bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring health risk of people living near the Secondary Transfer Stations and Landfills in Dhaka
Authors: Sara H , Alam R , Hasan T , Quayyum Z , Jerin D
Published: October 2020

Background

Proper management of increasing solid waste is a major challenge for Dhaka city. Hence, the consequences on health are numerous and depend on the nature of the waste, individuals exposed, duration of exposure and availability of interventions for those exposed. This study seeks to identify the potential health risk associated with contamination from STSs and landfills in Dhaka city.

Methods

This study has adopted a multi-method approach that includes qualitative data collection and analysis of secondary spatial data. Thematic analysis was performed for analysing the qualitative data and. Spatial data were collected from the Survey of Bangladesh and analysed to show the spatial distribution of 68 STSs out of 81 STSs in Dhaka City.

Results

Qualitative study suggests that the leachate migration from the landfill and STSs make the surrounding environment worse and causes health sufferings to the people living near the STS or landfill along with the people directly working. Furthermore, findings from the spatial data reveal that, 12 STSs within 50-100 meters and 54 STSs within 100 meters radius of an education institute and round 75 STSs are also located within 100 meters radius of the health facilities. Numerous settlements and natural features are also located within 500 meters of buffer zone from the both landfills. Flies and mosquitoes are breeding at a greater pace in and around the landfills where high quantities of solid waste are being dumped. Again, waterlogging is very common due to the dumping of waste which in turn is causing the spread of dengue and other water borne diseases in the surrounding area.

Conclusions

Poor management and incautious allocation of the STSs and landfills have adverse effects on the people's health residing nearby. Managing waste in the landfill and STS with a proper manner, and engaging more manpower with adequate safety equipment could be a great help to reduce the health sufferings of the people living nearby.

Key messages

Improper solid waste management practice effects on the health of people residing near the STSs and landfills. To manage the waste of the STSs and landfills in an efficient way and not cause daily nuisance to the nearby residents.
Traffic noise, air pollutants and incidence of diabetes mellitus: a population cohort study in Milan
Authors: Magnoni P , Murtas R , Russo A G
Published: October 2020

Background

Recent evidence suggests a link between long-term exposure to traffic-related pollution and incidence of type 2 diabetes mellitus, a leading cause of morbidity and mortality in adults. The present study aims at exploring this association in a highly urbanized setting such as the city of Milan.

Methods

This is a population-based retrospective dynamic cohort study in the municipality of Milan. All residents aged >35 years with no prior diagnosis of diabetes were included (N = 1096654), with follow-up ranging from January 2011 to June 2019. The residential address of each subject was geocoded and assigned mean values of traffic noise at the day-evening-night level (Lden, dB) and NO2 concentration (µg/m3) using a noise predictive model and a NO2 land-use regression model with 30x30 m grid resolution. Associations with a new diagnosis of diabetes were assessed with Cox proportional hazards models adjusted for age, sex, nationality and a socio-economic deprivation index. A dichotomous classification of addresses as city center/suburban based on the External Ring Road as a delimiter was also used for a stratified analysis.

Results

New diagnoses of diabetes occurred in 26134 subjects (2.4%). Models using NO2, either continuous or ranked into quintiles, yielded no significant results. When using noise to categorize traffic intensity (<65/65-69/70-74/≥75 dB), a positive yet non-significant trend was shown. At stratified analysis, increases in risk were found for the two highest levels of exposure in the city center (70-74 dB: HR 1.141, 95% C.I. 1.013-1.284; ≥75 dB: HR 1.185, 95% C.I. 1.058-1.328).

Conclusions

Residential proximity to high-traffic roads categorized according to traffic noise was found to be associated with an increased risk of being diagnosed with diabetes. The effect is evident in the city center, whereas in the suburban area it might be masked by individual and lifestyle factors that ought to be investigated in future studies.

Key messages

Living close to high-traffic roads in a highly urbanized environment increases the risk of diabetes. Policies aimed at reducing traffic intensity in large cities may lower the incidence of this highly prevalent chronic condition.
Perception of end-of-life decisions by healthcare professionals in home palliative care and hospice
Authors: Faggian E , Martinato M , Gregori D
Published: October 2020

Background

Home care and hospices are gaining higher importance in providing end-of-life care. The main aim of this study is to investigate clinical decisions of healthcare professionals in north-eastern home-care services and hospices caring for patients in their end-of-life. Moreover, the study aims to study nurses' and physicians' opinions on palliative care.

Methods

A questionnaire was administered to healthcare personnel in 5 homecare services and 2 hospices in a regional health service trust in north-eastern Italy. The questionnaire is made of three parts: the first deals with clinical decisions for the last patient who died, the second investigates opinions on terminal care, while the last collect data on participants.

Results

42 subjects have been enrolled, most of them are nurses, 64,1% without bioethics training and 53,8% without palliative care training. All the End- of-Life Decisions (DEL) were “non-treatment” decisions. None of the participants discussed the potential life-shortening effect with the patient. The involvement of patients' relatives in terminal care was meaningful for 86% of the professionals. The participants reported they usually discuss terminal issues only when patients or relatives ask for them, but palliative care seems to be the most discussed care-related topic.

