bluuebunny/crossref_metadata_2025 huggingface dataset:
How to build capacity to best use good/best practice
Authors: van Dale D , Leenaars K
Published: October 2020

In the Netherlands the best practice portals contains approximately 325 best and good practices with different levels of recognition (well described, theoretically sound and effective). Evaluations of the portal (2013 and 2018) show that the portal is well appreciated by professionals of municipal health services and stakeholders but the uptake of best practices can be improved. An implementation study (2014) to the uptake of interventions revealed that the RIVM had to work on dissemination strategies for policymakers, capacity building implementing best practices by professionals and incentive strategies for both groups. In this presentation the focus is on the capacity building of professionals.

In order to support professionals and policymakers with evidence-based decision making the RIVM developed the online Manual Healthy Municipality, Healthy School and Healthy Kindergarten. In the manuals overviews of best practices are presented per theme (e.g. smoking), target group (e.g. elderly) or setting (e.g. neighbourhood) in combination with tools and instruments for intersectoral collaboration, citizens involvement and monitoring and evaluation. These manuals are well known and combine process information (how) with product information (what: effective programs and what works overviews).

The implementation study showed also that professionals would like to have more support in the form of workshops and masterclasses. In order to get this the RIVM organizes workshops how to describe an intervention for recognition and how to adapt an intervention. The assumption that a recognized can't adapted to the local contexts was one of the inhibiting factors of the implementation of best practices. To ensure that the adjustments are made properly we have developed a checklist for the adaptation of interventions which is the base of the workshop. Professionals can also ask for a tailored work shop for example how to create support for the use of best practices.
Multimorbidity patterns and quality of life across European populations: Results from SHARE database
Authors: Makovski T T , Poblador Plou B , Schnell M , Stranges S , Zeegers M , Le Coroller G , Huiart L , van den Akker M
Published: October 2020

An increasing number of people living with multimorbidity may receive suboptimal care since health systems are not well prepared to respond to their complex needs. Identifying which conditions most commonly group together could support better care for patients with multiple diseases. This is particularly critical for conditions that have the most deteriorating effect on quality of life (QoL). The aim of the study was to: 1) identify multimorbidity patterns in Europe and 2) assess their impact on QoL. This was a cross-sectional analysis performed on the Survey of Health, Ageing and Retirement in Europe (SHARE) among adults aged 50+, in eighteen countries (n = 67,179). The Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) scale assessed QoL. Exploratory factor analysis (using 17 conditions) based on tetra-choric correlations, was applied to identify multimorbidity patterns. Associations between patterns and QoL were estimated with multilevel mixed-effects linear regression. The analyses were adjusted for socio-economic, clinical and psycho-social factors, and stratified by sex. Three multimorbidity patterns were found: 1) cardio-metabolic [frequency in men (27.7%); women (25.9%)], 2) psycho-geriatric [1.4%; 0.3%] and 3) mixed [11.7%; 17.4%]. Sample adequacy was confirmed by the Kaiser-Meyer-Olkin test [0.81; 0.84, for men and women, respectively]. The patterns showed slight sex differences. The frequency of all patterns increased with age, while patterns overlapped significantly in the population. The psycho-geriatric pattern had the most deteriorating effect on QoL [-4.5(95%CI:-6.2;-2.8) for men; -5.0(95%CI: -9.5; -0.5) for women]. Recognizing the most common disease patterns may allow more targeted planning and provision of care, including development of clinical guidelines, enhancing collaboration between health professionals, and creation of prevention plans to reduce complications and preserve the best QoL for patients with multimorbidity.

Key messages

First large population-based study on multimorbidity patterns and their impact on QoL across Europe, using SHARE database. The findings can serve to support better care for multimorbid patients.
Analysis of submissions to the EU’s public consultation on tobacco traceability and security features
Authors: Gallagher A , Evans-Reeves K A , Gilmore A B , Joshi A
Published: October 2020

Background

The Illicit Trade Protocol (ITP) requires all Parties to establish a tobacco track and trace (T&T) system. In 2016, the European Commission held a public consultation on T&T implementation in which interested parties were asked to respond online to 22 multiple-choice questions and were given additional opportunities to leave comments if desired. In May 2019, the EU's T&T system became operational. This paper explores tobacco industry influence over and policy positions within the consultation process.

Methods

The Illicit Trade Protocol (ITP) requires all Parties to establish a tobacco track and trace (T&T) system. In 2016, the European Commission held a public consultation on T&T implementation in which interested parties were asked to respond online to 22 multiple-choice questions and were given additional opportunities to leave comments if desired. In May 2019, the EU's T&T system became operational. This paper explores tobacco industry influence over and policy positions within the consultation process.

