bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning from success: implementation & evaluation of a national program
Authors: Harel-Fisch Y
Published: November 2019

The WHO - Health Behavior in School-Aged Children (HBSC) cross national survey, has monitored changes in youth alcohol use throughout the past 3 decades in over 45 countries in Europe and North America. While Israel has usually shown relatively low rates of adolescent smoking, drinking and drug use, the rates of problem drinking increased dramatically during the years 1994-2009. The rate of binge drinking in P30D for teens aged 11-15 tripled from 6.2% in 1994 to 20.6% in 2009. Findings were cleverly used to impact policy. The scientific evidence were disseminated to the press and targeted parliament and cabinet members. Consequently, the government funded the development and implementation of a comprehensive, long-term national program to reduce alcohol drinking among youth. The program was funded and implemented in three consecutive stages: 2010-12, 2012-14 and 2014-16 and was coordinated by the Israel Anti-Drug Authority. HBSC data were used as the monitoring system of the program. Activities included: implementing a comprehensive national strategy, building partnerships with relevant agencies, developing consistent and coherent messages, implementing national media campaigns, passing and enforcing a host of new legislation, implementing a wide variety of age and culture-specific school programs, and implementing community-based interventions. HBSC findings show that as a result of this national intensive program, binge drinking by Israeli youth dropped from 20.6% in 2009 to 12.4% in 2011, to 10.7% in 2014 and finally to 6.2% in 2019. All in all, binge drinking dropped to about one third of its magnitude in 2009, prior to the implementation of the national program. The paper discusses the unique role of HBSC in identifying a critical increase in binge drinking, influencing decision makers, providing base-line data for the national program and serving as its evaluation system.
Measuring health and well-being with the help of the community
Authors: Williams G , Verma A
Published: November 2019

Issue

The Well North Programme is a multi-centre study focused on reducing inequalities in deprived communities through locally-led interventions and activities. As a locally driven project where the local stakeholders were involved in the programme of work, it was important to involve the community when deciding what to measure.

Description

As part of the evaluation there was a need to produce a tool to capture health and wellbeing information that was relevant to the specific communities involved in the project. In order to do this, we established that we needed local people to define what they wanted to measure, and we would use evidence synthesis techniques to identify tools that could be used to measure it within the community.

Results

We formulated the Well North Star, a bespoke spider diagram designed to capture individual level data. The Star is a quantitative tool used to collect individual-level data at an individual, organisational and geographical level. Each arm of the star represents an important theme, selected for measurement by local people. Identified local stakeholders (including residents, voluntary sector, police and councillors) were invited to workshops in order to decide what issues were important locally. After group discussions and thematic analysis, up to seven issues were highlighted as the most important in the community. Two of the main issues highlighted within local communities were aspiration and access to local information. After extensive literature search, tools to measure these were insufficient (e.g. aspiration tools focused on aspiration to become famous) and so bespoke tools needed to be created.

Lessons

When conducting community driven research, it is important to involve representatives from the community in identifying issues that are important to them. There is a gap between what academics and researchers consider important in local communities and what the communities themselves consider important.
Workshop: Leaving no one outside: strategies for improving delivery of care undocumented migrants in Europe
Authors:   Organised by: Platform for International Cooperation on Undocumented Migrants (PICUM) Chair persons: Alyna Smith - Belgium
Published: November 2019

A number of recent publications, including WHO’s Report on the health of refugees and migrants in the WHO European region: no public health without refugee and migrant health (2018) and the report of the UCL-Lancet Commission on migration and health have underscored the ways in which vulnerability to poor health outcomes can be exacerbated due to factors related to migration and migration status.

This workshop will explore opportunities to improve delivery of health care, using a practical tool intended to support the design of inclusive health services. This checklist has been elaborated by a coalition of organisations (“Nobody Left Outside” platform) centred on the situation and needs of underserved populations, including the homeless, sex workers, prisoners, people who use drugs and undocumented migrants. This workshop will aim to test and validate the tool, looking at a particular population: people who are undocumented.

The workshop will aim to: Improve understanding of factors that undermine delivery of health services to severely underserved groups, focusing on the specific example of people with insecure residence status.Promote understanding of service-design strategies that broadly benefit these groups, applying and validating a practical tool to support inclusive service delivery.

Format: The workshop will aim to be as interactive as possible. Following opening interventions from experts, participants will be invited to share their insights and expertise to validate the service delivery design checklist that will be shared with them, and to identify the necessary policies and practices that wold ensure its effective implementation.

