bluuebunny/crossref_metadata_2025 huggingface dataset:
Births, miscarriages and induced abortions among foreign born women in Finland
Authors: Jokela S , Koukkula M , Lilja E , Klemetti R , Koponen P
Published: October 2020

Background

The increasing number of foreign-born women living in Finland has raised a need for more information about their sexual and reproductive health and need for services. This study explores the prevalence of births, induced abortions and miscarriages as well as the associated socioeconomic factors of foreign-born women.

Methods

This study used data collected in the Survey on Well-Being Among Foreign Born Population (FinMonik), conducted in 2018-2019. The random sample (n = 6 695) consisted of women aged 18 to 64 years and living in Finland. The participation rate among women was 56% (n = 3 746). The results were stratified according to country groups based on geographic region of origin: Middle East and Africa; Russia, former Soviet Union and Estonia; Asia; EU, North America, Latin America and others. The analyses were conducted with logistic regression adjusting for age. In the analyses, weights were used to reduce non-response bias.

Results

The proportion of women who had at least one birth in their lifetime varied from 67 to 80%. Those from the Middle East or Africa had the highest proportion of three or more births (41%). The proportion of women who had experienced induced abortion was highest among women from Russia, former Soviet Union and Estonia: 34% of these women had experienced at least one abortion while 20% had experienced at least two abortions. No difference in reported miscarriages was observed between the groups (20-27%). In all groups, married women (82%) and those with only basic education (82%) had more often at least one birth than unmarried women (61%) and those with higher education (70%). Compared to the other groups, lower educated Russian, former Soviet Union and Estonian women had more often experienced at least one induced abortion (44 %).

Conclusions

There are major differences in the prevalence of births and abortions among women from different regions and educational level.

Key messages

Challenges in sexual and reproductive health vary by region of origin. Low-threshold health services and health education are needed to guarantee better sexual and reproductive health for all women.
Sara Alert: An enduring national resource to support public health monitoring & disease containment
Authors: Feldman K , Butler M , Hay K , Holmes A , Krautscheid P , Nosal M , Scannell D , Sleeper H , Stoutenburg S , Jarris P
Published: October 2020

Background

Public health agencies had to respond swiftly to the novel coronavirus that emerged in 2019 (COVID-19) to try to contain the virus, which requires early identification of new cases. Monitoring exposed individuals is labor intensive and available tools are often limited. MITRE, a company that operates federally funded research and development centers for the U.S. government, rapidly developed a configurable monitoring tool that allows public health authorities to monitor potentially exposed individuals in their jurisdictions.

Methods

A team, including public health leaders, field epidemiologists, software engineers, and health communication specialists, was quickly assembled to design and develop an open source, disease-independent monitoring tool called Sara Alert. Outreach to key public health stakeholders, including partner organizations and local and state health departments, was conducted early for requirements gathering and to validate assumptions. Public health law experts were consulted regarding data privacy and security.

Results

By four weeks, a minimally viable monitoring tool was available for testing by public health partners. Exposed individuals can be enrolled and reminded daily to enter a temperature and any symptoms by web or mobile interface, SMS messaging or phone. Public health officials monitor and can quickly take action if symptoms consistent with COVID-19 are reported of if there is failure to report within a configurable time frame. Dashboards provide insight into aggregated data appropriate to level of view.

Conclusions

Sara Alert serves as a force multiplier that supports disease containment and allows resources to be directed where they are most needed. Successful development was possible because key stakeholders across public health practice were consulted early. Sara Alert is available, free, to state and local public health departments and serves as an enduring resource easily configured for the next public health emergency.

Key messages

Sara Alert serves as a force multiplier that supports disease containment and allows resources to be directed where they are most needed. Sara Alert serves as an enduring resource easily configured for the next public health emergency.
Effect of area-level factors on heat-associated morbidity and mortality in the Eastern Townships
Authors: Vandal G , Garant M , Cossette B , Pinsonneault L
Published: October 2020

Background

Multiple individual risk factors for morbidity and mortality during heat waves have previously been identified. Based on these, five categories of area-level indicators are used in Quebec, Canada, to identify geographical regions with presumed increased vulnerability: economic, social and biological vulnerability, housing characteristics and urban environment. However, we do not know which indicators correlate with an increase in morbidity and mortality during heat waves. This study evaluated, among 13 different area-level vulnerability factors from these five categories, which ones predict an effect modification of hot temperatures on morbidity and mortality.

Methods

For 2008 to 2018, we first explored the association between average daily temperature and four daily health indicators for the Eastern Townships region in Quebec: all-cause ambulance transports, all-cause emergency department (ED) visits, all-cause mortality and heat-related hospitalizations. We then used Poisson regression linear mixed models to investigate effect modification from the 13 area-level risk factors.

