bluuebunny/crossref_metadata_2025 huggingface dataset:
Egg consumption and risk of total and cause-specific mortality in a Mediterranean population
Authors: Ruggiero E , Castelnuovo A Di , Costanzo S , Persichillo M , Curtis A De , Cerletti C , Donati M B , de Gaetano G , Iacoviello L , Bonaccio M
Published: November 2019

Background

The relation between egg intake and health outcomes is controversial. We aimed to evaluate the association of egg consumption and risk of mortality in a large sample of an adult Mediterranean population.

Methods

We prospectively analyzed 22,849 men and women aged ≥35 y, recruited within the Moli-sani Study (2005-2010). Dietary data were collected by the EPIC food frequency questionnaire, egg intake was expressed as g/d and used as ordered quintiles. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression and competing risk models.

Results

Over a median follow up of 8.2 y, a total of 1,237 deaths were ascertained. Mean weekly intake was 1.8 eggs (13 g/d) and regular consumers (27 g/d corresponding to more than 2 eggs per week) were more likely to report less risk factors (e.g. history of cardiovascular disease, diabetes, smoking habit). After adjustment for possible confounders, eating eggs >2 times/week) was associated with increased risk of all-cause mortality (HR = 1.21; 95%CI 1.02-1.44 for Q4 vs Q1) and coronary heart disease/cerebrovascular mortality (HR = 1.51;1.04-2.18, for Q4 vs Q1) in a non-stepwise manner; eating more than three eggs per week increased risk of cardiovascular mortality by 33% (HR = 1.33;95%CI 1.00-1.76 for Q5 vs Q1), while no association was found with cancer death or mortality for other causes. Dietary cholesterol explained up to 37% of the excess of CVD mortality risk associated with the highest egg intake (>3 eggs/week).

Conclusions

Regular egg intake (>2 times/week) was associated with increased risk of CVD mortality in a general Mediterranean population, and part of this association was likely due to its cholesterol content.

Key messages

Eating egg regularly is not associated with health benefits, rather it appears to increase CVD mortality risk. High dietary cholesterol content is likely to be on the pathway between egg intake and increased CVD mortality.
Identifying and describing a model region to evaluate the impact of telemedicine
Authors: Harst L , Oswald S , Timpel P
Published: November 2019

Background

Telemedicine solutions providing patient-centered care over distance need to be integrated into the regional setting. The acceptance by both providers and patients hat to be continuously evaluated using methods of participatory implementation research. In controlled trials, often taking place in laboratory settings, these methods cannot be applied. In the following, research in progress is presented.

Methods

Based on socio-demographic data, epidemiology prevalence of age-related chronic diseases and data on the value of health care provision in Saxony, Germany a model region was chosen. Then, a focus group (n = 6) was conducted to differentiate the results and analyze the health networks of patients. For this, network maps putting the individual in the middle and his/her sources of information and support in case of illness in concentric circles around it, were used. The focus group was audiotaped, transcribed and analyzed by two researchers using MaxQDA.

Results

With a mean age of 47.8 years (n = 17,431), high prevalence of diabetes (>15.85 %) and hypertension (>39.1%) and an expected shortage of primary physicians in 2030, the town of Kamenz is a mirror image of the current health care challenges in rural areas of Saxony. Participants of the focus groups also stated problems in finding a primary physician or a dentist. Compensatory behavior, such as traveling large distances, relying on self-researched online diagnoses and immediately going to the emergency room for medical support was described. According to the network maps, primary sources of support in case of illness are partners and relatives, yet there is little connection between those and health care providers, as well as between different medical specialists.

Conclusions

The results will lead to potential use cases of telemedicine to be included into a standardized questionnaire for the assessment of telemedicine readiness in the model region.

Key messages

Telemedicine implementation in a rural area can be studied using a participatory approach. Focus groups and network maps are useful qualitative methods for participatory research and can inform the design of quantitative measurements.
Well Being of Older Gay and Bisexual Men and Women in England: Results of a Cross-Sectional Population Based Study
Authors: Grabovac I , Smith L , McDermott D T , Stefanac S , Yang L , Veronese N , Jackson S
Published: November 2019

Background

Lesbian, gay, and bisexual (LGB) older people are an under-represented population in research, with limited research noting more depression, loneliness, rejection, overall poorer health and well-being outcomes. Our study compared well-being, defined as quality of life (QOL), life satisfaction, sexual satisfaction, and depression, among LGB people with their heterosexual peers’.

Methods

Cross-sectional data from the English Longitudinal Study of Aging, collected 2012-2013. A total of 5691 participants were included in the analysis, with 326 (5.7%) self-identifying as LGB. We used CASP-19 questionnaire for well-being; the Satisfaction with Life Scale for life satisfaction; and the Center for Epidemiologic Studies Depression Scale for depressive symptoms. The question “During the past three months, how satisfied have you been with your overall sex life?” was used for sexual satisfaction. T-test and chi-square tests were used for differences in sociodemographic characteristics between LGB and heterosexual participants. Regression models were used to test associations between sexual orientation and well-being outcomes.

