bluuebunny/crossref_metadata_2025 huggingface dataset:
Social gradient in health literacy among primary healthcare users in Cyprus
Authors: Andreou N , Nicolaou C , Papastavrou E , Middleton N
Published: November 2019

Background

Health literacy (HL) is a critical determinant of health and citizens’ control over their health. The European Health Literary consortium developed a conceptual model and related HLS-EU-Q47 tool of four cognitive and three health domains and showed high levels of inadequate HL in eight European countries.

Methods

This methodological and descriptive study evaluated the metric properties of the tool in a new setting and assessed HL among a Greek-Cypriot population. Differences in HL by social position and health behaviours was assessed.

Results

A sample of 300 adults from a General Hospital participated, 65%:35% urban vs rural, 15.3% divorced/widowed, 33% tertiary education, as expected according to census. 53% rated their health as “less than good”, 45.6% were current or past smokers and mean BMI was 26.8 (SD 5.2). Cronbach’s alpha coefficient for internal consistency was >0.80 for cognitive (access, understand, appraise, and apply) and health sub-scales (healthcare, prevention, health promotion). A three factor structure explaining 52.1% of the variance was identified in exploratory factor analysis (“access to information”, “prevention and promotion-related literacy” and “user-provider interaction”). Half of the participants (50.7%) reported inadequate or problematic HL with statistically lower HL in older age-groups but no difference by urban: rural status. A clear social gradient was observed by education, income and subjective social position on a 10-step ladder. Regular alcohol consumption and low physical exercise were related with low HL, but not smoking or BMI.

Conclusions

HLS-EU-Q47 showed good metric properties in a new language and setting. The proportion of population with inadequate or problematic HL appears high but consistent with findings from other European populations. The observed social gradient in HL supports the criterion known-group validity of the tool as well as highlights an important aspect of health inequality.

Key messages

There is support for HLS-EU-Q47 as a valid and reliable measure of health literacy. A high proportion of the Cypriot population with problematic health literacy with a clear social gradient.
Environmental Challenges as Mental Health risks and oppotunities in the light of SDGs
Authors: Jevtic M , Bouland C
Published: November 2019

Background

Environmental risk factors such as air pollution, contaminated water, climate change, soil pollution, chemical exposures, ultraviolet radiation, noise pollution and others potentially contribute to diseases and mental disorders, such as depressive and anxiety disorders. Taken together mental, behavioral and neurological disorders accounted for 10% of the global disease burden in 2015 and is expected to increase to 15% by the year 2020.

Methods

We will identify health promoting factors on the background of the changing disorders spectrum. Based on a narrative review we identified as potentially environmental mental health promoting factors quality green areas, e urban planning, sanitation and public transportation, and decrease in noise pollution.

Results

Using the sustainable development goals (SDGs) as a benchmarking tool in national, regional and local development plans, citizens are empowered to improve their mental health through improved environment. Discussion: Mental health is an underresearched area in the field of environmental health. Intersectoral and interdsiciplinary collaboration can contribute to overcome boudnaries of specific disciplines and build bridges to support the overall goal of promoting and supporting mnetal health and reducing the burden of mental and neurological disorders.
Environment and mental health – developing a research agenda
Authors: Lindert J
Published: November 2019

Background

Environmental research and research on mental and neurological disorders remains largely separated. Research methods in both fields are different using diverse approaches. Aim of this talk is to highlight differences and commonalities in research methods in the fields of environmental and neuropsychiatric epidemiology.

Methods

A scoping review of methods was preformed using databases such as PUBMED, ISI Web of Science, Embase, CINHAL and PSYCHINFO.

Results

The search yielded several hundred citations. The search will be updated in July 2019 to provide the most recent results in the workshop. So far the review suggests that the fields of environmental epidemiology and neuropsychiatric epidemiology still are separated. Discussion: Approaches to build a joint research agenda will be discussed. Some methods which are used in both subdisciplines of epidemiology will be described in detail in the workshop. Likewise, challenges in collaboration will be discussed with the audience. This discussion with workshop participants is a possibility to learn from each other and build interdisciplinary bridges.
G-CSF spending: Cost Impact of an intervention conducted in a French area: Pays-de-la-Loire
Authors: Chaslerie A C , Fuchs B F , Grude F R , Bourgeois H B , Vigneau Victorri C V , Garrec N G
Published: November 2019

Issue

Granulocyte colony-stimulating factors (G-CSF), recommended by international oncology guidelines as a prophylaxis of febrile neutropenia are expensive drugs. Despite biosimilars marketing since 2008, G-CSF spending represents a major and growing expense for health insurance.