Conclusions

Comparison with previous studies can't be performed because of the small number of participants. DEL were exclusively “non-treatment”. We found relevant data about options of shortening life, which was not discussed at all. Mainly only the professionals who give great importance to patient's religious beliefs discussed spiritual themes with them. Finally, the professionals trained in palliative care were more comfortable starting to talk to patients about the possibility of receiving palliative care.

Key messages

This study investigates clinical decisions taken by professionals in home-care and hospices in terminal ill patients care and professionals ‘opinions on palliative care. Communication on palliative care (PC) has been widely investigated: professionals trained in PC were more comfortable starting to talk to patients about the possibility of receiving PC.
The Nutritional Surveillance at school: experiences from ATS Val Padana (Italy)
Authors: Troiano G , Chiesa M , Cirrincione M L , Merisio J , Mondini F , Biazzi M , Mirelli M , Orsini O , Firmi A M , Clasadonte V
Published: October 2020

Background

Correct habits acquired in childhood positively affect the future health of the adult person. Therefore the school meal isn't as a simple satisfaction of nutritional needs, but also an important moment of health promotion, which involves teachers and parents.

Objectives

In ATS Val Padana the Food Hygiene and Nutrition Unit evaluates school menu at the beginning of each year (including special diets for specific diseases that require diet therapy). During the school year, trained personnel carries out inspections in schools, according to annual planning. During the inspection are evaluated: - Presence/respect of the validated school menu Number of mealsPeople preparing and administering mealsFood preparation and storageLiking by childrenManagement of special dietsManagement of the meal as an educational moment

Results

132 inspections were performed: 70 in 2018 and 62 in 2019. 23 (17.42%) were conducted in nursery schools, 62 (46.96%) in kindergartens, 44 (33.33%) in primary schools, 3 (2.27%) in middle schools. 47 (35.60%) were privately managed; 61 (46.21%) were also equipped with a kitchen for preparing meals. 41 inspections (31.06%) showed slight criticalities; 9 (6.81%) serious problems (poor hygiene, lack of control over special diets - which required further inspections). A statistically significant difference was observed (p = 0.02) between 2018 and 2019, with a clear decrease in criticality in 2019. No difference in the results of the checks was observed in relation to the type of school, management, and to the presence or not of a kitchen (all p > 0.05).

Conclusions

The effectiveness of the control system is represented by the relationship between non-conformities detected during the checks and the number of performed checks. In 2019, despite the controls have increased compared to the previous year, the incidence of non-conformities has decreased. This indicates that control activities is positive to improve the quality of the school meal.

Key messages

The school meal is a fundamental educational moment for children. Control activities have positive impact on the quality of the school meal.
Relationship between dietary composition and normal body temperature and hypothermia
Authors: Kimura K
Published: October 2020

Background

Maintaining a core temperature of 37.0 °C is important for autoimmunity, but reports in recent years show a declining trend in body temperature in Japan. The present study aimed to identify the factors leading to hypothermia by examining the relationship between dietary composition.

Methods

The subjects were 80 healthy females (average age: 18.2±1.0 years). We used a questionnaire format to survey the dietary pattern of the subjects. The dietary patterns were assessed by examining the average meal content consumed per week over the last 1-2 months and meal consumption, including nutritional content and other factors, using analysis software. The subjects measured their tympanic temperature using a thermometer after waking up. Correlation coefficient was calculated to determine correlations between tympanic temperature and each item.

Results

A significant correlation was observed between tympanic membrane temperatures upon waking up and iodine intake (r = 0.301,P<0.05) as well as the adequacy ratio of iodine reference intake (ratio of iodine intake to the Dietary Reference Intakes for Japanese, r = 0.301,P<0.05). A comparison between the group with tympanic membrane temperatures of ≥ 36.0 °C upon waking up and that with temperatures of < 36.0 °C showed a significant difference in iodine intake (732±518μg vs 422±248μg,P<0.05) and the adequacy ratio of iodine reference intake (5.6±4.0 vs 3.2±1.9,P<0.05).

Conclusions

We examined the association of body temperature in Japanese women in their teens with their dietary composition and found a correlation between iodine intake and the adequacy ratio of iodine reference intake. Iodine is a substance essential for the production of the thyroid hormones thyroxine and triiodothyronine. Thyroid hormones regulate biochemical reactions, such as protein synthesis and enzyme activity, and play an important role in regulating metabolic activity. Therefore, iodine may influence body temperature via these hormones.

Key messages

Regular body temperature monitoring is recommended for the prevention of infectious diseases. When there is a decrease in the body temperature, dietary composition of the individual should be checked.
Examining the relationship between inflammation markers and anthropometric values in primary care
Authors: Mete B , Deger MS , Zoroglu G , Pehlivan E
Published: October 2020

Background

In recent studies, adipose tissue appears to be associated with inflammation. In this study, it was aimed to determine the relationship between inflammation markers and anthropometric measurement values and blood lipid values for purpose in primary health units.

