bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefit and costs of surveillance on cancer risk patients: the example of pancreatic cystic tumors
Authors: Cortesi P A , Tamburino D , Facchetti R , Micale M , Mantovani L G , Crippa S , Capurso G
Published: October 2020

Background

Increasing number of expert recommendations and guidelines of cancer surveillance have become available in the last decade. This complex scenario have increased the uncertainty on the most valuable approach to adopt. This study aim to evaluate the case of premalignant pancreatic primarily cystic tumors surveillance, assessing the differences of programmes proposed and applied.

Methods

A review of American, European and International guidelines for surveillance of asymptomatic neoplastic pancreatic cysts was performed to assess the difference of programmes proposed. An amibispective observational study, form 1995 to 2019, was conducted on patients with premalignant pancreatic primarily cystic tumors monitored in 10 centers from 4 European countries. We estimated incidence of pancreatic cancer and surgery intervention for high grade dysplasia (HGD)/Pancreatic cancer. We also assessed the follow-up visits and exams frequency during the surveillance period and the relative mean cost per patient-year.

Results

The guidelines reported significant differences in patient’s stratification, surveillance intensity (frequency of visits-exams), and surveillance duration. In the study conducted, 961 patients were enrolled with a median (IQR) follow-up of 4.47(2.8-7.0) years. HGD or Pancreatic carcinoma was reported by 43(4.4%) patients and 67(7.0%) undergone pancreatic surgery. Within the pancreatic surgery performed, 60.6% was rated as over-treated (None/low-moderate grade dysplsya). A big variability was reported in the surveillance with a median (IQR) visit per patient-year of 0.77(0.49-1.03) and with a mean cost per-patient year of €163.3.

Conclusions

Significant heterogeneity between surveillance approaches was reported in guidelines and clinical practice. Reliable and specific data on efficacy and costs associated to surveillances programmes proposed are needed in order to perform robust assessment and help decision makers in implementing the most valuable one.

Key messages

Significant variability of surveillance programmes proposed and applied for pancreatic cystic are reported in the guidelines and clinical practice. We need more robust efficacy and costs data in order to identify the most valuable surveillances approach to implement in clinical practice and recommend in the national and international guidelines.
Impact of the 2009-2014 economic crisis on suicide attempts and self-harm in Portugal
Authors: Pinheiro V , Nunes B , Pereira da Silva S , Caetano C
Published: October 2020

Background

Following the worldwide economic crisis of 2008, studies have found an increased risk for self-harm and suicide attempts, many of which need hospital care. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the hospital admission rates by attempted suicide and self-harm in Portugal.

Methods

A retrospective ecological study, with an interrupted time series analysis of hospital admissions by suicide attempts (data from the national Hospital Mobility Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data over 15 years old was retrieved from the National Statistics Institute. Poisson regression models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. All rates were adjusted for seasonality.

Results

A total of 35,077 hospital admission episodes by suicide attempt were retrieved. The mean admission rate was 2.947 per 100 000 inhabitants per month before the crisis, falling to 2.798 during the crisis period. Before the crisis, the total admission rate was decreasing 1% per year. After the crisis erupted, there was a level change, with a sudden increase of 7.9%. The suicide and self-harm admission rate, after 2008, was constant and approximately 38.8% higher than expected if the earlier trend had continued.

Conclusions

There was an increase in the total hospital admission rate by suicide attempts and self-harm during the economic crisis period in Portugal, when compared to the previous period.

Key messages

Economic crisis can pose considerable suicide risks. Urgent action is needed to prevent economic crisis leading to additional suicides.
Building trust and enhancing localization to improve access to women’s health services in Afghanistan
Authors: Rab F R , Stranges S S , Thind A D , Sohani S S
Published: October 2020

Background

Over 34 million people in Afghanistan have suffered from death and devastation for the last four decades as a result of conflict. Women and children have borne the brunt of this devastation. Afghanistan has some of the poorest health indicators in the world for women and children. In the midst of armed conflict, providing essential healthcare in remote regions in the throws of conflict remains a challenge, which is being addressed the Mobile Health Teams through Afghan Red Crescent (ARCS). To overcome socio-cultural barriers, ARCS MHTs have used local knowledge to hire female staff as part of the MHTs along with their male relatives as part of MHT staff. The present study was conducted to explore the impact of engaging female health workers as part of MHTs in conflict zones within Afghanistan on access, availability and utilization of maternal and child health care.

Methods

Quantitative descriptive and time-trend analysis were used to evaluate impact of introduction of female health workers. Qualitative data is being analyzed to assess the possibilities and implications of engaging female health workers in the delivery of health services.