Results

LGB participants reported significantly lower mean quality of life and life satisfaction, and had significantly lower odds of reporting satisfaction with their overall sex life and higher odds of reporting depressive symptoms in unadjusted models. After adjustment for sociodemographic and health-related covariates, there remained significant differences between groups in mean QOL scores (B= -0.96, 95% [CI] -1.87 to -0.06) and odds of sexual satisfaction (OR = 0.56, 95% CI 0.38-0.82).

Conclusions

LGB older people report lower quality of life and lower sexual satisfaction than their heterosexual counterparts, possibly associated with experiencing lifelong social discrimination.

Main message: Older lesbian, gay and bisexual people in England report significantly lower QOL and sexual satisfaction in comparison to heterosexual counterparts.
From health care hospitals to health literate organizations: the case of health literacy of health workers in Brazil
Authors: Martins R , Saboga-Nunes L , Regina Farinelli M , Gabriela Carascosa M , Ribeiro P
Published: November 2019

Background

Health literacy (HL) presents itself as a strategy to rethink lifestyles and enhance health promotion strategies (with the inclusion of social determinants of health) in the workplace. The aim of this research was to evaluate HL levels of health workers from the urgency and emergency sector of a public hospital in Brazil (Uberaba, Minas Gerais, HC/UFTM-SUS).

Methods

An exploratory, quantitative and qualitative research based in the European Health Literacy survey (validated to Brasil HLS-EU-BR) collected data from 216 participants, by the means of a CAWI methodology.

Results

A total of 141 participants were retained for data analysis. HL level of participants from the administrative sector reached a score of 40.0% for insufficient and problematic HL; 33.3% had sufficient HL levels and 26.7% showed excellent HL levels. For the category of Healthcare medium / technical level, 48.2% had inadequate and problematic HL; 37.5% had sufficient and 14.3% showed excellent HL levels. In the third category - Healthcare participants with higher education levels - 31.6% had problematic, 34.2% sufficient and 34.2% showed excellent HL levels.

Conclusions

This is the first time the instrument (HLS-EU-BR) to evaluate HL is used in a health professional setting in Brazil. This research demonstrated that HL is sensitive to socioeconomic differences and highlights the need to promote HL of health workers. Targeting lower socioeconomic groups that have a routine of dealing with the general public in a public hospital to increment HL levels, seems to be an option worth investigating. Such a proposition could not only benefit the specific worker, but target a social change in quality of care, health promotion and social support that can be centered in hospitals. This would trigger the needed change proposed by WHO in Nairobi and Shangai: shifting health care organizations to health literate organizations.
Migration and integration: the case of health literacy (HLS-EU-PT) as a foundation to promote cultural sensitiveness
Authors: Saboga-Nunes L , Silva A , Mendes S , Almeida B , André M R , Reis A
Published: November 2019

Background

Portugal has experienced trough-out his recent history successive migration patterns. Lately, with instability in Syria and the Mediterranean routes of migration between Africa and Europe, new challenges have emerged. One of them is related to migrants’ health and their navigation of health care system. In order to better understand cultural patterns of migrants, this research aims to explore their health literacy (HL) in the context of the European Health Literacy Survey framework (HLS-EU).

Methods

A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores <30). In order to access the migrant condition, a proxy variable considered the participant’s parents origin: at least one of the parents was born in a foreign country.

Results

Out of the 748 participants, 4.1% (n = 31) were considered migrants. Of the migrant participants, 6.9% have inadequate, 51.7% problematic, 24.1% sufficient and 17.2% excellent HL (HLS-EU-PT). Migrants have lower levels of HL when compared with nationals in this sample (respectively 58.6% and 45.8% for insufficient HL) but this difference is not statistically significant.

Conclusions

Although results didn’t show an association between being migrant and lower levels of HL (when compared with nationals), it is nevertheless relevant to consider that more than 1 in every two migrants (58.6%) have insufficient HL levels. Special consideration should be given to this group to promote HL levels and further research is needed to better understand how HL and cultural sensitiveness may work for a better integration of migrants.
Round table: The new EUPHA strategy 2020-2025: what are the new skills public health professionals need
Authors:   Organised by: EUPHA Chair persons: Dineke Zeegers Paget - EUPHA, Marieke Verschuuren - Netherlands
Published: November 2019

2019 is the last full year of the EUPHA strategy 2014-2020: Voicing knowledge. Enhancing capacity. The 2014-2020 strategy has allowed EUPHA to strengthen capacity building throughout Europe and has given our EUPHA sections and EUPHAnxt the visibility they deserve. Voicing knowledge has made big steps forwards with the help of our two presidents: Martin McKee and Natasha Azzopardi Muscat. But society has changed, new threats (fake news) are surfacing, old threats (measles) are coming back and EUPHA and its members need to adapt. In 2018, a working group was installed with representatives from our members, our sections, our Executives and EUPHAnxt to discuss what EUPHA should focus on in the next 5 years. The new strategy has (hopefully) been adopted by all our members in November 2019 (the day before the conference) and is presented here.