Description of the problem

Between 2010 and 2013 an unsustainable increase of G-CSF spending by 20% occurred in a French area: Pays-la-Loire. An intervention based on guidelines was carried out to the oncologists involved in ambulatory cancer care to reduce G-CSF spending by improving prescription and promoting biosimilars. Hospital oncologists have been the main target. A partnership between physicians and pharmacists of the Brittany - Pays-de-la-Loire Cancer Dedicated Observatory network and the Pays de la Loire Medical Department of Health insurance composed the operational team involved in the work. Interrupted time series analysis based on the French national health data system database were chosen to assess the impact of the intervention on G-CSF spending, their prescription and biosimilars use.

Results

Twelve professional meetings were performed to cancer medical teams from 7 community hospitals and 5 private hospitals of the Pays-de-la-Loire region. This intervention reduced G-CSF spending by 11% and improves G-CSF local use.

Lessons

This type of multi-stakeholder intervention carrying common to various health actor’s messages represents a promising tool to improve the quality of care and the control of health expenditure. These results and the possible cost saving showed have encouraged the heads of French health insurance to promote this action in 2019 in the whole France.

Key messages

In the current context of unsustainable increases in cancer cares related costs in France the rational use of G-CSF’s seemed to be one available resources. biosimilar promotion for ensure broad access to innovative cancer therapeutic for patients and finance cancer prevention campaigns.
Emotional demands at work and risk of long-term sickness absence among 1.5 million Danish employees
Authors: Framke E , Sørensen J K , Madsen I E H , Rugulies R
Published: November 2019

Background

Emotional demands concern aspects of work requiring an emotional effort of employees and have been associated with risk of depression and long-term sickness absence (LTSA) in previous studies. Associations may, however, partly be affected by reporting bias. Further, previous studies have primarily been conducted using smaller samples in selected job groups or sectors. We, therefore, examined the association between emotional demands and LTSA using a job exposure matrix (JEM) in a nationwide cohort.

Methods

We included all employed individuals in Denmark who were 30 to 59 years old in 2000. We assessed emotional demands at work with a JEM. JEM values were categorized into quartiles based on the distribution within each year and updated annually from 2000 to 2009. LTSA was register-based, defined as ≥ 6 weeks and assessed until 2015. Individuals with LTSA from 1998 to 2000 were excluded, yielding a sample of 1,521,352 individuals. Exposure in year t was related to outcome in year t + 1 until 2009. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) using Cox regression adjusted for age, sex, income and ergonomic job demands.

Results

During 15,453,980 person-years, we identified 594,858 LTSA cases. In the fully adjusted model, individuals in the highest emotional demands quartile had a HR of 1.30 (95%CI: 1.29-1.31) compared to individuals the lowest quartile Repeating the analysis separately for women and men showed similar results.

Conclusions

Emotional demands at work were prospectively associated with an increased LTSA risk in this JEM based nationwide cohort study.

Key messages

This study found that emotional demands at work predict risk of long-term sickness absence. Future studies should focus on factors that may buffer the association between emotional demands at work and long-term sickness absence.
Work-pressure, job-satisfaction and turnover intentions among health managers in Serbia
Authors: Šantrić Milićević M , Gačević M , Milić N , Filipović J , Todorovic J , Terzic-Supic Z
Published: November 2019

Background

Rationalization, freezing of salaries and additional taxation of salaries above a certain amount have marked the reform of the public health sector in Serbia in 2014/15. Health managers bear responsibility for success in reform activities, and improvement of subordinates’ job satisfaction and health care quality with constrained resources. This study explored factors associated with work-pressure, turnover intentions and job satisfaction among health managers in 323 public health institutions in Serbia.

Methods

Data of the 2015 job satisfaction survey of the Ministry of Health and the Serbian Public Health Institute were used to carry out a secondary analysis. Logistic regression was applied, including factors such as age, gender, occupation (doctors, nurses, other health workers, healthcare associates and non-medical managers), workplace, work-conditions’ satisfaction, general job satisfaction, and turnover intention in relation to work-pressure of 7818 health managers (response rate was 91.5%).

Results

Almost 39.5% of the health managers experienced high/very high work-pressure (p < 0.001), 51.2% were dissatisfied (p < 0.001), and 23.7% had turnover intention outside the health sector/country (p < 0.001). High/very high work-pressure positively correlated with health managers of secondary (Odds Ratio-OR =1.37, p < 0.001) and tertiary care institution (OR = 1.72, p < 0.001), female sex (OR = 1.19, p = 0.004), younger than 55 years of age (OR = 1.26, p < 0.001), and nurses (OR = 1.13, p = 0.024). Other factors showing positive correlations include job dissatisfaction in general (p < 0.001) and with all workplace conditions (p < 0.001), as well as turnover intentions (p < 0.001).

Conclusions

Work pressure of health managers seems to be perceived highest in the group of younger female nurse executives in hospital care. Their dissatisfaction with the job in general and with the working conditions, as well as turnover intentions positively correlate with the increase of work pressure.

