bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges in building image-based diagnostic support deep-learning algorithm for acute burns
Authors: Boissin C , Fransén J , Huss F , Wallis L , Allorto N , Laflamme L , Lundin J
Published: November 2019

Background

Acute burns are complex to diagnose and erroneous assessments impact on the victim’s mortality and morbidity. Specialists operate from a small number of burns centres and the capacity to provide timely assistance to front line clinicians is therefore limited. Diagnostic assistance through artificial intelligence could be an option to provide a timely and equitable diagnosis. This project sheds light on the feasibility of the development of an artificial intelligence algorithm for assisted diagnosis of acute burns and clarifies challenges faced along the way.

Methods

A bank of images has been built from a number of burn centres in South Africa and is continuously being updated (currently about 1200 images). Attempts have been made to train deep learning algorithms to diagnose the burn depth, an element that is challenging both at bedside and using image-based teleconsultation. We came across methodological challenges that need further consideration.

Results

Some challenges are clinical, i.e. inherent to the complexity of burn diagnosis, and imply the need of having an accurate diagnosis for the burn images on which the algorithm is trained. Other challenges pertain to the actual development of an algorithm. Prior to identifying burn depth a complex task relates to the feasibility of finding the burn itself in images of varying body parts and backgrounds. Further, training an algorithm for diagnosing burn depth also requires, large numbers of varying cases, the accurate labelling of the wound area for training, and decisions to be made as regards the best outcome to train upon. Current preliminary results indicate satisfactory identification of the burn area and promising results with regards burn depth diagnosis.

Conclusions

Development of artificial intelligence algorithms require strong collaborations and discussions between technical and clinical experts but are showing promising results.

Key messages

Development of clinical image-based automated diagnosis involve a number of critical challenges on both the technical and clinical sides that need to be addressed prior to optimization. Once optimally developed, deep learning algorithms are a potential solution to assist with the reduction of the burden of burns on the health services by providing timely, and cost-effective advice.
Evaluating a digital sepsis alert in a multi-site hospital: a natural experiment
Authors: Honeyford K , Cooke G S , Kinderlerer A , Williamson E , Gilchrist M , Holmes A , Glampson B , Mulla A , Costelloe C
Published: November 2019

Background

This study investigated the impact of a digital sepsis alert on patient outcomes in a busy London multi-site hospital. Sepsis is a serious illness and common cause of death, but rapid diagnosis and treatment improve patient outcomes. Digital health records allow algorithms to be embedded which ‘alert’ clinicians to patients who are at risk of developing sepsis. Despite the current promotion of ‘digital health’, evidence of the impact of algorithm driven alerts on patient outcomes is limited.

Methods

A retrospective natural experiment utilising the phased introduction of a digital sepsis alert into a large, multi-site hospital in England. Silent alerts (not visible to clinicians) acted as controls. Outcome measures were in-hospital all-cause mortality within 30 days of the alert, extended hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert). Inversely weighted multivariable logistic regression was used to determine associations between alert and patient outcomes.

Results

In a sample of 21,183 inpatients, the mortality rate was 5.9%. The active, visible alert was associated with lower odds of death (Odds Ratio (OR):0.76; 95%CI:(0.70, 0.84)). In 9988 emergency department attendances ending in admission, 40.6% had an extended hospital stay and 41.5% received timely antibiotics. The active alert was associated with lower odds of extended hospital stay (OR:0.93; 95%CI:(0.88, 0.99)) and increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57, 1.87)).

Conclusions

This study demonstrates that a move to digital health, through an automated sepsis alert, embedded in digital health records, was associated with improved health outcomes. Further work is needed to identify the causal pathway, which is likely to include more rapid treatment with antibiotics, and possible unintended consequences. These findings support the ongoing roll out of digital alerting and provide a model for robustly evaluating their impact.

Key messages

The introduction of an automated sepsis alert associated with the use of improvement methodology was associated with improved process measures and patient outcomes. Introduction of digital health interventions can, and should, be robustly evaluated with appropriate statistical approaches.
Workshop: Sharing best practices and building effective training at European points of entry
Authors:   Organised by: Netherlands National Institute for Public Health and the Environment Chair persons: Aura Timen - EUPHA (IDC), Christos Hadjichristodoulou - Greece
Published: November 2019

Infectious diseases can spread all over the world due to the transportation of people and goods through ships, aircrafts and vehicles. During the transportation on board of conveyances (ships, aircrafts, trains, buses), diseases can spread from person-to-person, by infected food or water or through vectors. The same can happen when travelers pass through points of entry (PoE) such as: ports, airports and ground-crossings.