Results

Of the 197 consultation responses analysed, 131 (66.4%) had financial links to the tobacco industry. 89 respondents were trade associations, 74 of which were financially linked (33 had TTC members). 29 (22.1%) of the financially-linked respondents were not transparent about their links. There was a clear divide in the policy preferences of respondents with and without a financial link. Collectively, respondents with a financial link supported an industry-operated solution.

Conclusions

There was an extensive lobbying effort by the tobacco industry over the EU's T&T system, with TTCs' interests being represented repeatedly through multiple trade associations. The transparency requirements regarding consultation respondents' affiliations with relevant stakeholders (such as tobacco manufacturers) should be improved for future tobacco-related consultations.

Key messages

There was an extensive lobbying effort on the part of the tobacco industry Several respondents with financial links to the tobacco industry did not disclose these. Collectively, respondents with a financial link to the tobacco industry supported an industry-operated solution which would not have met the requirements of the ITP.
Health literacy and mortality in individuals with NCDs: A 6-year Danish follow-up study (N = 29.473)
Authors: Friis K , Aaby A , Lasgaard M , Pedersen M H , Osborne R H , Maindal H T
Published: October 2020

Background

Non-communicable diseases impact to the globally unequal distribution of health. From a public health perspective, health literacy (HL) may be a promising modifiable social determinant, suggested to be associated with adverse health outcomes. Few studies have explored how HL is related to mortality in the general population and in subgroups. This study examines HL as a predictor for mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness.

Methods

Design: Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year survival analysis using Cox regression analyses. Participants: The study included people in the general population people reporting different long-term conditions: CVD (n = 2,389), COPD (n = 1,214), diabetes (n = 1,685) and mental illness (n = 1,577). Outcome Measures: Two subscales from the Health Literacy Questionnaire (HLQ) were included: 1) Ability to understand information about health well enough to know what to do, and 2) Ability to actively engage with healthcare providers.

Results

After adjusting for sociodemographic factors, multimorbidity and health behaviour, individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 [95% CI 1.11-1.73]). Higher risk was also observed among people reporting CVD (HR 1.47 [95% CI 1.01-2.14]), diabetes (HR 1.91 [95% CI 1.13-3.22]) and mental illness (HR 2.18 [95% CI 1.25-3.81]), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with mortality.

Conclusions

Aspects of HL predict higher risk of dying during a 6 years follow-up period. Our study serves as a reminder to public health organizations to consider the HL responsiveness of their services in relation to diverse HL challenges and needs.

Key messages

Aspects of health literacy predict higher risk of dying during a 6 years follow-up period in individuals with CVD, diabetes and mental illness. Our study serves as a reminder to public health organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.
The social engagement framework for addressing the chronic-disease-challenge
Authors: Alhambra-Borrás T , Tan S S , Macchione S , Vasiljev V , Zanutto O , Garcés-Ferrer J , Juraga D , Korenhof S , Rentoumis T , Raat H
Published: October 2020

Background

The Social Engagement Framework for Addressing the Chronic-disease-challenge (SEFAC) intends to empower citizens to self-manage chronic conditions by combining mindfulness, social engagement and ICT support. This study evaluates effects in terms of perceived effectiveness, utility, efficiency, sustainability and satisfaction with SEFAC intervention.

Methods

A prospective cohort study with 6-month pre-post design was conducted in Croatia, Italy and the Netherlands. A total of 270 citizens ≥50 and at risk of or with a chronic condition were recruited. Self-reported effects of SEFAC intervention were assessed post-intervention using 5-point Likert scale [Strongly disagree -Strongly agree] and overall satisfaction on a scale from 1-10.

Results

Post-intervention analyses of a preliminary sample of 98 participants showed the SEFAC intervention was effective. In particular, perceived effectiveness for stimulating the work towards a healthy lifestyle was found for: mindfulness training (63.3%; n = 62), social engagement (48%; n = 47) and ICT support (40.8%; n = 40). After the intervention, 57.1% participants (n = 56) reported having become more aware of moment-to-moment sensations, thoughts and emotions and being able to better accept them without getting lost in them. Most participants (73.5%; n = 72) found the intervention was beneficial (perceived utility). A total of 78.6% (n = 77) participants found it was worth the investment in time and effort (perceived efficiency) and 61% participants (n = 60) agreed the intervention led to sustainable changes/benefits that will last. Finally, satisfaction with the intervention was high overall (8.5 out of 10).

Conclusions

This is the first study to develop an intervention combining the concepts of mindfulness, social engagement and ICT support. By this combination, self-reported effects were satisfactory. We expect this intervention to be feasible and cost-effective to promote self-management and self-care of chronic conditions.