Key messages

Improving working conditions and job satisfaction is key to reduce work pressure of health managers. Young female nurse managers perceive highest levels of work pressure, and need reinforcement at work.
Economic hardship over twenty-two consecutive years of adult life and markers of early ageing
Authors: Foverskov E , Petersen G L , Pedersen J L M , Rod N H , Mortensen E L , Bruunsgaard H , Lund R
Published: November 2019

Background

The authors examined the associations between annual measures of economic hardship (EH) across 22 years of adulthood and objective measures of early ageing in a Danish late-middle aged population.

Methods

A linkage of longitudinal register data from Statistics Denmark covering the period 1987-2008 and cross-sectional survey data from the Copenhagen Ageing and Midlife Biobank collected in 2009-11 (N = 5,575). EH was defined as < 60% of the National median equivalized household disposable income and two exposures were calculated: 1) a categorical measure of total number if years in EH, and 2) trajectories of the probability of EH being low, declining, rising or high. Early ageing outcomes included four measures of physical capability, three inflammatory markers and one cognitive test. Associations were analyzed using linear regression models adjusted for sex, age, cohort, education, baseline income and long-term parental unemployment/financial problems.

Results

Four or more years in EH (reference=null years in EH) was related to poorer physical capability (chair rise: -1.49 counts/30 seconds [95% confidence interval (CI) -2.36, -0.61], hand grip strength: -1.22 kg [95% CI -2.38, -0.07], jump height: -1.67 cm [95% CI -2.44, -0.91] and balance: 18% [95% CI 9, 28]), poorer cognitive function (Intelligenz-Struktur-Test: -1.50 points [95% CI -2.89, -0.12]) and higher inflammatory levels (C-reactive protein: 22% [95% CI 4, 44], and Interleukin-6: 23% [95% CI 10, 39]). Comparing the four EH trajectories, people with a high vs. low probability of EH over time had poorer physical capability (chair rise: -1.70 counts/30 seconds [95% CI -3.38, -0.01], grip: -4.33 kg [95% CI -6.50, -2.16], jump: -1.68 cm [95% CI -3.12, -0.25], and balance: 31% [95% CI 12, 52]). No associations were observed with Tumor necrosis factor α.

Conclusions

This study suggests that sustained EH across adulthood may lead to early ageing.

Key messages

Sustained economic hardship in adulthood may lead to early ageing. Being in economic hardship for a few years is not associated with early ageing.
Is the solution really the ‘Nanny State’. Arm wrestling with industry
Authors: Moore M
Published: November 2019

M. Moore will discuss the nanny state approach and the arm wrestling with the food industry, providing examples and facilitating the development of key advocacy skills to play this power game.
Implementing integrated care for multi-morbidity: analysis of experiences in 17 European programmes
Authors: Struckmann V , Looman W , van Ginneken E , Bal R , Busse R , Rutten-van Mölken M
Published: November 2019

Background

Many countries are experimenting with new models of care provision and numerous integrated care programmes have been established internationally. However, little information is available on how to implement integrated care. The aim is to provide more in-depth insights in the implementation of integrated care for developers and managers of integrated care programmes, policy makers, health insurers, and researchers.

Methods

17 integrated care programmes addressing multi-morbidity were selected and studied in 8 European countries as part of the Horizon 2020-funded project SELFIE (Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE). An overarching analysis with data extraction forms of the Thick Descriptions completed for all 17 programmes in combination with previous insights from the literature was applied. Information about the implementation of integrated care was extracted and coded according to the six components of the SELFIE framework: service delivery, leadership & governance, workforce, financing, technologies & medical products, and, information & research and sub-elements of each component at the micro, meso and macro level.

Results

The results show the interrelatedness of the six SELFIE framework components and that alignment work between them, different elements and levels is important. The meso-level seems to be the driving force of implementation and that a stepwise approach to change by building upon what is already there (e.g. existing collaborative networks) and gradually expand and broaden the scope of the integrated care programmes was supportive.

Conclusions

Implementation activities should simultaneously focus at the micro, meso and macro-levels at which integration occurs as they strongly influence each other. Alignment of the integrated care programme and the active influence of the macro-level context by creating an enabling environment facilitates successful implementation.

Key messages

Integrated care should be implemented with an incremental growth model rather than from a disruptive innovation approach. Integrated care should involve bottom-up and top-down implementation at different levels of the programme.
Monitoring of non-communicable diseases in Belgium
Authors: Devleesschauwer B , Abboud L A , Bogaert P , Cornez A , Raes L , Scohy A , Van der Heyden J , Renard F
Published: November 2019

Non-communicable diseases (NCDs) account for the highest share of deaths and burden of disease in Belgium. Nevertheless, there is currently no national plan to prevent and monitor the health impact of NCDs. Recently, two initiatives have been launched by Sciensano, the Belgian institute for health, providing new opportunities for monitoring NCDs in an integrated and comparable way - i.e., the Belgian Health Status Report (HSR) and the Belgian National Burden of Disease Study (BeBOD).