Results

Preliminary results show a 96% increase in uptake of services for expectant mothers over the last four years. Average of 18 thousand services provided each month by MHTs, 70% for women and children. Service delivery for women and children significantly increased over time (p < 0.05) after inclusion of female health workers in MHTs. Delivery of maternity care services showed a more significant increase (p < 0.001). Time trend and qualitative analyses is ongoing.

Conclusions

Introduction of female health workers significantly improved uptake of health care services for women and children especially in extremely isolated areas controlled by armed groups in Afghanistan. Engaging with local stakeholders is essential for delivery of health services for vulnerable populations in fragile settings like Afghanistan.

Key messages

Understanding cultural norms results in socially acceptable solutions to barriers in delivery of healthcare services and leads to improvements in access for women and children in fragile settings. Building local partnerships and capacities and using local resources result in safe, efficient and sustainable delivery of healthcare services for vulnerable populations in fragile settings.
The challenge of bringing evidence in decision-making for public health emergencies: can preparedness reach out to HTA?
Authors: Chronaki C E , Miglietta A
Published: October 2020

Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and reliable data is typically lacking.

The process of including data for preparedness and training for evidence-based decision making in public health emergencies is not systematic and is complicated by many barriers as the absence of common digital tools and approaches for resource planning and update of response plans. Health Technology Assessment (HTA) is used with the aim to improve the quality and efficiency of public health interventions and to make healthcare systems more sustainable. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability to share data and to plan coordinated response. Digital health tools have an important role to play in this setting, facilitating use of knowledge about the population that can potentially affected by the crisis within and across regional and national borders. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define and align mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. Activities and policy development in the HTA network could inform this process. The objective of this presentation is to identify barriers for evidence-based decision making during public health emergencies and discuss how standardization in digital health and HTA processes may help overcome these barriers leading to more effective coordinated and evidence-based public health emergency response.
Discussion: Panel with all the speakers and Q&A from the audience
Authors: Petelos E , Favaretti C
Published: October 2020

Interacting with the audience through Q&A and exploring synergies between HTA and Public Health Emergency Preparedness and Response
Using novel methodologies to support burden of disease estimates
Authors: Hald T
Published: October 2020

A challenge to estimating burden of diarrheal diseases, particularly in LMICs, where laboratory capacity and surveillance systems are limited, is obtaining valid estimates of etiology proportions of cases. A commonly used method is systematic review of studies reporting pathogen isolation in diarrhea cases. However, studies often differ in design, source population, timeframe, and pathogens included, hampering extrapolation to the target population. In a study co-funded by the Bill and Melinda Gates Foundation and the UK Department for International Development, we explore a novel approach for estimating diarrhea etiology proportions in urban and rural populations in four African countries. We analyse sewage samples using short-read next-generation sequencing (NGS) to determine abundance of genes that can be mapped to specific bacterial genera, providing an estimate of the relative abundance of specific pathogens in each sample. In parallel to collecting sewage samples, a questionnaire-based population survey will estimate diarrheal incidence. By combining results, pathogen-specific incidence will be estimated and compared with incidence estimates from the traditional approach. The application NGS to human sewage has great potential for surveillance of foodborne infections, particularly in resource-poor settings where laboratory capacity for bacterial isolation is limited. First, NGS is a one method takes all approach, as it is based on detection of RNA/DNA, a language common across pathogens. Second, it is culture independent, allowing for real-time data generation and standardized sharing. Finally, few samples are needed to survey large populations for several pathogens at the same time. Thus, surveillance based on NGS of sewage may prove to be an indirect measure of incidence. Although it will not provide an estimate for the true incidence in the population, it will increase our understanding of the burden and as such be a proxy and novel way of ranking diseases.
Rapid-review findings of healthcare inequalities experienced by LGBTI people in 27 EU Member States
Authors: Zeeman L , Sherriff N
Published: October 2020

Background

A recent EU funded pilot project to reduce the health inequalities of lesbian, gay, bisexual, trans and intersex (LGBTI) people has drawn attention to the barriers faced by LGBTI people when they access healthcare.

Methods

A component of a larger Health4LGBTI study will be presented where rapid-reviews were undertaken in 27 EU Member States focusing on the barriers experienced by LGBI people and how they can be reduced.

Results

LGBTI people may experience discrimination in healthcare settings based on their gender identity and gender expression, sexual orientation or sex characteristics where heterosexuality, binary gender and assumed male/female sex characteristics were upheld as the norm. Encouraging promising practices in various health settings were evident where the barriers faced by LGBTI people were addressed. The session will present measures required to reduce the barriers faced by LGBTI people via appropriate training of health professionals combined with the efforts of researchers, policy makers and LGBTI people as targeted action across all health systems.