Key messages

This study provides an innovative intervention to promote self-management and self-care of citizens with chronic conditions. This is the first study to develop an intervention combining the concepts of mindfulness, social engagement and ICT support.
Internet gaming disorder symptoms among Slovenian gamers
Authors: Selak Š , Vinko M , Rehberger M , Lavtar D , Korošec A
Published: October 2020

Background

Problematic use of digital technologies has been attracting extensive amount of attention worldwide, especially (internet) gaming disorder (IGD). Prevalence of IGD varies across studies, depending mostly on the methodology, assessment tool and participant group. Despite numerous research on the topic a strong need to better understand technology's impact on population remains in order to better tackle this public health challenge.

Methods

National Survey on the Use of Tobacco, Alcohol and Other Drugs was conducted in 2018 on a national representative sample (n = 16,000; age: 15-64 years; 62.4% response rate), using mixed-mode (CAWI and CAPI). The final sample consisted of 9,161 respondents, of those 24.2 % (n = 2,212) reported having played a videogame in the last 12 months (gamers-only sample). Prevalence of IGD symptoms was assessed with 9-item Internet Gaming Disorder Scale-Short-Form using 5-point scale (total score: 9-45 points). Disordered and non-disordered gamers were dichotomized with a cut-off point at 36 points with higher scores indicating higher degree of IGD.

Results

Data shows 0.4% [95% CI:0.2-0.8] of the Slovenian gamers reported to have symptoms of IGD, whereas higher rates were observed within younger population. Namely, 1.0% [95% CI: 0.2-3.9] within 20-24 year olds and 0.7% [95% CI:0.2-2.2] within 15-19 year old. Men (0.5% [95% CI:0.2-1.2]) reported more IGD symptoms than women (0.1% [95% CI:0.0-0.8]). The share of IGD symptoms was also higher among unemployed and those who live without partner.

Conclusions

Results obtained in present study are consistent with results of comparable studies conducted in other countries. A relatively low share of IGD symptoms in the sample might be due to a high cut-off point. However, obtained data allows for tailored public health interventions in Slovenia, such as awareness raising and prevention and treatment programmes, as well calls for further analyses on IGD epidemiology and research methodology.

Key messages

0.4% of the Slovenian residents, who played videogames in the last 12 months reported to have symptoms of internet gaming disorder, with higher rates observed within younger population. The share of population experiencing symptoms of internet gaming disorder in Slovenia is similar to that of other countries where comparable studies were done.
Substance use disorder and the baby boomers: Does German outpatient addiction care face a change?
Authors: Specht S , Braun-Michl B , Schwarzkopf L , Piontek D , Seitz N , Wildner M , Kraus L
Published: October 2020

Background

The aging of baby boomers is expected to confront addiction care with new challenges. This study aims to investigate if German addiction care is confronted with a sustained change in its clientele that was initiated by the baby boomers.

Methods

Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an older (n = 6524) as well as a younger cohort (n = 15677). To isolate cohort effects, two-level random-intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each other cohort.

Results

Compared to the older cohort, alcohol use disorder lost importance while illicit substances use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the older cohort. Comparing baby boomers with the younger cohort, these relationships pointed in the opposite direction.

Conclusions

Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. The addiction care system ought to adapt its services to address the changing needs of its clientele.

Key messages

Baby boomers differed in comparison to the older cohort regarding type of substance use disorder and comorbid substance use disorders. The changes set off by the baby boomers continued in the younger cohort.
Job demands/control among people in paid work age 55-64 and their labour market status 11 years later
Authors: Farrants K , Head J , Framke E , Rugulies R , Alexanderson K
Published: October 2020

Background

As discussions about extending working lives are ongoing, more knowledge is warranted on working conditions that are associated with labour market status in older age.

Aim

Among employees aged 55-64 years, associations between job demands/job control with their labour market status 11 years later were explored.

Methods

A population-based prospective cohort study using a job exposure matrix (JEM) and nationwide register data. All 616,818 individuals in Sweden who in 2001 were in paid work and aged 55-64, were assigned JEM values for job demands/control that were categorized into tertiles resulting in nine combinations of job demands/control (reference=medium control/medium demands). Follow-up was in 2012 regarding labour market status (paid work, old-age pension, low/no income, sickness absence emigrated, dead). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multinomial logistic regression (reference category=old-age pension) with adjustment for educational level, age, birth country, family situation and type of living area.