To properly prevent and respond to public health events at PoE, designated ports, airports and ground-crossings core capacities for PoE are dictated in the IHR (2005), which should be in place at all designated PoE. According to the World Health Organization Global Health Observatory data, the IHR core capacities implementation at designated PoE at the European WHO region is 64%. In order to support countries with this implementation, exchange among countries of effective, legalized practices in accordance with IHR (2005), the so-called best practices, can be of important help.

Besides the goal to improve mere capacity, professionals in charge of communicable diseases at PoE should be prepared to respond to public health events and prevent cross-border spread. Education, training and exercises are common ways to achieve this, but demand extensive expertise, time and financial means. As part of a EU Joint Action, a collective training program for designated PoE is being developed, to share efforts and resources, and to help countries better respond to public health events.

However, regarding this training, many questions are still unanswered. What is effective training for public health events at designated PoE, and what components and methodology should it contain. What are the specific training needs of these people? What competencies should they have? What can we learn from previous trainings and what are best practices for designated PoE? The aim of this workshop is to provide a step-by-step overview of all elements that are essential to improve capacity and develop and organize effective training program for event management at designated points of entry in Europe. This study was funded by the European Union’s Health Programme (2014-2020).

Key messages

Extensive and long-term evaluation of training and exercising regarding infectious disease control at points of entry is needed, in order to design effective trainings and facilitate core capacities. Collection and dissemination of best practices in infectious disease control at points of entry, facilitate the challenging task of IHR core capacity implementation.
Workshop: Predictors and developmental timing of mental health problems among sexual minority individuals
Authors:   Organised by: EUPHA (SGMH) Chair persons: Corina Lelutiu-Weinberger - USA, Richard Bränström - EUPHA (SGMH)
Published: November 2019

As consistently shown across studies from various parts of the world, sexual minority individuals (e.g., those identifying as lesbian, gay, and bisexual [LGB]) are significantly at a higher risk for depression, anxiety, and suicidal thoughts and behavior when compared to heterosexuals.

The increased risk for poor mental health among sexual minority populations is believed to be a consequence of LGB individuals’ increased exposure to specific social stressors related to navigating a stigmatized minority identity. Studies trying to explain health inequalities based on sexual orientation have mainly focused on so-called minority stress processes, such as discrimination, internalized homophobia, expectations of rejection, and stress of concealing one’s sexual orientation.

This workshop will give examples of studies from various European countries on mental health predictors and trajectories by using various approaches such as population-based sampling, longitudinal data collection, and comprehensive theoretical frameworks. Dr. Gemma Lewis (University College London, UK) will present results showing that sexual orientation-based disparities in mental health are present already in early adolescence and increase throughout the school years. Arjan van der Star (Karolinska Institutet, Sweden) will present population-based data suggesting that openness about sexual orientation is not directly linked to lower risk of depression among sexual minorities, but is instead dependent on access to social support. Conor Mahon (Dublin City University, Ireland) will present results showing minority stressors as predictors of social anxiety among sexual minority men. Associate professor John Pachankis (Yale University, USA) will present results showing that, in addition to increased exposure to social stressors, barriers to societal integration can partially explain the elevated risk of suicidality among sexual minorities.

Key messages

Sexual minorities are a higher risk of mental health problems, such as depression, social anxiety, and suicidality, as compared to heterosexuals and these disparities can be identified early in life. Sexual orientation-based mental health disparities seem to be based both on disproportionate stigma-related stress and a higher prevalence of general risk factors for poor mental health.
Traumatic brain injury as a risk factor for dementia
Authors: Mezzalira E , Stopa B , Khawaja A , Izzy S , Gormley W
Published: November 2019

Introduction

The Centers for Disease Control and Prevention (CDC) reports that there were 2.87 million cases of traumatic brain injury (TBI) in the United States in 2014, 69 million worldwide. Some studies suggest a connection between TBI and increased risk of dementia, but it remains unclear whether the risk increases with age and TBI severity. Given our aging population, it is essential to better characterize the link between TBI and dementia.

Methods

We conducted a retrospective cohort study of two major academic medical centers for years 2000-2015. We identified all patients with TBI, aged 45 and older. Variables included age, TBI severity, pre-existing dementia, dementia diagnosed after TBI, years to dementia, and follow-up time. TBI severity was determined by head/neck AIS score, using ICD-PIC software. Mild TBI was defined as AIS 0-2, and Moderate/Severe as AIS 3-6. Analysis was done in R.v.3.0.1 software.