Conclusions

Although encouraging promising practices were evident, much remains to be done, to ensure healthcare becomes equally accessible to all.
Human rights and infectious diseases
Authors: Cabrera O
Published: October 2020

This short presentation will note the lessons from human rights-based approaches to HIV for the responses to other epidemics of infectious diseases.
The potential and current use of mHealth-based self-quantification tools for primary prevention
Authors: Nittas V
Published: October 2020

The panellist Vasileios Nittas will discuss about the potential and current use of mHealth-based self-quantification tools for primary prevention; key barriers and facilitators; their ethical, structural and contextual implications - as well as their impact on developing robust, evidence-based digital (public) health policies.
Building capacity for public urban mental health – example of Reflecting Citizens workshops
Authors: Jevtic M
Published: October 2020

Novi Sad is a shelter of six languages, and the place of encounter of different cultures, of nurturing diversity through jokes, recipes, literature, music, works of art. Diversity and colourful customs in Novi Sad are not just the reflection of positive movements, but also serious events, wars, big migrations, internal and external migrations. Today Novi Sad (and our region) are home of 21 ethnicities, with six official languages, complicated administration, and wish to live in peace.

Having in mind the contents and matrix which are developing in the Reflective citizens (RC) workshops, the idea was born that RC could become part of all activities of the city of Novi Sad, as tool to develop the dialogue of citizens in cultural spaces of Novi Sad, the European capital of culture in 2021.

The idea that Reflective Citizens migrate (move) through different cultural spaces and that thus (in contact with cultural contents) hypotheses, ideas and actions are born, which will in positive communication make contributions to the significance of all cultural values, is justifiable and in time gives a visible, positive result.

Reflecting citizens workshop could be seen as a method for building capacity concerning developing innovative concepts for public urban mental health.

Reflective Citizens workshops contribute in improving health in community through fostering dialogue and mutual reflection. Also, Reflective Citizens workshops are open space for all citizens who want to contribute to dialog, multiculturalism, tolerance, thus contributing quality of life, social environment and mental health also.
Health tourism and public health: when novelty crosses the added value of multilateralism
Authors: Saboga-Nunes L , Amaral A
Published: October 2020

Background

Of the EU citizens, 5% get medical treatment in another EU country (MTT), 33% are willing to travel to get MTT and 53% willing to travel for better quality MTT (Statista 2018). In Portugal between 2017 and 2018 almost 1000 patients were treated in another EU country (cost/mean of 10 thousand Euros). Portugal has increase hindrances in disease care at the NHS. The private sector increased its market share (attracting specialists out of the NHS). While waiting lists, as shortness of human resources prevails, have no sign of changing in the near future, European regulations create expectations to receive appropriate timely MTT. To deal with the complexity of the topic a study case based on cataract disease, will be used. As national strategies try to fill precise gaps to answer specific disease conditions, Medical Tourism (MT) demand can be seen as a strategy to decrease inequalities of access?

Methods

A tracer methodology, looking at cataracts treatment in the population, is used to understand how demand increase can be mitigated with a European answer of MTT.

Results

Although Portugal has the highest rate of cataract operations in the EU28 (14 operations per thousand inhabitants (2015)) demand is not answered by the NHS, with a wating list of 194 days for the first consultation and about 100 days of waiting lists to get operated (and increasing over recent years). Regional municipalities have tried to overcome this NHS failure by offering its populations treatment vouchers in another countries. Nevertheless, the National Audit Office ruled as illegal such initiatives and moreover, at the NHS, cataract operations are not allowed in another country.

Conclusions

Although very rare and specific disease conditions have been allowed to be answered by MTT, common and increasingly debilitated conditions, e.g. cataracts, remain inaccessible for citizens in proper and due time while MT stands as an open option.
An extended comparative analysis using vignettes of dental care coverage
Authors: Fattore G , Winkelmann J , Panteli D , Allin S
Published: October 2020

Background

Virtually all European countries state to guarantee universal healthcare coverage to their citizens. However, there is evidence, although scarce, that dental care is a special case as coverage is very limited in some countries and there are major differences across national jurisdictions. This comparative study tries to better understand how dental care is covered in Europe and Canada through the use of five vignettes presenting dental services for specific patients.

Methods

Experts from each country were asked to state whether the following situations were covered by their statutory systems: a) scaling and polishing to remove plaque deposits and calculus for an adult; b) treatment for caries including fillings and root canal treatment for an adult; c) prosthetic rehabilitation for an elderly; d) fillings and repairs for a seven-year old girl with serious tooth decay; e) orthodontic treatment for a 13 old boy.