Methods

The universe of this study has comprised healthy adults admitted to a community health units' diet clinic in a city of eastern Turkey in the city in 2019. Blood analyzes were done in the family medicine laboratory, those with high leukocyte values were excluded and 274 adults were included in the study. The relationship between blood lipid values, complete blood count, inflammation markers, neutrophil lymphocyte ratio (NLO), platelet lymphocyte ratio (PLO) and lymphocyte monocyte ratio (LMO) and anthropometric measurements of adults were investigated. Spearman correlation test, Kruskal Wallis test, Multiple Linear Regression test were used in the analysis of the data.

Results

The average age of 274 people participating in the study is 34.07 ± 9.92. According to BMI, no significant difference was found between NLO, PLO and MLO ratios. Significantly weak negative correlation between PLO and skeletal muscle, basal metabolic rate, body fluid amount and lean mass; a negative correlation between HDL and BMI, amount of body fat and amount of internal lubrication were found (p < 0,003). The increase in the amount of skeletal muscle causes a decrease in the level of total cholesterol, while the increase in the amount of internal lubrication causes an increase in the level of total cholesterol. A positive weak correlation was found between NLO and LDL(p < 0,001), a very weak positive correlation between NLO and total cholesterol and a very weak positive correlation between LMO and LDL(p < 0,014).

Conclusions

It was observed that there was a very weak correlation between anthropometric values and cholesterol levels and inflammation markers, and moderate levels of blood lipid values in healthy individuals.

Key messages

In primary care, measuring the body composition of healthy people at least once a year appears to be a valuable practice. Exercises that increase skeletal muscle and reduce the amount of internal fat should be recommended to patients with high cholesterol or healthy people at risk.
Prevalence of obesity and longevity: cohort study using national statistics
Authors: Vlassov V V , Lyapin G
Published: October 2020

Background

Obesity is a problem of major concern all around the world. On the personal level it leads not only to a decrease in life expectancy, but also increases the burden on health care. Objective of this study was to review the correlation between the longevity and prevalence of obesity in countries stratified by their economic prosperity.

Methods

We did a retrospective longitudinal analysis based on the World Bank and Global Burden of Disease data for the period from 1980 to 2015. We grouped countries by the national gross domestic product (GDP) per capita in purchasing power parity, and analyzed the correlation between life expectancy at birth, obesity prevalence for both sexes, 20+ years old, age-adjusted. For calculations and plotting we employ Python, libraries pandas, NumPy.

Results

We grouped countries at different time point during the study interval. Some countries changed their place in the range of GDP, and thus the shape of the curves describing the connection of obesity and longevity changed. In all groupings countries that are more affluent demonstrates higher longevity and higher prevalence of obesity. At all levels of GDP during the period of analysis we found the increase in obesity prevalence and increase of longevity. In poor countries the small increase in obesity prevalence is accompanied by the significant increase in longevity. Obesity-longevity tracks for individual countries suggest that they reflect the specific periods of the blossom or crisis in national economy and related aspects of life. For rich countries obesity-longevity curves suggest that the positive correlation is approaching the upper limit.

Conclusions

During the period 1980-2015 life expectancy is increasing at all levels of GDP with increase in the prevalence of obesity. Positive effect of a better nutrition, reflected by the prevalence of obesity, is powerful, but approaching its upper limit in the affluent countries.

Key messages

At all levels of economic development the life expectance is increasing with prevalence of obesity. Positive effect of a better nutrition, reflected by the prevalence of obesity, is powerful, but approaching its upper limit in the affluent countries.
CARPEM-LYNCH: a program linking hospital and NutriNet-Santé e-cohort data to test dynamic consent
Authors: Wendeu-Foyet G , Fassier P , Perrod G , Perkins G , Coffin E , Deschasaux M , Julia C , Mamzer M-F , Laurent-Puig P , Touvier M
Published: October 2020

Background

Technological innovations have contributed to rapid changes in translational research, allowing greater amounts of shared data on an unprecedented scale. However, methods for involving patients in research have not kept pace with changes in research capacity. Modern tools offering more flexibility in the management of patient consent are needed. The CARPEM-LYNCH program aims to explore the acceptance and feasibility of the concept of dynamic informed consent. It is a pilot program to test a research platform at the interface between hospital follow-up clinical data and data provided by patients through the NutriNet-Santé e-cohort platform.

Methods

Patients diagnosed with Lynch Syndrome followed at the European hospital Georges Pompidou (HEGP) are recruited and followed-up within the NutriNet-Santé online platform. In addition to generic NutriNet questionnaires (very detailed data on diet, physical activity, lifestyle, etc.), participants receive specific questionnaires related to their syndrome, perception of nutritional risk factors, and quality of life. Clinical data collected during standard hospital care will be linked to NutriNet data for participants who provide a dynamic consent. This dispositive will allow to investigate multiple dimensions of dietary behaviors and their health impact in these at-risk patients.