Key messages

Test a solutions-based model for the design of health services that addresses underserved groups, focusing on undocumented migrants. Identify policies and actors needed to enable effective delivery to “left behind” populations.
Jeffrey Lazarus
Authors: Lazarus J
Published: November 2019

Professor Lazarus will provide an introduction to the NLO checklist, the rationale for its creation, its intended application, including advancing the Sustainable Development Goals and countries’ commitments to achieving universal health care, and its grounding in the WHO Health System’s Framework.
Skills and knowledge to facilitate competence for health and wellbeing in Environmental Impact Assessment
Authors: Green L
Published: November 2019

Within Environmental Impact Assessments (EIA) any health impact assessed has routinely focused on environmental and socio-economic health determinants i.e. air quality/ emissions. However, the WHO recognises that health is much wider than this and health is influenced by a broad range of determinants, contexts, inequalities and experiences. Proposed development can affect a wide range of population groups and their health and well-being in diverse and significant ways.

The revised EU EIA Directive contains amended wording in relation to health consideration but also now requires ‘competent’ persons to undertake assessments. Competency can mean different things to different people but a clear set of standards, criteria and appraisal tools, training and professional competence and abilities are needed in order to be explicit to measure this and articulate how competence should be demonstrated in practice.

Findings

This paper describes a clear set of expected skills and knowledge outcomes that competent practitioners and multi-disciplinary teams need to exhibit; which policy makers and commissioners need to seek; and which reviewers should expect see applied, in order to ensure that high quality, fit for purpose EIAs are carried out which include the widest interpretation of health, wellbeing and inequalities. It discusses the work of the Wales HIA Support Unit to train and mentor practitioners and organisations and presents resources to enable this such as its Skills and Knowledge Development Framework, which provides a pathway to develop and support competence in practice, and the Quality Assurance Review Framework for HIA.

Conclusions

To enable competent broad holistic assessments to be carried out a clear set of criteria, tools, resources and training opportunities are needed in order to enable and facilitate a wide range of personnel to deliver a wide and inclusive health appraisal as part of EIA.
Cancer literacy applied in national cancer control plans – from policy to strategic guidelines in the EU
Authors: Sørensen K
Published: November 2019

Background

The study concerned a systematic analysis of National Cancer Control Plans (NCCPs) regarding cancer literacy. A national cancer control programme (NCCP) is a public health strategy designed to reduce cancer cases and improve quality of life of cancer patients. Cancer literacy is critically important for cancer patients who must make a complex set of diagnostic and treatment-based decisions at times of physical and emotional distress. Yet, it is unclear to what extent cancer literacy is reflected in cancer strategies such as the NCCPs.

Methods

The aim was to identify NCCPs from the EU to explore if health literacy or cancer literacy was included as a strategic priority. The NCCPs were retrieved in August to November 2018 from online portals as well as through key informants specialised in public health and health literacy.

Results

The data collection yielded 45 NCCPs of which 31 originated from the EU Member States. The document analysis revealed that six out of 45 NCCPs specifically included the term health literacy. The countries concern Austria, Belgium, Germany, Portugal, New Zealand and Maryland, the U.S. In addition, only one NCCP entailed the term ‘cancer literacý, namely the plan from Maryland focusing on ‘oral cancer literacý, specifically.

Discussion

Although, it is politically recognized that improving the health literacy of the population can be an effective strategy to promote a more (cost)-effective use of the healthcare services and population health the study of NCCPs revealed that ‘health literacy’ in general and ‘cancer literacý in particular, have not yet been commonly implemented as part of NCCPs. The countries who have actively mentioned health literacy, were all countries where health literacy is on the political health agenda in various ways.
The action network for measuring population and organizational health literacy (M-POHL) and its Health Literacy Survey 2019 (HLS19)
Authors: Dietscher C , Pelikan J
Published: November 2019

The first European comparative survey of population health literacy (HL), HLS-EU, triggered a lot of health policy and health systems responses. In the sense of “What doesn’t get measured doesn’t get done”, data seem important to capture the attention of decision makers and to support evidence-informed policy and practice. This is one of the reasons why the WHO publication “Health Literacy - The Solid Facts” (2013) demands regular internationally comparative surveys of HL.

Building up on initiatives by HLS-EU researchers and the German-speaking WHO member states, the Action Network on Measuring Population and Organizational HL (M-POHL) under the umbrella of WHO Europe’s Health Information Initiative (EHII) was founded in 2018 to achieve this aim. M-POHL’s objectives are to support regular measurements of population HL and of organizational HL and to use the results to support evidence-informed policy and practice. A unique feature of M-POHL is that it brings together research and policy: countries typically participate with a research and a policy representative. Experiences so far show that policy representatives in M-POHL find the continuous collaboration with research extremely valuable for maintaining momentum around HL in their respective countries. So far, 24 countries have been involved in M-POHL.