Next to the new strategy, EUPHA will have to develop a 5-year work plan to describe what needs to be done to achieve this strategy. More importantly, what is expected of the public health network. What skills do they need? How should the training, life-long education be shaped?

In this workshop, we will first present the changing environment (McKee), followed by a presentation on our new strategy (Azzopardi Muscat and Nagyova). We will than have a Round Table with representatives of our members and of our partners. Questions to be discussed/answered are: do they have these skills already, how can we move forward, what is missing.

Round Table members: Danijela Stimac, Croatian Public Health AssociationYves Charpak, French Society of Public HealthJorid Grimeland, Norwegian Public Health AssociationPasquale Cacciatore, EUPHAnxtWalter Ricciardi, Italian Society of Hygiene, Preventive Medicine and Public Health, president-elect of the World Federation of Public Health AssociationsKasia Czabanowska, ASPHER immediate past president

Key messages

Public health will be stronger when we plan collaborative actions. Evidence to policy should focus on actionable recommendations.
European network staff eXchange for integrAting precision health in the health Care sysTems” project
Authors: Mariani M , Pastorino R , Ricciardi W , Boccia S
Published: November 2019

Background

Precision health aims to prevent and predict illness, maintaining health and quality of life for as long as possible, by drawing on the new technological and data science tools to translate volumes of research and clinical data into information that citizens, patients and doctors can use.

Objective

The ExACT consortium, funded by the Marie Curie Research and Innovation Staff Exchange (RISE) 2017 - Horizon 2020, is aimed at building a community of academic and non-academic institutions that generates high quality, multidisciplinary collaboration by exchanging knowledge in research and training activities on precision health.

Results

From 2019 to 2023, 74 secondments are foreseen; staff involved will be trained on precision health research topics unavailable at their home institutions. The research topics include 5 domains: Integration of Big Data and digital solutions into healthcare systems; design and promotion of innovative citizen engagement models; education of healthcare professionals and leadership; HTA in precision health; Ethical-legal, social, organisational and policy issues surrounding precision health.

Conclusions

Secondees will produce key reports, policy recommendations, scientific papers, and informative materials for citizens, fostering public-private interplay and fostering integration of precision health in the EU health systems, contributing to better health for EU citizens.

Key messages

Once the secondees are back in their home institution, they will use competences acquired during the secondment to advance the research, and transfer the knowledge to the home organization. Sharing knowledge,building synergies and expertise and encouraging best practices,among top-level institutions,will stimulate translational effort for implementing precision health in EU health system.
Asymptomatic malaria: building bridges with communities through patients in Côte d’Ivoire
Authors: Hounsa A , Yao D , Attia A R , Gokpéya M , Sackou K J , Kouadio L
Published: November 2019

Background

In malaria-endemic areas, asymptomatic carriers are a reservoir of parasites that contribue to the persistence of malaria transmission. In Côte d’Ivoire, this situation is poorly documented. The objective of our study was to assess the frequency and socio-environmental factors associated with asymptomatic malaria in the town of Assuefry, located in the northeast of Côte d’Ivoire, a region where malaria prevalence remains high.

Methods

A cross-sectional study in two stages was conducted from October to December 2018, first at the Urban Health Center (UHC) in Assuefry and then in the households. The sample size calculated for patients was 162 extrapolated to 201 people. All persons received at the CSU who had clinical symptoms of malaria and a positive Rapid Diagnostic Test (RDT) were included. In the households of these index subjects, a follow-up survey allowed active RDT screening for malaria among all household members with no clinical signs of malaria. The socio-environmental factors taken into account were: the area of residence (urban or peri-urban), domestic animals husbandry, water storage at home, nearby garbage dump, wastewater collection and disposal system, type of housing and number of people in the household.

Results

The frequency of asymptomatic malaria was 341 (38.8%) out of 879 household members visited. Both female and male gender was concerned (51% vs. 49%). The 5 to 25 years old group concentrated nearly 82% of all cases. Only domestic animals husbandry was associated with asymptomatic malaria at the household level (p = 0.021).

Conclusions

The high frequency of asymptomatic malaria found in this study is a challenge for the National Malaria Control Program in Côte d’Ivoire. This should be taken into account while organizing control strategies.

Key messages

The frequency of asymptomatic malaria in Côte d’Ivoire is high. Control strategies must take into account in the guidelines the challenges of detecting and treating asymptomatic malaria. For the judicious use of antimalarial drugs, any subject with a positive RDT without clinical signs of malaria should receive a ‘Drop - Thick’ before treatment.
Hepatitis B vaccination status and vaccine immune response among children in rural Senegal
Authors: Perieres L , Coste M , Ndiour S , Halfon P , Sokhna C , Ba E , Diallo A , Boyer S
Published: November 2019

Background

Hepatitis B vaccination during childhood is key to reduce the prevalence of Hepatitis B virus (HBV) infection. In Senegal, a highly endemic country, the three-dose hepatitis B vaccine and the birth dose vaccine were introduced in the Expanded Programme on Immunization (EPI) in 2004 and 2016 respectively. This study aimed to determine chronic HBV infection prevalence, hepatitis B vaccination status and vaccine immunity among children in Senegal.

