bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating process-mining interoperability: stroke case analysis on Italian health real-world data
Authors: Faragalli A , Bucci A , Gesuita R , Unim B , Spazzafumo L , González-García J , Telleria-Orriols C , Estupiñán-Romero F , Palmieri L , Carle F
Published: October 2020

Background

The Institute for Health Sciences in Aragon developed a process-mining based algorithm deployed using a container solution to describe the Stroke Care Pathway reproducible in different Health Systems. Our aim is to apply the proposed solution to administrative data of an Italian region to explore interoperability in the case of the stroke care; the study is developed in the context of the Joint Action on Health Information 'InfAct' funded by the European Commission.

Methods

The target population included 1538055 residents in Marche Region who received National Health System (NHS) assistance in 2017. The collected information was sex, date of birth and death, residence from NHS Beneficiaries database; admission and discharge date/time, hospital code, admission type, discharge status, up to 6 diagnoses from Hospital Discharge database; admission date/time, urgent care facility code, discharge status, diagnosis from Emergency Care database. Patients without hospital/urgent care events were excluded from NHS Beneficiaries database. Care pathway traces and map with frequency information, timing across the pathway and timeline plots with time information were the outputs obtained.

Results

Data included 17752 patients, 10390 hospital, and 18329 urgent care events. Results were represented graphically, easy to read and spread: 500 episodes of stroke were detected, 66% of patients was hospitalised after emergency room (ER) admissions, 19% directly hospitalised and 10% discharged after ER admission. The most frequent access and exit points of the pathway were ER admission and hospital discharge.

Conclusions

The application of the stroke case to Italian data demonstrates feasibility and usefulness of interoperability in analysing health care administrative data for public health purposes. A European health information system is crucial to build capacity between researchers across Europe and improve health data on Health Monitoring and Health System Performance Assessment.

Key messages

Sharing a process-mining methodology deployed using a container solution is a useful strategy to describe care pathways and ensures results’ reliability across European Health Systems. Developing and testing tools to encourage interoperability between researchers across Europe is essential for public health policymaker in Europe.
Fall prevention in Dutch general practices: A descriptive study
Authors: Meekes W M A , Leemrijse C J , Korevaar J C , van de Goor L A M
Published: October 2020

Background

Falls are an important health threat among frail older people. GPs are often the first to contact for health issues and therefore they can be seen as the designated professional to offer fall prevention. At the moment, it is unknown what GPs in the Netherlands exactly do regarding fall prevention. This study aims to describe what GPs in the Netherlands do during daily practice in regards to fall prevention.

Methods

Thirty-four GP practices located throughout the Netherlands were followed for a period of 12 months. When a GP entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the GP received a pop-up with the question “Is this patient frail?”. If according to the GP the patient was frail, the GP subsequently completed a short questionnaire.

Results

About 65 GPs completed 1396 questionnaires. More than half (n = 726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF). Of 276 patients, GPs did not know if they had experienced a fall and of 408 patients if they had a FOF. Of the patients that had experienced a fall in the previous year and/or had a FOF, 37% received fall preventive care. Reasons for not offering such care were i) GP and patient did not think that the patient had a high fall risk (38%), ii) the patient finds treatment too intensive or too much of a hassle (21%) and iii) the patient was not convinced (s)he had a high fall risk and so treatment was not necessary (12%). The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors.

Conclusions

The results show that GPs are not always aware of a patient's fall history or FOF and that only part of the patients that had experienced a fall and/or had a FOF receives fall preventive care. Hence, it is important to develop and implement strategies for GP practices to systematically screen for fall risk and to offer fall preventive care to reduce falls among frail older people.

Key messages

Thirty-seven percent of the frail older people that experienced a fall in the previous year and/or had a fear of falling, received fall preventive care. The three most treated underlying causes are mobility problems, fear of falling, cardiovascular factors.
Experiences and expectations of women from ethnic minority background on perinatal mental health
Authors: Soltani H , Watson H , Walton E , Harrop D , Young A , Johnson L
Published: October 2020

Introduction

Being from ethnic minority backgrounds is a risk factor for poor perinatal mental health (PMH). To enhance services and prevent the devastating impacts of mental health problems on maternal morbidity and mortality, it is important to understand the experiences and expectations of women and families regarding related service provisions.

Methods

This will present the results of a two staged study including: a) a systematic review examining the state of evidence on the experiences of women from ethnic minority backgrounds on PMH. We searched 4 databases and using a convergent approach, synthesised the data thematically. b) an exploratory survey, distributed through a maternity service user and parenting Facebook group. Quantitative data were analysed using descriptive statistics and a thematic analysis was used for the qualitative data.