Results

Three vulnerability factors significantly caused positive effect modification between temperature and daily all-cause ambulance counts: the chronic diseases index, the percentage of people aged 65 years or older and the percentage of people aged 65 or older and living alone. For heat-related hospitalizations, four factors caused positive effect modification: the same three as for ambulance counts, plus the proportion of people that spend 30% or more household income on rent. For the ED-temperature association, only the percentage of people with low income caused positive effect modification. There was no significant association between temperature and daily mortality.

Conclusions

This study will help public health officials target preventive interventions to areas with the vulnerability factors that most strongly predict heat-related morbidity.

Key messages

Some, but not all, individual risk factors are useful at the area-level to predict areas with the strongest increases in morbidity associated with hot temperatures. The chronic diseases index and the percentage of people 65 and older living alone both accentuated the association between hot temperatures and ambulance transports or hospitalizations.
8.G. Workshop: Public health systems leadership and capacity building in changing Times
Authors:   Organised by: UK Faculty of Public Health,   Chair persons: Maggie Rae - UK
Published: October 2020

Objectives

There is clear need for a diverse public health work force with the training, skills and expertise to provide leadership across health systems. The purpose of the proposed workshop is to share experience and learning on system leadership and capacity building in public health, using the work of the UK Faculty of Public Health as a case study.

The workshop will cover: the nature, key role and the distinguishing features of system leadership in public health;capacity building through competency-based training, adaptive public health curriculum, systematic educational and training activities; and development of multidisciplinary workforce;generation and transfer of knowledge; andthe case for value-driven workforce, systems and leadership.

The Faculty of Public Health is the UK's professional standards body for public health specialists and practitioners, with over 4000 members working around the world. As the professional membership body for public health it has played a leading role in education, training, and assuring an internationally respected public health workforce and development of robust public health systems; promoted public health knowledge; and been powerful advocate for the reduction of inequalities and the very best conditions for health and wellbeing to flourish.

The roundtable workshop will include experienced senior public health practitioners, academics, and leaders who will briefly present from their different perspectives. This will include consideration of the historical perspective and conceptual frameworks around system leadership; the journey towards development of multidisciplinary workforce and recognition of the diversity of the wider workforce; evolution of public health curriculum and education and training activities; knowledge transfer in leadership, advocacy and analysis; and why ethics matters and what can be done about them.

There will be opportunity for reflection and discussion with participants and the panel on system leadership and capacity building, including on the merits and risks of different approaches and implications for policy research and practice.

Key messages

System leadership and capacity building need to be adaptive and shaped by the needs of the times and based on moral mandate of public health. Development of multidisciplinary workforce; effective generation and transfer of knowledge; and value-driven workforce, systems and leadership are key to improving and protecting the public’s health.
Patient-centered approaches applied in inpatient and outpatient TB services in Armenia
Authors: Grigoryan Z , Truzyan N , Petrosyan V
Published: October 2020

Background

Healthcare system performance indicators are common instruments measuring and facilitating quality improvement. The End-TB strategy urges provision of integrated patient-centered (PC) care for all forms of tuberculosis (TB). This study aimed to assess and compare quality of inpatient and outpatient TB services using international standards on specific PC indicators to identify potential targets for improvement.

Methods

Joint Commission International (JCI) accreditation standards, adapted to local needs and context, were used as a basic instrument for qualitative and quantitative data collection. We utilized Patient and Family Right (PFR) and Patient and Family Education (PFE) 15 standards with 49 measurable elements as PC indicators for the nationwide assessment of TB services. A scoring system and a scaling approach were used to convert all-source-data and present the overall performance of services.

Results

We reviewed and analyzed data from 10 legal documents, 34 medical records and 155 interviews and focus group discussions with TB healthcare providers, patients and family members from inpatient and outpatient TB services to define the degree of compliance of their practices and treatment experiences to JCI standards. Outpatient TB services met the PFR and PFE standards at the 51%-level receiving a grading of partially performed and requiring improvements. The inpatient services met the PFR and PFE standards at 39%- and 26%-level respectively, receiving a grading of minimally performed for the JCI standards, showing statistically significantly less patient centeredness compared to the outpatient services (p = 0.007, CI 0.234; 0.4234), and requiring major improvements.