Methods

A cross-sectional study including HBV screening was conducted at home among children aged 6 months to 15 years (i.e. born after the introduction of the HBV vaccine in the EPI) in the rural zone of Niakhar. Dried Blood Spot (DBS) samples were collected for the detection of HBsAg, anti-HBc Ab and anti-HBs Ab using chemoluminescence. Vaccination status was assessed using information on vaccination cards. Detectable vaccine immunity was defined with an adjusted DBS threshold of DOI≥0.36 IU/mL (corresponding to 10 IU/mL in venous blood sampling).

Results

Between October and December 2018, 455 children were enrolled. Preliminary results show that 7/455 (1.5%) had been in contact with HBV (positive anti-HBc Ab) and 5/455 (1.1%) had chronic HBV infection (positive HBsAg).

Only 161/455 (35.4%) children had a vaccination card available. Among those, 150/161 (93.2%) received at least 3 doses of hepatitis B vaccine, of which 83/150 (55.3%) had detectable vaccine immunity. The proportion of children with detectable vaccine immunity was significantly higher in children <5 years than in children aged 5-9 and 10-15 (72.3% versus 47.3%, p = 0.006 and 72.3% versus 14.3%, p < 0.001).

Conclusions

Preliminary results suggest a low prevalence of HBV chronic infection among children born after the introduction of HBV vaccination in Senegal. However, detectable vaccine immunity rapidly decreases with age among vaccinated children, signalling a need for further studies on the immune response to HBV vaccination in this context.

Key messages

HBV chronic infection is low among children born after the introduction of HBV vaccination in Senegal. Further studies on the immune response to HBV vaccination in this context are needed.
Danish policymakers and research evidence in public health policy process
Authors: Loncarevic N , Bertram M , Tanggaard Andersen P
Published: November 2019

Background

Evidence-informed policymaking in public health, understood as interaction of the best available research evidence and “other types of evidence”, is known to have sound influence on population well-being. However, lack of using and producing research evidence by public health policymakers has been well documented. The aim of this study was to assess policymakers’ research involvement in the research process as well as motivators and barriers for the use and production of research evidence.

Methods

A cross-sectional online survey was carried out in the period of Dec 2018 - Jan 2019 using a pre-tested, self-administrated questionnaire. Participants were Danish policymakers’ members of the Danish Society of Public Health (DSPH) and with practical experience being involved in a health policy-making process. The questionnaire was distributed through the DSPH members email list. Reported outcome variables; for this abstract are parts of the larger study: health policymakers’ research involvement in the last 12Mo; policymakers’ motivators and barriers to use and produce research in policy-making.

Results

Response rate: 100/480 (15%). 78% were involved in critical evaluation of research for policy-making; 77% were able to identify relevant research literature; 41% did not use research evidence; 40% did not conduct any surveys; 57% did not write research reports; 65% never used reference systems; 46% did not analyze any research data. The three motivators reported to use and produce research in the last 12Mo were: identification of the problem that needs to be addressed; development of research skills; and job satisfaction. The three main barriers were: other job-related priorities; lack of time for research; lack of research funding.

Conclusions

This study reinforced that public health policymakers need more practical knowledge and skills as well as organizational support and management to use and produce research evidence for evidence-informed policy-making.

Key messages

Successful evidence-informed policymaking requires capacity-building interventions targeting policymakers, supported, implemented and evaluated by their organizations. Policymakers do not dismiss evidence-informed policy practice, but their “positions” and conditions at a work place sometimes do not allow them to fully follow it.
Caesarean section and neonatal outcomes among women of migrant origin in Finland
Authors: Bastola K , Koponen P , Gissler M , Kinnunen T
Published: November 2019

Background

In Finland, limited information is available on neonatal disparities among migrant origin women. We investigated differences in caesarean section and neonatal outcomes between migrant and Finnish origin women in Finland.

Methods

National data from the Medical Birth Register of Finland included information on the most recent singleton birth of all women (n = 382 233) between January 2004 and December 2014. We categorized women into nine regional categories based on their country of origin by linked population data from Statistics Finland. Women with Finnish origin were used as a reference group. Our main statistical method was logistic regression analyses adjusted for age, socio-economic status, pre-pregnancy body mass index, gestational age, parity, marital status, smoking during pregnancy, and ponderal index.