Results

A total of 15 studies met the inclusion criteria for the systematic review, highlighting the need for an in-depth exploration of these women with issues related to culture stigma and relevance of care provision. The survey questions explored these issues further. There were 51 responses representing 14 different ethnic minority backgrounds, the largest groups being Pakistani and Indian (21.6% and 19.6% respectively). The majority of the respondents reported accessing support for mental health problems very challenging (58.5%). Qualitative data revealed several overarching themes; 'Suffering in silence', 'The need for a safe space to talk' 'What about women like me-community support'?

Conclusions

Women from ethnic minority groups face barriers to seeking help from PMH services due to ongoing stigma, poor attitudes and behaviours of health professionals and inappropriately designed services. Culturally competent care providers with appropriate training are required to ensure women feel safe to access care. The effects of peer supporters as part of PMH services require further investigation.

Key messages

Maternity services should ensure that support for perinatal mental ill health meets the needs of women from ethnic minorities. Research is needed to develop interventions on healthcare professionals' education and cultural competency and services which promote access to culturally appropriate spaces to talk and be listened to.
Rapid scientific update response to public health professions during Phase I of COVID-19 pandemic
Authors: Caminada S , Angelozzi A , Barbaro A , Brambilla G , Carusi D , De Castro P , Gentili D , Mistretta A , Mochi P , Rosi A
Published: October 2020

Issue

Preparedness can be considered the Achilles heel in Western Coutries to adequately fight Sars-CoV-2 pandemy. The Istituto Superiore di Sanità (ISS) has been challenged to give rapid technical and scientific advices to the State and Regions on a huge variety of Sars-CoV-2 aspects related to public health.

Description of the problem

Rapid and timely accumulation of knowledge and empirical evidence is critical for policymakers and emergency managers to maximally inform their decisions through scientific evidence and to better guide and mobilise the expertise of academics and general practitioners towards effective solutions.

Results

An ad hoc “Scientific Literature working group” at ISS in the period 23/03 - 31/05 screened a total of 4,568 pre-prints and 15,590 peer reviewed papers extracted from PubMed, arXiv.org, medRxiv and bioRxiv, which gave rise to the following deliverables: a) a daily pre-prints alert selection delivered to ISS President for the routine national Scientific Technical Committee meetings on Sars-CoV-2 chaired by Italian Civil Protection (still ongoing), and, b) a weekly open access issue of Covid Contents publications (8 volumes, https://www.iss.it/en/covid-contents), as summary of most interesting peer-reviewed papers for public health professions.

Lessons

The needed cross-cutting approach is leading to: interdisciplinarity enhancement within the ISS; coverage of broad expertise areas and interest of health care providers; cross-linkage between the different aspects/disciplines involved in this pandemic and share of experiences.

Key messages

Committed Institutions have the responsibility to support practitioners and decision makers to understand relevant aspects of medical, physical, occupational and public safety, in case of emergency. The Silos culture has to be overcome. There is nothing more powerful in any Institution than having all researchers rowing fiercely in the same direction.
How do diagnostic self-tests change healthcare relationships? A qualitative study
Authors: Roussel S , Rondeaux S , Braeckman T , De Vriese C , Van Den Broucke S
Published: October 2020

Background

Diagnostic self-tests in Belgian pharmacies are a recent phenomenon. While considered a way to empower patients to take informed decisions, self-tests also challenge the relationship between patients and health professionals and between pharmacists and general practitioners. This study explored how the introduction of diagnostic self-tests in pharmacies influences the health care relationships.

Methods

A qualitative study, part of the Care-test research program, was conducted using semi-structured interviews with 18 patients, 25 doctors, and 16 pharmacists from Brussels. Data collection ended after data saturation. Reflexive thematic analysis was performed.

Results

Mutual partnership approaches were not mainstreamed and mainly intuitive when existing, with patients being often more in demand for a partnership with their doctors than what their doctors offered. This perceived lack of dialogue led some patients to autonomous behaviours, qualified as “non-adherence” by professionals (self-medication with medicinal herbs, unilateral adaptation of therapies including those for HIV-infection and for orphan disease, etc.). Not all the patients, however, were in demand for a more active role. Some deferred to the doctor's choice, but they did not experience another kind of relationship. The doctor-pharmacist collaboration mainly entailed factual information exchange, although more collaborative relationships exist. Current collaborations related to self-tests were limited due to their novelty and controversial nature. While patients were generally in favour of diagnostic self-tests, professionals had divided opinions about them.