Results

Overall, there were 14,199 patients with TBI, of which 9,938 (70%) were mild and 4,261 (30%) were moderate/severe. Mean age was 70.5 (±14.0). There were 1,422 cases (10%) of pre-existing dementia, and 850 (6%) cases of dementia diagnosed after TBI. The mean follow-up time was 1,129 (±1,474) days.

The 75-84 age group had the highest incidence of TBI (28%). When compared by age group and TBI severity, the proportion of moderate/severe TBI increased with increasing age. The proportion of pre-existing dementia increased with age, as expected. Notably, there is increased incidence of dementia after TBI in patients aged 65 and older (7-10%, p < 0.001). There was no observed effect of TBI severity on the risk of dementia after TBI.

Conclusions

Our results indicate that TBI is a risk factor for the development of dementia, especially in patients aged 65 and older. Given the global public health burden of these two diseases it is critical to develop effective TBI primary prevention strategies.

Key messages

TBI is a risk factor for the development of dementia. Need for public health measures to mitigate the risk of TBI in the patient population 65 and older.
Occupational health effects during periods with heat
Authors: van den Hazel P , Zuurbier M , Flouris A , Nybo L , Kingma B
Published: November 2019

Hydration status, awareness and the attitude to health and performance effects of preventing dehydration was evaluated in five industries across Europe. The prevalence of dehydration was assessed via analyses of urine samples from 139 workers and questionnaires collected from employers as well as employees collected from ten different work places. In total 80 % of all workers were either suboptimal hydrated at the onset of work or became dehydrated during their work shift with levels equal to or higher than those associated with impaired function in cognitively dominated tasks and complex motor function. The high prevalence of dehydration is in conflict with ∼75% of all workers that emphasize drinking as the most important mitigation strategy during periods with elevated heat strain. Also, work safety and prevention of negative health effect was stressed as very important both by employers and employees (average score 9 out of 10). Although, hydration is emphasized by work-safety advisories, it seems clear that more effective 24/7 hydration strategies are warranted. We propose that future protection of workers against detrimental effects of heat should consider personalized alerts that can integrate the importance of timing to facilitate the development of appropriate hydration habits that accounts for the large inter-individual variation in sweating and hence differences in water and electrolyte needs.
People with a disability status in the French claim database: which characteristics and diseases?
Authors: Colinot N , Thomas M , Verboux D , Rachas A , Gastaldi-Ménager C h
Published: November 2019

Background

Due to a lack of data, populations with disabilities have been poorly studied. Here, we described the characteristics and diseases of people receiving a financial support for a disability and compared them to the general population.

Methods

We extracted data of all health insurance general scheme beneficiaries (87% of the French population) 20-64 years of age in 2016 from the national health database, including information on adult disability allowance (ADA) and disability pension (DP). Diseases were identified using algorithms mainly based on ICD-10 diagnoses from hospital stays, long-term diseases information and specific medications. The proportion of patients with a given disease was compared between people with ADA or DP or without a disability status using relative risks adjusted for age and sex (aRR), estimated by Poisson regression.

Results

Among 32.5 million people, 770,566 (2.5%) had an ADA (mean age 47, 49% women) and 733,599 (2.4%) a DP (mean age 53, 55% women). Disability status was associated with a higher proportion for all studied diseases, with high aRR found for mental illness (ADA: 44.8% (aRR: 17); DP: 26.5% (aRR: 8.9) versus 2.5% in those without disability status), in particular mental retardation (aRR: 108 and 4.7 respectively), neurologic or degenerative diseases (ADA: 13.5% (aRR: 16); DP: 9.0% (aRR: 9.8) versus 0.8% in those without disability status), in particular paraplegia (aRR: 36 and 25), but also cancers, diabetes and chronic and acute cardiovascular diseases.

Conclusions

About 5% of French health insurance beneficiaries 20-64 years old received a financial support for a disability in 2016. All studied diseases were more frequent in this population than in those without a disability status. These results are useful to inform public authorities on health status of these populations and to implement public health policies targeting these populations with special healthcare needs.