Results

Compared with Finnish women, Sub-Saharan African women had higher odds for caesarean sections OR 2.14 (95% CI 1.96, 2.33), preterm births OR 1.22 (95% CI 1.0, 1.43), low 5 minutes Apgar score OR 3.73 (95% CI 3.09, 4.49), and intensive care unit care OR 1.39 (95% CI 1.24, 1.56) for newborns. South Asian and East Asian women were at increased risk for caesarean births OR 1.52 (95% CI 1.36, 1.71) and OR 1.19 (95% CI 1.10, 1.28) respectively, preterm birth OR 1.46 (95% CI 1.20, 1.77), and OR 1.28 (95% CI 1.13, 1.46) and low 5 minutes Apgar score OR 2.06 (95% CI 1.55, 2.76), and OR 1.36 (95% CI 1.11, 1.67) compared with Finnish women. Middle Eastern and Latin America/Caribbean women had higher odds for caesarean births OR 1.13 (95% CI 1.02, 1.24), and OR 1.66 (95% CI 1.39, 1.97) respectively and low 5 minutes Apgar score OR 1.69 (95% CI 1.34, 2.14) and OR 2.12, (95% CI 1.37, 3.26) compared with Finnish women.

Conclusions

Groups of women with higher risk for caesarean section and poor neonatal outcomes were identified and they may need more attention in maternal and child health services.

Key messages

Women from Sub-Saharan African, East Asian and South Asian origin had an elevated risk for most of the poor obstetric outcomes compared with Finnish women. Women from East Asian and Russian/former USSR countries had lower risk for caesarean section and newborns care in intensive care unit compared with Finnish women.
Vaccination apps: a missing opportunity from various perspectives?
Authors: Catozzi D , Gualano M R , Kakaa O , Voglino G , Bert F , Siliquini R
Published: November 2019

Introduction

Apps for vaccination are rarely a topic in scientific literature, despite the growth of interest in mobile applications about physical exercise, food intake and even chronic diseases management. Since 2014 WHO is wishing and technically supporting the development of a pan-European vaccination app to overcome the trending vaccine hesitancy, and instituted this year a Department of Digital Health. This research aims to evaluate apps for general population, and parents in particular.

Methods

We looked for apps from Google Play Store, the official Android store, searching single words related to vaccination with an Italian IP address, then exporting results. The research provided 1086 univocal apps that underwent a selection based on title, marketplace description and website if available, and further classified by category and other variables.

Results

The 117 selected apps were downloaded 15 million times in total. The most common category is vaccination reminder and recorder (41% of apps with 2.4 mln downloads - DL), alone or as a part of a broad health manager, mostly designed for parents. The second one is medical education apps (35%, 343k DL) most of which in English and designed for healthcare professionals, then games (10.3% of apps but the most downloaded with 12 mln DL), appointment makers (7.7%, 122k DL) powered by Regional Healthcare Service, and vaccination travel managers (6%, 13k DL). Only 26.5% provided both description and app content in Italian.

Conclusions

While literature states reminding apps may be a helpful resource to ease the completion of vaccinal duty, the n° of downloads shows a lack of interest or expose flaws in their features (e.g. absence of translation). This study also displays offer fragmentation regarding these new technological opportunities to raise vaccination awareness among peoples: neither a single Italian app is provided by the Ministry, nor a pan-European app by E.U., making WHO’s wishes even more actual today.

Key messages

Vaccination reminder apps are a helpful but under-utilized tool for parents, maybe due to offer fragmentation, lack of translation and need of country adaptations. The creation of a centralized information service for mobile users is a challenge for European Digital Health in times of trending vaccine hesitancy.
The impact of a national public awareness campaign on dementia knowledge and help-seeking in Ireland
Authors: Hickey D , Glynn R W , Shelley E , Lawlor B
Published: November 2019

Background

Dementia is a growing public health issue in Ireland primarily due to the ageing population. Increasing public knowledge of dementia has been identified as a key priority to reduce disease burden. This study evaluated the impact of a dementia communication campaign on dementia knowledge and help-seeking intention among the general public in Ireland.

Methods

In 2016, a nationally-representative sample of over 1,200 adults in Ireland was surveyed to inform a nationwide dementia awareness campaign entitled Understand Together. Multiple factors were examined including sociodemographic characteristics, dementia advertising awareness, dementia knowledge and help-seeking intention. A similar survey (N = 1,003) was conducted in 2018 to evaluate public awareness of the campaign and its association with dementia knowledge and help-seeking intention. Data from the 2016 and 2018 surveys were analysed using univariable analysis and logistic regression, adjusted for sociodemographics.

Results

Awareness of dementia advertising increased from 17% (2016) to 32% (2018) (p < 0.001). Women (OR 1.51, 95%CI 1.14-2.00), rural residents (OR 1.48, 95%CI 1.10-2.00), respondents aged 40-59 years (OR 1.96, 95%CI 1.40-2.74) or 60+ years (OR 2.18, 95%CI 1.47-3.22), and those who knew someone with dementia (OR 2.06, 95%CI 1.55-2.75) were more likely to be aware of the campaign. Very good or good dementia knowledge and awareness that dementia risk is modifiable increased from 24% to 33% (p < 0.05) and 46% to 52% (p < 0.05), respectively. There was a linear association between campaign awareness and both help-seeking (OR 1.81, 95%CI 1.36-2.40) and holding a positive view of the potential benefits of early diagnosis (OR 1.97, 95%CI 1.35-2.88).