Conclusions

The study reveals divergent views between patients and health professionals and amongst professionals, about self-tests and the need for a partnership between patients and professionals. This suggests a need for health professionals to be better skilled in dealing with participative approaches.

Key messages

Mutual partnership and Interprofessional collaboration are not mainstreamed in health care. Patients, doctors and pharmacists had divergent views about diagnostic self-tests and about the need for partnership.
What makes digital health intrusive? Qualitative findings from an international study on diabetes
Authors: Oikonomidi T , Ravaud P , James A , Cosson E , Montori V , Tran V T
Published: October 2020

Background

Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why.

Methods

We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]).

Results

We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests.

Conclusions

Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden.

Key messages

Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.
Smoking during pregnancy. Results of the cross-sectional KiGGS Wave 2 study and trends
Authors: Garnica Rosas L , Kuntz B , Zeiher J , Starker A
Published: October 2020

Background

Maternal smoking during pregnancy represents a significant risk, increasing the adverse consequences for mothers and newborns. Different national targets have been developed in Germany to reduce smoking rates during pregnancy. To monitor the achievement of these goals, this study aims to assess social differences and temporal trends of smoking behaviour during pregnancy in mothers living in Germany.

Methods

Data of children aged 0 to 6 with valid information on maternal smoking habits during pregnancy were subtracted from German Health Interview and Examination Survey for Children and Adolescents (KiGGS)(KiGGS baseline 2003-2006, n = 6,525 and KiGGS wave 2 2014-2017, n = 4,838). The information on maternal smoking during pregnancy was recorded retrospectively as part of a self-administered written questionnaire. We estimated the prevalence of smoking in pregnancy and multivariable logistic regression models to assess the association with the age of the mother at the time the child was born, the socioeconomic status of the family and the migration background. In addition, to analyse trends over time, we compare the current data with the KiGGS baseline study.

Results

The prevalence of mothers who smoked during pregnancy decreased statistically significant from 19.9% (KiGGS baseline) to 10.9% (KiGGS wave 2). Younger mothers aged up to 24 years were more likely to smoke during pregnancy (OR 1.74; 95%CI 1.04-2.89), similar to those with intermediate (OR 5.52; 95%CI 2.90-10.48) or low socioeconomic status (OR 22.43; 95%CI 10.84-46.39), and those without (OR 4.18; 95%CI 2.27-7.70) or with one-sided migration background (OR 2.47; 95%CI 1.26-4.84), in comparison to the groups of reference.

Conclusions

Our findings, present the reduction of smoking prevalence during pregnancy, recognising the effectiveness of the tobacco control programs in Germany. However, more emphasis on the prevention strategies for young and socially disadvantaged women are still required.

Key messages

Smoking prevalence during pregnancy has decreased in Germany over time, though still represents a challenge for public health and tobacco control. The prevention strategies should reduce the social breach, to extend the benefit among women and their offspring.
India’s national health insurance scheme: Analysis using the Growth Diagnostics Framework
Authors: Wundavalli L , Topno N
Published: October 2020

The world's largest health assurance scheme, Ayushman Bharat-Pradhan Mantri Jan Suraksha Yojana (AB-PMJAY) was launched in India in 2018 to achieve universal health coverage aspired in the National Health Policy 2017.

Our objective was to critically analyse AB-PMJAY through the lens of Growth Diagnostics Framework developed by Hausmann, Rodnik et al using secondary data. The framework analysed the scheme on five aspects: physical investment, knowledge/application/productivity, productive livelihood, skill set and cooperative federalism in terms of demand and supply side problems. The analysis was conducted for six months.

The results highlighted issues relating to supply side such as availability of beds, equipment, manpower, information systems, deficient rural public health facilities, health insurance governance, scaling technological capabilities, improving procurement of drugs, equipment, technical training of staff in IT; highly skewered ratio of public and private sector hospital beds and manpower. Demand side issues include high demand of services, requirement of research and development related to premium rates, maturity of the scheme, pay outs, increased demand of specialists/technicians/health administrators in government sector and willingness of federal states to enroll in the scheme.