Key messages

High frequency of diseases, including mental illness and neurodegenerative diseases, but also a large panel of other diseases was observed in people with a financial support for a disability. Public health policies targeting people with a disability should account for the large spectrum of diseases in these patients.
Housing facilities for asylum seekers in Germany: Ethical concerns regarding social exclusion, othering and negative effects on health
Authors: Agbih S
Published: November 2019

Background

Asylum seekers face many barriers in accessing health care and their well-being is impaired in manifold ways. According to Public Health research the impact on health of social determinants is much higher than the influence of access to health care. Therefore, it is important to take other living conditions like accommodation into serious consideration.

Methods

The focus will be on how housing conditions allow or prevent opportunities for social participation and autonomy. As a philosophical-ethical paper this contribution attempts to identify moral concerns and ethical questions regarding housing situations under the lens of inclusion and exclusion. This will lead to the question whether they constitute forms of othering. In a first step it will be clarified how inclusion and exclusion are used as analytic frame, particularly whether and how far they are not only descriptive terms but also normative ones. Exemplary cases of housing facilities for asylum seekers in Germany will be given and questioned regarding practices of inclusion and exclusion and how this affects participation and autonomy.

Conclusions

Apart from contributing to barriers in accessing health care different types of “exclusive” housing for asylum seekers often impedes on social participation and disempowers autonomous choices. Since social exclusion is known to affect (mental) health this raises concerns for health and well-being as well as several other ethical questions.

Questions for further discussion:

What is the responsibility of Public Health regarding the housing conditions of asylum seekers and the negative effects of othering on health?

How do we perceive this in the light of solidarity?
Spiritual participation and its relation to housing conditions for refugees in Germany
Authors: Özisik S
Published: November 2019

Background

Many studies claim a positive relation between religious / spiritual participation and individual wellbeing. Thus, religious communities play a supportive and socializing role, and supply group assistance, security and solidarity also for refugees. Some dimensions of religion, such as the opportunity of practicing congregational rituals, transmitting religious traditions to the next generations, and building a religious/spiritual community may be linked to the housing conditions.

Objectives: The contribution aims to answer the following questions by showing the effects of housing conditions on the well-being of refugees: Is the spirituality of refugees affected after settlement in collective accommodation sites, and if so how?Does the distance or proximity to collective worship places affect the spiritual participation of refugees and their activities in religious organizations?

Methods

The data is derived from an ongoing research project at Bielefeld University, Germany. The research uses a multimethod approach. Semi-structured qualitative interviews (28) are supported by participatory observations and questionnaire application (N = 120).

Results

Both in the Interviews and quantitative survey, many Christian, Yezidi and Muslim respondents explicitly argued about their religious participation / nonparticipation due to their housing conditions either in collective accommodation or private housing.

Conclusions

Christians and Yezidis have fewer opportunities of collective practises of religion due to remote accommodations. The Muslim participants on the contrary have more options of practising with their coreligionists. The availability of religious institutions near to housing places affects this directly.
Artificial Intelligence-based tools to control healthcare associated infections: where do we stand
Authors: Scardoni A , Odone A
Published: November 2019

Background

Control of Healthcare associated infections (HAI) is a key public health concern in Europe. Current HAI surveillance systems are based on manual medical records review, vulnerable to misclassification & expensive. Artificial intelligence (AI), as a digital tool, offers great potential to HAI control. Still, scant evidence is available on both its practice and impact.

Methods

As part of a broader multidisciplinary project, we conducted a systematic review to retrieve, pool and critically apprize all the available evidence on practice, performance and impact of AI-based HAI control programmes. We followed PRISMA and searched the Medline and Embase databases for relevant studies. Included studies were stratified by HAI type and outcomes of interest, including all possible performance measures, clinical, organizational and economic outcomes.

Results

We screened 2873 records, resulting in 27 papers included in the review. Studies were carried out in 9 countries, the majority in the US (56%), 18.5% in EU countries, 25.9% published in 2018. Two thirds of studies focused on selected types of infections. Study designs were very diverse and performance observed for HAI detection were very heterogeneous, precluding pooled calculation of summary diagnostic accuracy estimates in most instances, but generally higher than non AI-based models. Overall performance measures of AI algorithms were: sensitivity range 19%-92%, accuracy 70.2%-96.1%.

Conclusions

Use of AI for HAI surveillance of HAI has increased reliability compared to traditional surveillance or to automated surveillance models. With ongoing improvements in information technology, implementation of AI models will improve the quality and capacity of surveillance will support hospital HAI surveillance.

