bluuebunny/crossref_metadata_2025 huggingface dataset:
Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide
Authors: Jones A
Published: October 2020

Unhealthy diets are a leading cause of death and disability globally. The WHO recommends Member States implement front-of-pack (FOP) nutrition labels to guide consumers towards healthier food choices, as part of comprehensive strategies to prevent diet-related non-communicable diseases. Interest in FOP nutrition labelling is increasing, but there is limited guidance for policymakers developing regulations necessary for effective implementation. A rapidly evolving evidence base, limited regulatory capacity and possibility of legal challenge by affected food industry stakeholders can create ‘regulatory chill', whereby governments are dissuaded from progressive public health policymaking. We use a framework for analysing public health law and available best-practice guidance to evaluate key components of 31 FOP nutrition labelling regulations endorsed by governments up to June 2019. Analysis of regulatory form shows recent rapid uptake of label formats that are easier for consumers to understand and increasing use of mandatory legislation. However, policymakers must decide much more than whether to apply ‘stars', ‘traffic lights' or ‘stop signs'. The substance of effective regulation must contain strategic regulatory objectives, clear specifications for displaying the label on pack, a valid scoring mechanism and a justified scope for including foods. While there are limited data on current practice, good governance of FOP nutrition labelling regulation also requires transparency and accountability in processes of label development, implementation, evaluation and enforcement to promote continuous improvement and withstand undue commercial interference. Whether developing new FOP nutrition labels or reforming existing ones, our findings support policymakers to design and implement best-practice, evidence-informed regulation.
Recent trends of climate disasters: Lessons we can learn
Authors: Wannous C
Published: October 2020

Dr Chadia Wannous has more than twenty-five years of experience in program management, coordination, and research with particular focus on emergency preparedness and response and risk reduction of health threats. She is currently Coordinator and Senior Advisor at the Towards a Safer World Network for Pandemic Preparedness (TASW). For the past decade, Dr. Wannous served in the UN Office for Disaster Risk Reduction (UNISDR) in Switzerland as Senior Policy Advisor coordinating the implementation and advocacy for the health components of the Sendai Framework for Disaster Risk Reduction and the Science and Technology Partnership, to optimize UN work on global initiatives related to preparedness and response.

This data rich presentation provides a global scan of health impact of climate change and recent health mitigation and adaptation measures.

Dr Wannous will speak to specific examples, what led to these climate initiated disasters, what went wrong or served to exacerbate the catastrophes in terms of preparedness and responses. She will share the lessons learned providing real examples of both public health successes and ‘failures'.
Pharmacists’ one-to-one counseling succeeds in promoting flu shots among target population
Authors: Brunelli L , Morsanutto A , Tosolini M , Iob A , Schiava F , Degrassi L , Pancino C , Andreatti M , Tonutti G , Brusaferro S
Published: October 2020

Background

Vaccine hesitancy among general population can be even greater regarding flu than other vaccine preventable diseases, as complacency towards influenza is quite high and confidence can be reduced by the confounding effect of influenza-like-illnesses. Health professionals face hesitant people alleging many different motivations against flu vaccination, some of them being susceptible to tailored one-to-one health promotion.

Methods

During 2019/20 flu vaccination campaign, 44 trained pharmacists of Carnia District in Friuli Venezia Giulia Region (Italy) surveyed at-risk people accessing 25 pharmacies regarding beliefs on flu vaccination and offered one-to-one advice. As stated in the Italian national vaccination plan, subjects with comorbidities or older than 65 were considered at risk. Adherence to influenza vaccination during past flu season and reasons for that choice, as well as intention to be administered flu shots after counseling were registered.

Results

A total of 2,748 at-risk subjects adhered to the project with a mean age of 70±12 years, 57% of them being females; 1,702 (38%) did not adhere to flu vaccination campaign last year. Most of them confirmed a low complacency level, reporting to have refused flu vaccination because of “not getting ill” (43%) believing that vaccines are dangerous (12%) or not effective (5%); some did not know they could access flu vaccination (8%). After counseling, 2196 (80%) decided to adhere to flu vaccination, in particular 83% (1284/1555) of over 65 and 84% (684/816) of at-risk subjects.