Conclusions

The ongoing campaign, as well as future communication strategies, should continue to focus on increasing awareness of modifiable risk to support prevention. Campaign messaging/modalities should be targeted at harder to reach population groups.

Key messages

Public communication on dementia can improve knowledge and help-seeking. Health communication campaign evaluation can identify, and inform the targeting of, hard to reach population groups.
Public participation in health data governance: a scoping review
Authors: De Freitas C , Silva S , Maia T , Amorim M
Published: November 2019

Background

The sheer growth of the health data shared and traded globally holds great promise and menace to public health. Big health data can foster scientific advancements with potential to heal millions across the globe. However, inerasable digital footprints left by the use of apps and digital services challenge people’s privacy and autonomy in (un)foreseeable ways that may cause them to stop sharing data. While many argue that public participation in data governance is a right, others view it as a means to increase data subjects’ recruitment and amass large quantities of data. Little systematic knowledge exists, however, about the arguments for and impact of public participation on health data policy and management.

Methods

A descriptive systematic scoping review was performed. Studies indexed in PubMed, WoS and PsycINFO published until March 2019 were searched. Only empirical, original, peer-reviewed studies reporting on public participation on health data governance were included. Eligibility and data extraction were performed by 3 researchers.

Results

The 21 studies analyzed point to public participation in several governance dimensions including data access, linkage, dissemination and policy. Involvement of (potential) data subjects in health data governance was substantiated by democratic arguments of legitimacy, transparency and accountability. However, the need to earn public support for data generation and use can override these arguments and foster utilitarian approaches that may transform participatory exercises into a technology of legitimation for a priori made decisions. Furthermore, although public participation in data governance can deliver instrumental benefits (e.g. participant-centred data policy), systematic assessment of participatory exercises’ impact is lacking.

Conclusions

Public participation in health data governance can promote public trust in and thrust for science. Further research is needed to fully assess its impact.

Key messages

Democratic-led participatory exercises in health data governance can foster public trust in science. Further research is needed to fully assess the impact of public participation in data governance.
How primary care and public health interact in local health contracts in France?
Authors: Kendir M s , Bodo Mr Le , Breton M r , Bourgueil M r
Published: November 2019

The demographic and epidemiological changes orient health care services towards communities with a focus on prevention and health promotion. Moreover, in France, the rapid decline of General Practitioners affect access to care in certain areas. Thus, it has made a call for interaction of primary care (PC) services and public health which can be strengthened by the actions at the local level. In 2009, the local health contracts (Contract local de santé; CLS) were developed to foster collaborative actions on the social determinants of health and to improve access to care. Considering the critical contribution of PC in these issues, one may ask how CLS mobilized PC and facilitate linkages between actions oriented toward population and primary care.

The objective of this ancillary study (part of the CloterreS project), is to explore how often and how CLS involve PC in access to care and public health related actions.

A mixed-method study based on document analysis, with a random sample of 17 CLSs (N = 165) from all French regions, was developed. A quantitative analysis of the 440 forms identified in 17 CLS computed frequency of involvement of PC actors and/or PC organizations and a qualitative analysis defined typology of interactions.

All CLS and 20.1% (n = 86) of the forms involved PC actors and 43.2% (n = 185) concerned access to care. Of the access to care forms, 35.7% (n = 66) concerned PC. The most common strategies related to actions on the health workforce and on planning of services. The role of primary care professionals was as the target of the action and rarely as leader and partner.

PC, mostly GP’s involvement, had a big place and access to care was at the core of local health contracts. The impact of CLS as an instrument to invite interaction public health and healthcare at the local level should be further assessed.

Key messages

Many of the local access to care actions involved primary care professionals. The local level appears strategic to integrate public health and health services yet more evidence is needed on its role.
Prison health: governance and monitoring do matter
Authors: Lopez-Acuña D
Published: November 2019

This presentation will focus on the concept of good governance for prison health, touching upon concepts such as equivalence of care, independent healthcare, standards of care and human rights approaches to healthcare in detained settings. Effective governance and policymaking are supported and fostered by timely and accurate information, however this is largely lacking in European prison systems. Although some steps ahead have been made with the launch of the Health in Prisons European Database (HIPED) in 2016, strengthening health information systems in prison settings is a key priority.
Exploring online anti-vaccination movements: the role of social media in public health communications and reporting
Authors: Soborg B
Published: November 2019