Main messages

AI offer great potential to healthcare associated infections control. Preliminary evidence show AI-based models have perform better than manual or automated models for HAIs detection.
Skills building seminar: Develop collaborative tools among public health societies to mutually reinforce their interventions
Authors:   Organised by: Société Française de Santé Publique Chair persons: Yves Charpak - SFSP, Emmanuel Rusch - France
Published: November 2019

National public health societies face specific national challenges but also common challenges in several countries but in specific national contexts. At EPH2018, a first workshop entitled ‘ Can national public health societies work together for mutual support on their daily challenges? “ had allowed the national public health societies represented to highlight their interest and their ability to work together. Among the different lines of work identified, one of them was particularly emphasized: ‘How to make allies and influence health policies?’.

This line of work brings different reflections: When adopt postures of conflict and / or cooperation with the public authorities? How to choose to argue from evidence based public health and / or to build and tell simple and consistent stories? What are the situations where we risk going from ‘collaborating with’ actors to’being manipulated by’ actors? What are the conditions for forming effective alliances in public health?

Several topics have been identified as common issues facing the different national public health societies: migration and health, alcohol, food and information of public, physical activities and active mobility, environmental pollution.

As part of this workshop we want to share the feedback of experiences presented by several national public health companies on common public health issues to learn lessons to strengthen their actions.

The feedback presented will help identify and construct shared analysis frameworks, to identify the conditions favoring the influence of national public health societies. The development of these common tools will strengthen their interventions at a national level and enhance their collective effectiveness at the European level. EUPHA is the relevant framework for inscribing this approach in time and space.

Key messages

Eupha is the ideal place to meet other public health companies and find opportunities to develop practical transnational collaborations for a better impact of public health at the national level. The sharing of experience on common topics will strengthen the influence of the SNSPs and the impact of their actions at the country level.
Public Health, Ministry of Health and Economic Actors: the case of food and information of public
Authors: Lombrail P
Published: November 2019

The experience of France in the implementation of a frontof- pack label, the Nutri-Score, clearly illustrates the constant tug-ofwar between public health experts and the industry and provides a framework for an efficient strategy that could be replicated at the EU level.

Dietary risk factors is in the top three leading causes of morbidity and mortality in Western Europe. Such high burden of diseases urges the implementation of strong and efficient public health strategies in order to curb the impact of poor diets. The public health community has long promoted strategies impacting both individual dietary behavior and the food environment, in a consistent global framework. However, the latter strategies imply to act upon the food and beverage manufacturers, to provide consumers with better information on the nutritional quality of the foods they produce and to ensure a shift in the nutritional composition of the food offer towards healthier foods.

Among the various public health nutrition strategies that are considered efficient in both modifying consumer behavior and enticing reformulations by the food industry, front-of-pack food labeling has been identified as a key policy component in a global program.
The Scottish case: minimum unit pricing for alcohol
Authors: Hilton S , Katikireddi S V
Published: November 2019

There have been longstanding social and public health concerns about the levels of harmful alcohol consumption in Scotland. The Alcohol (Minimum Pricing) (Scotland) Act 2012 targets all alcohol sold through licensed premises in Scotland by ensuring it cannot be sold below a set minimum unit price. The pricing policy is currently set at 50p per unit of alcohol. Following a legal challenge and a vote in the Scottish Parliament, minimum unit pricing was implemented in Scotland on 1 May 2018. The aim of the Scottish alcohol policy has been to reduce the adverse public health consequences of alcohol consumption. It has also been identified as a potential measure for reducing health inequalities since alcohol-related harms are strongly socially patterned. The Scottish alcohol policy is important case to consider for a number of reasons. First, the nature of the policy differs. Rather than the introduction of a variable floor price, which may encourage switching in consumption from one product to another to maintain alcohol intake, minimum unit pricing introduces a price threshold that is uniform across all alcohol products. Second, minimum unit pricing is being introduced into a competitive commercial environment with strong vested interests, rather than a government-controlled monopoly. Third, the policy has been framed as a public health intervention, rather than primarily for revenue-raising reasons. Research on its development and evaluation will be considered to inform broader discussions on policy advocacy. Here we show a visualisation of the minimum unit pricing policy network to highlight how the public health community could work in more coordinated manner to support alcohol policy interventions.
Improving child and adolescent public health from a sociological point of view
Authors: Karvonen S
Published: November 2019

Changes in social divisions and their intersections are keys to understanding child and adolescent health from a sociological perspective. Furthermore, with European societies facing demographic change, aging of the population will also lead to a change in the societal position of children, young people and their families. This paper will focus on discussing ways to improving child and adolescent public health with special reference to broader societal and demographic changes and their implications to service provision, milieux and (collective) lifestyles of families. Broadly the point of the presentation is that ignoring the larger societal context may amount to prioritizing services, programmes or income transfers contributing to few or no public health effects at all.
Why do we need for timeliness of research in decision-making?
Authors: de Jong J , Hansen J , Groenewegen P
Published: November 2019

Background

Compared to the policy process, the research process is slow. As a result, research evidence is not always available when needed in the policy process. These differences in timelines between research and policy hinder the use of research evidence in the policy process. In order to support evidence-based policy making, timeliness of research is important.