Conclusions

More than one third of over 65 or at-risk surveyed subjects did not receive influenza vaccination during 2018/19 flu season. One-to-one tailored counseling conducted by pharmacists resulted to be effective in tackling vaccine hesitancy among 2019/20 flu shot target population.

Key messages

Motivations underlying vaccine hesitancy toward flu vaccination continue to impair health outcomes of target population. A one-to-one counseling intervention conducted by pharmacists with specific targets should be useful to improve seasonal flu vaccine coverage.
The RHD Endgame Strategy; the blueprint to eliminate rheumatic heart disease in Australia by 2031
Authors: Wyber R , Noonan K , Halkon C , Enkel S , Carapetis J
Published: October 2020

Background

Rheumatic heart disease (RHD) is a preventable yet deadly condition resulting from untreated Group A Streptococcus infection. Despite being eliminated from most high-income countries, RHD and its precursor acute rheumatic fever (ARF) persist in developing countries and settings of disadvantage. In Australia, Aboriginal and Torres Strait Islander people experience among the world's highest rates. Following five years of research, investigation and advocacy, the Endgame Strategy provides a technical foundation to eliminate RHD in Australia by 2031.

Methods

A range of potential strategies to reduce ARF and RHD were identified. Approaches at the social and environmental, primary, secondary and tertiary prevention levels were evaluated using the GRADE Evidence to Decision framework, together with structural review of the health system. Recommendations were made according to level of prevention opportunity and responsibility. Modelling was undertaken to estimate the health and economic impact of an indicative bundle of the most promising strategies.

Results

Reducing household crowding, improving health infrastructure, strengthening primary healthcare and enhancing delivery of secondary prophylaxis were identified as having the greatest potential impact on RHD. They are also largely acceptable, practical and readily implementable with investment. Modelling indicates that this approach would reduce ARF and RHD by 69% and 71% respectively, preventing 471 deaths and saving $188 million on healthcare expenditure to 2031.

Conclusions

Eliminating RHD is only possible with a holistic approach led by Aboriginal and Torres Strait Islander people with communities at the core. This will entail funding communities to develop programs, resourcing a national RHD unit to coordinate efforts across Australia, guaranteeing access to healthy housing and built environments, establishing comprehensive skin and throat programs and improving the health of those living with ARF and RHD.

Key messages

RHD demands responses from the health sector strengthened by political advocacy and engagement to drive evidence-based decision making. The evidence and collective experience now exist to eliminate RHD, an exemplar of the gap in health outcomes between Aboriginal and Torres Strait Islander peoples and the non-Indigenous population.
Coronavirus - Crisis Communication in Croatia
Authors: Grbic M , Grbic D Stimac , Stimac L , Sostar Z
Published: October 2020

Introduction

The coronavirus outbreak has set off alarms around the world, leading to border closures, trade controls, travel bans and other measures. The Wuhan coronavirus epidemic continues to spread globally to the new European hotspot in Italy. New information about the epidemic and the virus is changing rapidly as the virus spreads and appears in parts of the world. Although official announcements by the Croatian Government and Crisis Staff calmed the public with pictures and data on the disease, it showed something else that heightened public concern and caused two conflicting phenomena among citizens - on the one hand, the majority showed understandable doubt about the information that could have raised the concern for their own health while the rest of the population ignored the facts. The market showed complete unwillingness to cope with this epidemic and a chronic shortage of protective equipment (masks, disinfectants...) emerged. Most of the citizens' queries and concerns were moving in the direction of personal protection, child protection and justification for holding large gatherings.

Results

By March 8, 2020, twelve COVID-19 patients were recorded in Croatia, of which 5 were patients in Rijeka, 3 in Zagreb and 4 in VaraÅ¾din. The first sick person is a Croatian citizen from Zagreb who became infected during his stay in Italy (Milan, Lombardy province).

Conclusions

In this crisis, several basic principles of crisis communication with the public have been forgotten: The first source of communication often becomes the source against which everyone else is measured.Accuracy is crucial to credibility.Emotion cannot be countered by facts. People must first know that the government cares.The public should regain a sense of control over circumstances beyond control.A lack of public respect in a crisis undermines trust.Honesty is fundamental to maintaining trust.