Our recommendations highlight the importance of gaining the trust and confidence of citizens in public sector, reducing asymmetric information, mandating a formulary policy in hospitals, measures to prevent private hospitals from indulging in cream skimming and dumping patients, increasing package amounts for chronic conditions like dialysis, more health technology assessments, strengthening referral levels of care, focusing on outcome based standards for facilities, creating demand for preventive and promotive care using innovative ICT tools and coordination with different systems of medicine, addressing social determinants of health through inter-sectoral convergence.

Key messages

Growth Diagnostics Framework is a novel way to study a national health insurance scheme. India's national health insurance scheme is dynamic and aspirational that requires multi sectoral co-ordination.
Value-driven workforce, systems and leadership
Authors: Tahzib F
Published: October 2020

Background

Our norms and values are key to decision making, policy and practice. Some commentators have highlighted need for greater courage and purpose in public health leaders and systems. There is need for greater appreciation of moral mandate of public health and implications for public health system leadership and capacity building activities and practice

Objectives

Demonstrate the case for value-driven workforce, systems and leadership Share key findings and learning from research by the Faculty of public health around the public health values, and activities to build capacity and competency around the issue.

Body of the session

Surveys of the public health workforce and schools of public health have consistently highlighted need for education and training in public health ethics and law for some time and their key role for effective public health policy and practice. In this presentation there will be demonstration of the key findings of the surveys and their consequences, including moral distress for the workforce and potential failings of public health systems Some key activities and initiatives in building competency and capacity in public health ethics and law will be described. This will include activities to develop organisational values and professional values and the important distinctions between them, and development of public health code of ethics and professional conduct as part of efforts for professionalisation of the public health workforce.

Conclusions

Value-driven workforce, systems and leadership are key in meeting complex public health challenges. Building competency and capacity of the workforce and public health institutions are important part of the agenda.
The USA
Authors: Willison C E , Singer P M
Published: October 2020

Background

In the United States, political regimes directly influence health policy agenda setting, adoption and reform. The priorities of health policy shift across administrations and over time as political parties evolve, polarization occurs, and key political actors change. What is less clear is the degree to which other ideologies - such as nationalism and populism - shape the types of policies that are pursued and adopted in health care. We hypothesize that trends in nationalism and populism in the US across presidential administrations influence the scope of access across different populations in health policies. Additionally, we argue that the rise of populism and nationalism in the United States under the Trump administration has led to restrictions on accessing health programs through targeted limitations placed on certain populations.

Methods

We apply a comparative historical analysis framework to track changes in healthcare policy over time that reflect populist or nationalist agendas. We analyze health policies enacted and pursued by presidential administrations as well as trends in populism and nationalism across presidential administrations in the U.S.

Results

Results demonstrate that as populist sentiments rise, a parallel trend of increased othering in health policies takes place. This othering appears to reflect policies targeting supporters through both policy spoils and values while constraining opposing groups (e.g. increased restrictions on out-group members such racial/ethnic minorities).

Conclusions

Our results highlight the tension that exists in populist and nationalist health policy. Populist and nationalist leaders need to strike a balance between ensuring that their “people” continue to have access to health programs, requiring targeted limits placed within programs. Much of the limitations placed on populations are accomplished through submerged mechanisms and by devolving administration and governance to state and local governments.
Strengths and Difficulties Questionnaire (SDQ) as an assessment tool for measuring emotional and behavioural problems in young children
Authors: Dahlberg A , Fält E , Sarkadi A , Fabian H , Salari R
Published: October 2020

Evaluation of new initiatives to tackle mental health problems in children requires instruments that are both valid and reliable. One such instrument is the Strengths and Difficulties Questionnaire (SDQ), an assessment tool for child emotional and behavioural problems. The instrument was developed by Goodman in the 1990's and is being used worldwide in both clinical settings and research projects.

However, previous studies on the SDQ have mainly focused on school-aged children and adolescents. We know very little about the usefulness of the SDQ for measuring preschool children's mental health problems. Using data from a large number of parents and preschool teachers of children aged 3-5 (> 11 000 questionnaires), we tested the psychometric properties of the SDQ, examined the inter-rater agreement and provided cut-off points.

The original five-factor model of the SDQ was supported and it was shown to be a reliable instrument in the hands of mothers, fathers and preschool teachers. We also found significant, albeit poor, agreement (ICC) between parent and teacher ratings and good agreement between parents' ratings. Teachers reported lower levels of problems compared to parents. Compared to girls, boys were generally reported to have more problems. Thus, we provided separate cut-offs for each age group, gender and rater category.