Results

The pilot phase has started. The first 20 patients have been included, showing good acceptance of the dynamic consent. Qualitative analysis of their responses is ongoing to optimize tools before large-scale deployment and extension to other hospital centers.

Conclusions

This experience of merging hospital and e-cohort data through dynamic consent to advance knowledge on health impact of diet and lifestyle in Lynch patients opens up a multitude of perspectives.

Key messages

Dynamic informed consent offers opportunities for data sharing between clinicians, researchers and patients with a promising impact on translational research. Dynamic informed consent can provide practical and sustainable solutions to the challenges of recruiting and retaining participants, managing consent and it can also be a source of economic efficiency.
A Listeria monocytogenes ST325 clone is widespread in the Lombardy Region dairy processing plants
Authors: Finazzi G , Filipello V , Gori M , Scaltriti E , Bracchi C , Menozzi I , Tanzi E , Bolzoni L
Published: October 2020

Background

Listeria monocytogenes is a foodborne pathogen with low incidence but severe manifestations in at risk categories (up to 30% fatality rate in YOPI). L. monocytogenes can form biofilm and persist in food processing environments for decades. In the Lombardy Region up to 50% of listeriosis cases have been attributed to dairy products. This study aimed at investigating a L. monocytogenes clone widely present in one of the most important Italian cheese production chain.

Methods

Through a retrospective analysis of the Lombardy Region PFGE database a cluster comprising isolates from eight PDO Gorgonzola and Taleggio dairies (2013-2019) was identified. A representative subset of 33 isolates was typed with MLVA and MLST. All isolates were further typed with WGS and compared to all Lombardy clinical isolates (n = 9) that shared the same Sequence Type (ST). Genomic relationship among isolates were investigated with cgMLST and SNP analysis.

Results

All isolates had the same MVLA/MLST profile (ST325). cgMLST and SNP analysis divided the isolates in two clusters that however shared a very high similarity (99.4%). Interestingly, isolates collected from same production plants clustered separately. Conversely, isolates collected in different years and plants clustered together. By querying the L. monocytogenes MLVA database it was possible to identify isolates of the same production chain with identical profile back to the year 2005. ST325 clinical isolates represented 2% of all typed clinical isolates and have an incidence of 0.007 cases/100000 inhabitants. Due to the high genomic similarity, it was not possible to link any clinical isolate to a putative source.

Conclusions

Our data suggest a persistent contamination by a L. monocytogenes ST325 clone traced back to the year 2005 present in the dairy production chain of Lombardy. Given the high similarity among the isolates further analyses with a larger dataset and are needed to elucidate the epidemiology of this clone.

Key messages

A highly clonal contamination by L. monocytogenes is widespread in the Lombardy Region dairy production chain. The low incidence of ST325 among the population suggests a low pathogenicity of the strain, however the occurrence of an ongoing long-term outbreak cannot be excluded.
Food allergy: knowledge level of food handlers at school canteens
Authors: Liz Martins M , Estrela I
Published: October 2020

Background

Food allergy becomes a public health problem whose prevalence in children is increasing. Due to the daily number of children using school canteens, these settings play an important role on allergic reactions prevention, being essential to know the knowledge level of food handlers.

Methods

This study focused on Portuguese schools of the city of Porto, that daily offer 6500 lunches to children aged 3 to 10 years old. The study was performed in all school canteens having children with food allergies (n = 25). To evaluate knowledge level on food allergy, a questionnaire was applied to all food handlers responsible for meals serving, considering hot topics related to food allergy and cross contamination practices. Each question was scored: 0 (lack); 1 (correct); -1 (incorrect), ranged 0 to 20 points. The knowledge level was converted in a 4-level scale: <50% (non-acceptable); 50-74% (acceptable); 75-89% (good); 90-100% (very good).

Results

Despite of 44.9% of food handlers presented a good level knowledge, it was observed that 38.8% of participants showed non-acceptable values. The knowledge mean level was 11.9 (±4.1) points. A high knowledge was observed for cooks (13.8±3.0) and canteen managers (20.0±0.0) (p = 0.006), as well as, for a high school level. Only 36.7% of participants had training on food allergy, with no influence on knowledge level (0.610). Participants having training on food safety has a higher knowledge level (13.0±3.9) than food handlers having no training (9.8±3.7) (p = 0.008). The majority of respondents showed to know food handling good practices when exposed to case studies related to food allergy.

Conclusions

A positive level of knowledge on food allergies was observed for the majority of food handlers. Nevertheless, a high number of participants had no training on food allergy. This work has a potential impact on children's health, awareness for the need to implement regular training actions and surveillance systems at school canteens.