Results

Women in occupations with high control (OR low demands/high control 1.21, CI 1.06-1.39, medium demands/high control 1.32, CI 1.20-1.46, high demands/high control 1.29, CI 1.20-1.37); and men in occupations with high demands/high control (OR 1.11, CI 1.02-1.21) were more likely to be in paid work. Those in occupations with high demands at baseline were less likely to have low/no income at follow-up (OR women high demands/medium control 0.51, CI 0.37-0.68, high demands/high control 0.68, CI 0.50-0.92; men high demands/medium control 0.55, CI 0.31-0.96, high demands/high control 0.47, CI 0.32-0.74.

Conclusions

High job control combined with any level of demands for women and high demands for men aged 55-64 in 2001 were associated with higher OR of having main income from paid work in 2012, and high job demands combined with any level of job control were associated with lower OR of low/no income.

Key messages

Combinations of job demands and job control among workers aged 55-64 years in 2001 were associated with labour market situations in 2012. Using a job exposure matrix divided into tertiles allows for greater detail in measuring high, medium, and low demands and control than methods used in previous studies.
Social engagement technologies and their use among grandparents and adult grandchildren
Authors: Mueller J , Foran H
Published: October 2020

The quality of close family relationships can affect the health and well-being of older adults. Further, research suggests that relationships between grandparents and adult grandchildren can have a positive impact on the lives of each generation, particularly regarding social and emotional support. Social engagement technologies may provide new opportunities for older adults to foster and maintain family relationships, including those between grandparents and adult grandchildren. The current cross-sectional study examined associations between the use of social engagement technologies and health and well-being outcomes in 177 younger adults (M = 26.67, SD = 7.83; 81.4% female) and 202 older adults (M = 71.09, SD = 8.17; 77.8% female). Social technology use was assessed through ﬁve mediums that are used to enhance social connectivity (e.g., e-mail, social network sites, online video or phone calls, instant messaging, and smartphones). Higher use of social engagement technologies was associated with better self-rated health, subjective well-being, and social support among younger and older adults. Interestingly, social technology use was associated with less depressive symptoms only for older adults (r=-.26, p<.05). There was, however, no correlation between social technology use and loneliness at the bivariate level. Of all five media, only smartphone use was correlated with more positive evaluations of the grandparent-grandchild relationship. After controlling for age, both grandparent-grandchild relationship quality and social technology use were associated with better self-rated health, subjective well-being, and social support for grandparents and adult grandchildren.

Key messages

Taken together, these findings indicate the need for a nuanced perspective on the benefits of social engagement technologies. More research is needed to explore the use case for social engagement technologies among older adults and their family members.
Meal delivery and public health nutrition: a comparison study in three international cities
Authors: Poelman M P , Thornton L , Zenk S
Published: October 2020

Background

The food environment has been recognized as a dominant driver of public health nutrition. Although planning mechanisms are increasingly being triggered to help control the proliferation of fast food outlets, the recent upsurge in meal delivery options has reshaped the food environment. Currently, we lack insight in the breath of meal delivery options. Therefore, this study sought to examine between-city differences and within-city socio-economic differences in the number of online meal delivery options and meal types.

Methods

A cross-sectional study was conducted in three international cities. Across 10 sampled addresses in Chicago (USA), Amsterdam (The Netherlands) and Melbourne (Australia), meal delivery options provided by a major international meal delivery company were sampled. Bonferroni adjusted Chi2-tests were conducted to assess between-city - and within-city socio-economic differences.

Results

Across the 10 sampled addresses in each city, there were 1668 delivery options in Chicago, 1496 in Amsterdam and 1159 in Melbourne. In total, 10220 keywords (representing 148 different meal types) were recorded across all delivery options. In Amsterdam and Melbourne, a greater number of options was available for the addresses in the least disadvantaged neighborhoods. Among all cities, sandwiches (14.6%), burgers (14.4%), and pizza (13.4%) were most commonly advertised. In contrast, salads (7.8%) and 'healthy' options (5.5.%) were less frequent offered for delivery.

Conclusions

Meals available for delivery did not favor a healthy diet, and healthy options were less often advertised then unhealthier ones. Currently, meal delivery platforms appear to operate in a largely unregulated environment continued growth is likely in the near future. It is vital that public health professionals and policy makers become aware of this online component of the food environment and its potential consequences for public health nutrition.

Key messages

Most commonly advertised meals for delivery do not favor a healthy diet, and healthy options were less often advertised then unhealthier ones. It is vital that public health professionals and policy makers become aware of the online component of the food environment and its potential consequences for public health nutrition.
Dietary patterns and their association with cardio-metabolic outcomes in US firefighters
Authors: Christodoulou A , Sotos-Prieto M , Kales S N , Christophi C A
Published: October 2020

Background

Cardiovascular disease is prevalent among US firefighters. Obesity is known to be associated with an increased risk of CVD and it can be prevented by following a more Mediterranean style diet. The aim of this study was to identify the dietary patterns of US firefighters and assess how these patterns are associated with cardio-metabolic outcomes in the specific population.