Conclusions

Strengthening interventions towards patient-centeredness are essential in both inpatient and outpatient services, but Armenia needs to put more emphasis on inpatient care to bridge the gap between the existing and recommended practices.
The Netherlands
Authors: Rinaldi C , Bekker M
Published: October 2020

Background

While the literature on the relationship between populist radical right (PRR) parties and public health is still relatively scarce, early evidence suggests that PRR parties and their exclusionary policy agenda could be a threat to population health and health equity. The aim of this case study is to take a closer look at the standpoints and influence of the Dutch Party for Freedom (PVV) on national health and healthcare policies. The PVV is considered the main PRR party in the Netherlands and has been part of the 2010-2012 center-right coalition government.

Methods

This case study was informed by various information sources including academic literature, publicly available data, party manifestos and other statements issued by the PVV, coalition agreements, newspaper articles and interviews.

Results

Two key characteristics of PRR parties can be identified in relation to the PVV's standpoints on health and healthcare: authoritarianism (believing in the value of obeying and valuing authority) and nativism (believing that there is an ethnically united people with a territory). This is, for example, exemplified through strong support for the expansion of home and elderly care, while simultaneously opposing free, non-acute healthcare for refugees and asylum seekers who have not (yet) financially contributed to the healthcare system.

Conclusions

Health and healthcare are generally not priority issues for the PVV, whose political agenda tends to focus on immigration and law and order. While the party takes a leftist position on some aspects of the healthcare system, a nativist rhetoric remains present.
Management of Emergency Services in Lombardy during COVID-19 epidemic using Business Intelligence
Authors: Sechi G M , Migliori M , Dassi G , Pagliosa A , Bonora R , Oradini-Alacreu A , Odone A , Signorelli C , Zoli A
Published: October 2020

Background

In Italy on the 20th of February, the first Italian patient was tested positive for Coronavirus Disease 2019 (COVID-19) in the Lombardy region. The Regional Emergency Medical Services (EMS) Trust (Azienda Regionale Emergenza Urgenza, AREU) of the Lombardy region decided to apply a Business Intelligence (BI) System to take timely decisions on the management of EMS and to monitor the spread of the disease in the region in order to better respond to the outbreak.

Methods

Since the beginning of the COVID-19 outbreak, AREU developed a BI System to track the daily number of first aid requests received from 1.1.2. (Public Safety Answering Point 1). BI evaluates the number of requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview. Moreover, BI analyses the pattern of the epidemic, identifying the numerical trend of episodes in each municipality (increasing, stable, decreasing). Currently, AREU is still implementing the BI as the epidemic is still ongoing.

Results

In the Lombardy region on the 20th of February the number of the first aid requests for respiratory and/or infectious episodes were 314. This figure increased sharply during the month of February and March reaching its peak on the 16th of March with 1537 episodes. In the area around Bergamo, this number experienced a greater rise compared to the rest of the Lombardy territory, going from 74 episodes on the 20th of February to 694 on the 13th of March. Therefore, AREU decided to reallocate in the territory the resources (ambulances and human resources) based on the real-time data elaborated by the BI system.

Conclusions

The BI System has been of paramount importance in taking timely decisions on the management of EMS during the COVID-19 outbreak in the Lombardy region. Indeed, BI can be usefully applied to promptly identify the trend of the COVID-19 epidemic and, consequently, make informed decisions to improve the response to the outbreak.

Key messages

The Emergency Medical Services Trust of the Lombardy region applied a Business Intelligence System to promptly respond to the outbreak of COVID-19 and reallocate the resources based on real-time data. AREU used a Business Intelligence System to track the daily number of first aid requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview.
Time trend (2008-2016) of food consumption based on the degree of food processing in United Kingdom
Authors: Madruga M F , Martínez Steele E , Levy R B , Rauber F
Published: October 2020

Background

Ultra-processed foods have been rapidly displacing traditional dietary patterns based on unprocessed and minimally processed foods. We assessed the time trend of food consumption based on the degree and purpose of food processing in United Kingdom from 2008 to 2016.

Methods

Cross-sectional data from the National Diet and Nutrition Survey were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system. Linear regression models were used to estimate linear trend of food consumption across years, adjusted for sex, social class occupation, age and region.

Results

From the 2008 to 2016, the dietary contribution of processed culinary ingredients increased from 4.1% to 4.8% (p for trend<0.001), while the contribution of processed foods decreased from 9.5% to 8.4% (p for trend=0.001), respectively. The contribution of unprocessed or minimally processed foods (from 30.4% in 2008 to 30.2% in 2016; p for trend=0.462) and ultra-processed foods (from 56.0% to 56.6%, respectively; p for trend=0.194) across survey years has not appreciably changed. Regarding the subgroups, butter and plain oil (Processed culinary ingredients) increased over time, while beer, food preserved and bread (processed food) decreased. Among ultra-processed foods, pre-prepared meals, biscuits and industrial desserts increased, while reconstituted meat and margarine decreased. Among unprocessed or minimally processed foods, poultry, cereals, eggs and legumes increased, while roots, red meat and fresh fruit juice decreased.