Methods

Examples are provided, e.g. where research was on time to be included in the policy process and where research was too late to be included in it. These examples are described and analysed to provide for recommendations on how to better align both processes.

Results

It is shown that in order to create timeliness of research, policy makers and researchers should talk on a regular basis. This increases the chance that results from the research are included in policy making.

Conclusions

Timeliness of research is important for evidence-based policy making. In order to create timeliness of research, interaction between researchers and policy makers is important.
Sharing hospital-based health technology assessments internationally
Authors: Marchetti M , Daugbjerg S
Published: November 2019

Issue/problem

National healthcare systems worldwide are at a critical point due to the fiscal sustainability challenges faced. At the same time, healthcare systems are under pressure to meet the global demand for adaptation of medical innovations arriving into the market persistently.

Description of the problem

Hospitals often serve as the entry point for new technologies to the healthcare system. It is therefore extremely important that Health Technology Assessments (HTA) are available in timely order to accurately inform decision-makers on both short- and long-term effects of a health technology to avoid inappropriate investments. Hospital based HTA (HB-HTA) was developed to accommodate the need for evidence-based hospital-specific information in a timely manner. A substantial increase in the use of HB-HTA has been observed in the last years. However, only few reports are being published. A database for the structured collection of HB-HTA reports could help the dissemination and collaboration between hospitals.

Effects/changes

A survey answered by an international group of experts knowledgeable in HB-HTA from eighteen different countries has showed that there is an interest to realize the collection and dissemination of HB-HTA reports on an international scale. However, confidentiality and resources for a database are barriers for the dissemination of HB-HTA reports. The challenge will therefore be to overcome these barriers and design a database containing high quality, comparable and complete HB-HTA reports with proper data security, regular maintenance and user support.

Lessons

International collaboration in HB-HTA is the key to timely inform decision-makers without compromising the quality of the data or the methodology.
Parental socioeconomic position and chronic inflammation during adolescence
Authors: Fraga S , Severo M , Ramos E , Kelly-Irving M , Silva S , Ribeiro A I , Petrovic D , Barros H , Stringhini S
Published: November 2019

Background

Early life adversity has been associated with increased risk of inflammation and inflammation-related diseases in adulthood. This study aimed to examine the association of parental socioeconomic position with chronic inflammation over adolescence.

Methods

We used information on 2942 members (1507 girls and 1435 boys) of the EPITeen cohort that was established in 2003 in Porto, Portugal, and included 13 years old adolescents that were further evaluated at 17 and 21 years. Mother’ and father’s education and occupation were used as indicators of parental socioeconomic position. High-sensitivity C-reactive protein (CRP) was measured at three points in time (13, 17 and 21 years). CRP levels were categorized in tertiles separately for each wave; chronic inflammation in adolescence was defined as having CRP levels in the highest tertile in at least 2 waves and never in the lowest tertile.

Results

Over adolescence, the prevalence of chronic inflammation was significantly higher among participants with low parental socioeconomic position. Low parental socioeconomic position was associated with chronic inflammation in adolescence, after adjustment for sex, perinatal and physical environment factors, health-related behaviours and health status in adolescence OR = 1.63; 95%CI: 1.11, 2.40 for lowest vs. highest mother’s education and OR = 1.61; 95%CI: 1.12, 2.30 for lowest vs. highest father’s education.

Conclusions

Low parental socioeconomic position is associated with chronic inflammation during adolescence. Our results suggest that the early life socioeconomic environment has an impact on inflammatory processes over adolescence.
WHO Action Network on Measuring Health Literacy: the Italian pilot for the Survey 2019 Title
Authors: Palmieri L , Rosano A , Cadeddu C , Donfrancesco C , Galeone D , Mastrilli V , Elia R D , Lo Noce C , Acampora A , Giampaoli S
Published: November 2019

Background

Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to Ministry of Health funds, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS.