Key messages

A large number of food handlers showed non-acceptable knowledge levels and no training on food allergy. Professional category influenced knowledge, being important the motivation and training of all employees.
Lifestyle change predictors in the general population
Authors: Stirparo G , Bini M , Odone A , Signorelli C
Published: October 2020

Background

Even thought lifestyle changes have a main role in cardiovascular disease prevention, people show a weak adherence to medical advices. Aim of our study was to identify anamnestic predictors of poor compliance for lifestyle changes in a general population.

Methods

We submitted a 26 questions questionnaire to 301 general population subjects, investigating multiple anamnestic characteristics. Afterwards, we proceeded to explain people the main line of the European society of Cardiology guidelines on Cardiovascular prevention. Finally, we asked the subjects if this prevention campaign was able to modify their lifestyle.

Results

Sixty-four percent of interviewed were prone to change their lifestyle. Females answered positively more than males (73% vs 59%, p = 0.011). In terms of cardiovascular risk factors only the presence of dyslipidemia was significantly associated with a will of change (84% vs 58%, p = 0.000). Age (49 (18) vs 46 (20) ), familiar history of cardiovascular disease (69% vs 63%,p=0.320) and the presence of a previous cardiovascular event (68% vs 66%,p=0.841), do not predict the adherence to lifestyle change.

Key messages

Cardiovascular disease dose not influence people’s decision in life style change. Male gender represents an anamnestic characteristics that predict a poor adherence to lifestyle changes while people affected by dyslipidemia more frequently are prone to modify their routine.
Food Insecurity and National School Feeding Program in Brazil – 2004 to 2013
Authors: Souza I , Silva V S
Published: October 2020

Background

One of United Nations Millennium Development Goals (MDG) is to eradicate extreme poverty and hunger. In this sense, the National School Feeding Program (PNAE) in Brazil is one of the largest school feeding program in the world and the only one with universal service. It's exist before of Brazil's Family Grant Program (PBF) - a conditional cash transfers program - and the only condition to access is to be a student in public school (kindergarten to high school). So, the aim of this work is to verify the association between food insecurity and the PNAE in Brazil (2004 to 2013).

Methods

The database used in the present study was the National Household Sample Survey (PNAD) thats incorporated Food Security Supplement (FS Supplement). The food security was conceptualized in four levels: food security (FS) and the three types of food insecurity (FI), Mild FI (MiFI), Moderate FI (MoFI) and Severe FI (SFI). Only household with people with less than 18 years-old at public school was analyzed. The database are from 2004, 2009 and 2013 PNAD. The association between food insecurity and PNAE (user or non-user) was conducted by multiple correspondence analysis and logistic regression (the results are preliminary).

Results

The FI in 2004 was present in 35.2% of households (95%CI: 32.9-37.5), 30.5% (95%CI: 28.7-32.3) in 2009 and 22.9% (95%CI: 20.9-24.8) in 2013. In all years of the study the most users of PNAE living in a household with FI than non-users, that's show in multiple correspondence analysis (two dimensions with a total of 31,7% of variance) and logistic regression (OR: 1.26, 95%IC: 1.24-1.28).

Conclusions

Author's agree that downward trend in food insecurity in Brazil was a result from Family Grant Program (PBF). Additionally, the PNAE continues as protective factor of FI, because people with less than 18 years-old at public school who lived in a household with FI can have at least one meal a day.

Key messages

School Feeding Programs contribute to Millennium Development Goals, as to eradicate extreme poverty and hunger. National School Feeding Program in Brazil is a protective factor for Food Insecurity.
Examining the relationship between Orthorexia Nervosa and healthy lifestyle behaviors in students
Authors: Oktay B , Gokce A , Oze A
Published: October 2020

Background

Orthorexia Nervosa (ON) is an eating disorder characterized by a pathological obsession to healthy eating and excessive preoccupation with the consumption of healthy food. The ON levels of individuals are affected by their healthy lifestyle behaviors. The aim of this study is to determine the relationship between ON levels as well as associated factors and healthy lifestyle behaviors in female students at Malatya Battalgazi Dormitory.

Methods

Our descriptive cross-sectional study was conducted in 2019 and included 300 female dormitory students. The survey form used in the study consisted of questions regarding sociodemographic characteristics and eating habits; the Orthorexia Nervosa Evaluation Scale and Healthy Lifestyle Behaviors Scale were also utilized. The Chi-Square, Student t, One Way ANOVA, Mann-Whitney U and Kruskal Wallis tests were used in the statistical analysis of data and p < 0.05 was found to be significant.

Results

It was found that 16.7% of students had an inclination towards ON. Students who had 2 meals a day or less exhibited significantly lower ON tendencies compared to those who had 3 meals a day or more (p < 0.05). The groups showed statistical variations in total Healthy Lifestyle Behavior scores and sub-class scores when compared according to levels of parental education (p < 0.05). While the average Healthy Lifestyle Behavior score total was 124.8±14.61 in students who displayed ON tendencies, those that did not show such tendencies had a mean score of 120.0±19.74.