The results suggest that SDQ can reliably be used for measuring emotional and behavioural problems in young children in community settings. They also suggest that parent and teacher reports are complementary; hence, reports from both types of informants should be considered when using the SDQ as a method to identify mental health problems within the child health services. However, inter-rater agreement between mothers and fathers was good, meaning that it may be sufficient to obtain data from a single parent informant.
Using a simple direct-to-consumer marketing strategy to increase participation in parenting programs
Authors: Salari R , Dahlberg A , Sarkadi A , Fängström K
Published: October 2020

Low participation in evidence-based parenting programs not only presents a major challenge for population trials where a minimum level of intervention exposure is necessary to detect population-level impact, but also undermines the incorporation of these programs into routine practice settings. As part of a large population trial, we aimed to increase participation in a series of parenting seminars by using a simple direct-to-consumer marketing strategy, i.e., redesigning the program flyer.

We captured parents' attention by affirming that “parenting is not always easy”, highlighted the potential benefits of participation, clarified what participation entailed, and addressed some of the common barriers such as the stigma associated with participation in parenting programs. Because fathers and mothers were shown to have different needs, we tailored the flyers to mothers and fathers separately.

Testing the flyers on a small sample of parents showed that both mothers and fathers perceived the flyers as relevant. As expected, mothers were more likely to express interest in the program when they saw the flyer which focused on benefits related to dealing with child behavioural problems and featured a mother-child dyad, while fathers preferred the flyer which highlighted the benefits related to dealing with emotional problems, and featured a father-child dyad.

Next, following the same procedure that was used to deliver the original flyers over the first 18 months of the project, we used the new flyers to inform parents about the upcoming seminars over the next 24 months. The preliminary results showed that although the average number of parents participating in each seminar had initially decreased from about seven to four, after the introduction of the new flyers, the number increased consistently and reached an average of nine parents during the last 6-month period.

The results shows that program uptake can be increased using simple direct-to-consumer marketing strategies.
Influence of ultra-processed foods on prevalence of inadequacy in Portuguese adults and elderly
Authors: Costa de Miranda R , Rauber F , Moraes M , Rodrigues S , Bertazzi Levy R
Published: October 2020

Background

Ultra-processed foods (UPF) consumption has been widely associated with low diet quality. We aim to investigate its energy contribution and influence on prevalence of nutrient inadequacy in Portugal.

Methods

Cross-sectional representative study involving 3102 adults and 750 elderly enrolled in the 2015-2016 National Food, Nutrition and Physical Activity Survey. Dietary intake was assessed by two non-consecutive 24h recalls. Food items were classified according to the NOVA system. Total energy intake and energy contribution provided by UPF group were determined. Inadequate intake was evaluated across quintiles (Q) of UPF consumption by adjusted Poisson regressions. We adjusted the usual intake estimate by Multiple Source Method and considered the World Health Organization (WHO) recommendations.

Results

UPF contributed with 24% and 16% of daily energy intake in adults (1904 kcal/day) and elderly (1603 kcal/day), respectively. In both age groups, practically all individuals had inadequate intake of sodium, while about a half or more of population had inadequate intake of fibre and potassium. As the dietary share of UPF increased, the prevalence of inadequacy of free sugars (PR = 1.53 for adults and 1.56 for elderly) and saturated fat (PR = 1.18 and 1.15, respectively) increased significantly. In adults, this same trend was also seen for fibre (PR = 1.03) and potassium (PR = 1.12). Particularly relevant was the increase in prevalence of inadequacy of free sugar from 10.5% (Q1) to 67.6% (Q5) in adults and 5.8% (Q1) to 41.8% (Q5) in elderly. Prevalence of inadequacy of saturated fat raised from 27.3% (Q1) to 68.9% (Q5) in adults and 29.4% (Q1) to 46.8% (Q5) in elderly.

Conclusions

Effective strategies are needed to reduce UPF consumption among Portuguese adults and elderly in order to prevent them from diet-related non-communicable diseases.

Funding

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

Key messages

Ultra-processed food contributes with 24% and 16% of daily energy intake in Portuguese adults and elderly. As the ultra-processed food consumption increases, the prevalence of inadequacy of free sugars and saturated fat increases for both, while inadequacy of fiber and potassium also increases for adults.
Unraveling community engagement in health promotion among vulnerable families: a multiple case study
Authors: Hogeling L , Vaandrager L , Koelen M
Published: October 2020

Community engagement has since long been promoted among health promotion practitioners, policy-makers and scientists. However, many uncertainties remain when it comes to the workings and effects of community engagement in health promotion. The aim of this study is to provide in-depth insights into the workings and effects of community engagement.