Methods

Individuals were recruited from within a FEMA sponsored study from the Indiana Fire Department. IFD members with permanent station assigned were included. All participants underwent the Public Safety Medical examination, which includes occupational and medical history; a physical examination; routine laboratory tests; resting electrocardiograms; and maximal treadmill exercise testing. Participants self-reported their dietary habits.

Results

The mean BMI of the participants was 30.0 ± 4.5 kg/m2 and the percentage of body fat was 28.1 ± 6.1%. Using principal component analysis, two dietary patterns were identified, namely a Mediterranean style diet and an American Standard style diet. The Mediterranean style diet is positively associated with HDL cholesterol (β = 2.08, p = 0.001) even after adjusting for gender, BMI, VO2 max, max METS, age, and body fat percent. Triglycerides (β=-3.195, p = 0.585) and glucose (β=-0.079, p = 0.219) decreased with the Mediterranean style diet. The Standard American diet was also significantly associated with HDL cholesterol (β=-4.82, p = 0.002) and LDL cholesterol (β = 0.455, p = 0.014). In addition, body fat percentage increases significantly in the Standard American style diet (β = 1.778, p = 0.029), even after the adjustments.

Discussion

Two dietary patterns were identified in US firefighters - a Mediterranean style diet and an American Standard diet. Mediterranean diet was protective whereas the American Standard diet had the opposite effect. This could help provide suitable recommendations that could improve the lives of US firefighters.

Key messages

Two diet patterns have been identified in US firefighters. The Mediterranean style diet seems to have a protective effect. The American Standard diet has a negative impact on cardio-metabolic outcomes as expected.
The impact of informal payment on Caesarean delivery rates in obstetric care in Hungary
Authors: Veroszta Z , Boros J
Published: October 2020

Background

Our objective is to investigate factors increasing the likelihood of Caesarean sections in Hungary, in particular whether planned Caesarean deliveries might be a consequence of the widespread informal payment practice in obstetric care.

Methods

We use data from the “Cohort '18 - Growing Up in Hungary” birth cohort study. In the 1st wave a nationwide representative sample (N = 8,287) of pregnant women was surveyed in 2018/2019. The 2nd wave was conducted 6 months after childbirth. Data was analyzed by a multinomial logistic regression model. The output variable was the type of childbirth: natural (ref.)/Caesarean/planned Caesarean. The explanatory variables were informal payment at birth, private/public prenatal care, maternal health, SES.

Results

Based on the explanatory model (Pseudo-R2=0.278) the increased likelihood of planned Caesarean section is associated with out of pocket payment at birth (Exp(B)=3.749). This health system related factor absorbs the effect of social background for the possibility of planned Caesarean section, since its inclusion in the model reduces the independent influence of SES. However, the likelihood of planned Caesarean delivery compared to natural births is also determined by the mother' age and physical condition.

Conclusions

The high Caesarean delivery rates (over 40%) in Hungary are largely due to features of health system finance, particularly for planned Caesarean deliveries (22% of births). Although deliveries basically take place in public hospitals, the presence of an out of pocket paid private doctor at birth is a frequent and socially selective factor. Whereas planned Caesarean sections are strongly determined by SES, at the system level it is channeled into the various private or informal forms of financing.

Key messages

Informal payment within the general public care system strengthens the social selection in prenatal and delivery care in Hungary. This effect is reflected in the proportion of planned Caesarean sections.
Assessing Contact, Coverage, and Quality of continuum of care in Uttar Pradesh, India
Authors: Gupta S , S K , Yonzon K , Kumar P , Choudhry V
Published: October 2020

Background

Given the high neonatal mortality in LMIC, strategies suggest a continuum of care (COC) as an effective framework to ensure timely and appropriate service provision throughout the MNCH continuum. However, the measurement approaches traditionally focus on assessing continuum of care from the lenses of time-based coverage and missing out on the quality of coverage and service delivery. This paper aims to assess the continuum of care based on these three parameters and the factors affecting its achievement.

Methods

Multistage sampling design identified live births and stillbirths in the last calendar year (March 2018-February 2019) across the 50 districts of Uttar Pradesh(n = 16646).COC was assessed on three measurements 1) Contact: Any contact with the health system across the continuum, 2)Coverage: Adequate contacts of the health system through outreach services and clinical care, and 3)Quality: receiving adequate services along with these contacts. Further, a multilevel regression model was used to estimate the factors associated with the continuum of care.