M-POHL uses projects to meet its objectives. Its first project will be the next European comparative survey of population HL, abbreviated as “HLS19”. This will build up on HLS-EU by using a standard short form of the survey tool for all participating countries, completing it with optional packages on new topics (digital HL, communication and orientation in health care), and allowing for a few country-specific items. Data collection for HLS19 will start in autumn 2019 and last until March 2020. Based on current expressions of interest, between 10 and 14 countries will participate in the survey. An internationally comparative report will be available in 2021.
Using technology and cross-cultural teams to deliver trauma-informed medication management
Authors: Buckley T , Kuoch T , Scully M
Published: November 2019

Issue/Problem

Cambodian Americans have high rates of mental health conditions, diabetes and cardiovascular disease. Unique risk factors include history of malnutrition, torture, social isolation, and poor social determinants of health. Community CARES is a trauma-informed model applicable to any trauma community with complex chronic health and mental health problems.

Description of the problem

High-touch, high-tech approaches can improve access to culturally and linguistically appropriate medication therapy management (MTM) services. Over 12 months, pharmacists teamed with community health workers (CHWs) to provide MTM services in Connecticut and California. Face-to-face consultations occurred in Connecticut, while patients and CHWs in California used teleconferencing with the pharmacist in Connecticut. Project goals: improve drug therapy outcomes, reduce inappropriate medication use, improve medication adherence, display cost savings.

Results

96 patients, average age 69, completed the project. Patients averaged 6.6 medical conditions and 10.3 medications. Pharmacists identified 604 medication-related problems, resolving 93%. Drug therapy outcomes increased 35%, medication adherence improved 23%, inappropriate medication use decreased 35%, and depression screening scores improved 25%. Return on investment ratio was 6:1, a savings of $3032/patient/year. Health improvements from face-to-face and telehealth MTM consultations were similar.

Lessons

Healthcare workforce is optimized by linking CHWs with pharmacists and technology to deliver cost-effective MTM services. The approach is generalizable to populations challenged by distance, disability, language, or culture. Public health care policies need to reflect team approaches and value-based payment models.

Main messages: The virtual cross-cultural team MTM model for underserved populations has the potential to meet the triple aim goals of better care, better health, and lower costs in multiple settings.

Key messages

Virtual cross-cultural team MTM model for underserved populations. Meets the triple aim goals of better care, better health, and lower costs in multiple settings.
Health and healthcare in the year 2040 – Facts for planning a complex and uncertain future
Authors: Funk T , Forsberg B
Published: November 2019

Background

In the Stockholm region, a regional political assembly is responsible for health care services for a population of 2.3 million. In November 2017, the political leadership decided on a programme to project health and healthcare developments in the Stockholm region until 2040 as a basis for a longterm health plan. This presentation aims to describe the methodology used, share some results and raise some questions for further work. Through the presentation we also seek collaboration with European partners involved in similar health planning work.

Methodology

Six perspectives for analysis were defined and under each a set of areas for deeper analysis identified. It was agreed that the planning should be fact-driven. Under the constraint of availability, data covering the period 2000 to 2017 was collected for around 90 variables. Data was gathered from various publicly available databases and was analysed in Microsoft Excel.

Results

Stockholm’s population increased continuously since the millennial shift and could increase by another 28% until 2040. Since 2000, life expectancy increased by 2 years for women and 3 years for men. More than 85% of the burden of disease is caused by chronic diseases. However, the overall disease burden per 100 000 population has been decreasing over the years. In 2017, more than 21 million outpatient care visits were done. Extrapolations of these trends show that the disease burden per capita will continue to decrease, but the total burden of disease as well as demand for health care will continue to increase.

Discussion

A fact-based analysis of future health and healthcare proved to be an efficient base for planning and discussions of future health care services. Results confirmed some well-established perceptions of developments but also pointed to some misconceptions and established “facts” that proved to be false. New digital services make prediction of the future health service mix dynamic and challenging.

Key messages

To meet future health care needs, future health and health care trends should be planned for and considered in decision making processes. Forecasts and health care planning should be fact-based to have an as accurate picture of future health and health care trends as possible.
Models and evidence of intersectoral cooperation in prevention and health promotion
Authors: Walter U , Röding D , Kruse S , Heinze N , Rana V , Komainda N , Haß W , Quilling E
Published: November 2019

Background

Inter-sectoral coalitions are regarded as a key principle of health promotion. The study examines the questions of how these are defined, which scientific theories and models are available, and which methods and parameters are used for their evaluation.