Key messages

Accuracy is crucial to credibility. Emotion cannot be countered by facts.
COVID-19 and newspapers: a content & text mining analysis
Authors: Corvo E , De Caro W
Published: October 2020

Background

COVID-19 occurred in Italy in February, after its outbreak in China. The number of news on newspapers and on media was massive, however, this communication did not take into account properly the level of comprehension of general public of health related issues, which in turns can have a huge impact on public health and related policies. In the light of above this study aims to analyze press coverage during the COVID-19 pandemic/epidemic in Italy.

Methods

An analysis of the press and related online journal coverage during CoVID-19 was conducted. A total of 1512 articles in two months were analyzed. Two main analyses were carried out, a coding quantitative content analysis of newspapers article data and a textual analysis and a sentiment analysis using Taltac 2.10 and Voyant Tools.

Results

There was an overall similar idea among different newspapers, this means that both tabloids and broadsheet newspapers show an overall similar content, with a small difference on quality and tone. Results, moreover, displayed two different chronologically lead trends during the COVID-19 crisis. The first two week articles were mainly focused on the illness per se, in terms of prevention, care, cure but also fear, and anxiety; while after a while, around 2 months later newspapers were much more focused on the socio-political-economic impact that COVID-19 had on Italy and potentially could have in the closer future, also for the health organizations.

Conclusions

Newspaper attitude in publishing sensationalistic articles and titles show to take small account of the effect that could potentially have on general public understanding of the issues connected to the virus. This both in the outbreak in terms of what could be the effect of the virus on their health and later on the economy of the country. More attention should be paid in analysing the impact that newspaper communication has on general public behavior and reactions.

Key messages

Information is crucial for the management of epidemic/pandemic disease. Panic of population is the result of inaccurate information communication.
The practicality of telemedicine and telehealth during the COVID-19 global outbreak
Authors: Ohannessian R , Yaghobian S
Published: October 2020

On 30 January 2020, the WHO declared a Public Health Emergency of International Concern (PHEIC) for the COVID-19 outbreak. On 7 March 2020, there were more than 100,000 confirmed cases in 88 countries. Telemedicine, otherwise known as telehealth, has been used at small scale in past outbreaks, including previous coronavirus outbreaks (SARS; MERS) and other PHEICs (Ebola; Zika). The objective was to describe the global larger scale use and practicality of telehealth in the COVID-19 outbreak.

The 2015 conceptual framework of telemedicine during an outbreak for epidemiological assessment and clinical management (Ohannessian R.) was used to describe the use cases. A multi-country analysis from China, France, USA and UK was performed with a literature review using official institution websites, grey literature, media/business reports, as scientific articles were not yet published.

Video and chat consultations were used for symptomatic patient assessments through private telehealth providers in all countries. In the USA, the Telehealth Services During Certain Emergency Periods Act of 2020 was voted by the Congress on 4 March 2020 to suspend restrictive rules of Medicare funding for telehealth home consultations. Triage via online auto-questionnaires were created by private providers and public authorities. In the UK, from 26 February to 2 March, 70,000 enquiries were made to a dedicated NHS111 online service. In China, teleradiology networks were also used for diagnostic of COVID-19 cases. Video consultation was used in France to monitor home isolated patients and non COVID-19 patients, to avoid risks of exposure.

Telehealth has been useful to the COVID-19 outbreak but efforts to better describe cases and evaluate impact on the public health response should be promoted. National and international health authorities should be aware of the opportunities offered by telehealth during outbreaks, and may consider its integration in public health emergencies preparedness plans.

Key messages

Telehealth was useful for the public health response to COVID19 outbreak. Telehealth should be integrated into public health preparedness plans.
Instagramming our way through public health communication: why and who is using it?
Authors: Vareda R , Garcia T , Rachadell J
Published: October 2020

Background

From disease prevention to health promotion, communication is key for Public Health (PH) practice and, according to the 9th Essential Public Health Operation its goal is to improve populations health literacy and capacity to access, understand and use information. Though social media is frequently presented as a potentially useful tool for PH communication, there is a lack of evidence about its effectiveness and impact on PH outcomes. This study researches Instagram® as a PH tool and aims to know who is using it, what content is shared on the platform and how much engagement there is.

Methods

This cross-sectional study regards information on 1000 Instagram® posts with the hashtags publichealth, publichealthpromotion, healthpromotion, publichealthmatters and publichealtheducation. Authors categorized post content and creators, and reviewed the number of likes and comments per post to determine engagement. Data analysis was performed on IBM SPSS® Statistics.