Conclusions

We observed substantial changes in the consumption of processed food and processed culinary ingredients over time. The consumption of ultra-processed food remained unchanged over time, and still account for more than half of total calorie intake in UK. Despite this, substantial changes in some subgroups including ultra-processed, were observed for the four NOVA groups.

Funding

CAPES and FAPESP 2016/14302-7.

Key messages

The consumption of ultra-processed food remained unchanged over time, and still account for more than half of total calorie intake in UK. Actions to mitigate high consumption ultra-processed foods are necessary given that these foods have been strongly associated with obesity and diet-related chronic diseases.
Consumption of ultra-processed foods on free sugar intake of Portuguese infants: The Upper Project
Authors: Costa de Miranda R , Rauber F , Moraes M , Torres D , Lopes C , Rodrigues S , Bertazzi Levy R
Published: October 2020

Background

The dietary share of ultra-processed foods (UPF) has been associated with low diet quality, including high content of free sugar, mainly in adults' populations. We aim to assess the influence of UPF consumption on free sugar intake of Portuguese infants.

Methods

Cross-sectional representative study including 573 infants (6-23 months old) who participated in the 2015-2016 National Food, Nutrition and Physical Activity Survey. Dietary intake was collected by two non-consecutive food diaries (time interval 8-15 days). Food items were classified according food processing degree by the NOVA system. Total energy intake and percentage provided by each NOVA food groups as well as the free sugar content of the overall diet were assessed. Mean free sugar intake was evaluated across quintiles (Q) of UPF consumption by linear regression adjusted for socioeconomic covariates.

Results

Mean energy intake was 935 kcal/day, in which 49.1% was derived from unprocessed/minimally processed foods, 7.2% from processed culinary ingredients, 7.0% from processed foods and 36.6% from UPF. The mean dietary share of UPF ranged from 12.5% (Q1) to 65.5% (Q5) of total energy. Within UPF, infant formulas (19.3%), milk-based drinks (6.7%) and sweet snacks (4.8%) contributed the most to energy intake. Mean free sugar intake in the overall diet accounted for 8.1% of total energy intake, in which 92.5% came from UPF. As the UPF consumption increased, the dietary content of free sugar increased significantly (β = 0.77; p < 0.001). Contribution of free sugar in total energy intake raised from 2.9% to 12.7%, representing an increment of 338% from the lower to the upper quintile of the dietary share of UPF.

Conclusions

Portuguese infants had an important intake of free sugar. Nearly all of this intake came from UPF, which calls for public health efforts to avoid UPF consumption by this population group.

Funding

FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR); POCI-01-0145-FEDER-032090.

Key messages

Ultra-processed foods contributed with 36.6% of total energy intake and 92.5% of free sugar in the diets of Portuguese infants. As the ultra-processed foods consumption increased, the dietary content of free sugar increased significantly from 2.9% (Q1) to 12.7% (Q5), representing an increment of 338%.
Clinical coordination across care levels according to medical specialty in the Catalan health system
Authors: Campaz D , Esteve-Matalí L , Vargas I , Sitjas E , Plaja P , Sanchez E , Ramon I , Medarde E , Vázquez M L
Published: October 2020

Background

In primary care-based national health systems, cross-level clinical coordination is a priority, as it contributes to quality of care and efficiency. Studies show that clinical coordination may vary depending on doctoŕs specialty. The study's aim was to determine the differences in experience and perception of clinical coordination and their related factors according to the doctor's specialty in the Catalan health system

Methods

Cross-sectional study, based on an on-line survey applying the COORDENA-CAT questionnaire to 1666 secondary care doctors. Descriptive and multivariate analysis were used to compare five groups of specialties (potentially decentralised, hospital-based, internal-medicine/geriatrics, gynaecology, and paediatrics), for experience, perception and factors related to clinical coordination.

Results

Clinical coordination experience was relatively high in all groups, with differences when comparing with decentralised specialties; hospital-based specialties and internal medicine/geriatrics presented lower care consistency and follow up across levels, while gynaecology and paediatrics showed higher accessibility. General perception of coordination was low, being worse in hospital-based specialties (PR:0.80,95%CI0.72-0.89) and better in gynaecology (PR:1.36,95%CI1.18-1.56). Moreover, hospital-based specialties reported lower use of coordination mechanisms and less interaction with doctors from the other level (PR:0.42,95%CI0.23-0.72), than gynaecology (PR:2.04, 95%CI1.22-3.45).