Results

Preliminary analysis of the vignettes from 10 countries show that there is a large variation between countries in who delivers dental care, how much it costs and who pays for it.

Conclusions

Full coverage of dental care is rare in Europe and the extent of coverage varies greatly across countries in Europe and also in comparison to Canada.
Policies to prevent non-communicable disease: implementation trends in 194 countries 2015–2020
Authors: Holmer H , Allen L
Published: October 2020

Background

Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide. The WHO proposed 19 “Best Buy” policies to prevent NCDs, mainly addressing four leading risk factors: tobacco, alcohol, unhealthy diets and insufficient physical exercise. Yet, little is known about how implementation has changed over time and the role of geopolitical factors. This study addresses that crucial gap.

Methods

We calculated policy implementation scores for all 194 WHO member states from the 2015, 2017 and 2020 WHO NCD Progress Monitor Reports. We analyzed global trends across the three years for all countries and by geopolitical group and used linear regression to assess association with health, economic and political indicators.

Results

The global average implementation score in 2020 was 47.0% (SD 19.8%), compared to 44.9% (SD 19.1%) in 2017 and 39.0% (SD 19.3%) in 2015. Implementation scores varied by income level (p < 0.001), with high-income countries' average implementation score over twice that of low-income countries (59.7% vs. 28.9%). Implementation improved for all policies in 2015-2020 except the three alcohol policies which decreased. Implementation scores were associated with the proportion of deaths due to NCDs (β 0.8, 95% confidence interval 0.7-0.9, p < 0.001); however, on average, countries with a greater increase in the proportion of deaths due to NCDs were less likely to implement NCD policies (p < 0.001).

Conclusions

Implementation of policies to prevent NCDs is improving over time, but the average implementation score remains below 50% and progress is uneven. Our findings suggest the need to increase implementation of recommended interventions, particularly in low- and middle-income countries and where the proportion of NCD deaths is growing fastest, and to urgently address the decreasing level of implementation of alcohol interventions.

Key messages

Implementation of recommended, cost-effective policies to prevent NCDs is improving but remains low, and alcohol policies are decreasing. Low-income countries, and countries where the proportion of deaths due to NCDs is growing the fastest, are least likely to have recommended policies in place to prevent NCDs.
Automated HIV screening in the emergency department –earlier diagnosis, improved clinical outcomes
Authors: Vaz Pinto I , Guimaraes M , Castro V , Santos C , Galiano A , Friaes J , Bile A , Casqueira A
Published: October 2020

Background

HIV/AIDS is a public health problem worldwide because undiagnosed patients maintain onward transmission. To stop viral transmission an upscale in diagnostics is needed so that more patients start treatment; patients on treatment and with undetectable viral load do not transmit the virus to other persons (“Treatment as Prevention”).

Objectives

We aimed at identifying more HIV infections in the emergency Department (ED) and at doing so earlier in the course of disease.

Methods

we designed an automated and clinician independent HIV screening project in the ED. Electronic Medical Record (EMR) automatically generates a request for HIV antibody (HIV Ab) test when a patient: a) is 18-65 years of age and has a request for any blood test; b) is not identified in the EMR as being HIV infected; c) does not have an HIV Ab in the EMR in the previous year. Nursing staff receive a visual warning of patients' eligibility for screening and an extra tube label is printed out for HIV testing. The patient is informed of screening at the moment of blood drawing and an <> strategy is applied (optional verbal informed consent or <> of screening).

Results

In 16 months, a total of 21.487 people were eligible for screening. 18.072 HIV Ab screening tests were done. The opt-out rate was 6.3% and there were 44 new HIV diagnostics (prevalence rate 0.24%). Late presenting patients (baseline CD4 counts <350) dropped from an average of 56% in the previous 6 years at our institution to 36.3%. Median CD4 count at diagnostics went up from 192 to 388 cells/mm³.

Conclusions

An automated and clinician independent HIV screening program in the ED proved to be successful at identifying more HIV patients and at tackling the problem of late presentation. Diagnosing early in the course of infection is beneficial for the individual patient, but also represents a gain in general public health because onward transmission is stopped by starting antiretroviral treatment.

Key messages

Early diagnosis through universal screening. Treatment as prevention.
Planning tool for the development of interventions to prevent overweight in childhood and youth
Authors: Schröder M , Babitsch B , Hassel H
Published: October 2020

Background

Studies have shown that interventions to prevent excess weight gain in children and teenagers are often planned unsystematically and not evidence-based. Planning high-quality interventions to prevent childhood obesity is a complex process requiring time and personnel, both limited resources in health promotion. The aim of this project is to develop an evidence-based, user-oriented planning tool to support and optimize the planning process of interventions to prevent excess weight gain in children and teenagers.