Results

The most common content categories were communicable diseases (n = 383), non-communicable diseases (n = 258) and healthy lifestyles (n = 143). Health professionals post more about communicable diseases (43,6%) and non-professionals about healthy lifestyles (36,1%). Non-professionals (n = 191) post about PH issues almost as much as health professionals (n = 220) and PH associations (n = 201). Most don't reference their sources (n = 821). Posts on communicable diseases have the most likes and comments per post (mean of 172 likes and 3,1 comments).

Conclusions

Half the Instagram® posts analysed in this study were made by health professionals or organizations. Communicable diseases, non-communicable diseases and healthy lifestyles were the most frequent content categories and had the most engagement. The majority of posts didn't reference their sources. Though Instagram® seems to be a potential PH communication tool, further research is needed to confirm its benefits for PH.

Key messages

Social media platforms like Instagram® are potentially powerful tools for PH communication. There is a need to understand the efficacy of social media as health promotion tools.
Labour market trajectories and health in Catalan youth
Authors: Gutiérrez-Zamora Navarro M , Belvis Costes F X , Bolíbar Planas M , Benach de Rovira J
Published: October 2020

Background

Difficulties with integration and job insecurity are currently a characteristic of youth labour market trajectories (YLMT), which have been associated with negative health impacts. This study sheds light on the relationship between YLMT and current health outcomes.

Methods

The study has a mixed methods sequential exploratory design, focusing on young people aged 25-34 in Catalonia, Spain. In the quantitative phase, longitudinal retrospective data from the Survey to the Catalan Youth 2017 SYC-2017 (n = 1247) was used to obtain a typology of YLMT by clustering techniques. Then, the association between such career paths and health outcomes was tested. In the qualitative phase, semi-structured individual interviews were conducted to a sample (n = 12) of SCY-2017 participants, structured according to the typology, sex and rural/urban criteria. Transcriptions were analyzed by mixed generation of categories.

Results

Three types of YLMT were obtained: permanent (PT), temporary (TT) and discontinuous (DT). Compared to PT, TT(p < 0.01) and DT (p < 0.001) were found to be a significant risk factor for self-perceived poor health. Similarly, DT were found to be a risk factor for life dissatisfaction (p < 0.05). Trajectory type is not associated with smoking, however, alcohol (p < 0.05), cannabis(p < 0.05), cocaine (p < 0.05) and overall consumption (p < 0.05) are associated with DT. In the qualitative phase, material deprivation, hazardous working conditions, future unpredictability and the prolonged experience of unemployment, powerlessness and insecurity were identified as key explanatory mechanisms of the YLMT health relation.

Conclusions

YLMT has an impact on different health outcomes and quality of life through numerous causal paths and mechanisms related to the objective and subjective experience of insecurity. The precarisation of the labour market and the lack of decent employment opportunities for the young should be addressed as a primary public health concern.

Key messages

This study highlights the impact of labor market precariousness on the mental and physical health of Catalan youth as a public health concern. Three broad causal pathways have been identified: material deprivation, the ability to act as an organization in the construction of horizons and exposure to physical and psychosocial risks at work.
The cost of diets according to nutritional quality and sociodemographic characteristics in Belgium
Authors: Pedroni C , Vandevijvere S , Seck M , Desbouys L , Castetbon K
Published: October 2020

Introduction

Prices of foods may influence purchases and therefore, the overall quality of diets. Our objective was to estimate cost variations according to the nutritional quality of diets and to identify sociodemographic characteristics associated with the cost differences in adults' diets.

Methods

Data from adults (N = 1,158; 18-64 years) included in the 2014-2015 Belgian National Food Consumption Survey were used. Dietary assessment was based on two 24-h dietary recalls and a food frequency questionnaire. The “Mediterranean Diet Score” (MDS) and the “Healthy Diet Indicator” (HDI) were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the 2014 GfK ConsumerScan panel food price data. Associations were estimated using linear regressions.