Conclusions

Doctors' experience and perception of clinical coordination was lower among hospital-based specialties and internal medicine/geriatrics and higher in gynaecology and paediatrics. These differences may be explained by complexity, coordination needs, level of specialty decentralisation or related factors. Further research is needed to understand such differences and consider the coordination needs of each specialty to improve cross-level clinical coordination.

Key messages

Differences between specialities might be explain by the complexity, level of specialty decentralisation or factors related to clinical coordination. Clinical coordination needs of each specialty should be deeply explored to improve cross-level clinical coordination.
Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES) - implementation evaluation at operational level
Authors: Bastiaens H
Published: October 2020

SPICES focuses on the primary prevention of CVDs in vulnerable populations in Europe and Sub-Saharan Africa by raising awareness regarding CVD and its risk factors and by supporting lifestyle behaviour change in primary care and community settings. It is an implementation project employing a mixed methods evaluation approach. The RE-AIM QuEST and CFIR frameworks are used to guide the evaluation of impact on lifestyle and actual CVD risk and describe implementation barriers and explain how implementation context may influence translation to different settings. The presentation will focus on how these frameworks were used in practice and across settings.
The Scale-Up of Diabetes and Hypertension Care (SCUBY) - large-scale evaluation using routine health information systems
Authors: Buffel V
Published: October 2020

The SCUBY project aims to (1) change the organization of primary health care for diabetes and hypertension in order to (2) improve the outcome of chronic care in three countries (Belgium-Slovenia-Cambodia). These two aims require two types of data, namely data on the organization of care and data on the chronic illness outcomes. It can however be challenging to (1) gather all these data (from various sources) on both the organization and outcomes and (2) create cross-culturally valid datasets. The presentation will present the strategy of SCUBY to gather data and discuss the issues of cross-cultural validity.
The impact of social stress and strain on cognitive function in older people
Authors: Lindert J , Paul K C , Lachman M , Ritz B , Seeman T
Published: October 2020

Background

Social stress and strain, especially discrimination and inequality might have an impact on memory and cognitive function. This is a major concern for older individuals, their families, communities and societies. We sought to assess changes in episodic memory (EM) and executive functioning (EF) among men and women in the 'Midlife in the United States' (MIDUS) cohort study, to delineate variations in EM and EF by gender, and to determine the impact of social stress/strain at three levels (family, work, society) on longitudinal changes in EM and EF in men and women.

Methods

We used data from the MIDUS study - a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave in our study (1995) included 4963 non-institutionalized adults aged 32 to 84 (M = 55, SD = 12.4). The dependent variables are EM and EF, which were assessed with the Brief Test for Cognition. The independent variables were social stress and discrimination variables at the family/partner level, the work level and the society level, assessed with validated discrimination measures. To assess cognition changes we estimated adjusted linear regression models.

Results

Women report more perceived inequality for their family and more family strain than men across all age groups. After controlling for other explanatory variables, the main effect on cognition for all age groups was found for perceived inequality of one's family opportunities.

Conclusions

Reducing social stress and providing opportunities might be an important measure to support episodic memory and executive functioning in aging populations.
Moderate exercise for Active Aging: results of a randomized controlled trial in people over 65 years
Authors: Carta M
Published: October 2020

*also on behalf of the Active Aging Group Study - members
Future mechanisms for funding research on unhealthy commodities – criteria for industry-supported research funding programs
Authors: Cohen J
Published: October 2020

Research funding is scarce and some argue that commercial enterprises not only can, but should, fund extramural research. Others are concerned by the evidence that commercial funding of research is used by these commercial interests to subvert the scientific process, to gain credibility and to advance their own financial interests, without regard to broader societal values and needs. A key question is whether there might be a funding model whereby industry-supported research funding programs are acceptable to the public health community and that support broader societal goals. We developed eight criteria for evaluating research funding programs that include support from the tobacco industry: (1) transparency and independence; (2) competitive funding process; (3) ownership of data and freedom to publish; (4) independent research agenda; (5) governance; (6) protection against conflict of interest; (7) industry public relations gains that counteract public health; and, (8) feasibility. We will discuss the applicability of similar programs for funding research on other unhealthy commodities, and on the practices of other harmful industries such as the fossil fuels industry.
Sustainability of food systems, supported by public institutions, case of Slovenia
Authors: Gabrijelčič Blenkus M
Published: October 2020

Slovene National nutrition and PA strategy 2015-25 is comprehensively addressing food systems. Public institutions, offering food programs to specific population groups such as children in kindergartens, students in primary and secondary schools, older adults in residential homes, patients in hospitals, all create a substantial demand for foods, purchased partially from the public budget. For food programs there are nutrition guidelines, for school environment mandatory in the School Nutrition Law. The extent of the foods, purchased in short food chains has the effect on local economies in rural communities, on the environment and also on the quality of foods per se, as food could be harvested when fully ripped. Slovenia has established the Catalogue of foods as a support for transparent food public procurements in 2018.