Methods

The scoping review in three databases (PubMed, Web of Science, LIVIVO) included studies in English and German published in 1/2010 to 5/2018. The results were analyzed qualitatively. In addition, relevant websites and textbooks in the field of public health, health promotion and social work were subjected to a document analysis in an iterative procedure.

Results

The database searches yielded 186 hits, of which 48 publications were systematically examined. Document analysis revealed 128 materials. Six common terms on inter-sectoral cooperation (network, collaboration, partnership, coalition, cooperation, alliance) were identified. Uniform definitions and unambiguous distinctions do not exist. Overall, only a few of the identified inter-sectoral collaborations are theoretically based, nine publications present models. Only seven studies provide insights into the effectiveness of model/theory-based strategies, whereby these almost exclusively examine output parameters. In particular, there are parameters on structure and process (e.g. team functioning, coalition capacity). Qualitative success factors and barriers were identified (e.g. integration of different actors, development of new financial sources, formalization). Eight validated instruments are identified. Four studies also examine the outcome level and demonstrate intended effects on behavioral parameters.

Conclusions

For research and practice, it is necessary to sharpen the terminology of intersectoral cooperation. Existing models should be systematically used and evaluated. In the future, an evaluation of the outcome of inter-sectoral cooperation and long-term effects will be increasingly necessary.

Key messages

Inter-sectoral coalitions are an evolving field, and both their theoretical foundation and empirical testing are still in their infancy. While success factors are well investigated, evaluations at the outcomes level are particularly necessary.
Tuberculosis contact investigations in congregate settings in Rome, Italy: contribution of migration
Authors: Sane Schepisi M , Miglietta A S , Cerocchi C , Grillo P , Renzi S , Cirilli R , Pavone R , Vaccarello S , Magrelli F , De Angelis G
Published: November 2019

Background

In middle to low incidence countries tuberculosis (TB) is known to concentrate in big cities as national incidence falls: in the last decade TB incidence in Rome metropolitan area and in Lazio region has been higher than the national estimates; TB incidence among foreign born fell by more than half despite remaining higher than among Italian born.

We aimed to describe the current dynamics of TB transmission among residents of our local health unit in Rome metropolitan area in order to drive specific TB control interventions at local level.

Methods

We retrospectively evaluated characteristics of TB cases and results of contact investigations among the residents of ASL Roma 2 in congregate settings over year 2018.

Results

Overall 217 TB cases were notified, of which 70.5% with pulmonary involvement. Male/female ratio was 2.4/1 and age group most affected was 25-44 among foreign born and >65 among natives. During the study period foreign born cases accounted for 65% of the total number of TB cases. 19/141 (13.5%) foreign born patients were hosted in a reception center. 479 exposed close contacts were screened, with no evidence of secondary TB disease transmission. No identifiable links were found among cases occurred in the same immigrant reception center.

Conclusions

Italian guidelines recommend symptom screening for TB and LTBI testing both of new entrants and of long term residents -including second–generation migrants- from high TB burden countries. These findings suggest that local public health efforts should prioritize the identification of reactivations of remotely acquired latent TB rather than of new postarrival infections acquired in the host county through local transmission.

Key messages

City-specific data on TB incidence trends among native and foreign-born residents help understanding the wider interaction between migration and TB. To prevent TB incidents in congregate settings remotely acquired latent TB should be targeted.
Mesothelioma: a rare cancer in the Valencian Region’s Cancer Registry (Spain)
Authors: Cavero Carbonell C , Miguel Marco N , Sabater Gregori X , Esplugues Cebrián A
Published: November 2019

Background

Malignant mesothelioma is a rare type of cancer. The estimated incidence in Spain is 535 cases per year, being more frequent in men and reaching the highest rate of incidence between the ages of 60-70. Objective: to determine the characteristics of those affected by the mesothelioma in the Valencian Region during the period 2005-2016 and identify the temporary evolution.

Methods

A cross-sectional study was performed. Cases were identified through the Valencian Region’s Cancer Registry (VCR), those registered between 2005-2015 were identified by the ICD9-CM (code 163*) and 2016’s by the ICD10 (code C45). Cases were validated through the review of clinical documentation. The incidence and mortality were calculated and a descriptive analysis was developed including clinical, demographic and social characteristics.

Results

379 cases were identified and confirmed. 58.4% of the cases were men and the average age of diagnosis was 67 years. 85.1% were Spanish. 87.3% of cases had died and the average age of death was 70 years. An increasing incidence has been observed, being 11.4/1000000 inhabitants (CI95%:8.4-14.3) in 2016. The malignant mesothelioma morphology distribution was: 45.1% epithelial, 43.8% non-specified, 6.6% fibrous and 4.5% in two-phase. In 90.8% of the cases the assessment used to confirm the diagnosis was the primary tumour’s histology, in 3.7% was a cytology or hematologic analysis, in 2.6% was metastatic tissue histology, in 1.3% were clinical signs, in 0.5% was other clinical test like MRI/CT scan, in 0.3% was a postmortem histology and in 0.8% assessment was unknown.