Conclusions

Students with ON tendencies have a higher healthy lifestyle behavior score. In addition, students consuming less than 2 main meals daily showed less signs of ON. In this case, it is necessary to prioritise updating and improving the methods evaluating the ON trends. It is thought that ON tendencies can be reduced and healthy lifestyle behaviors can be improved in students with education concerning nutritional awareness.

Key messages

The female students staying at Malatya Battalgazi Dormitory show low signs of ON. Healthy lifestyle behaviors of female students staying at Malatya Battalgazi Dormitory are above average.
Using documentation to develop grounded advocacy for equity focused public health work
Authors: Magnusson M , Hallmyr M
Published: October 2020

Health inequity is a global concern. The Public Health Unit (PHU) of a local hospital conducts activities in partnership with many actors, aiming at decreasing the health gap. This commission highlights the need to advocate for shared participation, influence and control and for methods that make health care available, accessible and acceptable for all. A platform for such advocacy includes analysis of interventions based on evidence-informed strategies.

How may PHU:s activities (2019) have contributed to health equity? Analyses build on documentation in the Health Equilibrium Methodology system which draw on Social Cognitive Theory, critical reflection and quantitative measurements.

PHU participated in 81 meetings on the strategic level. Common values and trust, more stable in long-term partnership, facilitated development of population-focused activities that could support marginalised groups. On the population level the Unit participated in 170 activities. Examples were bicycle courses, family centred talks with dietician, tobacco talks with youths and groups for mothers of Somalian origin. Common strategies were to support self-efficacy by confirming and communicating knowledge, to use reciprocal determination by drawing attention to environmental factors, to affect outcome expectations by highlighting links between lifestyle and health and to facilitate healthy habits by making guidelines accessible. Critical reflection highlighted barriers for making use of general advice. Data indicate that professional reflection is needed to implement shared participation, influence and control and that trust-building is dependent on stable presence.

Professional reflection, systematically documented and taken into account is needed to fully use health care potential to ensure Right to health for all.

Trust takes time to build but creates possibilities for inhabitants to raise health issues from their perspective, enabling meaningful support

Key messages

To take the full potential of public health work into account actors should use systematic documentation focusing on processes, avoiding to reduce evaluation to numerical reports. Health care professionals that aim at closing the health gap need to distance themselves from their personal perspectives by using systematic critical reflection of their practice.
Innovative data analysis approach informing policy action to improve wellbeing and health equity
Authors: Allen J , Yang L , Dyakova M , Kadel R , Couzens L , Van Eimeren M , Hill R
Published: October 2020

Wales is leading the way as one of the first countries supporting the World Health Organization to take forward the work of the Health Equity Status Report Initiative (HESRi) at a national level. The Welsh Health Equity Status Report Initiative (WHESRi) has been established to strengthen this global wellbeing and health equity agenda, applying a cutting-edge HESRi methodology first in Wales, providing valuable lessons and experience, which can enable other countries to take action to address health inequity. WHESRi includes three research streams: a) Health equity data analysis; b) Policy analysis and c) Health economic analysis.

The National Survey for Wales (NSW) (cross-sectional study design) is used to 'decompose' the gap in a health outcome using the Blinder-Oaxaca decomposition methodology. The analysis breaks down contributions to the inequitable health outcomes observed between different population groups, by factors that differ systematically between the groups. Factors, which align to the five HESRi health equity conditions (Health Services, Income Security & Social Protection, Living Conditions, Social & Human Capital and Employment & Working Conditions).

The work is also exploring how different health outcomes e.g. mental health and life satisfaction, result in different relative contributions to inequities in those outcomes from the five conditions.

Analysis of the 2016-17 NSW shows that the prevalence of good health is significantly higher in those who are not materially deprived (75.6% CI 74.5% to 76.6%) compared to those who are (55.3% CI 52.3% to 58.4%). Preliminary data suggests that when decomposing the gap in self-reported health between those who are materially deprived and those who are not, the largest contributing factor to the inequity is systematic differences in the degree of Income Security and Social Protection (39%).

The analysis identifies priority policy areas for action and further analysis.

Key messages

The health gap can be stratified and explained by five essential health equity conditions. Explaining the health gap informs cross-sector policy action and investment prioritisation towards healthy prosperous lives for all.
Training the next generation in transdisciplinarity
Authors: Pineo H , Moore G , Rowson M , Aldridge R W , Turnbull E
Published: October 2020

Background

Transdisciplinarity is ideally suited to investigating the determinants of health, as it requires the understanding of multiple, interlinking factors such as poverty, culture, education, environment, and public policy. In this study, we set out to understand how others have taught transdisciplinary research methods to identify common teaching methods and best practices.

Methods

We conducted two separate literature reviews using OVID Medline. The first identified articles that conducted transdisciplinary research and the second focused on teaching transdisciplinary research. Studies from both searches were included if they described the methods used to teach transdisciplinary research. Data were extracted on teaching strategies, student assessment, and the cited benefits of both.