In a multiple case study, we investigate three health promotion projects among vulnerable families in The Netherlands. The projects are all funded by the Healthy Futures Nearby Programme. Data was collected by group interviews, telephone interviews and written progress reports. We adopted a realist approach, in which we first identified assumptions about community engagement. We then analysed the qualitative data for context-mechanism-outcome configurations to test and refine this programme theory.

Preliminary results show that active engagement can strengthen social networks, empowerment and perceived health among vulnerable families. However, specific contexts, in combination with the project interventions, may or may not trigger positive responses (mechanisms). Vulnerable families may feel they matter when asked to actively contribute in a project, which in turn can enhance their self-confidence. In another context, we found vulnerable families overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We will present a full list of context-mechanism-outcome configurations that describe possible effects of community engagement of vulnerable families.

The two sides of the assumptions project teams hold about effects of community engagement, show that tension exists around actively involve communities in health promotion projects. In-depth insights into the workings and effects of community engagement will provide health promotion scientists and practitioners with knowledge to shape and optimize community engagement in health promotion projects.

Key messages

The study shows that, in practice, tensions exist between expected effects of community engagement and actual unclarity about what community engagement can do in for vulnerable people. Contexts of health promotion projects, in combination with specific interventions, may or may not trigger positive responses to active involvement among vulnerable families.
Inequalities in life expectancy by place of residence and its changes in Lithuania during 1990-2018
Authors: Sauliune S , Mesceriakova-Veliuliene O , Kalediene R
Published: October 2020

Introduction

Health inequalities have emerged as a big issue of public health in Lithuania. Recent studies have demonstrated increasing mortality differentials between different socio-demographic groups of the population. Urban/rural place of residence is related with a set of socio-economic characteristics, different access to material resources, presence or absence of social support, and attitudes to health-related behavior.

The aim of the study

To determine inequalities in life expectancy and its changes by place of residence (urban/rural) in Lithuania during 1990-2018.

Methods

Information on deaths and population numbers for the period of 1990-2018 was obtained from National Mortality Register and Population Register. Life expectancy for males and females of urban and rural populations was calculated using life tables. Changes in the magnitude of life expectancy inequalities by place of residence were assessed using rate differences (urban-rural); while trends in inequalities were estimated by conducting the Joinpoint regression analysis.

Results

Life expectancy among males and females was longer in urban compared to rural areas throughout the entire study period. Life expectancy increased statistically significantly for urban and rural males and females with the most notable increase for males, especially those living in rural areas (on average by 0.4% per year from 64.1 years in 1990 to 70.05 years in 2018). Inequalities in life expectancy by place of residence decreased statistically significantly among Lithuanian males from 3.48 years in 1990 to 1.39 years in 2018, while among females only the tendency of decrease was estimated.

Conclusions

Inequalities in life expectancy of males and females by place of residence decreased significantly in Lithuania throughout the period of 1990-2018, mainly due to positive changes in life expectancy among rural males.

Key messages

Inequalities in life expectancy of males and females by place of residence decreased significantly in Lithuania throughout the period of 1990-2018. Life expectancy increased for Lithuanian urban and rural males and females with the most notable increase for males, especially those living in rural areas.
Oral health status and treatment needs of school going children in a tribal area in Southern India
Authors: Thomas S , Chacko R , Khanapur G D , Kattula D , Rose A
Published: October 2020

Background

Children suffer a significant burden of oral diseases which impacts their quality of life, and general health. Many epidemiological studies have looked at oral health status and treatment needs among children in urban and rural areas across different age groups. There was limited literature assessing the oral health status among children in tribal areas, which presents unique challenges in terms of: topography, availability of health services, and complex socio-cultural health practices.

Methods

Cross-sectional study was conducted among 655 children across six schools between 12-15 years in Jawadhi Hills, Tamil Nadu, India. World Health Organization's, Oral Health Surveys were used for clinical and risk factor assessments. Clinical examination was conducted, and self-assessed questionnaire was administered to the children to assess the risk factors to poor oral health. Since dental fluorosis was common, drinking water samples were collected to assess fluoride levels in the community.

Results

Prevalence of dental caries and gingivitis (gum disease) was found to be 22.3% and 87.3% respectively. Dental Pain was reported by 57% of children as the most common reason to visit the dentist. Prevalence of dental fluorosis was found to be 53.6%. Multiple logistic regression showed: gender, dental fluorosis, diet, and maternal education significantly associated (p < 0.005) with dental caries. Fluoride levels in water was found to be higher than permissible limits (>1.5 ppm).