Conclusions

The data about mesothelioma included in the VCR could be considered solid due to the results obtained through the validation. The mesothelioma’s malignancy it is evident, despite its low incidence, its mortality rate is high. The increasing trend observed is in agreement with those experts who estimate that the highest rate of incidence will be between the years 2020-2040.

Key messages

The data about mesothelioma recorded in the Valencian Region’s Cancer Registry could be considered solid due to the results obtained through the validation of information procedure. The increasing trend of malignant mesothelioma observed is in agreement with those experts who estimate that the highest rate of incidence will be between the years 2020-2040.
Measuring organizational performance. A review of the dimensions of hospital performance indicators
Authors: Carini E , Pezzullo A M , Frisicale E M , Cacciatore P , Pilla A Di , Grossi A , Gabutti I , Cicchetti A , Boccia S , Specchia M L
Published: November 2019

Patients’ increasing needs and expectations demand for an overall assessment of hospital performances. Several Agencies described sets of performance indicators and there is not a unanimous classification. The ImpactHTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital organizational performance. The aim of this review is to identify the dimensions of quality in which hospital performance indicators are grouped, and to assess if there has been an evolution over time of the above-mentioned dimensions.

Following the PRISMA statement, PubMed, Ovid and Web of Science databases were queried to perform an umbrella review. Articles focusing on secondary care settings, published January 2000-May 2018 were considered. The study design included was systematic review.

3680 records were screened and 6 systematic reviews ranging 2002-2014 were included. The following dimensions were described in at least 50% of the studies: 6 studies classified efficiency (53 indicators analyzed); 5 studies classified effectiveness (12 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (8 indicators) and timeliness (4 indicators). 3 reviews did not specify the indicators related to the dimensions listed, 1 gave a complete definition of the meaning of each dimension and related indicators.

The research shows steady awareness of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions; apparently, there is still not much attention to sustainability, appropriateness and accessibility in terms of indicators measuring, although those dimensions are described in one of the latest review. Another review described a new dimension, resources and capacity, which focuses on the availability of new technologies, underlining the growing importance of the adoption of digitalization in healthcare.

Key messages

Main dimensions of performance indicators: efficiency, effectiveness, patient centeredness, safety. More emphasis to sustainability and appropriateness to align with today’s healthcare challenges.
Development of the Austrian version of the Hospital Survey on Patient Safety Culture
Authors: Draganović ŠD , Offermanns G O
Published: November 2019

Background

Patient safety culture in hospitals (PSC), as well as its measurement and development, have received plenty of attention in Europe in recent years. Several instruments have been developed for its measurement in European countries. As Austria does not have empirically reviewed questionnaires to measure PSC jet, the research question of this study was: Is the globally admitted American questionnaire “Hospital Survey on Patient Safety Culture (HSOPSC)” (Sorra & Nieva, 2004) suitable for the healthcare system in Austria?

Methods

The HSOPSC contains 42 questions, which constituted twelve factors altogether. The pre-test was done with 101 health professionals. The online survey was conducted in ten public hospitals in 2017. Overall 1525 health professionals participated, which corresponded to a response rate of 23%. A new instrument, namely “Hospital Survey on Patient Safety Culture in Austria (HSPSC-AUT)”, was developed using the Exploratory Factor Analysis (EFA) and the Confirmatory Analysis (CFA).

Results

The factor structure of HSOPSC was not identical to the factor structure of HSPSC-AUT, developed in our study. The study showcased a new tool, HSPSC-AUT, with 30 items altogether, consisting of seven departmental factors, two hospital factors and one outcome factor. This new tool (HSPSC-AUT) showed pleasant results on the model, indicator, and construct level. The results of CFA for HSPSC-AUT (χ2 [360] = 1408.245, p = 0.0001) showed a better model compared to HSOPSC. The absolute and relative fit-indices showed excellent model adjustment (RMSEA = 0.049, SRMR = 0.041, GFI = 0.927, CFI = 0.941, TLI = 0.929).

Conclusions

The study presents a new instrument, HSPSC-AUT, for the measurement of PSC. According to the results, HSPSC-AUT (10-factor structure) has a better model fit than the original HSOPSC. This was confirmed by chi-square test, absolute and relative fit-indices, informational criteria, reliability, and construct validity.