Methods

To identify existing tools for planning interventions, a systematic literature review (SLR) was first conducted in the databases PubMed, LIVIVO and Cochrane. In addition, seven interviews were carried out with practitioners in schools and communities to determine difficulties encountered during the planning process. This data served as the foundation for the design of an initial draft of the planning tool, which was subsequently tested in focus group discussions (FGD) with potential users.

Results

The SLR identified a total of 23 planning tools. Of these, four comprehensive and evidence-based ones were chosen to compare planning steps and context requirements. The interviews revealed that practitioners require support with problem and needs analysis, target setting and the development of theory-based strategies. The first planning step of the tool was tested in FGD and modified in response to group feedback. An optimized version of the tool can be presented. Future work will focus on converting the tool into a web-based application and pretesting it in schools and communities.

Conclusions

The planning tool will support the systematic development of evidence-based prevention interventions. It provides a comprehensive roadmap to the planning process, guiding the user step by step. The conversion into a web-based application will simplify and support these planning steps. This project is supported by the Federal Ministry of Health, Germany.

Key messages

The tool enables time-saving, structured and quality-assured planning of prevention interventions. Requirements resulting from practice were considered in the development of the planning tool.
Health literacy and associated factors in patients with chronic diseases, Brazil
Authors: Tenani C F , Sousa M L R , Batista M J
Published: October 2020

Chronic diseases of the population have been a global challenge for public health. Considered a new field of study, health literacy (LS) is the ability to obtain and understand basic health information and services needed to make health decisions. Worse outcomes, such as less control of chronic diseases, have been associated with LS. Thus, the objective of the study was to investigate the association of LS, clinical and behavioral conditions in patients with chronic non-communicable diseases (NCDs) users of the public health service in Brazil. It was a cross-sectional study, conducted from July to December 2019, with 238 adult users of the public health service, in a random sample, from 10 basic health units, in Piracicaba-SP, Brazil. A questionnaire was applied to obtain socioeconomic, behavioral, and LS data (Suka et al, 2013). The outcome was LS (high, medium and low) and the independent variables: CNCDs (diabetes, systemic blood pressure), clinical conditions (pressure, tooth loss, pain, visible plaque and insertion loss), behaviors (brushing, use of dental floss), determinants (type and frequency of service use) and self-perception (oral health and quality of life) in health. Descriptive statistical analysis was performed, and the Chi-Square test, based on a conceptual model adapted for LS (5% significance level). They had low levels of literacy 35.3% (n = 84), average 35.7% (n = 85), and high 29.0% (n = 69). Low LS levels were associated with older individuals, low education, less brushing and flossing, irregular use of dental services, edentulism, pain, loss of insertion, negative self-perception of oral health and quality of life, and better systolic blood pressure index. The results of this study show the association of LS with behavioral and clinical factors, showing an important role in the health-disease process in this population. LS should be considered in health promotion policies in future studies.

Key messages

Our study shows the importance of health literacy, and its association with health outcomes in individuals with chronic non-communicable diseases. Within the important global epidemiological panorama of chronic diseases, better understanding the role of LS is important, and it can collaborate with health promotion strategies for this population.
The use of mobile applications as a tool supporting health
Authors: Grzebieluch J , Wołoch M , Felińczak A
Published: October 2020

Background

Mobile health (m-health) covers activities in the field of medicine and public health carried out by using mobile devices. It also includes mobile applications, which are one of the main branches of e-health. The aim of the study was to determine the relationship between the use of mobile health applications by students and everyday behaviour activities that promote health.

Methods

The study involved 208 students of three Wrocław universities. It was conducted from March till April 2018 and the online diagnostic survey (CAWI) method was used.

Results

70.2% of respondents declared they had mobile health applications installed on their smartphone.

49% declared that they used mobile health applications, while 51% did not. Respondents who used the application significantly more often than non-users, took care of their health in almost all of the ways listed in the questionnaire: care about mental health(28%), the quality and duration of sleep(41%), healthy diet(64 %), physical activity(81%), implementation of health-related activities in everyday behaviour(28%), monitoring my health(52%). People, who use health applications significantly more often, undertake most of the physical activities (running 42.2%, working out the gym 39.2%, riding bike 38.2%, attending group classes 33,3%, swimming 21.6%). Respondents use application mostly for 'Registering, supporting physical activity'(80%)

Conclusions

Almost half of the examined group of students use mobile health applications in their daily lives and this group assesses themselves as health-conscious people in its various manifestations and aspects.