The HSR, launched in February 2019, integrates health status information in a continuously updated website: www.healthybelgium.be. Key indicators, identified through literature and stakeholder consultations, highlight specific needs and warning signals. Currently, the HSR integrates self-reported information on NCD prevalence from the Belgian Health Interview Surveys, with objective information on cancer and diabetes from the Belgian Cancer Registry and health insurance data, respectively. Future versions will include a broadened scope with national best estimates for other NCD groups.

The BeBOD study was launched in 2016, aiming to provide a first set of internally consistent burden estimates by 2020. BeBOD will complement the HSR by integrating information on morbidity and mortality of NCDs into a single measure of burden of disease - the Disability-Adjusted Life Year (DALY). DALYs quantify the number of healthy life years lost due to disease, and allow comparing the burden of fatal and non-fatal conditions. Annual updates of the BeBOD study will further provide unprecedented opportunities to monitor the impact of NCDs over time.

In addition to the new opportunities provided by the HSR and BeBOD study, NCD monitoring requires continued investment in active data collection and integration of available data sources. In term, these NCD monitoring systems will provide a solid basis for evaluating the impact of NCD control policies.

Key messages

There is currently no national plan to prevent and monitor the health impact of non-communicable diseases in Belgium. The Belgian Health Status Report and the Belgian National Burden of Disease Study provide new opportunities for monitoring non-communicable diseases in an integrated and comparable way.
Best practices for core capacities at ports
Authors: Hadjichristodoulou C , Mouchtouri B
Published: November 2019

Introduction

A survey was conducted in the frame of the EU HEALTHY GATEWAYS joint action with the purpose to identify best practices implemented at designated points of entry-ports of EU Member States for: core capacities implementation; detection, surveillance and management of public health events; vector surveillance and control practices at ports; contingency planning; risk communication; and inspection of ships for vectors.

Methodology

A questionnaire was disseminated to the EU Member States designated partners of the joint action. “Best practices” were considered those which fulfilled the following four criteria: a) practices are implemented according to the International Health Regulations (2005) requirements for core capacities; b) practices are documented and legislated/formalised; c) staff have been trained in implementing the documented practices; d) practices have been tested with exercises or have been applied in real life events.

Results

Data were collected from 15 ports of 13 countries including eight designated ports and one that that designation has not been completed. Best practices were described for medical services including diagnostic facilities, training programmes, exercise for testing contingency plans, staff competency frameworks, equipment and health measures implementation. Standard Operating Procedures and national legal frameworks were collected.

Conclusions

Despite the progress that has been made in the IHR core capacities implementation, it seems that best practices exist based on the countries priorities and needs. There are not many examples of PoE implementing best practices in all areas of the survey. Achievement of core capacities is a continuing effort and exchange of best practices among EU MS can be beneficial.
The contribution of eHealth to improve fall and balance disorder care in the elderly
Authors: Gaspar Andréa , Velez-Lapão Luís
Published: November 2019

Background

The global ageing and consequent vulnerability for chronic multimorbidity, balance disturbances and falls represent a significant public health challenge that needs to be addressed. The use of Information Systems and Technologies to support eHealth services responding to balance disorders represents an opportunity to optimize health outcomes and insure autonomy support for older people.

Methods

A systematic review was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) to describe the contribution of eHealth to balance disorders care of older adults. The search was limited to English language journals and to reports that were published in the last 5 years related to use of eHealth in the context of balance and fall, restricted to the population older than 60 years of age without functional limitation by neurological disease.

Results

From a total of 1005 unduplicated articles, only 12 articles complied with the eligibility criteria. It was found a growing interest on the research but it was not possible to effectively compare the results of the studies. This can be explained due to diversity of older population engaged on the studies, differences in follow-up times, lack of homogeneity of study methodology and use of different remote technologies, yet to reach maturity. It was observed a gap between investigation and actual clinical use that should be addressed.

Conclusions

The use of eHealth in the context of older people with fall risk due balance disorders represents an opportunity to be explored, reaching the fragile and growing elderly population. The patient, caregiver and health human resources engagement and the homogeneity on research are necessary keys to allow clinical applicability and alignment with health policies.