Key messages

The development of an instrument for measuring safety culture is the first step leading to a better PSC. For this reason, HSPSC-AUT is recommended as an instrument to measure the PSC in Austria. Finally, it can be said that the development of a new questionnaire as well as the related measurements of validity and reliability have added value to science and practice.
Knowledge, false myths and beliefs on vaccines among pregnant women: results from NAVIDAD study
Authors: Gualano M R , Olivero E , Voglino G , Rossello P , Quattrocolo F , Bert F , Siliquini R ,   Navidad Collaborating Group
Published: November 2019

Background

The diffusion of false myths and vaccine hesitancy are alarming phenomena in European countries and leads to decreasing trends in infant vaccine coverages. Aim of the study was to analyse the level of confidence and correct awareness about immunization, which are crucial for the success of vaccination programs.

Methods

As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency, among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee’s knowledge, beliefs and misconceptions, as well as their socioeconomic status, sources of information about vaccines and confidence in the Italian National Healthcare Service.

Results

Of the participants, only 9% of women completely believed to efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on the majority of the themes. There was a significant difference in level of knowledge considering educational level: women with a high educational level have less probability to obtain a low knowledge score (OR 0.43 [95%CI 0.34-0.54]). The level of knowledge was influenced also by the sources of information: women who got information from General Practitioner and from Institutional Web sites have significantly less chance to have misconceptions (OR 0.74 [95%CI 0.58-0.96]; OR 0.59 [95%CI 0.46-0.74]). Finally, results underlined the influence of trust in healthcare professional information on likelihood of having misconceptions (OR 0.49 [95%CI 0.27-0.89]).

Conclusions

Data suggest the efficacy of healthcare professionals and Institutional Web sites as source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence on vaccines.

Key messages

There is a general lack of knowledge about vaccinations among future mothers. Most of misconceptions regarding vaccinations are related to their safety: this could affect confidence and complacency. To increase vaccine confidence, there is a strong need to inform future mothers: our data show the importance and efficacy of Health Professionals and Institutional Web sites as information sources.
One year update following removal of high sugar sweetened beverages from a university campus
Authors: Fitzpatrick P , O’Connor J , Doyle G , Delaney L , Lades L , Lawlor O , Mullins B , Murrin C
Published: November 2019

Healthy UCD is a health promotion initiative designed to create a sustainable healthy university campus. The aim of the study was to report on student and staff attitudes and provider attitudes to the removal and income from drinks one year following the removal of carbonated sugar sweetened beverages (HSSBs) on a large university campus, University College Dublin (UCD).

In 2018 Healthy UCD, in partnership with the contracted beverage supplier, conducted a seven-week trial where all HSSBs were removed from the main campus and replaced with sugar-free or low-sugar alternatives. This was in advance of a levy on HSSBs to be introduced nationally. During the trial, drinks sales rose by 4%. Following the trial, a survey of students was conducted across the campus which provided the motivation to the University Management Team to approve removal of HSSBs on a permanent basis. Staff and student complaints were monitored over the following year. Drinks sales data was obtained from retail outlets for 2019 and compared to the same sales period for the previous year.

Retail sales for drinks continued to grow despite removal of HSSBs, with 8% growth in the year following removal. A small number of complaints were documented. The most important was a query about those staff and students with diabetes mellitus who might need high sugar energy products and the removal of a particular HSSB which is sold in Ireland. This HSSB had not in fact previously been sold in UCD. The national advice regarding access to high sugar products in the case of hypoglycaemia from Diabetes Ireland was provided satisfactorily for all staff and students.

Removal of HSSBs from a university campus is possible; advice must be provided to those who may feel negatively impacted by the change.

Key messages

Removal of high sugar sweetened drinks from a university campus is possible; advice must be provided to those who may feel negatively impacted by the change. Sales can grow despite health-related changes of the food environment.
The determinants of patients’ opinions about physicians’ services in the Internet-based ranking site
Authors: Smola P , Martuszewska M , Maciak A , Duplaga M
Published: November 2019

Background

The rankings of physicians’ services constructed on the basis of the feedback from patients became a popular form of the appraisal of their work. The main objective of the study was the assessment of predictors of the patients’ satisfaction with services provided by physicians of selected specialities.

Methods

The opinions about physicians of three specialties (paediatricians (P), gynaecologists (G) and family medicine physicians (FM)) who accumulated the highest numbers of opinions, were extracted from the rankinglekarzy.pl website. Only 100 physicians of each specialty who were the most frequently scored were included. Apart from the scores on six individual criteria, the data reflecting the number of opinions (NOO), the type of medical practice (TMP), number of specialties (NS) and PhD title (PhD), as well as the location of the practice (LOP) were collected. The total score was calculated as the sum of scores assigned to individual criteria.