Results

Our search of transdisciplinary research papers provided 528 papers whilst our search on teaching transdisciplinary research methods identified 100. After screening, we included 23 papers. Forms of teaching transdisciplinary research were diverse, and included mentoring and multi-mentoring to learn from the experiences of others, small group work to develop interpersonal transdisciplinary skills, immersion in real-life experiences to develop research skills and peer discussion groups to facilitate peer-peer learning. Assessment methods included critical evaluations of past projects and group coursework.

Conclusions

Our review highlighted that a combination of interactive, problem-based discussion and hands-on learning experiences (assessed and non-assessed) were used for transdisciplinary learning and skills acquisition, which needs to be combined with an assortment of exposures to different disciplines in the forms of lectures, readings and learning material.

Key messages

Training the next generation in transdisciplinarity involves a diverse range of methods including immersion in real-life experiences. Transdisciplinary teaching involves an assortment of exposures to different disciplines in the forms of lectures, readings and learning material.
Promoting equity through monitoring inequalities in the semi-rural region of Girona
Authors: Batlle Amat P , Lazaro-Lasheras L , Oliveras S , Perafita X , Tarrés A , Vilà A
Published: October 2020

Problem

Girona's region is a semi-rural territory with 750,000 h located in the northeast of Spain. There is no system to monitor health, well-being and health inequalities. This causes a lack of local public health equity policies.

Description

Design, implementation and results of participatory process, carried out over 6 months, to identify the information and data needs to be monitored locally for social determinants and health inequalities. Process has 4 phases: Selection of technical and political profiles representing coastal and inland, rural and urban municipalities linked to the fields of social determinants of health.Diagnosis: 2.1. Systematic collection of information through: i) Self-administered online questionnaire, sent to 250 policy makers and 580 technicians. ii) 6 focus groups 2.2. Data analysis to prioritize data and information needs.Evaluation and conclusions.Dissemination of results and transfer of knowledge.

Results

Involve actors in the identification of health information needs and their determinants permit to build a shared model of indicators. Spread the model of social determinants and their effects on health and well-being, increasing awareness of inequalities and health strategy in all policies. Identify the need to adjust some state and international indicators locally to be useful in local proximity policies.

Lessons

Involving local stakeholders has enabled the Girona's Observatory of Social Determinants of Health and Well-being to respond more efficiently to the information needs of technical and political decision makers. Indicators for monitoring health and inequality at the state and international levels need to be lowered at the local level so that they can be heard in the decision-making process of actors at the local level.

Key messages

It is necessary to adjust international health indicators to territorial realities in order to adjust local health and wellness policies. Local policies need health and wellness monitoring indicators to guide their policies.
Assessment of access to water, sanitation and hygiene in rural schools of Central Kazakhstan
Authors: Bolatova Z , Toleubekov B , Kulov D , Sukhanberdiyev K , Tussupova K
Published: October 2020

Background

The Sustainable Development Goals (SDGs) call for universal coverage and access to drinking water, sanitation and hygiene (WASH) for all by 2030. Access to WASH in schools is one of the priority areas, considering Joint Monitoring Program is lacking the data from many developing countries, particularly, rural areas including Kazakhstan. The aim of the paper is to assess the access to WASH at schools in rural regions of central Kazakhstan.

Methods

The study was conducted in three rural schools using focus group discussion with school heads, the observation of drinking water and sanitation units, and a questionnaire survey among 166 pupils. All tools cover the set of questions about the availability and the privacy of WASH facilities, accessibility, acceptability to pupils, functionality.

Results

Results of the study show that the main water source of Algabas and Kerney schools is a centralized piped water supply provided into the school building and 85,91% of pupils from these schools report the uninterrupted availability of water from this source. However, Sartau has its well, and only 51,72% of pupils from this school indicate that water from the main source is continuously available. All toilets are flushing toilets inside of schools and not connected to the centralized sewage system. The maximum number of the toilet is 6 in the Kerney school; however, this amount of toilets is not enough for the number of pupils by the national norms. Majority of pupils (89,15%) report that the school toilets are always available. Nevertheless, 34,87% of pupils indicate no toilet paper as a reason for not using the school toilet. Handwashing facilities are located near the toilets and in classrooms. Only 53,02% have soap available and 42,77% have access to hand drying facilities after handwashing.

Conclusions

The current study shows rural schools of Central Kazakhstan are not provided with sufficient materials for pupils to manage personal hygiene appropriately.

Key messages

The study is essential for mapping the situation of WASH in schools. This study provides the baseline data for JMP; consequently, it is crucial to plan the UN SDGs in Kazakhstan.
Trajectories of adherence to adjuvant endocrine therapy for 5 years in women with breast cancer
Authors: Memoli V , Lailler G , Le-Bihan C , Bendiane M K , Lauzier S , Mancini J , Bousquet P J , Bouhnik AD
Published: October 2020

Background

Adjuvant endocrine therapy (AET) is a daily oral medication prescribed for women with hormone-sensitive breast cancer (BC) to reduce recurrence and mortality risks. However, many women do not take AET daily or do not persist with AET for the recommended duration of at least 5 years. Our aims were to identify: 1) trajectories of AET adherence for the 5 years; 2) factors associated with these trajectories.