As children spend almost a third of their day in kindergarten or school and consume a large part of their daily energy intake in educational environments, such types of environments present important factors in the development of child nutrition habits. Strong evidence of the importance of access to healthy and balanced nutrition in schools for children's health is available, and a nutritionally regulated school environment is associated with a lower risk of childhood obesity, which can also be facilitated by a transparent and quality-oriented procurement system. In Slovenia, all schools have kitchens, which serve up to four fresh cooked meals per day (breakfast - uptake around 17% of all Slovene primary school children, mainly in younger age groups, mid-morning snack - uptake around 98%; lunch, uptake around 70%, afternoon snack - uptake around 20%). Around one quarter of Slovene primary school students from lower SES get school meals fully subsidized. Total ban on vending machines in primary schools, preventing from snacking, is in place since 2010. Organized school nutrition enables women in Slovenia to enter labour market equally.
Study of the impact of anti-tobacco legislation on public health in the Russian Federation
Authors: Agishina T A , Kontsevaya V A , Gambaryan M G
Published: October 2020

Background

Smoking increases the risk of developing many diseases, both non-infectious and infectious. On February 23, 2013, the Russian Federation adopted an anti-smoking law, which provided for a two-stage ban on smoking in public places. Since June 1, 2013, smoking has been banned in schools, hospitals, public transport, railway stations, workplaces, and since June 1, 2014 - in trains, hotels, bars, restaurants.

Purpose

To study the dynamics of monthly hospitalization rates for respiratory diseases and acute otitis media in three regions of the Russian Federation (Chuvash Republic, Samara and Arkhangelsk regions).

Methods

A retrospective analysis of the monthly hospital incidence of pneumonia of various etiologies (ICD-10 J12-J18), other acute lower respiratory infections (J20-J22), asthma (J45), status asthmaticus (J46) and acute otitis media (H65.0, H65.1, H66.0) from 2012 to 2017. The data were analyzed by the method of interrupted time series. The information was provided by the regional Fund of Medical Insurance.

Results

Two control points were identified - June 2013 and June 2014. We demonstrated the reduction of hospitalization rates for acute lower respiratory infections and pneumonia immediately after each of the two stages of the anti-smoking policy implementation in all regions studied. In the Arkhangelsk region, the decrease was 19% in 2013 and 22% in 2014, in the Samara region - 20% and 23%, and in the Chuvash Republic - 31% and 39%. The reduction of hospitalization for asthma, status asthmaticus and acute otitis media was observed only in Chuvash Republic: the decrease in the number of hospitalizations for asthma and status asthmaticus was 11% in 2013 and 12% in 2014, and for acute otitis media - 25% and 35%. In other regions the decline was non-significant.

Conclusions

Anti-tobacco legislation leads to an immediate and significant reduction in the number of hospitalizations for lower respiratory tract infections.

Key messages

The ban on smoking in public places reduces infections of the lower respiratory tract and acute otitis media. Anti-tobacco legislation has a positive impact on public health.
International benchmarking for health policy evaluation: the French National Health Strategy
Authors: Luciano L , Low E , Rey S , Gaini M
Published: October 2020

Background

International benchmarking is a valued source of inspiration and learning for policy-makers to develop successful public health policies. Through comparison, the external coherence of one policy can be measured and its objectives redesigned. The French national health strategy (SNS) 2018-2022 comprises the French health policy framework focusing on four priority areas. The aim of this study was to conduct international benchmarking of current national health strategies to explore the external coherence of the SNS and evaluation methods.

Methods

A scoping review was conducted through available governmental and public health agencies' websites to survey national/federal health strategies in select high-income countries.

Strategical approaches, governance and policy duration were compared with four health priorities of the French SNS: prevention, social/territorial inequalities, quality of care, innovation. A descriptive analysis of these strategies' evaluation methods, including relevant indicators, was executed.

Results

Out of 18 countries selected, 11 have a current strategy akin to the four priorities of the French SNS, with a timeline stipulated to implement the policy. The strategies of Australia and Switzerland, out of nine countries with strategies covering these areas, bear the closest resemblance to the French SNS. Evaluation methods varied largely across countries.