Results

The final data set consisted of 9482 opinions (4234 for P, 2057 for FM, and 3191 for G). The multivariate regression model revealed that odds of obtaining the maximum total score (MTS) depended on S, NOO, LOP, and TMP. G had higher odds of receiving the MTS than P and FM (OR, 95%CI, 0.75, 0.68-0.83, and 0.72, 0.64-0.82, respectively). MTS was less frequently received by physicians practicing in medical centres (0.56, 0.49-0.62) and hospitals (0.55; 0.44-0.70) than in private practices, but not by those practicing in more than one place (3.81, 2.78-4.21). Higher NOO was related to lower odds of receiving MTS (0.992; 0.990-0.995).

Conclusions

There are significant differences in patients’ assessment of services provided by physicians of three analysed specialties. The type of practice has a considerable impact on the satisfaction of patients. Interestingly, it seems also that the number of specialties and PhD title do not influence patients’ opinions about the quality of the medical doctor’s services.

Key messages

Internet-based rankings of physicians may be an important source of information about provided medical services. Key factors influencing patients’ opinions include specialty, the type and the location of medical practice, but not scientific a scientific title and number of specialities.
Umbrella review of strategies to improve uptake of screening programmes
Authors: Hyseni L , Maden M , Boland A , Kypridemos C , Collins B , O’Flaherty M
Published: November 2019

Introduction

High participation rates in screening programmes targeting non-communicable diseases are instrumental in achieving full screening benefits; however, screening programmes remain underused, especially among vulnerable populations. We conducted an umbrella review to assess the type of approaches screening programmes use to maximise uptake, the effectiveness of the approaches and the impact on equity.

Methods

Electronic databases were searched (1999-2019) for systematic reviews on approaches aimed at improving uptake of screening programmes for adults in middle- and high-income countries, with participation rate as the primary outcome. A narrative synthesis was undertaken to present the results by strategy, screening programme and strength of evidence. This study was registered in PROSPERO [CRD42019132087].

Results

In total, 3,059 records were identified, and 82 systematic reviews were included. Preliminary findings suggest contradictory evidence, and effectiveness appears to depend on the disease screened for and specific program implementation. Invitation methods including letters and direct reminders seem to work universally. However, combined approaches using access-enhancing, individual- and system-directed strategies seem to be more effective than single approaches such as invitation methods alone. Few studies evaluated the impact on equity.

Conclusions

Strategies to improve uptake of screening programmes have the potential to be effective. However, there are many components within the system, either at individual, health care professional or health care system level that can influence uptake of screening programmes. Within each screening programme, it is likely that a range of interventions is needed to improve the uptake as opposed to a single intervention.

Key messages

Improving uptake of screening programmes is a complex issue with many factors influencing the process. A range of interventions is favoured over single interventions.
Burden of disease due to nitrogen dioxide exposure in Germany
Authors: Plass D , Tobollik M , Wintermeyer D
Published: November 2019

Background

Numerous studies identified adverse effects of air pollution on health. According to the recent Global Burden of Disease Study about 2.9 million people died prematurely due to the effects of ambient particulate matter (PM) pollution in 2016, which resulted in about 70 million years of life lost (YLL). In addition to PM, a growing body of evidence shows convincing associations between nitrogen dioxide (NO2) with several health outcomes. The case study provides a health risk assessment for NO2 in Germany.

Methods

A systematic review was performed to select health outcomes with strong evidence for an association with NO2 and to derive an updated exposure-response function (ERF). The exposure assessment was performed on a 1x1 km2 grid by combining measured and modelled data (annual means of NO2 background concentration) with population density. Exposure data and the ERF were combined by the population attributable fraction formula. The main analysis was performed using a counterfactual of 10 µg/m3.

Results

Only for cardiovascular mortality the evidence for the association with long-term NO2-exposure was rated as “strong”. Thus, the main analysis merely included this outcome. For the year 2014, 5,966 (95% CI: 2,031-9,893) attributable deaths and 49,726 (95% CI: 16,929-82,456) YLL were estimated. Looking at time trends a decrease of disease burden was observed compared to the year 2007 where 7,832 (95% CI: 2,669-12,973) attributable deaths and 69.244 (95% CI: 23.601-114.690) YLL due to NO2 were calculated.