Key messages

The use of eHealth in the context of older people with fall risk due balance disorders represents an opportunity to be explored, reaching the fragile and growing elderly population. Homogeneity on research is necessary to allow clinical applicability and alignment with health policies.
A National Digital Diabetes Prevention Programme: Feasible, acceptable and effective?
Authors: Murray E , Valabhji J , Lavida A , Henley W , Daff K , Irwin J , Brownlee L , McGough B
Published: November 2019

Background

Type 2 Diabetes (T2DM) is a global public health priority affecting 425 million adults with 352 million more at risk of developing T2DM. Intensive group programmes focusing on weight loss and physical activity can prevent or postpone the development of T2DM, but certain groups (e.g working age) find it difficult to attend sessions. Digital options offer a flexible alternative with the potential to widen access and increase uptake. The National Health Service of England (NHSE) has initiated a pilot of a national digital Diabetes Prevention Programme (DPP) to determine its feasibility, acceptability and impact. This is the first national digital DPP in the world, and lessons learnt will be of interest internationally.

Methods

Single arm, pre-post design located in 9 geographic areas with a total population of 5.6 million adults. Adults identified in primary care as being at risk of T2DM were referred to a digital diabetes prevention intervention (DDPI). Baseline data included demographic details (age, gender, ethnicity, highest level of education achieved) and clinical data (weight (kg), Body Mass Index (BMI) and glycated haemoglobin (HbA1c mmol/mol)). Clinical data were collected at baseline, 6 and 12 months, with the primary outcome change in HbA1c at 12 months.

Results

The programme was effectively implemented in all 9 areas with a total of 5,053 referrals. 3,228 (64%) of those referred registered with a DDPI. Mean baseline values for registered patients was BMI 31.1, Weight 87.7 kg and HbA1c 43.4 mmol/mol. To date, 2,687 patients have reached the 6 month point, of whom 867 dropped out. Mean (95% CI) HbA1c change was -1.6 (-1.8 to -1.4) mmol/mol (n = 1,264) and mean (95% CI) weight change was -4 (-4.3 to -3.7) kg (n = 1,184).

Conclusions

A national digital DPP is feasible, acceptable to patients and healthcare providers, and appears to be associated with beneficial impacts on HbA1c and weight in those who participate.

Key messages

A digital DPP is feasible, acceptable and associated with reductions in weight and HbA1c amongst participants. A digital DPP could be a useful part of a public health strategy to combat T2DM.
Compared to whom? Reference groups in socio-economic comparisons and self-reported health
Authors: Gugushvili A , Jarosz E , McKee M
Published: November 2019

Background

The association between socio-economic position and health is believed to be mediated, in part, by psycho-social comparison of one’s situation to that of others. But with who? Possibilities include family, friends, elites, or even those in other countries or in previous times. So far, there has been almost no research on whether the reference point matters.

Methods

We take advantage of a comparative data set that, uniquely, allows us to ask this question. The Life in Transition Survey was conducted in four Southern European and 30 Central and Eastern European and Eurasian countries. We sought differences in the probability of good self-reported health among those using different reference groups, including own family, friends and neighbours, domestic elites, people living in other countries and, those living prior to the major politico-economic transition. We used multivariable and multilevel mixed-effects Poisson regressions and estimated treatment effects via the regression adjustment of Poisson models.

Results

In most cases the choice of reference group did not matter but in some it did. Among men in Eastern European and Eurasian societies, those who compared themselves to their parents and their own families before the start of transition were less likely to report good health compared to those who did not compare their own economic situation with any specific reference group.

Conclusions

For some individuals, the choice of who to compare one’s situation with does seem to matter, pointing to an area for future investigation in research on psycho-social determinants of health.

Key messages

We found no difference in self-reported health between those who compare their situation with friends and neighbours, domestic elites, and people living in other countries. In post-communist countries, those who compared their situation to that of their parents and their own situation before the politico-economic transition were less likely to report good health.
Do poor health behaviors have an impact on the transition from sick leave to disability pension?
Authors: Svedberg P , Helgadóttir B , Mather L , Narusyte J , Ropponen A , Blom V
Published: November 2019

Background

High age, being a woman, and having low socioeconomic status are among the important risk factors for transitioning from sickness absence (SA) to disability pension (DP). But, little is known about the effect of poor health behaviors, although there are indications that poor health behaviors increase the risk of both SA and DP. The aims were to study the associations between three poor health behaviors (current smoking, high alcohol consumption and low physical activity levels) and DP among individuals who recently been sickness absent, and to explore whether having multiple poor health behaviors increased the risk of transitioning from SA to DP.

Methods

This prospective cohort study included 1991 twin individuals aged 20-46 who participated in a survey in 2005 and who had been on long-term SA in the two years preceding baseline (date of answering the survey) data collection of health behaviors (smoking, alcohol and physical activity) and relevant covariates. The participants were followed up for incident all-cause DP until the 31st of December 2012 (mean follow-up 5.2 years). National register data of SA and DP were used, and the association between each health behavior and DP was estimated using Cox proportional hazards regression analyses. The results are presented as Hazard Ratios (HR) with 95% Confidence Intervals (CI).