Conclusions

The majority of countries contain a health strategy with a longer duration compared to the French SNS, irrespective of governance. Similar priorities were found for countries with a national health strategy, with other countries developing at least prevention plans. Most countries provided only partial evaluation methods or overall health target indicators, to be taken into account for the development of the French SNS evaluation plan

Key messages

International benchmarking is essential to identify best practices in health policy design. As a result, future French health strategies may benefit from a longer duration of implementation. If great efforts were put in place in France to build a strategy evaluation plan, other countries focused mostly on implementation reports or monitoring national health targets through indicators.
The Association of Socio-demographic Determinants and Mammography Screening in women in Serbia
Authors: Susnjevic S , Milijasevic D , Mijatovic Jovanovic V , Niciforovic Surkovic O , Kvrgic S , Tomasevic T
Published: October 2020

Introduction

Serbian screening mammography programs target women 50-69 years with biennial screening.

Methods

Research was conducted as a cross-sectional study on a sample of 2784 women aged 50-69 years in Serbia, as a part of the Health Survey in Serbia, 2013. The association between the socio-demographic determinants as independent variables, and mammography screening (within the past 2 years) as dependent variable were examined using univariate and binary logistic regression. Multivariate model were adjusted for marital status, education, employment status, DHS Wealth Index, type of settlement and self-perceived health. The minimum level of significance was p < 0.05.

Results

Only 22.2% of women aged 50-69 have done mammograms within the past 2 years in Serbia. In binary logistic regression model as predictors for a mammogram were singled out level of education, wealth index and self-perceived health. Women with medium level of education have 1.4 times higher chance to perform a mammogram in relation to those with low education (OR = 1.4; 95%CI 1.12-1-80), while women with high level of education have 1.8 times higher chance to do a mammogram in relation to those with low education (OR = 1.8; 95%CI 1.33-2.58). Women with good financial situation were 1.4 times more likely to perform a mammogram in relation to those with poor financial situation (OR = 1.4; 95%CI 1.05-1.80). Women who perceived their health as well have 26% less chance to do a mammogram compared to those who perceived their health as a poor (OR = 0.74; 95%CI 0.56-0.97).

Conclusions

This study showed the disparity in the prevalence of mammography utilization. The predictors for mammogram performance among women were: high level of education, high wealth index and self-perceived health as poor.

Key messages

The only breast cancer screening test that has been proven effective in organized, population-based programs is mammography screening. Screening mammography reduces the risk of death due to breast cancer. It is useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.
Total and added sugar intakes, sugar types and cancer risk: results from the NutriNet-Santé cohort
Authors: Debras C , Chazelas E , Srour B , Kesse-Guyot E , Julia C , Galan P , Hercberg S , Latino-Martel P , Deschasaux M , Touvier M
Published: October 2020

Background

Excessive sugar is now recognized as a key risk factor for several cardiometabolic diseases. In contrast, the associations between sugars and cancer risk in cohort studies have been less investigated, and data is lacking regarding differential effect of sugar types and sources. Experimental data suggest that sugars could play a role in cancer etiology, through obesity but also through inflammatory and oxidative mechanisms and insulin resistance. Our objective was to study the associations between total and added sugar intake and cancer risk, accounting for sugar types and sources.

Methods

101,279 French adults from the NutriNet-Santé prospective cohort study (2009-2019) were included. Sugar intake was assessed using repeated 24h-dietary records, designed to register participants' usual consumption for more than 3,500 food and beverage items. Associations with cancer risk were assessed by multi-adjusted Cox proportional hazard models.

Results

Sugar intake was associated with increased cancer risk (2,503 cases, Hazard Ratio Quartile 4 vs 1=1.17, 95% Confidence Interval 1.00-2.37, P trend=0.02). This association was mainly driven by breast cancer (783 cases, HR Q4 vs Q1=1.51 (1.14-2.00); P trend=0.0007) and remained significant even when weight-gain during follow-up was accounted for. Associations were more specifically observed for added sugars (P trend=0.02), free sugars (P trend=0.007), sucrose (P trend=0.01), and sugars from milk-based desserts (P trend=0.02), from sugary drinks (P trend=0.002), and from dairy products (P trend=0.01).

Conclusions

These results suggest that sugar (especially added sugar), of which intake is increasing in Western countries, may represent a modifiable risk factor for cancer prevention, adding to its well-established effect on dental and cardiometabolic health. These findings provide important and novel insights to the current debate on the implementation of sugar taxation, marketing regulation, and other sugar-related policies.

Key messages

In this large-scale prospective cohort of French adults, sugar intake (especially added sugar) was associated with higher cancer risk. These results suggest that (added) sugar may represent a modifiable risk factor for cancer prevention, adding novel insights to current debates on implementing sugar-related public health policies.
A health impact assessment (HIA) on a new motorway bypass in Strasbourg, France
Authors: Christie D , Dardier G , Jabot F , Roué-LeGall A , Cantoreggi N , Mallet Y , Tabbone L , Simos J
Published: October 2020

Issue

In 2018-2019, HIA was carried out on a projected 24-km north-south motorway bypass in a rural area west of Strasbourg, intended to alleviate pressure on a pre-existing motorway that cuts through the city centre. Although transport is a major source of impacts on health, HIA is rarely performed on new road construction projects, globally.