Results

64% (60.04-67.65) of the women and child received health system contact across the continuum while only 2.1% (1.57-2.78) and 2.8% (2.33-3.44) women and children achieved coverage and quality based COC, respectively. Achievement of COC coverage and COC quality is highly affected by the service delivery platform, with women at outreach platform being more likely to achieve adequate coverage while women at facilities are more likely to achieve quality services across ANC, delivery, and PNC.

Conclusions

Achievement of both coverage and quality based COC remains low in Uttar Pradesh, India. Even those who achieve contact(s) failed to receive quality services along with these contacts with health systems. Efforts should be focused on building quality service at the outreach and non-outreach platforms across the continuum of care for reducing the risk of neonatal mortality.

Key messages

Owing to the lack of an integrated approach for service delivery across outreach, clinical care and community care, continuum of care remains broken for most of the mothers and children. For targeting coverage and quality of COC, focus should be on improving the quality of service provision across the outreach platforms which are already in reach of the women.
Teaching bioethics at the Medical School, University of Ibadan, Nigeria: Prospects and challenges
Authors: Akintola S
Published: October 2020

Background

Teaching bioethics (BE) is one way to contribute to reflecting if research on humans, health policies and interventions are legitimate. Nonetheless, BE and law have been a relatively new subjects in medical schools in Nigeria, with increasing interest only since the late 1990s following the Pfizer Trovan study. Literature in this emerging field mostly refers to experiences from high-income countries (HIC), literature on low-and middle-income countries (LMIC) is scarce.

Objectives

This presentation describes over 10 years’ experience of teaching BE in the residency program, to doctors and within a Masters in BE Program of the University of Ibadan, Nigeria. The paper discusses the content, skills, teaching approach and tools employed in these activities. Challenges of the teaching process are identified and future teaching strategies suggested.

Results

The crop of students are largely unemployed young graduates, health professionals, ethics committee members. They come from Southern Nigeria; there is a weak representation from the Northern states of Nigeria. Based on students and lecturer evaluation reports, we can report that it is important to teach BE in LMICs such as Nigeria. A country that has experienced many ethically challenging and even evil activities in medicine and medical research coupled with a radically changing value system. Teaching universal norms of BE in a country with a high level of illiteracy and cultural differences where religion plays a major role in defining what is right, wrong or appropriate remains a challenge.

Conclusions

For BE training to be impactful and result in systemic and structural changes in health policy and education in Nigeria, the government must invest in proper institutionalization of research and clinical ethics in curricula in Nigeria.

Key messages

Efforts need to be increased in Nigeria and other LMICs to teach BE. HIC institutions could offer guidance by becoming partners organizing ethics training.
Women who inject drugs in Russia: stigma as a barrier in access to HIV and drug treatment services
Authors: King E , Alexandrova O , Batluk J , Shaboltas A
Published: October 2020

Background

There are over one million people living with HIV in Russia. People who inject drugs experience major disparities in their susceptibility to the virus and in their access to HIV services. Women who inject drugs (WWID) have been shown to be at heightened susceptibility to HIV, through both unsafe drug use and unprotected sex. Less is known about the social determinants of engagement in care specifically among WWID.

Methods

We conducted a qualitative research study in St. Petersburg in order to assess what factors influence engagement in HIV-related and drug rehabilitation services. We conducted in-depth interviews with 20 service providers and 30 WWID from June-November 2018. We recruited providers to represent a range of services, including government clinics, non-governmental organizations, and family services. We recruited WWID through community outreach services. We used thematic analysis and a team-based approach to coding data.

Results

A major theme across our data was the stigma and discrimination that WWID experience in their everyday lives and in their interactions with the healthcare system. WWID are subjected to stigmatization related to gender norms about drug use, the capacity to fulfill their roles as mothers, (for some) engagement in sex work, and (for some) HIV-positive serostatus. WWID are often reluctant to seek HIV-related services, including testing and treatment, out of fear of being treated poorly because of their drug use. The omnipresent societal stigma manifests into self-stigmatization and many WWID questioned their deserving of and abilities to seek healthcare services, including drug rehabilitation and HIV-related care.

Conclusions

Interventions are needed to address the stigma and discrimination that WWID in Russia experience in families, communities, and health institutions. Additionally, psychosocial interventions may help to address the self-stigmatization that sometimes influences WWID's self-efficacy to seek services.
Prioritising health information needs in Europe: a Policy Delphi survey
Authors: Seeling S , Thißen M , Achterberg P , Carle F , Lyons R , Van Oyen H , Tijhuis M , Unim B , Zelviene A , Fehr A
Published: October 2020

Background

Health information (HI) includes data on population health, health determinants, health care systems, and health-relevant policy developments. Duly prioritised HI is essential to inform decision-makers, researchers and the public. Little can be found in the literature on HI prioritisation methods and procedures in Europe. Our study aims to close this gap.