These people are more likely to engage in various types of physical activity

Key messages

The results of the research clearly indicate the positive relationship between the use of mobile applications and health-promoting behaviours and undertaking physical activities. The development and dissemination of mobile applications can significantly affect the extension of possibilities for health promotion activities and supporting a healthy lifestyle.
E-health, community housing and nursing interprofessional clinic for equity
Authors: Chiasson R , Aboulhouda I , Roy G , Boucher A , Gagnon M-P , Boutin S , Kankindi B , Ouellet M
Published: October 2020

Problem

From a focus on transmittable diseases, attention to prevention and promotion has become a priority since 2011. Influenced by the Political Declaration of the High-level Meeting on the Prevention and Control of Non-communicable Diseases and The Rio Declaration on Social Determinants of Health, many countries across the world have identified targets aiming at chronic diseases prevention, preventable death and reduced morbidity. Individual behavior changes remain a challenge for health practitioners. Shanghai Declaration suggests that health literacy is a critical determinant for healthy choices and decisions.

Description

A healthy living program has been developed and offered in partnership between local public health and university Laval. We present the case of the community housing Mimosa du Quartier and its preventative nursing clinic. Eight-week Preventative circles and e-prevention interventions from kinesiologist, nutritionist and nurses are explored. IPads were provided to families and we used REACT technology.

Results

Discussion on e-health relevance, feasibility and impact is proposed. Program description, personalised action plan using SMART goals, health literacy and prevention gains are revealed. Relevance, feasibility and perceived impact are discussed. Learning about the user's experience, we can improve the telehealth program in support of continuity of care within the homes of families. This strategy is key to self-management and empowerment Lessons. Health promotion with e-prevention is strategic for sustainable family health. Combining strategies can improve outcomes. This pilot research shows promising results and practical considerations are given to the importance of the relational and alliance aspect of the care relationship even through technology use, to digital literacy capabilities, to family's motivation and engagement and finally to the advantages provided by the technology use.

Key messages

E-health prevention is an innovative avenue to fight chronic disease. Increased engagement in self-management leads to equity and less adverse outcomes for vulnerable families.
Improvement of the module for occupational diseases in the structure of occupational health record
Authors: Iancheva M , Kundurzhiev T , Tzacheva N , Hristova L
Published: October 2020

The study is based on the National Science Program 'eHealth in Bulgaria (e-Health)', funded by the Ministry of Education and Science. Partnership Contract No. D-01-200/16.11.2018

Issue

Occupational health is closely linked to public health and health system. In Bulgaria there are many software products related to the registration and reporting of occupational health.

Description of the Problem

It is necessary to study all the determinants of occupational health, including the risks of diseases and accidents in the occupational environment, social and individual factors. The establishment of electronic systems for registering and monitoring both the health status of each worker and the possible hazards in the work environment is associated with the introduction and use of the occupational health record of each worker.

Results

The methodology for improving the module for occupational diseases in the structure of the occupational health record in Bulgaria has been developed. The classifications are in compliance with the legislation in the country and the requirements of the developing Eurostat methodology for European statistics on occupational diseases are applied. The occupational health record will serve both employers and physicians working in Occupational Health Services.

Lessons

The occupational disease module in the structure of the occupational health record will contribute to the statistical comparability of occupational disease data at regional and national level. Not only will the registration of the harmful factors of the working environment and the diseases related to the work process, but also the introduction of timely measures to ensure good occupational and public health.

Key messages

Through the occupational disease module, the structure of the occupational health record introduces the possibility of taking adequate measures to ensure good occupational health. The occupational health record will serve both employers and physicians working in Occupational Health Services.
Could artificial intelligence make human doctors obsolete? A survey based on public attitudes
Authors: Chen Y Y , Li Y , Li C J
Published: October 2020

Background

With the outbreak of pandemics such as SARS, MERS and COVID-19 etc., making full use of artificial intelligence (AI) become the focus of social discussion. Some experts think AI can reduce infection probability of medical staffs and improve medical efficiency, while opponents believe AI will increase unemployment and medical ethical crises. We try to answer the question: From public perspective, could AI replace human doctors?

Methods

According to occupational status and biological gender, we select four groups as respondents: on-job and retired men, on-job and retired women. We investigate their attitudes towards AI application in medical field. After collecting 400 anonymous questionnaires, we use sample statistics, ANOVA and cluster method (CFSFDP) to find out cognitive similarities and differences between different groups.