Conclusions

Children requiring treatment (∼ 200) were referred to the local hospital, and treatment was done free-of-cost. School authorities were informed about the current oral health status of children and advised to conduct regular health education & dental camps; the importance of girls' education was emphasized. Local authorities were alerted about the fluoride-rich water situation in the community and educated about defluoridation methods that the community can employ at household level.

Key messages

Evidence-based burden of oral diseases was presented to the local authorities for the first time, with a call for action. A referral system was established between the schools and the local hospital, to ensure continuity of oral health care for the children.
Efficiency of groups of primary healthcare centres: a frontier analysis of primary care in Portugal
Authors: Santos J V , Souza J , Pinto A , Ramalho A , Pereira A , Pestana J P , Camanho A , Freitas A
Published: October 2020

Background

Primary health care (PHC) is the cornerstone of several health systems. The Portuguese PHC is organized in five mainland regions (ARS), that oversee 55 local groups of primary healthcare centres (ACES). We assessed the efficiency of all 55 ACES in mainland Portugal, as well as organizational and socioeconomic determinants of the efficiency.

Methods

A cross-sectional non-parametric frontier analysis was performed for 2017. The first model included two inputs (i.e. number of physicians and number of nurses) and a single output (i.e. number of PHC visits), while the second model included an additional output, i.e. Prevention Quality Indicator (PQI) overall composite (avoidable hospitalizations) adjusted for age and sex - as undesirable output. In a second stage, a (multivariate) Tobit regression was used to assess organizational and socioeconomic determinants of efficiency.

Results

In the first model, only 8 ACES (14.5%) were on the efficiency frontier, while 25 ACES should readjust their human resource balance. In the second model, 9 ACES (16.4%) were considered efficient. When considering quality, one ACES previously considered inefficient moved to the frontier and two ACES lost their benchmark position. The second-stage analysis indicates that groups with a higher proportion of PHC units with pay-for-performance incentives were associated with higher efficiency.

Conclusions

Most ACES have the potential to improve their production levels., A better management of human resources can contribute to improve overall efficiency. ACES with a higher proportion of units with pay-for-performance schemes seem to be more efficient. These findings contribute to the evaluation of policies to integrate and scale up PHC services locally, such as the recent primary care networks in the NHS UK.

This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.

Key messages

Most Portuguese ACES have the potential to improve their outputs given their current level of human resources. Local groups that aggregate more PHC units with pay-for-performance schemes are associated with high efficiency.
Primary Health Care for Municipalities with High Rural Dispersion
Authors: Jaramillo-Mejia M C , Cancelado-Carretero H M , Bermúdez Jaramillo P C , Osorio Murillo O , Gil J C , Nuñez-Cabrera A , Blandón-Lotero L C
Published: October 2020

Background

The production, delivery of services and scope of health outcomes have generated new forms of organization of the Colombian Healthcare System. Complex solutions developed with a focused techno vision have not been functional, nor adaptable to territories of scattered high rurality (TARD), mainly on the Colombian Pacific coast.

Objective

To build a differential PHC model for rural communities (TARD), ensuring access to quality health care services and improving social determinants.

Methodology

Four municipalities of the Pacific coast were selected. Based on the analysis of the implementation of PHC and RISS, the innovation and problem-solving method -design-thinking- was used to generate knowledge in a practical way. The method was developed with communities and experts.

Results

The prototype model is based on Healing the Territory as its core, and governance in health, intersectoral, social capital, own health, health services and interculturality as its differential elements. The model requires serving the population based on risks and complementary actions, with new hiring models, access routes to services and traditional practices. Another actor is institutionally, which from governance and public policy must define guidelines for service delivery, accountability and incentives. Finally, intersectorality as a binding node for defining cross-sectoral development and joint intervention policies that facilitate the improvement of social determinants of health.

Conclusions

The health model in TARD contributes to reflection and generates social innovation from the territories so that decision makers propose changes in public policy for its implementation. The post-conflict brought hope to the community, to build a better, more equitable society, with access to quality health services and improved living conditions.