Results

The mean diet cost was 5.79€/day (SEM: 0.07). Adjusted for covariates and energy intake, it was significantly higher in the highest (T3) tercile of both scores than in the lowest tercile (T1) (MDS: T1=5.60€/d (0.09) vs. T3=6.03€/d (0.10); HDI: T1=5.42€/d (0.09) vs. T3=6.34€/d (0.10)). Higher intake of fruits, vegetables, fish, dairy products, vegetable oil, fibre and potassium and lower intake of free sugars were associated with higher diet cost. Both diet quality and cost were higher in 35-64-year-old (vs. 18-34 years), active (vs. students) and post-secondary education (vs. secondary education or lower) respondents. The association between quality and cost of diets was weaker in males and among individuals with higher education levels.

Conclusions

Healthier diets are more expensive than less healthy diets in Belgium. These findings contribute to a better understanding of social inequalities in diet in order to support public health policies and actions.

Key messages

Strategies need to be developed to improve the affordability to a healthy diet. In particular, messages promoting healthy diet targeted to the vulnerable populations should better consider the food cost.
Addressing low consumption of fruit and vegetables in England: a cost-effectiveness analysis
Authors: Pinho-Gomes A C , Knight A , Critchley J , Pennington M
Published: October 2020

Background

Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F&V) in England, but economic analyses of structural policies to change diet are sparse. This study aimed to estimate (1) the health and economic burden attributable to the low intake of fruit and vegetables (F&V) by English adults, and (2) the cost-effectiveness of three policies promoting consumption of F&V in England - a universal 10% subsidy, a targeted 30% subsidy for low-income households, and a nationwide social marketing campaign (SMC).

Methods

Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL), and the healthcare costs attributable to consumption of F&V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies.

Results

Low consumption of F&V accounted for 16,321 [10,091-23,516] deaths and 238,767 [170,350-311,651] YLL due to cardiovascular diseases, type 2 diabetes and cancer in England in 2017, alongside £705,951 [398,761-1,061,559] million in healthcare costs. From a societal perspective, the incremental cost-effectiveness ratios were £22,891 [22,300-25,079], £16,860 [15,589-19,763], and £25,683 [25,237-28,671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20,000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy was the only policy that would also reduce inequalities.

Conclusions

Both a SMC and subsidies can significantly increase consumption of F&V and reduce the attributable burden of disease and healthcare costs, but their cost-effectiveness varies substantially. A targeted subsidy to low-income households is most likely cost-effective and can additionally reduce inequalities.

Key messages

Low intake of fruit and vegetables accounts for a substantial number of deaths and years of life lost and represents a heavy burden for the healthcare system in England. From a societal perspective, a targeted subsidy to low-income households was most likely cost-effective and it would reduce inequalities.
Food insecurity among Finnish private sector service workers and food pantry clients
Authors: Erkkola M , Uusitalo L , Puputti K , Saari T , Jallinoja P , Rahkonen O , Nevalainen J , Walsh H
Published: October 2020

Background

There is a paucity of comparable quantitative data on the prevalence and predictors of food insecurity in high-income countries. We applied the Household Food Insecurity Access Scale (HFIAS) to assess food insecurity among i) the Service Union United members; female-dominated, low-income employees of the Finnish private service sector, and ii) a convenience sample of Finnish food pantry clients.

Methods

The HFIAS classification was based on 9 validated questions capturing respondents' perceptions on food scarcity and behavioural responses to food insecurity due to lack of resources during the past month. The resulting indicator categorized respondents as food secure, and mildly, moderately and severely food insecure. We performed cross-tabulations and regression models to assess if education, housing, self-perceived health, income, and resource scarcity associated with levels of food insecurity. In addition, gender, age, and self-perceived disadvantage were assessed among the food pantry clients.

Results

Among the service workers (n = 6 573, 6% of those invited), 35% were food secure, 29% mildly or moderately food insecure, and 36% severely food insecure. The respective proportions were 28%, 26%, and 46% among the 129 food pantry clients. All assessed variables were associated to food insecurity status in the service workers (p < 0.01 for all). Among the food pantry clients, men (OR 1.60; 95% CI 1.09 − 4.80) and homeless/tenants in community rental units (OR 7.12; 95% CI 2.42 − 20.95) were most likely to experience severe food insecurity.

Conclusions

Alongside the food pantry clients the majority of the service workers demonstrated some degree of food insecurity, with a considerable proportion being severely food-insecure. This predominantly low-income group is subject to rapid changes in the labour market and social security systems. The data demonstrated that well-known SES indicators and self-perceived health are linked to food insecurity.