Results

Reliability (Cronbach's alpha coefficient) and validity (KMO test) of questionnaires are 0.740 and 0.875 respectively. To the four groups, there are significant (p < 0.01) differences in answers of 7 questions but non-significant differences in the remaining 3 questions. By CFSFDP, questionnaires are automatically grouped into two clusters. Largest group in two clusters are on-job women and on-job men, respectively. Although 82.5% of respondents pay attention to news about AI, the overall average score for “public attitude to AI application in medical field” is 2.828 (full-score is 5.000), below neutral-score (3.000).

Conclusions

To AI application in medical field, cognitive differences among different groups are in existence, especially between on-job men and women. But in general, the public held a negative attitude towards the AI application in medical field, and trust human doctors more.

Key messages

According to the survey, it seems that AI is lesser probability to replace human doctors in recent years. It is also necessary to consider the public attitudes when promoting medical AI.
“The nurse assistant app” to improve healthcare worker performance during antenatal care in Tanzania
Authors: van Pelt S , Massar K , van der Eem L , Shields-Zeeman L , de Wit J B F , Ruiter R A C
Published: October 2020

Background

The Nurse Assistant App (NAA) was developed to improve the quality of antenatal care in Magu District Tanzania by providing digital assistance to healthcare workers. The NAA guides healthcare workers step by step through all necessary antenatal care interventions and provides tailored advice and suggestions for follow-up actions. We used the Intervention Mapping framework to retrospectively evaluate the development of the NAA.

Methods

Desk research into the content, evidence base, and development of the NAA was performed combined with semi-structured interviews with two initial developers to fill in a planning tool consisting of 40 criteria for systematic evaluation of the data.

Results

Findings showed that the NAA was developed based on existing literature on antenatal care guidelines as well as the knowledge and experience of a broad variety of stakeholders and that five of the six steps of Intervention Mapping were performed. However, the development of the NAA lacked a theoretical foundation on behaviour change models. Future research will focus on the experiences of healthcare workers providing antenatal care using the NAA.

Conclusions

The NAA was developed in collaboration with relevant stakeholders and took practical matters as well as evidence from existing literature into account. However, we recommend that the responsibility and ownership of the NAA should be shared with the local government to increase the potential and sustainability of the NAA.

Key messages

The NAA was developed to improve the quality of antenatal care in rural Tanzania targeting healthcare workers. The current evaluation informs future digital health tool developers in sub-Saharan Africa about elements to take into account during the development phase such as systematic mapping of the process.
Digitally-enabled approach to improving primary care in a rural and remote low-resource setting
Authors: Ansell L
Published: October 2020

Introduction

An innovative digitally-supported multi-sectoral solution for supporting end-to-end primary care for rural and remote low-income populations in Western Visayas, Philippines was examined to determine its efficacy in supporting health access. This solution brings together multisectoral stakeholders using a digital platform to coordinate the provision of a virtual primary care system. The solution also supports ordering and delivery of low-cost insurance and medicines, with the aim of reducing out-of-pocket payments and complementing public-sector services.

Methods

Processes and outputs for a novel data-driven digital health solution were documented and analyzed through a mixed methods approach. Researchers conducted interviews with a range of stakeholders, including program beneficiaries and partners. Quantitative data focusing on the project outputs were also examined.

Results

Through an integrated digital platform to coordinate inputs from the public sector (Department of Health); private sector (pharmaceutical, insurance, and telecom firms); and community (in the form of a peer-worker network), this model offers an example of an innovative approach to primary health delivery in low-resource settings. These inputs are leveraged and informed by a 'big-data' precision approach, based on detailed epidemiological profiles of community residents. This dataset allows for the evidence-based identification of village-specific health priorities and development of corresponding interventions. This approach has contributed to increased access to medicines; affordability of medicines and health services; and community resilience among the target populations. However, barriers involving a local shortage of health human resources and cumbersome eHealth regulations affect program impact.

Conclusions

This research provides evidence for the scale-up of a multisectoral digital approach to support the implementation of UHC targets in Philippines.

Key messages

Implementing digital health solutions in low-resource settings is possible. Changes are needed in Philippines health regulations for digital health to properly support UHC implementation.
Information needs of public health professionals in Russia
Authors: Kaygorodova T , Kriukova I
Published: October 2020

Purpose

To analyze information needs of the Russian public health professionals

Methods

Statistical, sociological, bibliometrics and content analysis

Objectives

To analyze results of a survey of information needs of public health professionals; To analyze requests by public health professionals; To present topics and types of information resources needed by public health professionals