Methods

The French Cancer Cohort includes data on hospitalizations, ambulatory care and drug claims for all cancers diagnosed in France (SNDS database). Women diagnosed with a 1st non-metastatic BC in 2011 who had ≥ 1 AET claim within 12 months of surgery were included. For each woman, we estimated the monthly proportion of days covered (PDC) by an AET for 5 years after the first AET. Monthly PDCs were used to model AET adherence trajectories using group-based trajectory modeling. Statistical criteria were used to assess the suitability of the selected model. The factors associated with the trajectories were identified using multinomial logistic regressions.

Results

33,260 women were included. A 6-trajectory model was selected: 1) Stop of AET in the 1st year (6.6%), 2) Adherence for 1 year and stop (5.7%), 3) Adherence for 2.5y and stop (6.3%), 4) High adherence for 4.5y and stop (8.3%), 5) Sub-optimal adherence for 5y (4.3%), 6) Very high adherence for 5y (68.8%). Factors associated with non-adherence trajectories are mainly extreme age (>70y) and switch in AET.

Conclusions

About 70% of women had an optimal adherence for 5 years. Our results showed that women who changed AET during the treatment course were at higher risk of non-adherence. Among non-adherent women, the switch in AET is frequent and probably often related to the management of side effects. Interventions to detect and manage these side effects may help to support women with AET use. Effective management of these effects during all the 5 years could be needed to maintain adherence.

Key messages

About 70% of women had an optimal adherence for 5 years. Women who changed AET during the treatment course were at higher risk of non-adherence.
Spatial distribution of children used Ritalin at the neuropediatrics clinic in Maringá (PR), Brazil
Authors: De Lima C H , Paiola G C , Massuda E M , Maier A M R R
Published: October 2020

Blackground

Brazil is the second largest consumer of methylphenidate in the world. Considering the social determinants on the health of people and communities, the objective of the research is to evaluate the influence of social and economic factors on the prescription of methylphenidate for school-age children.

Methods

Quantitative exploratory study with primary data collected from the electronic medical records of school-aged children, 6 to 11 years old, in a neuropediatric clinic at a Basic Health Unit of the Unified Health System (SUS) in a city located in the southern region of Brazil, with the date of the last withdrawal of methylphenidate between the period of March 2017 to November 2019.

Results

104 patients who used methylphenidate were evaluated, 85 male and 19 female, with an average age of 8.26 years at the outpatient clinic and 9.19 years currently, the youngest being 6 years old and the largest 11 years old, with deviation 1.47 standard. Preliminary results indicate that 50.96% of prescriptions were aimed at children from places of greatest social vulnerability.

Conclusions

It was found that the majority of school-age children prescribed ritalin at the clinic are from poor neighborhoods. Building this panorama based on socioeconomic determinants suggests the need to understand the influence of how environments with higher levels of violence can influence the health-disease process, both for integrality to diagnosis and for longitudinality to treatment. New studies are suggested that consider children who have not been treated in the public health service.

Key messages

Impact of the evaluation of socioeconomic determinants on the prescription of methylphenidate for school-age children. Integral and longitudinal treatment with methylphenidate for children from poor areas.
Qualitative study on Bhutanese patients’ perceptions of modern, Sowa Rigpa, and local medicine
Authors: Hosoda M
Published: October 2020

Modern society has seen a rapid shift toward biomedicalization. However, there is now an increasing trend of using complementary and alternative medicine for holistic treatment. Bhutan promotes the physical, mental, and spiritual well-being of its citizens through its universal healthcare system, production of herbal medicines, Buddhist practices, and governmental policy of Gross National Happiness. Patients can choose one or a combination of modern, traditional (Sowa Rigpa), and local healing practices for treatment. For this study, in-depth, semi-structured interviews were conducted among randomly-selected patients (N = 20). Interviewees were categorized based on demographics, past medical experiences, upbringings, and expectations for medical care providers. All participants were found to rely on modern medicine (n = 20), many used traditional medicine (n = 13), and some had experienced local medicine (n = 9). Only a fraction had solely relied on modern medicine (n = 5) and a select number relied on all three practices for treatment (n = 7). In addition to determining patients' reliance on one or a combination of healing practices, this study identified their perceptions of the strengths and limitations of each method. To this end, the participants' reasonings for relying on certain practices over others for particular ailments were investigated. A key finding was that patients believe the flexibility in the reliance of one or multiple treatment types optimize their health and facilitate access to medical resources. Further collaborations between modern medical practitioners and complementary and alternative medical care providers are necessary to advance the integration of these three practices and ensure patient well-being.

Key messages

Bhutan provides universal health coverage to access basic public health services in both modern and traditional medicine, giving patients the freedom to choose their own modes of treatment. Referrals and communication between modern medical practitioners and complementary and alternative medical care providers are necessary to ensure patient health and well-being.