Description

The HIA included the screening, scoping, assessment and recommendations phases. Assessed health determinants were outdoor air quality, noise, mobility/access to health services, road safety, urban planning and the living environment. Methods included a literature review, the AirQ+ air pollution model, cartography and an NVivo analysis of answers to a public enquiry.

Results

Noise was set to increase for 1-4% of the population in the study area, but impacts related to air pollution appeared to be negligible and road safety did not change substantially. Mobility and access to health services were to improve, with strong local differences (inequalities): some areas benefitted from access to the new motorway without being affected by noise or traffic, while for others it was the opposite. Stakeholders who participated in the public enquiry were concerned about the loss of agriculturally and environmentally valuable land, viewed as a collective cultural asset. Those living in the vicinity of the bypass expressed anger at the reduction of the quantity and quality of green areas, which was experienced as an injustice given their choice to live in a rural area. Our recommendations related mainly to the pre-existing urban motorway, where reducing traffic volumes and speeds, as well as diverting trucks onto the new bypass, had the most promising effects on health.

Lessons

Due to its rural localization, the new road had limited health effects through air pollution, which is the focus of many transport-related HIAs. Through the analysis of the public enquiry, the HIA showed that the project generated anger and distress.

Key messages

The substantial investment represented by the new bypass did not solve pre-existing problems related to environmental health but generated new ones linked to social and mental health issues. Many HIAs miss out on valuable qualitative information because interviews or focus groups cannot be carried out with local stakeholders. Secondary analysis of public consultations can fill this gap.
Students as advocates of global health goals: the case of medical education in Germany
Authors: Kreitlow A , Steffens S , Kuhlmann E
Published: October 2020

Background

Germany has started to take on greater responsibility in global health policy. Furthermore, new threats, such as climate change, have increased sensitivity. However, health professionals are not well prepared to respond to the new tasks and the changing needs of the population. Global health is still largely missing from the education and training programmes of the vast majority of professional groups in Germany. This paper aims to illustrate how students can become advocates of global health education and enhance institutional change, when health policy fails to act effectively.

Methods

An elective programme introduced in September 2019 in the undergraduate medical curriculum at Hannover Medical School, Germany, serves as a case study to explore the tools and substance of the programme, as well as the stakeholders involved.

Results

The new global health programme utilises a window of opportunity in the curriculum, which includes a small number of mandatory seminars which students can chose from. It builds on five major pillars: collaboration between students and the programme coordinator and participatory curriculum development; the SDGs as framework and guidance of the curriculum; a multiprofessional and transsectoral teaching team; collaboration with NGOs; strong networks through collaboration with the national German medical students' association. Sustainability remains a major challenge, yet there is now institutional and financial support at Hannover Medical School and the new German National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education also includes global health issues.

Conclusions

Students as advocates for global health can make a difference and enhance institutional change through transsectoral, participatory teaching programmes.
Gender and global health education, what is it about the Global South
Authors: Atobrah D
Published: October 2020

Background

International policy frameworks have strengthened advocacy for gender equality, as agreed in SDG 3. However, gender considerations in research and the related methodological approaches often focus on gender-oriented topics in the global North with little attention on gender perspectives in ostensibly neutral disciplines such as health, and with even less consideration in African societies. The aim is to illustrate how feminist research principles, sensitivity to gender relations and gender performance are cross-cutting and integral in the use of patient-centered methods, ethics and culture.

Methods

Material was taken from an ethnographic study based on in-depth qualitative interviews conducted with cancer patients in Accra, Ghana. Eight cases studies of women diagnosed of breast cancer, ovarian, endometrium or cervical cancer were selected for the present analysis.

Results

In highly gendered societies like Africa health research is shaped by the peculiar ethical considerations on gender and cultural issues. This leads to a situation where female researchers may have favourable opportunities for gathering qualitative material because of gender stereotypes. However, they face gendered expectations of their research participants during data collection periods, and this may provoke adverse reactions, if the researcher does not meet the expectations. Education into patient-centred methods, therefore, must strengthen competencies of health professionals to critically reflect their own gendered realities and confront masculinity and femininity reactions by research participants, while being culturally sensitive and ethical at the same time.

Conclusions

Advocacy for gender approaches in global health education is important but not sufficient. Action is needed to develop a methodological approach sensitive to the gendered conditions of patient-centred research in the Global South.