Conclusions

Our results show a considerable burden due to NO2 in Germany. Compared to previous estimates for PM (ca. 41,100 attributable deaths in 2014) the burden due to NO2 is much lower. However, due to methodological constraints we could not incorporate higher concentrations from traffic hotspots. This, and the fact that we only considered one health outcome in our main analysis, suggests that our results might be an underestimation.
Individual and area-level factors associated with ambulatory care sensitive conditions in Finland
Authors: Satokangas M , Arffman M , Leyland A , Keskimäki I
Published: November 2019

Background

Geographic variation is common in ambulatory care sensitive conditions (ACSCs) - used as a proxy indicator for primary care quality. Its use is debated as it is more strongly associated with individual socioeconomic position (SEP) and health status than factors related to primary care. While most earlier studies have been cross-sectional, this study aims to observe if these associations change over time. Finland offers a good possibility for this due to its extensive registers and unexplained over time convergence of geographic variation in ACSC.

Methods

This observational study obtained ACSCs in 2011-2017 from the Finnish Hospital Discharge Register and divided them into subgroups of acute, chronic and vaccine-preventable causes. In these subgroups we analysed geographic variations with a three-level multilevel logistic regression model - individuals, health centre areas (HC) and hospital districts (HD) - and estimated the proportion of the variance at each level explained by individual SEP and comorbidities, as well as both primary care and hospital supply and spatial access at three time points.

Results

In the preliminary results of the baseline geographic variation in total ACSCs in 2011-2013 - the model with age and sex - the variance between HDs was nearly twice that between HCs. Individual SEP and comorbidities explained 46% of the variance between HDs and 29% between HCs; and area-level proportion of ACSC periods in primary care inpatient wards a further 12% and 5%. This evened out the unexplained variance between HDs and HCs.

Conclusions

Geographic variation in ACSCs was more pronounced in hospital districts than in the smaller health centre areas. The excess variance between HDs was explained by individual SEP and health status as well as by use of primary care inpatient wards. Our findings suggest that not only hospital bed supply, but also the national structure of hospital services affects ACSCs. This challenges international ACSC comparisons.

Key messages

Geographic variation in ACSCs concentrated in larger areas with differing population characteristics. The national structure of hospital services, such as use of primary care inpatient wards, affects ACSCs.
Essential knowledge for junior doctors regarding infectious disease control: a modified Delphi study
Authors: van den Berg N M , de Hoog M L A , Seeleman M C , Jambroes M
Published: November 2019

Background

Physicians play an important role in the control of emerging infections and antibiotic resistance. Therefore, all physicians should have sufficient knowledge regarding infectious disease control. It is unknown what knowledge is considered as sufficient; the Dutch National Framework on learning outcomes for medical curricula only offers general terms for this topic. The aim of this study was to determine which learning items are considered as essential knowledge for junior doctors in the Netherlands. The results can support curriculum development regarding infectious disease control.

Methods

An online two-round Delphi study was performed, involving four expert groups: general practitioners; public health physicians; medical students; and educational coordinators of Dutch universities. Experts were asked to rate sixteen learning items, selected by a literature review. A learning item was considered as essential knowledge if at least 80% consensus was reached on a 5-point Likert scale. Respondents were able to explain their score, to alter the exact wording after each learning item and to add learning items. This input was used for qualitative analysis, in addition to the quantitative scores.

Results

Both rounds of the study were completed by 27 experts. Six learning items were identified as essential knowledge based on the 80% criterion. By combining qualitative and quantitative data, two additional learning items were identified. Important learning items were mainly focused on understanding and applying basic principles on a case, like identifying measures to prevent spread of infections based on transmission route.

Conclusions

To our knowledge, this study is the first to identify a list of essential learning items on infectious disease control, which can be used for training purposes. This list supports curriculum development in medical education and strengthens the infrastructure for infectious disease control in the Netherlands by training professionals.

Key messages

The Delphi method helped us to identify essential knowledge concerning infectious disease control for junior doctors. The results can be used to increase the knowledge base for this topic. Essential knowledge focuses mainly on understanding and applying basic principles to a case. Detailed knowledge is considered less important, provided that physicians know where and when to find it.
Case study: Drug related problems in prison settings
Authors: Montanari M
Published: November 2019

Persons in prison generally have poorer physical and mental health and social well-being than their peers in the community, reporting high rates of acute and chronic physical and mental disorders, including, substance use disorders and drug related infectious diseases. People in prison report high prevalence of illicit drug use before and during incarceration and high rates of drug related infections. Acute risks for those using drugs are found in the first period after prison release. Available interventions in prison setting lower life expectancy than their peers in the community. Common risk and social factors are related to poor health and imprisonment and those two components should be addressed in a comprehensive way. The presentation will provide an overview of the last available data on drug use, drug related problems and prevalence of infectious diseases in prison in the European countries.