Results

Results showed that compared to never smoking, current smoking was associated with a higher risk of transitioning from SA to DP (HR 1.76, 95%CI 1.08-2.84). Alcohol use, lack of physical activity or having several poor health behaviors showed no significant associations.

Conclusions

Being a current smoker influences the risk of transitioning from SA to DP. Poor health behaviors are well established risk factors for poor physical and mental health. Hence, from a public health perspective it is important to emphasize the value of improving health behaviors in general but also among people with a history of SA.

Key messages

Many factors including health behaviors influence the risk of transitioning from sickness absence to permanent work incapacity in terms of disability pension. Supporting people on sickness absence to improve their health behaviors, e.g. smoking cessation, could be a promising approach to prevent exit from the labor market through disability pension.
Copenhagen Burnout Inventory On A National Representative Sample Of Pre-School Teachers
Authors: Piperac P , Terzic-Supic Z , Todorovic J , Maksimovic A , Karic S , Santric-Milicevic M
Published: November 2019

Background

Pre-school teachers are faced with work-related stress and are at increased risk of development of burnout syndrome. The aim of this study was to evaluate the reliability of the Serbian version of Copenhagen burnout inventory (CBI) on a National Representative Sample of preschool teachers in Serbia.

Methods

This was a cross-sectional study conducted between October 2018 and April 2019 which included 456 preschool teachers in Serbia. The instrument contained questions on socio-demographic, socio-economic characteristics, lifestyle characteristics, workplace environment and Serbian version of CBI. Univariate linear regression, multiple linear regression, Cronbach alpha coefficients were performed.

Results

Cronbach alpha of three domains of CBI were: personal burnout-0.907, work-related burnout-0.878, client-related burnout- 0.903. Multiple linear regression analysis showed that having a tenured contract (ß=3.46, p = 0.04), working in shifts (ß=7.94, p = 0.01), and having worse self-perceived health status (ß=-8.88, p = 0.01) were significantly associated with personal burnout. Working in shifts (ß=-4.67, p-0.012) and having worse self-perceived health status (ß=-7.82, p < 0.001) were significantly associated with work-related burnout. Age (ß=0.53, p < 0.001), living in urban areas (ß=-6.55, p = 0.015), alcohol consumption (ß=5.09, p = 0.016), number of children teacher work with (ß0.407, p = 0.005), having teaching equipment (ß=-4.46, p = 0.033), and having worse self-perceived health status (ß=-7.17, p < 0.0001) were significantly associated with client-related burnout.

Conclusions

CBI is a valid instrument for the assessment of burnout among preschool teachers in Serbia. Many workplace-related factors, which could be subject of preventive measures, are associated with domains of burnout in this population.

Key messages

Workplace-related factors are associated with burnout among preschool teachers in Serbia. CBI is valid instrument for assessment of burnout among preschool teachers.
Workshop: Alcohol policy reforms in European countries – challenges and solutions
Authors:   Organised by: National Institute for Health and Welfare, Finland, ANPAA; EUPHA (PHPP) Chair persons: Sofia Ribeiro - Portugal, Ilmo Keskimäki - Finland
Published: November 2019

Alcohol-related harm is a major public health concern in Europe, with levels of alcohol consumption and associated health harm among the highest worldwide. According to the European Commission, premature deaths linked to alcohol account for over 7% of all European morbidity, and alcohol is a major avoidable risk factor for neuropsychiatric disorders, cardiovascular diseases, cirrhosis of the liver, cancer and unintentional and intentional injuries. Even moderate use of alcohol raises long-term risks of certain heart conditions, liver disease and cancers, and frequent use can lead to dependence.

There is extensive research on efficient strategies to reduce alcohol-related harm, alongside high-level policy recommendations. Examples are the WHO’s global strategy to reduce harmful use of alcohol and the WHO European office’s European action plan to reduce the harmful use of alcohol 2012-2020. The European Union (EU) strategy to support member states in reducing alcohol-related harm expired in 2012. Since then, the Committee on National Alcohol Policy and Action (CNAPA) has drawn up a non-binding Action Plan in relation to alcohol and EU countries have the main responsibility for their national alcohol policy.

Despite strong evidence bases supporting alcohol policy, the implementation of potentially effective alcohol policy is often challenged by companies with commercial interests seeking to undermine evidence and advocate for less effective alternatives. These alternatives, such as education or voluntary industry action, are often favoured by politicians and the public. This opposition to evidence-based alcohol policy represents a challenge to public health.