Methods

We designed a two-round online Policy Delphi and addressed 119 contacts, mainly public health and health information experts, in 33 InfAct partner countries. The first round included structured and full-text questions; in the ongoing second round, participants rank prioritisation approaches according to 'desirability', 'feasibility', 'importance' and 'confidence'.

Results

In the first round, 19 questionnaires were fully completed; the presented results also include replies from interrupted surveys and drop-outs. 58% of the participants reported the existence of structured national HI prioritisation processes; 65% indicated stakeholder involvement, and 54% the application of defined criteria. National health targets or strategies played a major role in HI prioritisation. 17 respondents from 13 countries agreed to participate in the second round. Based on analysis of the first round, participants rank approaches to HI prioritisation, preferences for stakeholder involvement and coordination, partners and methods for criteria development, the role of national and international frameworks and options for good-practices in HI development. The expected outcome of our study is not one single recommendation for HI prioritisation, but a list of good practice-approaches.

Conclusions

Health systems in Europe are heterogeneous, and so are health information systems. Mapping, sharing and ranking HI prioritisation approaches will facilitate knowledge exchange in the context of building a sustainable EU HI-system and may inform relevant EU processes.
Developing recommendations for good practice in national health reporting
Authors: Thißen M , Seeling S , Achterberg P , Fehr A , Haneef R , Palmieri L , Tijhuis M , Unim B , Ziese T
Published: October 2020

Background

Health reporting should deliver up-to-date data and information on the population's health status, its determinants and on national (or regional) healthcare services. Establishing an information or discussion base for health policy is an important objective ('data for action'), but health reporting also addresses other target groups like scientists, the media or the general public. Depending on the needs and competencies of the respective target groups, requirements for health reporting formats will differ. At the same time, heterogeneity of health reporting practices in Member States causes, next to occasional language barriers, difficulties in facilitating access to EU-comparable information. To allow for alignment and identification of good practices, our study aims to provide a comprehensive overview of the health reporting formats in the EU.

Methods

A web-based desk research of health reporting formats and their target groups was conducted among EU Member States and associated InfAct partner countries. Good practice examples were identified on the basis of quality criteria derived from 'Good Practice in Health Reporting' for Germany and the Eva PHR (Evaluation of National and Regional Public Health Reports) project. Based on the findings of the desk research, a guidance document for health reports will be drafted in close cooperation with InfAct partner countries.

Results

The guidance should accommodate the heterogeneity of reporting practices at EU level while defining desirable and feasible good practice standards. Although the focus is on public health reports, recommendations for other formats of health reporting will also be included. It will facilitate the preparation, dissemination and access to EU-comparable and high-quality health information.

Conclusions

The guidance is expected to be a useful tool for making health information adequately available to the targeted groups while reducing inequalities in health reporting across the EU.
Well-being and Health among adolescents living in a rural area in Northern Germany (East Friesland) - Result of the WOGE study
Authors: Natan M , Sisenop F , Lindert J
Published: October 2020

Background

Relationship of wellbeing of adolescent and community determinants in rural areas are mainly unknown. The aims of this study is 1) to provide data on wellbeing of adolescents in a rural area, 2) to analyses the association of sociodemographic variables and satisfaction with their community with adolescents` wellbeing.

Methods

We conducted a representative cross-sectional study (June 2018 - May 2019) in a rural catchment area including adolescents aged 14-18 years. We included socio-demographics (age, gender, education status), and time spent with parents in our study. Additionally, we measured wellbeing with the Ryff wellbeing scale (42 Items) and satisfaction with the community with a self-developed scale (21 Items). Data were analysed with uni- and multivariate linear regression models.

Results

A total of n = 157 adolescents (n = 82 girls/n=73 boys, age mean=16.7 years) participated in this families health study. The majority (97%/n=152) lived with their parents, and 70% (n = 110) had siblings. Among them were n = 146 adolescents (93%) who are in school-based education, and n = 11 (7%) are under work training education. Overall, adolescents reported high well-being scores (mean=166.78, SD = 32.8, 95%CI=161.24-172.19) and high satisfaction with their community (mean=13.67, SD = 1.63, 95%CI=13.45-14.03). Surprisingly, adolescents loved to spend time with their parents. Multivariate analyses suggest no significant associations of age (p-value=0,565), gender (p-value=0.961), education status (p-value=0.271) with well-being. However, community satisfaction is associated with well-being (p-value=0,006).