Key messages

The model makes a theoretical contribution on the role of innovation in health, to provide solutions to problems in the territories of scattered high rurality. The model requires serving the population based on risks and complementary actions.
Ambiguity in Swiss vaccine mandate legislation
Authors: Deml M J , Tarr P E
Published: October 2020

Background

The Swiss Epidemics Act 2016 foresees no vaccine mandates in routine settings. Only in certain settings can the federal government, after consulting with Swiss cantons, “declare vaccinations mandatory for risk groups, persons at threat of particular exposure, and persons exercising certain activities once a serious danger has been established.” Parliament proposed this Act in March 2012 arguing that recent infectious disease outbreaks required stronger preparedness plans clearly delineating responsibilities of the Confederation, cantons, and third parties. Swiss naturopath Trappitsch gathered >75,000 signatures to launch a referendum contesting the law. Main criticisms dealt with ambiguous language around mandates, infringement upon individual liberty, and fear of an overreaching federal government. Nevertheless, the Swiss populace voted to pass the law (60% in favor) in September 2013.

Methods

Qualitative interviews with key informants (N = 5 public health officials-PHO) and analysis of press coverage of the legislation/referendum allow for an investigation of the ambiguity of the mandate language and the referendum's consequences on this issue in public discourses.

Results

Several PHOs/politicians stated during the referendum that “nobody would be vaccinated against their will” and implied that the law would apply, for example, to non-vaccinated healthcare professionals who could be transferred to different care units to protect patients. Such specificities never appeared in the law. Ambiguous language around mandates served as a point of contention around which vaccination critics united and gained political traction. Such criticisms put State actors in the position of needing to more clearly articulate their perspectives.

Conclusions

With neighboring countries enacting vaccine mandate policies (France, Italy, Germany) in response to resurgence in measles cases, current legislative language leaves the question of mandates open to interpretation
The challenges of aging in China: is healthy ageing a key for medium-long term sustainability of care?
Authors: Yang Y
Published: October 2020

Unlike developed countries, which are 'being rich while being old' and 'being rich before getting old', China was in a state of 'being rich before getting old' when it first entered an aging society. With the arrival of an aging society in 2026, even with the current economic development trends, it is difficult for China to reach the level of 'richness', that is, the population aging process is ahead of the economic development process, which makes the risks and challenges facing China more severe. It is estimated that by 2050, the proportion of GDP spent on pensions, medical care, care, welfare and facilities in China's GDP will increase from 7.33% to 26.24%, an increase of 18.91 percentage points. Faced with such a severe aging challenge, China urgently needs to develop a path to actively respond to aging with Chinese characteristics, and provide experience for countries that have also stepped into the ranks of “before getting rich”. The 'Healthy China Strategy' is one of the important national strategies emphasized in the report of the 19th National Congress of the Communist Party of China, which aims to provide the people with a full range of full-cycle health services. This marks a major shift in China's top decision-makers' understanding of the issue of aging: without 'healthy aging,' there can be no truly 'healthy China.' However, in the face of basic national conditions such as a large population, a weak foundation, few resources, and inadequate development, healthy aging in China still needs to break through a series of bottlenecks and obstacles. The welfare state is not the only reference for China, let alone a model that should be copied. In this regard, the article will put forward a number of targeted policy recommendations.
Health inequalities: Harnessing data and data linkage to bridge the gaps
Authors: Sparke C
Published: October 2020

There is a complex interplay between health and welfare, where social factors such as an individual's education, employment, and relationships can impact their overall health, and vice versa.

The Australian Institute of Health and Welfare (AIHW) is a national body that monitors the health of Australians including the social determinants and the distribution of health across populations. Where inequalities are observed, it investigates, where possible, the contributing factors. The AIHW is uniquely placed to address data gaps in inequalities, with a remit to monitor both health and welfare outcomes of Australians, access to a range of data and established relationships with national and jurisdictional governments.

The AIHW reports against national frameworks such as the National Strategic Framework for Chronic Conditions. A variety of information sources are used. These include health surveys and administrative data on mortality and hospitalisations to estimate inequalities using standardised area based indices of socioeconomic status. The AIHW creates products to suit different audiences such as policy makers, researchers and the general public. These include reports, interactive web visualisations and fact sheets.

AIHW research into mortality inequalities has consistently found that substantial mortality inequalities exist in the Australian population, particularly amongst those from areas of socioeconomic disadvantage. In 2016, if all Australians had the same cardiovascular disease (CVD) death rate as people in the highest socioeconomic areas, there would have been 8,600 fewer deaths.

In recent times data linkage has increasingly been used to link health and social data to provide a broader understanding of the associations between social determinants and health and the health experiences of priority population groups.

This presentation will give an overview of current monitoring efforts in Australia, and provide examples of methods used and current work in this area.