In this session, we will discuss recent developments in alcohol policy reform in Estonia, Finland and Scotland; reflecting on the outcomes of policies and the challenges faced in implementation. We invite commentaries from national experts and from the DG Sante and WHO Euro. Among these the French commentary will address the influence of the alcohol industry in circumventing effective public health policies, with discussions concerning the new strict French low-risk guidelines on alcohol use as one example. The objective of this workshop is to share experiences of the challenges faced in applying effective alcohol policies, to discuss ways to tackle those challenges, and to invite the EU and the WHO to share their views on ways to overcome these barriers in future policy advocacy.

Key messages

Commercial determinants of health are a powerful force in preventing effective public health policy on alcohol-related harm. The public health community need to work in a persistent and coordinated manner to bring in a suite of effective alcohol policy interventions across Europe.
Finnish alcohol policy reform: battle over public health objectives
Authors: Mäkelä P
Published: November 2019

A new Alcohol Act came into force in Finland in 2018. The preparation of a comprehensive reform of the alcohol legislation was started already in 2011. The aim of Finnish alcohol policy has been to reduce alcohol-related harm, and the central means to do that have been by way of high taxation and restrictions in the physical availability of alcohol, in which the state alcohol monopoly has had a central role. The process of reforming the act was a long battle between forces that wished to continue underlining the public health aims and using efficient tools to reach those aims on the one hand, and neoliberal politicians aligned with the strong alcohol industry lobby and enthusiasts in social media who wished to get rid of regulation. The new Act somewhat expanded the rights of grocery stores to sell alcohol and de-regulated the on-premise trade by dismantling regulations in the old legislation. The retail state monopoly was weakened as a result, but it still has an important impact on restricting the physical availability of alcohol. Previously when alcohol has been made more available, consumption has increased, and also this time this was the expected outcome. However, an interrupted time series analysis has shown no statistically significant effect of the law change in the first year. One central explanation seems to be that price competition has been less intense than expected. Nonetheless, despite the fact that alcohol taxes were raised, a 10-year downward trend in alcohol consumption from 2008 to 2017 was halted.
Organization and content of primary care for adolescents – comparison of actual and desired situation
Authors: Jansen D E M C , Visser A , Vervoort J P M , Kocken P , Reijneveld S A , Blair M , Alexander D , Rigby M , Michaud P A
Published: November 2019

To successfully navigate increasing autonomy, independence and health behaviors in adolescence, accessible adolescent health care services (AHS) are essential. AHS comprise all services in primary care that are aimed at the specific needs of adolescents and can be provided in various settings such as public services, private services, schools and hospitals. In the MOCHA project (Models of Child Health Appraised) we assessed the structure and content of AHS in 30 European countries against the standards in the field of adolescent health services: accessibility, staff attitude, communication, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community. The results revealed that although half of the 30 countries did adopt adolescent-specific policies, many countries did not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care is limited. In addition, one third of the countries do not have a formal policy which guarantees the confidentiality of a consult and the possibility to consult a physician without parents knowing. Finally, around half of the countries do not have specialized centers in adolescent health care in order to tackle comprehensive health issues. Access to adolescent health care services needs to be improved for vulnerable adolescents such as migrant adolescents. Schools, ambulatory settings and hospitals should offer accessible, comprehensive health care and a culturally appropriate approach, particularly given the number of migrant adolescents living in EU and EEA countries. Finally, the health care systems should improve their communication strategies, to assist young people in understanding their rights and responsibility in the domain of health, and how and where to access to adequate care.
Clinical philosophy in the context of pediatric care
Authors: Ehrich J , Hirn L , Manemann J
Published: November 2019

Medical care may be better in many countries than it currently is. Developing countries are in the need to catch up with affluent countries, and rich countries have a need for answering the question of how quality of health care can be improved for their total population despite increasing high-technology-induced cost through comprehensive cost-benefit analyzes. Health is about 85% dependent on general health care and 15% on medical care. The current quality differences of health care not only have their roots in economic crises, but in the lack of application of the thought model of ‘root-cause-effect long-term consequences.

The questions arise as to whether this lack of integration of philosophical perspectives and activities contributes to deficiencies in the health care system and how philosophy could lead to new pathways of thinking. Obviously, the health systems of many European countries are having major problems translating the necessary changes in care from the theory level to the policy executive at the practical level. Furthermore, in many health care systems, adequate socio-philosophical concepts for adapting to constantly changing social conditions are missing with regard to adequate, accessible and affordable health care.

This presentation discusses the pros and cons of greater involvement of spiritual welfare, clinical philosophy and philosophical practices in medical care for adolescents in order to improve 1. adherence to therapy, 2. resilience and 3. resonance in the treatment triangle of ‘patient-family-therapist’.
Identifying best practices in junk food taxation and other food policies: Selected examples and their assessment
Authors: Romaniuk P
Published: November 2019

Issue/problem

Noncommunicable diseases are the main contributor to the global mortality, being responsible, as estimated, for 71% of deaths each year. About 80 of dietary dependent diseases has been identified so far, and their prevalence tends to exceed 30% in some populations.