Results

public health professionals usually prepare informational and analytical reports and reviews for decision-makers. Therefore, it is important to understand what issues this group of information consumers is interested in, as well as what information resources they may need. To address this purpose, the authors have surveyed this group of specialists and analyzed their requests for information submitted to WHO Documentation Center in the Russian Federation. The results obtained made it possible to define major information needs of Russian public health professionals. By topics, they are arranged as follows: analysis and trends in mortality by age and cause of death; analysis and trends in fertility; analysis of information resources on healthy lifestyles, physical activity, healthy diet an risk factors, as well as analysis of international experience and comparisons. Distribution by information resources used by the public health professionals: Russian collections of statistical data, National report on health; articles from Russian journals on public health and nutrition; statistical databases of the World Health Organization; Eurostat; WHO reports on different public health issues (tobacco control, excessive alcohol consumption, obesity and unhealthy diet, etc.); WHO/Europe reports on health and well-being; WHO evidence reports on public health problems; PubMed - articles on public health questions; Cochrane library, etc.

Key messages

This poster presents the results of a study of the information needs of public health professionals. The study was conducted by interviewing these specialists at conferences and seminars.
Evaluation of Nomophobia and Loneliness in High School Students in Turkey
Authors: Kılınç A , Çam C , Ünsal A , Arslantaş D
Published: October 2020

Background

Nomophobia, short for “no mobile phone phobia”, is defined as having an involuntary and unreasonable fear when the mobile device is unreachable or uncommunicable. Students who are going through the puberty are vulnerable to nomophobia. In the study we aimed to evaluate nomophobia and loneliness levels of high school students.

Methods

This cross - sectional study was conducted in the first academic semester of 2018 and 850 high school students in Eskisehir constituted the study group. To evaluate the nomophobia levels of the students, Nomophobia Questionnaire (NMP-Q) and to evaluate the loneliness levels, UCLA Loneliness Scale was used. The questionnaire prepared in accordance with the literature was filled out by the students under the observation of the researchers. Mann Whitney U, Kruskal Wallis, Spearman Correlation analyses and Multiple Linear Regression was used. P values less than 0.05 was accepted as statistically significant.

Results

In the study group, 429 (50.5%) were female and 421 (49.5%) were male and their ages ranged from 13 to 19, the mean age (SD) was 15.66 (1.18) years. The mean score (SD) obtained from NMP-Q was 54.92 (14.87) while the mean score (SD) obtained from UCLA loneliness scale was 13.95 (4.60). Advanced analysis showed that; in females, in those who first used smartphone before the age of 13 and in those who have more friends on social medias than in real life nomophobia levels were higher. It was also found that the students' nomophobia levels increase with the the number of times they check their phones and the amount of time they spent on their smart phones (F = 28.424, P < 0.001, R²=0.213). There was a positive weak correlation between nomophobia and loneliness levels (r = 0.353, p = 0.001).

Conclusions

It was concluded that nomophobia is an important public health issue among adolescents. Factors that can be changed, such as phone use habits and loneliness was important determinants for nomophobia.

Key messages

Nomophobia may affect the adolescents’ daily but most importantly school life negatively. It might be helpful to plan education programs to raise awareness among the students, parents and teachers for reducing the nomophobia.
Battling the infodemics: health communication effectiveness during COVID-19
Authors: Sabat I , Varghese N E , Neuman-Böhme S , Barros P P , Brouwer W , van Exel J , Schreyögg J , Stargardt T
Published: October 2020

The coronavirus disease (COVID-19) outbreak in many parts of the world has posed serious concerns to the public health. During this period of crisis, the World Health Organization (WHO) reminds all countries and communities that the spread of this virus can be significantly slowed or even reversed through the implementation of robust containment and control measures. The WHO has also asked the public to be careful while reading and spreading health recommendations from untrustworthy online sources of information. Myths and misbeliefs about the prevention and spread of COVID-19 not only create global panic but also pose risks to people's lives and public health in general. Rampant misinformation on the disease slows down the efforts of public health bodies to contain the outbreak. Therefore, the role of public health bodies in communicating the right message and in the right form to the public is crucial.

In our study, we aim to assess the effectiveness of communication strategies used by international and national public health authorities to inform the public on COVID-19 risks and prevention. In particular, we conduct a survey experiment on a large sample (N = 4000) of adults from seven European countries to test the efficacy of public health messages in a form of prevention and corrective information provision. The study seeks to investigate how people's risk perceptions and behaviors change subject to the preventive information provision or treatment with the information countering widely spread misperceptions about the COVID-19 as compared to the control group.

The findings of this research will be relevant for policymakers and public health professionals in the development of effective communication strategies during disease outbreaks.

Key messages

Risk perceptions towards COVID-19 and their determinants across European countries are unknown. Unclear effectiveness of public health messages in a form of prevention and corrective information provision.