Key messages

Severe food insecurity was common among predominantly low-income private sector service workers and food pantry clients. Food insecurity is linked to SES indicators and wellbeing.
Co-designing mHealth technologies with youth: REACH Initiative in Turkey and Lebanon
Authors: Karadag Caman O , Karabey S , Sumbuloglu I , Yazbik-Dumit N , Ben Amor Y
Published: October 2020

Issue

Many young people face barriers in accessing youth-friendly health information and health care. Differing cultural norms, languages, laws, and stigma pose additional challenges for young refugees in host countries. There is a need to implement more innovative, youth-friendly and widely used solutions to address the health education and health care needs of young people.

Description of the practice

REACH (REfugees Act and Communicate for Health) is a regional initiative, which aims to bridge the gap in health literacy and health care access among refugee and local youth via digital technologies in Turkey and Lebanon. Using community based participatory action research (CBPAR) approach, REACH aims to assess the impact of information and communication technologies on accessing health information and services among youth in countries that host large refugee populations. The initiative is supported by TaiwanICDF, Blue Chip Foundation and Columbia University.

Results

With a strong youth-adult partnership, the initiative includes stakeholders’ meetings, a mixed-methods study (survey and photovoice study with youth, qualitative interviews with service providers and policy makers), photo exhibitions, panels, and production of policy reports and scientific publications. Based on local needs in each country, REACH works with refugee and local youth, software developers, academia, local health authorities, UN organizations and NGOs to develop a multilingual mHealth application to increase health literacy and improve health care access among young refugee and host communities, and aims to assess its effectiveness to contribute to the limited evidence base on using health technologies for youth health promotion in forced migration settings.

Lessons

Using CBPAR and co-design approaches and engaging both refugee and local youth in the process of assessing needs and developing mHealth technologies can help to mitigate risks and increase the success rate of interventions.

Key messages

Community involvement and empowerment as well as harmonization between refugee and host communities increases the success of health interventions and builds a shared environment in host countries. mHealth solutions can be used for youth health promotion in a cost-effective way, and help in reaching vulnerable or stigmatized youth that struggle with health information and health care access.
Development and validation of a social position measure in Greece
Authors: Lamnisos D , Dimou G , Giannakou K
Published: October 2020

Background

A valid measure of social position is important for investigating health inequalities. The registrar general classification is not theoretically based or validated and it is based only on occupation. On the other hand, the National Statistics Socio-economic Classification (NS-SeC) distinguishes between different social positions in terms of both their typical labour market and work situations. The aim of this study was to validate the NS-SeC in a Greek population.

Methods

A cross-sectional study was conducted in 2018 in Athens, Greece. Participants were classified in one of the seven social position classes of NS-SeC based on their responses to questions related to their occupation, employment status (employer, self-employed or employee), supervisor or manager and number of employees in the workplace. Participants were also asked to rate their general health over the previous 12 months in one of three categories: “good”, “fairly good”, or “not good”. The multivariable logistic regression model was used to investigate the predictive validity of NS-SeC.

Results

73 individuals with a mean age 43.2 (sd = 11.5) participated in the study. The 46.6% of the participants belonged to the class “managerial and professional occupations”, the 20.5% to the class “intermediate occupations”, while the 31.5% belonged to the class “routine and manual occupations”. The adjusted odds ratio (OR) for “fairly good” or “not good” general health was five times higher in the “routine and manual occupations” in comparison to the combine group of the other two classes (OR: 5.1; 95% Confidence Interval: 1.4-18.2).

Conclusions

The Greek version of NS-SeC has an excellent predictive validity and it is considered a valid measure of social position in a Greek population. Therefore, it can be used by public health authorities and public health researchers to investigate health inequalities attributed to socio-economic conditions.

Key messages

The Greek National Statistics Socio-economic Classification is a valid measure of socio-economic position. The Greek National Statistics Socio-economic Classification could be used by public health authorities and public health researchers to investigate health inequalities.
Implementation of a self-management programme: recruitment strategies in five European countries
Authors: Doñate-Martínez A , Pisano-González M , Boone A L , Vázquez R , Peñacoba D , Valsecchi V , Zora S , Tan S S , Baker G , Garcés J
Published: October 2020

Introduction

The Chronic Disease Self-Management Programme (CDSMP) has been successfully implemented in over 30 countries worldwide, demonstrating its effectiveness and cost savings to healthcare systems. The CDSMP aims at people with any chronic condition and caregivers, but it has not targeted specific vulnerable populations at different sites simultaneously. In this sense, this study presents the recruitment strategies to involve vulnerable populations in the CDSMP framed under the EU-funded project EFFICHRONIC (ref.: 738127).