Description of the problem

The growing prevalence of these diseases, along with impact on the quality of life, disabilities, as well as rising direct and indirect economic costs, constitute a basic foundation for emerging efforts to develop and implement new solutions within national health policies aimed at modifying dietary behaviours and reducing their negative impact on health status of individuals and populations. To address these problems the Joint Funding Action “Effectiveness of existing policies for lifestyle interventions - Policy Evaluation Network (PEN)” has been initiated, in which 28 research group across Europe are collaborating.

Results

The primary aim of the presented study will be to discuss the usage of the PEN instrument to identify best practices in food policies, including sugar sweetened beverages and junk food taxation. Previous examples of the instrument implementation will also be presented, including New Zealand, Australia and Canada, along with the results of current works on its development within the project. The second basic aspect for the study is to discuss and assess examples of food policies implemented in selected countries in terms of their effectiveness in modifying unhealthy behaviours.

Lessons

The time that has passed since the implementation of the evaluated solutions is too short to assess actual impact on health. Nonetheless, the existing evidence, including data from countries being the most successful examples of junk food taxation, like Mexico and Hungary, suggest that their impact on consumer choices, health literacy and also food industry in terms of food products composition, is positive.
Round table: Using evidence for action – the story on life-course vaccination
Authors:   Organised by: EUPHA (IDC), ECDC Chair persons: Anna Odone - Italy, Karl Ekdahl - ECDC
Published: November 2019

Vaccination represents a cost-effective public health intervention that saves millions of lives globally each year as well as increasing health and wellbeing of the population. Approximately 20 vaccines are currently in use in routine schedules, with several new or improved in the research pipeline. While immunisation programmes have traditionally targeted children, in recent strategic thinking around vaccination has shifted from an infancy focus to a life course approach that considers the benefits of vaccination at all ages. There are many benefits to targeting different age groups for vaccination, such as targeting individuals at an age that maximises protection (HPV among teenagers, shingles among older adults); boosting waning immunity (Td/IPV among teenagers); protecting at-risk individuals when they are most vulnerable (influenza in pregnancy, pneumococcal vaccine in older adults at clinical risk); protecting newborns in utero before they have the chance to be vaccinated (pertussis in pregnancy); or targeting an older age group to indirectly protect younger infants (MenACWY vaccination of teenagers).

Even though the public health benefits of the life-course approach are evident, delivering vaccination programmes spanning such disparate groups represent constant challenges. These challenges can be grouped into: a) limited access to services b) communication challenges influencing attitudes and knowledge of vaccination and c) logistical challenges associated with the use of a wide range of settings for vaccination.

This session will explore, at country and regional levels, experiences and reflections on delivering vaccination across the life course, and evidence-based policy and operational actions taken to deliver an optimal programme at all ages.

Key messages

Life course vaccination presents opportunities to better protect the population but also brings unique challenges, both from the patient side and from the health systems side. Evidence-based tools and strategies to improve vaccine programmes across the life-course are increasingly available. Country and European level action is needed to achieve optimal results.
Investing in communication education- the example of vaccine hesitancy
Authors: Ljungqvist I
Published: November 2019

The European Centre for Disease Prevention and Control (ECDC) works on vaccine acceptance by searching for evidence, consulting with key stakeholders (epidemiologists, public health experts, family doctors, non-governmental organisation representatives for Roma, travellers, other under-served population groups), and identifying pilot interventions/ practices.

ECDC aims to strengthen workforce capacity on vaccine acceptance by developing a training for trainers. To guide the development of this multi-annual programme ECDC organised an expert meeting in April 2019 focusing on discussing and designing main elements of the training for trainers in vaccine acceptance at the country level. Key conclusions of the meeting include: A range professionals should ideally be trained on how to communicate to increase vaccine acceptance: frontline healthcare professionals, pharmacists, gynaecologists, teachers, politicians, journalists.Investments should be made both in postgraduate professional development of frontline healthcare professionals, as well as in university curricula for medical, nursing and teachers training.Training should include both knowledge around vaccines and immunization, as well as communication skills to discuss about vaccines and motivate immunization. Possibly legal aspects at the country level should be included, too.Vaccine acceptance should be addressed throughout the life course and vaccines.Training should be delivered in a blended format, with face-to-face sessions (especially for skills building) and e-learning (especially for knowledge components).Training should include a common European-level core but be done by local trainers, in the local language and adapted to the local context.Training initiatives should be integrated into a “bigger picture”: sustainability of such an initiative should be taken into account, as well as the most efficient and interventions. Seeking synergies and partnerships are key in ensuring long-term success.