Objective: The HLS-EU-Q16 questionnaire was administered to a sample of adult population during the Health Examination Survey-HES of the CUORE Project started in 2018, to verify and evaluate the feasibility of the HL survey.

Methods

One hundred people aged 35-74 years, resident in Reggio Calabria (South of Italy), were interviewed (face-to-face) following consecutive access to the HES. According to the HLS-EU-Q16 sum score, three levels of HL were defined: inadequate, problematic, and sufficient. HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES.

Results

HL mean score of 98 completed questionnaires (47 men, 51 women) was 13.0 (SD = 3.5), with no sex difference; prevalence of persons with inadequate HL was 11.2%, problematic 26.5%, sufficient 62.3%. Sufficient HL level presents the highest prevalence (72%) of high educational level. Smoking habit decreases as HL level increases.

Conclusions

The HLS-EU-Q16 questionnaire represents a standardised tool applicable in the general population. Preliminary results from the Italian pilot of the HLS-EU-Q16 suggest that the survey is feasible within the HES of the CUORE Project, with the opportunity to link HL data with HES measured data. More than one third of interviewed adult population have inadequate/problematic HL.
Promoting sexual health literacy among migrants in Sweden
Authors: Svensson P , Carlzén K , Agardh A
Published: November 2019

Background

Migrants constitute a growing share of the European population. Refugees and migrants in Europe have a higher risk for poor sexual and reproductive health than the native-born population. These differences can be explained by limited access to sexual health care, family planning and prevention.

Newly arrived migrants in Sweden are offered a programme encompassing civic orientation provided in mother tongue by communicators. MILSA web-based education platform aims to secure a national standard for civic orientation. Over a three-year period, 200 communicators across Sweden will receive training. This study will explore civic orientation as an arena for health communication, and the role of the communicators for delivering sexual health information. It will identify active components for the delivery and uptake of sexual health information.

Methods

Qualitative in-depth interviews were conducted with nine migrant women during their resettlement, and with twenty communicators participating in MILSA education platform.

Preliminary results

Receiving information in mother tongue by communicators with cultural competence increases access to information. Shared understandings of shame and stigma associated with sexual health constrain the quality of delivery and uptake. Leadership, pedagogic skills, cultural competence, and responsiveness to target group are important qualifications for the communicators. Communicators need an understanding of both cultures, how they interact, and the influence of migration on cultural identity to deliver SRHR information. Trust among participants, and between the communicator and participants is essential for the delivery and uptake of sexual health information.

Conclusions

Building competence to deliver sexual health information among professionals who encounter migrants at an early stage in the resettlement has the potential to build sexual health literacy and reduce barriers to accessing sexual and reproductive health.

Key messages

Civic orientation is an important arena for reaching migrants with SRHR information. To empower the migrants to take control of their sexual and reproductive wellbeing in the new country, this information must be culturally, linguistically appropriate and delivered pedagogically.
Round table: AI and Big Data: Ethical Challenges and Health Opportunities
Authors:   Organised by: Digital Public Health Conference Chair persons: Patty Kostkova - UK
Published: November 2019

The recent emergence of Big Data in healthcare (including large linked data from electronic patient records (EPR) as well as streams of real-time geolocated health data collected by personal wearable devices, etc.) and the open data movement enabling sharing datasets are creating new challenges around ownership of personal data whilst at the same time opening new research opportunities and drives for commercial exploitation. A balance must be struck between an individual’s desire for privacy and their desire for good evidence to drive healthcare, which may sometimes be in conflict. With the increasing use of mobile and wearable devices, new opportunities have been created for personalized health (tailored care to the needs of an individual), crowdsourcing, participatory surveillance, and movement of individuals pledging to become “data donors” and the “quantified self” initiative (where citizens share data through mobile device-connected technologies). These initiatives created large volumes of data with considerable potential for research through open data initiatives. In this workshop we will hear from a panel of international speakers working across the digital health, Big Data ethics, computer science, public health divide on how they have addressed the challenges presented by increased use of Big Data and AI systems in healthcare with insights drawn from their own experience to illustrate the new opportunities that development of these movements has opened up.