Vaccination against Human Papilloma Virus (HPV) was successfully introduced in the Danish childhood vaccination program in 2009 for girls aged 12 with coverage reaching approximately 90%. However, media attention focusing on vaccine safety resulted in a rapid drop in vaccination coverage from 2015. In May 2017, a national campaign “Stop HPV - stop cervical cancer” with aim to regain trust in the official HPV vaccine recommendation and to increase vaccination coverage, was launched. The primary target group of the campaign are mothers in doubt whether to HPV vaccinate their daughter. One of the main elements of the campaign is the social media strategy which includes a Facebook (FB) page “Stop HPV - stop cervical cancer”. New content is made for the page one or twice weekly with a wide range of different post styles used. The FB page is staffed throughout the week and every comment made on the FB page personally answered by the staff. The communication strategy used for the campaign is “heart-brain” with a strategy of communicating “brain” facts about safety and effectiveness of the vaccine while on the other hand telling narrative “heart” stories, such as personal stories of women with cervical cancer. The strategy is in line with recommendations from World Health Organization (WHO) who acknowledge health communication related to vaccines is not only about telling facts, but also about eliciting emotions, creating trust and ensuring genuine understanding by the target group. Communicating on FB about the Childhood vaccination programme has not been used by the Danish Authorities before and there has been a keen interest to learn from the campaign initiative. To quantify and qualify the interaction on Facebook, engagement rates and sentiment analysis to the different types of FB posts have been evaluated and focus groups used to describe the preferred communication style. Data from the evaluation and the impact of the campaign will be presented at the workshop.
Taking the high road: The politics of win-win approaches
Authors: Gingrich J
Published: November 2019

Background

Policy is rarely a direct reflection of public opinion. Party systems and patterns of political competition shape the way issues are presented in politics and the incentive politicians have to act on them. Despite the alleged pro-elderly bias of many political institutions in European countries, and the potential for some types of spending on the elderly to provide broader social benefits, policymakers often do not introduce the most effective policies for supporting healthy ageing.

Methods

Political manifestos and voting patterns will be examined in order to determine how/if public opinions are translating into changes in government that want to tear down the welfare state and blame it on ageing.

Results

Although it is true that public spending (e.g. pensions, health) on the elderly remains more extensive and insulated from cuts than other forms of spending, second, in many (not all) countries policies that would help the elderly age in a healthy way are to introduced. These latter policies, which include spending on the poorest elderly, ensuring access to high quality home care and other services, and investing in declining regions where elderly people are often disproportionately likely to live, often are limited.

Conclusions

Where cross-class/cross-generational coalitions come together to address gender inequities (among the elderly and working age), and develop public services, high road models are possible. Where conflict is framed largely inter-generationally, the well-being of pensioners may be preserved in the short-run, but less investment in the long-run infrastructure of healthy ageing emerges. To make these arguments, the paper shows descriptive patterns of policy developments from the 1980s to today, combined with a brief case study of the UK.
Education, lifestyle and life course differences in level of work incapacity – genes and environment
Authors: Seglem K , Torvik F , Røysamb E , Gjerde L C , Magnus P , Reichborn-Kjennerud T , Svedberg P , Ørstavik R , Vollrath M
Published: November 2019

Background

As many countries face an aging workforce, it is becoming ever more relevant to understand the underlying causes of work incapacity across the entire working age. Previous twin studies have demonstrated that work incapacity is influenced by genetic as well as environmental factors. Furthermore, educational attainment and lifestyle behaviors are relatively stable from early adulthood and are associated with work incapacity. This association may be confounded by unobserved factors - both genetic and environmental. In two separate twin studies, we examine 1) the stability and change in genetic and environmental factors influencing work incapacity from age 18 until retirement, and sex differences in these effects, and 2) the associations and likelihood of causality between educational attainment, lifestyle and sickness absence.

Methods

study 1: A population-based sample of 28,759 twins were linked to high quality national registry data and followed for up to 23 years. We measured work incapacity as the total proportion of potential workdays lost due to sickness absence, rehabilitation, and disability benefits.

study 2: Data from a subsample of 8,806 twins who completed health questionnaires were linked to registry data on sickness absence and educational attainment. Self-reported lifestyle behaviors were smoking, physical activity and BMI (height and weight).

Results

study 1: Structural equation modeling indicated moderate genetic influences on work incapacity throughout life in both men and women, with a high degree of genetic stability from young to old adulthood.

study 2: Preliminary regression analyses indicated that genetic factors largely confound the associations between educational attainment, lifestyle and sickness absence.

Conclusions

Genetic factors seem to be a major issue in understanding causes of work incapacity. Largely the same genetic factors influence individual differences in work incapacity throughout working age.
Maturity of integrated care in Poland - What can we learn?
Authors: Wiktorzak K
Published: November 2019

Issue/Problem

The need for sustainable resourcing drives professionals, end-users and the wider public and private sectors to draw on their experience and expertise to meet those needs. Tools and methodologies that help understand these complex transformational processes and orchestrate discussions of all stakeholders involved are core to this process. As a result, Poland was keen to apply SCIROCCO tool to assess their readiness for integrated care.

