers. Moreover, engagement with members from both the host community and the migrant/refugee community in the design and implementation phases is essential. The need to track all activities through data collection and periodic evaluations is important in order to evaluate the effectiveness of systems. Funding was mentioned as important to secure continuity of projects and systems. Bridging communication barriers is a major facilitator to reduce health disparities. Differences in the types of practices and challenges per country were noted. Translators and cultural mediators are a key element in successful implementation, but across EU there is a need for more specialized staff to face the cultural barriers of the large variation in refugee/migrant backgrounds. The empowerment of migrants/refugees in promoting well-being through the engagement of the host community to help reduce stigma and discrimination is a successful strategy facilitating the access to care due to the increase of their health literacy skills. Finally, tailored services to give an answer to the specific needs of migrants and refugees are important, for example at first reception centres, standard medical screening and psychosocial risk assessment was recommended. Through this analysis, we can distinguish community-based care models elements facilitating the access of migrants and refugees to healthcare.
A comparison of the effects of maternal anxiety and depression on child development
Authors: Gete S , Calderon-Margalit R , Grotto I , Ornoy A
Published: November 2019

Background

Most studies on the association between the mental health of mothers and the development of their offspring have focused on maternal depression, but only a few have investigated the association between maternal anxiety and child development. We aimed to compare the associations between maternal depression and anxiety symptoms 6-8 weeks postpartum and infant development at 1 year.

Methods

We conducted a longitudinal study of 396 mother-child dyads. The mothers were recruited after birth in 3 different hospitals in Israel in 2017 and were followed for one year. Mothers were assessed by completing the General Anxiety Disorder-7 (GAD-7) questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) 6-8 weeks postpartum. Child development was assessed by the Ages & Stages Questionnaires (ASQ-3) at 12 months. Multivariate linear regressions were used to explore the relationship between the EPDS and GAD-7 scores and child development, all as continuous variables, adjusting for maternal education, parity, and gender.

Results

Depressive symptoms postpartum were only associated with poor personal-social skills (β=-0.5, 95% CI: -0.91, -0.08). Increasing maternal anxiety was associated with poorer development in communication skills (β =-0.48, 95% CI: -0.93, -0.04), personal-social skills (β =-1.02, 95% CI: -1.58, -0.46), solving problems skills (β =-0.7, 95% CI: -1.27, -0.14) and fine motor skills (β =-0.46, 95% CI: -0.9, -0.02). Neither anxiety nor depressive symptoms were associated with gross motor skills. Controlling for quality of attachment, the associations of depression and anxiety with development were no longer significant, suggesting mediation.

Conclusions

Postpartum anxiety was a stronger predictor of low developmental scores than depression, and associations were probably mediated by impaired attachment. Identifying and supporting mothers experiencing anxiety after birth may mitigate the risk of developmental delays in children.

Key messages

Maternal anxiety was found to be a significant risk factor for developmental delay at 1 year of age. The association between maternal anxiety and child development was probably mediated by attachment.
The use of quality indicators (QIs) to evaluate the oncologic care in CCCN: a systematic review
Authors: Cocchiara R A , Mannocci A , Cianfanelli S , Sestili C , D’Egidio V , Lia L , Backhaus I , Dorelli B , Federici A , La Torre G
Published: November 2019

Due to the increase of life expectancy for cancer patients, it has become necessary to implement complete and economically sustainable clinical care pathways that integrate different professional competences. The Comprehensive Cancer Care Network (CCCN) model consists of multiple specialized structures that cooperate for cancer patients care. Quality Indicators (QIs) represent valid and reliable tools of evaluation that allow a standardized comparison among different structures. The aim of this systematic review was to highlight a wide and complete description of the implemented QIs within the CCCNs and to identify and analyze methodologies used for the development of QIs. The literature was performed investigating two databases (PubMed and Scopus) and the search identified 7342 studies. After duplicate removal, title and abstract screening, and full text evaluation, 46 studies were included in the study. Most QIs were implemented in USA, Germany and Italy where the CCCN approach seems to be well defined. Eighty -two QIs concerned diagnosis, 260 concerned treatment, 7 concerned prevention, 29 about follow up, 71 about palliative care, 12 concerned rehabilitation and 7 research. The majority of the identified QIs belonged to the process domain, followed by the structure ones. Excluding QIs related to the management of cancer in general, the most represented organs resulted breast, colorectum and lung. Overall, it can be stated that the most represented categories of QIs concerned diagnosis and treatment. Furthermore, also the palliative care domain appeared very represented. Regarding the methodology of the QIs development, a consensus approach among experts and the Delphi method were the most frequently used methodologies. Only a few studies included the participation of patients for the implementation of the QIs. This systematic review provides a synthesis of existing QIs related to the setting of integrated oncological care

Key messages

The CCCN has been recognized as an ideal model for structuring the process of care that guarantees a complete and integrated approach for the management of oncological patients. Quality Indicators represent valid and reliable tools that should be used to perform a standardized comparison among different healthcare systems and to guarantee a homogeneous quality of care.
Perceived health and quality of life in chronic and end-stage kidney disease
Authors: Legrand K , Speyer E , Stengel B , Frimat L , NGUEYON SIME W , Briançon S , Ayav C
Published: November 2019

Background and objectives

Health-related quality of life (HRQoL) is increasingly considered a major outcome in patients with chronic kidney disease (CKD), but the size of its effect on physical and mental health at different disease stages, compared with the general population, is unclear.

Design, setting, participants, and measurements

We compared HRQoL measures in four groups: 2,687 outpatients with moderate (stage 3, estimated glomerular filtration rate [eGFR] 30-60 mL/min/1.73 m2) or advanced (stage 4-5, eGFR < 30 mL/min/1.73 m2) CKD under nephrology care from 40 nationally representative facilities, 1,658 patients with a functioning graft, 1,251 dialysis patients randomly selected from the national REIN registry, and 20,574 participants in the French Decennial Health Survey, representative of the general population.

Results

Mean age (years) was 67, 69, and 55 in patients with non-end-stage CKD, on dialysis, or with transplants, respectively; 60% were men. Age- and gender-standardized health status was perceived as fair or poor in 27% of those with moderate CKD and more than 40% of those with advanced CKD and those on dialysis, compared with 12% in transplant patients and 3% in the general population. Compared with the general population, HRQoL physical scores adjusted for age, gender, education, obesity, and diabetes, were significantly lower, by a factor of 2.2 among patients with moderate CKD, 4.1 among those with advanced CKD, 10.2 among those on dialysis, and 4.1 among those with transplants. The effect was stronger for those younger than 65 years. The mental score was lower only for dialysis patients.

Conclusions

This study highlights the importance of the physical health effects beginning at the moderate stage of CKD. More attention to patients’ CKD-related perceived health is needed.

Key messages

Physical health declined significantly from moderate through end-stage CKD, with impact greatest among the youngest patients. More attention to CKD’s impact on quality of life is needed.