Conclusions

Sociodemographic variables were not associated with adolescents' satisfaction but with well-being in this rural community. A potential explanation might be that adolescents rely on their families rather than the wider community. Further studies are necessary to investigate the role of family relations in explaining the high well-being of this population.
Health services for asylum-seekers: evidence from countries of arrival, transit and destination
Authors: Bozorgmehr K
Published: October 2020

Background

Systematic assessments of health services for asylum seekers are relevant to identify strengths and weaknesses of responses to migration movements. Building on recent research, the presentation maps and summarises health service responses in Germany and six countries of the European Union and derives lessons learnt.

Methods

The presentation builds upon three pieces of evidence: 1. A health system assessment of Germany's response to refugee movements in 2015 using data from a national survey among public health services. 2. A scoping study of six EU countries in which 27 semi-structured in-depth interviews with first-line staff and health officials to collect information about existing guidelines and practices at each stage of reception in first-entry (Greece/Italy), transit (Croatia/Slovenia), and destination countries (Austria/Sweden). 3. A study assessing mental health care services in Germany from initial registration to follow-up after transfer in districts.

Results

The studies highlight system related shortcomings related to coordination of care, lack of standardisation, fragmentation of services and financing structures, inter- and sub-national governance structures, as well as limitations in communication and data collection systems that translate into poor health services, duplication of efforts, and discontinuity of care during the migration trajectory.

Conclusions

While the studies assessed the situation between 2015 and 2018, structural approaches, innovations and system level reforms will be needed to improve health system responses in the future. Such reforms, however, appear to be absent from the policy discourse so that increased efforts from the public health community are required to strengthen and improve health services for asylum seekers.
FAO/WHO GIFT: increasing the availability, harmonization and use of individual quantitative food consumption data worldwide
Authors: Ferreira de Sousa R , Balcerzak A , Bevere T , Padula de Quadros V
Published: October 2020

Introduction

Understanding the various eating habits of different population groups, according to the geographical area, is critical to develop evidence-based policies for nutrition and food safety. The FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT) is a novel open-access online platform, hosted by FAO and supported by WHO, providing access to harmonized individual quantitative food consumption (IQFC) data, especially in low- and middle-income countries (LMICs).

Methods

FAO/WHO GIFT disseminates IQFC data as ready-to-use food-based indicators in the form of infographics, and as microdata. The infographics intend to facilitate the use of these data by policy makers, providing an overview of key data according to population segments and food groups. The microdata is publicly available for download, and is intended for users that would like to do further analysis of the data.

Results

FAO/WHO GIFT is a growing repository. By June 2020, 14 datasets were available for dissemination and download, and an additional 44 datasets will be made available by 2022. FAO/WHO GIFT also provides an inventory of existing IQFC data worldwide, which currently contains detailed information on 268 surveys conducted in 105 countries.

Conclusions

FAO/WHO GIFT collates, harmonizes and disseminates IQFC data collected in different countries. This harmonization is aimed at enhancing the consistency and reliability of nutrient intake and dietary exposure assessments globally. FAO/WHO GIFT is developed in synergy with other global initiatives aimed at increasing the quality, availability and use of IQFC data in LMICs to enable evidence-based policy-making for better nutrition and food safety.
Equity in local health: participatory tool to assess physical and socioeconomic settings in Spain
Authors: Ocaña A , Peiró-Pérez R , Pérez Sanz E , Legaz Sánchez E , Paredes-Carbonell J
Published: October 2020

To address local health with a focus on equity and social determinants in a participative way, an intersectoral health analysis must be within reach, with the participation of citizens in every step of the process, as well as the support and commitment of policy-makers. Tools that allow collective evaluation of the people's places and organized data collection are also required.

In June of 2019, the translation and transcultural adaptation of the Place Standard Tool, as well as its validation in two municipalities was launched to have available a Spanish tool to evaluate places focusing on equity and social determinants, including equity in all the phases of the assessment process of the territory, promote and facilitate participation of vulnerable populations in every step, analyze results and interventions taking into account axes of inequality, build capacity at different levels, and address the resulting health necessities with an intersectoral focus on social determinants.

A Spanish participatory tool with a focus on social determinants was validated. Equity was addressed through focus groups consisting of vulnerable people, analyzing the results by axes of inequality. The participation of citizens was included in the place assessment, and in the prioritization of actions to be developed in the areas with the worst evaluation. An intersectoral group is currently working on the planning of the proposed actions. The first action is a plan to foster the use of bicycles and a mobility analysis to improve urban transportation.

The tool allows the participatory place assessment, and facilitates the connection of results and interventions to social determinants of health. It offers organized results which facilitates the intersectoral approach of derived interventions. The support of policy-makers is essential to carry out actions that impact social determinants of health, and to avoid creating false expectations among the citizens.