Results

The application of SCIROCCO self-assessment tool showed a range of strengths and weaknesses of Poland to adopt and implement integrated care. More than 15 stakeholders were involved in this process which proved the importance and added value to the assessment process. In addition, the outcomes of this process help to identify the potential focus of the capacity-building support.

Lessons

SCIROCCO tool is a very useful participatory tool which can help to drive the transformational change towards integrated care.
Violation of maternal integrity during childbirth: a micro-, meso- and macrostructural perspective
Authors: Batram-Zantvoort S , Wandschneider L , Razum O , Miani C
Published: November 2019

Background

Violation of maternal integrity (VMI) during childbirth is reported by women world-wide and reflects one aspect of gender-related violence against women. Terminology and concepts to describe VMI range from disrespect and abuse over mistreatment in childbirth to obstetric violence. The choice of terms might determine the scope of reference: while mistreatment encompasses rather interactional forms of VMI embedded on a microstructural level of society, obstetric violence includes a critical view on gendered power imbalances and is therefore considering cultural, political and economic exposures situated on macro- and meso-level. To identify different ways of explicitly integrating or implicitly reflecting micro-, meso- and macrostructural dimensions of VMI, we examine terminology, methodology and results in published research.

Methods

For our review, we chose a meta-ethnographic approach, viewing studies on VMI as primary data in terms of defining, collecting, describing and analysing the phenomena of VMI. Our goal lies in first determining the explanatory model of each study and second synthesising these findings to outline a multilevel framework on maternal integrity.

Findings

Studies predominantly concentrate on interaction-related determinants of VMI. To integrate macro- and mesostructural factors of VMI within a comprehensive framework, further epidemiological research on structural and social determinants of maternal health as well as interdisciplinary collaboration on the intertwining of gender imbalances in health care is needed.

Conclusions

By differentiating between macro-to-micro-level factors of VMI, potential causes that go beyond the interaction level (e.g. policy, financial allocation, legal laws, maternal care conditions) can be identified to improve both research and implementation in obstetric care.
Nature-based health promotion: a valuable tool in prison partnerships
Authors: Baybutt M
Published: November 2019

In the context of the current UK prison reform agenda and concern about the high incidence of violence, substance misuse, self-harm and suicide, prison-based horticulture can make a significant contribution to the creation of safe, secure, supportive and health-enhancing environments. By joining up health and justice agendas, therapeutic programmes have the potential to serve as powerful catalysts for wider systemic change, tackling inequalities and social exclusion within societies across the globe.

This presentation critically discusses findings from evaluative research, ‘Greener on the Outside for Prisons’ (GOOP), delivered in prisons in North West England. It aims to illustrate impacts of prisoners’ participation in an innovative social and therapeutic horticultural programme. The qualitative study was informed by a theoretical exploration on socio-ecological model of health emphasising interconnections between environment, behaviour and wellbeing, recognising the dynamic interplay between situational and personal factors; by a psychosocial perspective, positioning the individual in networks of interpersonal relationships, organisations, and social, political and economic systems; and by insights from the Biophilia Hypothesis.

Findings suggest that engagement in GOOP were important to improvements in health and wellbeing with wider context-specific benefits. Working across key agendas of health, education and resettlement, GOOP has effectively demonstrated the potential of horticulture to impact positively on mental wellbeing, physical activity and healthier eating.

Additionally, it contributes towards social inclusion through the development of key transferable skills, life competencies, processes of socialisation, and preparation for successful resettlement and employment beyond prison, which are ultimately key determinants of future health and life chances.
Social cost-benefit analysis of tobacco control policies in the Netherlands
Authors: de Kinderen R J A , Wijnen B F M , Evers S M A A , Hiligsmann M , Paulus A T G , de Wit G A , van Gils P F , Over E A B , Suijkerbuijk A W M , Smit F
Published: November 2019

Background

In the Netherlands approximately 23% of the population of 15 years and older smokes. The main research questions were to identify what social costs- and benefits can be expected when various tobacco control policies would be implemented in The Netherlands, how do costs and benefits change over time, and which sectors in society could expect to incur costs and in which sectors accrue profits.

Methods

A SCBA was conducted using a combination of the Chronic Disease Model developed by the National Institute for Public Health and the Environment (RIVM), the SimSmoke model and a specially designed excel model. Policies included both tax increases (i.e. increase of excise tax on tobacco of 5% or 10% each year) and a policy package as proposed by the World Health Organization (i.e. including mass media campaigns and mediabans).

Results

When no new policy measures are implemented, the prevalence of smoking will decrease by 2.3 percentage points over the next 35 years. The policies reviewed in this report have the potential to decrease smoking prevalence by 14.2 percentage points (and in a ‘smoking-free society scenario, by as much as 17.4 percentage points). Furthermore, the results show that the intervention costs for all scenarios are minimal, and that investing in health is beneficial as seen from both the public health and fiscal perspective.

Conclusions

This study demonstrated that reducing the prevalence of smoking has beneficial effects for various stakeholders within the Dutch society: such as employers (e.g. increased productivity) and consumers (e.g. increase quality of life).