Key messages

The potential of open access to healthcare data, sharing Big Data sets and rapid development of AI technology, is enormous - so as are the challenges and barriers to achieve this goal. Policymakers, scientific and business communities should work together to find novel approaches for underlying challenges of a political and legal nature associated with use of big data for health.
Modelling healthcare access for migrants and refugees in Europe: identifying the major health issues
Authors: Gil-Salmerón A , Riza E , Karnaki P , Zota D , Linos A
Published: November 2019

The Mig-HealthCare systematically searched to identify the key health areas of refugee/migrant health in order to facilitate interventions that help access to care services for migrants and refugees. The literature review was carried out in March 2018 using 3 large scientific databases using a combination of search terms following the PRISMA methodology and a standard set of items used to report on systematic reviews. Based on the predefined inclusion and exclusion criteria, a total of 118 publications were used for data extraction. It is important to note, that in almost all of the sources identified, the following cross-cutting factors were described as influencing access to healthcare: Continuity of Information, how it relates to policy, how it differs between health services and across-borders. Furthermore, the organizational coordination among social and health care providers in the host country determinates the successful access to healthcare of migrants/refugees.Language & Communication takes into consideration both the healthcare service and its provision of translators and cultural mediators, and the host country language proficiency of the migrant/refugee.Organizational improvement of access and delivery of health care services for migrants and refugees in addition to Cultural Competence of the healthcare providers meaning the ability to maximize their sensitivity in the service of care to culturally diverse groups.Health literacy understood as the motivation and competences of the migrant population to access, understand, appraise, and apply health information.

Additionally, the health issues of particular importance for migrants/refugees as emerged from the systematic review, including mental health, maternal/child health, health promotion, NCDs and chronic diseases, Oral/|Dental health, and Vaccinations should be included in planning future needs and healthcare access.
Deaths of despair and Brexit votes: cross-local authority statistical analysis in England and Wales
Authors: Koltai J , Varchetta F M , Mckee M , Stuckler D
Published: November 2019

Objectives

To test the hypothesis that ‘deaths of despair’, a marker of social suffering, was associated with greater support for Brexit in the UK’s 2016 EU referendum.

Methods

Cross local authority regression models of 2016 Brexit referendum vote shares for each local authority in England and Wales on changes in rates of suicide and drug-related deaths pre- (2005-2007) and post-recession (2014-2016), adjusting for several socioeconomic and demographic factors.

Survey population: 345 local authorities in England and Wales.

Results

Greater mortality rates from deaths of despair were significantly associated with higher Brexit vote shares. In unadjusted models, an increase of 10 drug-related deaths per 100 000 associated with a 13.20 percentage point increase in Brexit votes (95% CI: 7.09 to 19.31), while an increase of 10 suicides per 100 000 was associated with a 9.93 percentage point increase in vote shares for Brexit (95% confidence interval 6.21 to 13.65). These associations are explained by local area-level economic and education factors.

Conclusions

Worsening external causes of death correlate with Brexit voting. Such deaths may serve as an early warning indicator for political instability.

Key messages

Prior research has shown correlations between deaths of despair and votes shares for Trump in the 2016 US presidential election. We extend this research to the UK, showing that greater mortality rates from deaths of despair were significantly associated with higher Brexit vote shares.
Maternal immigrant status and signs of neurodevelopmental problems in early childhood
Authors: Schmengler H , El-Khoury Lesueur F , Yermachenko A , Taine M , Cohen D , Peyre H , Saint-Georges C , Thierry X , Melchior M
Published: November 2019

Background

A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of two-year-old children using standardized parent-report instruments.

Methods

We used data from the French representative ELFE birth cohort, initiated in 2011. The study sample included 9,900 children of non-immigrant French, 1,403 children of 2nd, and 1,171 children of 1st generation immigrant women followed-up to age two years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI).

Results

In fully adjusted linear regression models, maternal immigrant status was positively associated with M-CHAT scores, with stronger associations in children of 1st (β-coefficient: 0.19; 95% CI 0.08-0.29) than 2nd generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of 1st generation immigrant mothers native of North Africa (vs. non-immigrant French: 0.33; 0.16-0.49) or French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of 1st generation immigrant mothers, particularly from mostly non-francophone regions. Children of 1st generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores.

Conclusions

Our findings suggest that maternal immigrant status is associated with higher risks of early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Standardized screening instruments may aid the early detection and treatment of these difficulties, helping to address inequalities in neurodevelopmental health in children of immigrants.

Key messages

Children of immigrant mothers in a population-based sample appear to have elevated neurodevelopmental risks, as assessed by maternal report. This is in line with evidence from clinical samples. We found strong variations according to maternal region of origin, with the highest risks in children of 1st generation immigrant mothers from North Africa and French-speaking Sub-Saharan Africa.