Methods

The CDSMP was implemented in five countries (Spain, Italy, France, the Netherlands and the United Kinkdom) approaching several vulnerable target groups. The programme consists of strictly scripted group sessions during 6 weeks imparted by previously trained monitors. EFFICHRONIC recruitment was performed in 3 consecutive steps combining population-based and individual strategies: i) development of vulnerable maps to detect areas with higher vulnerability; ii) creation of alliances with different actors; and iii) identification of end-users.

Results

Over 234 leaders were trained distributed over the five sites and 237 workshops with end-users were organized following the recruitment strategies. The average number of engaged participants per workshop was 13. In total, 2,962 vulnerable persons were engaged and 2,177 finalized the programme, meaning a drop-out rate of 25%. The sample was composed of ethnic minorities, immigrants, refugees, older people living alone or in institutions, people with few economic resources or living in therapeutic communities, inmates and members of different kinds of associations.

Discussion

The strategic coordination at loco-regional level between multidisciplinary stakeholders has been a key success factor to obtain maximum recruitment. The activation of different strategies simultaneously optimized the project results approaching a wide variety of end-users and communities.

Key messages

Stakeholder engagement is crucial to identify and recruit vulnerable individuals in need of support for the management of their chronic conditions. Recruitment strategies must be adapted to each specific context and culture to achieve relevant adherence levels and benefits.
Influencing factors and determinants of health literacy
Authors: Grillich L , Kostial E
Published: October 2020

Health literacy has demonstrable effects on health status and quality of life and is a prerequisite for health-promoting behavior. Thus, health literacy is naturally an Austrian health target. Actions to strengthen health literacy should specifically address its determinants and influencing factors. To provide the best available knowledge for this goal, we developed an impact model of how influencing factors (indirect influence) and determinants (direct influence) will lead to increased health literacy based on the best available evidence

We conducted an umbrella review on systematic, narrative and scoping reviews that deal with concepts, models or definitions of health literacy. The systematic literature search in MEDLINE (Ovid/Epistemonikos) identified 256 relevant abstracts. Two authors checked the abstracts and included 32 in the full text assessment. Fourteen studies were ultimately included in the umbrella review. We extracted influencing factors, determinants, and outcomes and coded, summarized, and renamed them in an inductive approach to ensure uniform terminology. In total, we identified 10 specific influencing factors and 13 measurable determinants. A graphical impact model visualizes the causal relationships between influencing factors and determinants and how they affect the main dimensions of health literacy together: decision, appraisal, access & seek.

The impact model illustrates that health literacy is prevalent when decisions are made and implemented and that strengthening health literacy is best achieved through approaches that influence the determinants at the individual and situational level. With the list of specific influencing factors and measurable determinants, the impact model presented differs from all health literacy models available to date. The impact model gives clear recommendations on which concrete influencing factors and determinants programs for strengthening health literacy should be used to aim for positive changes.

Key messages

Interventions to strengthen health literacy should aim to improve both situational and individual determinants. A key situational determinant is the availability of accessible, understandable and reliable health information.
The French implementation study PARENTHESE to improve prenatal care of immigrant women
Authors: Azria E , Eboue F , Fallon M , Khomry O , Sauvegrain P , Vasseur P , Akrich M , Joinau F
Published: October 2020

Numerous studies have shown that non-Western immigrant women have higher maternal and perinatal mortality and morbidity than women and children from host countries. This increased risk is partly explained by less access to quality antenatal care and more sub-optimal care.

The organisation and provision of prenatal care in France remain unchanged on a model that is not very sensitive and adaptable to the specific needs of certain groups such as non-Western migrant women.

Group prenatal care, an alternative and innovative model, can theoretically be rigorously implemented within the framework of the recommendations for prenatal care set by the French Haute Autorité de Santé and thus meet the objectives assigned to it.

This alternative method of monitoring, implemented in different US settings, seems to increase access and adherence to prenatal monitoring, as well as women's involvement in its monitoring. Some studies also suggest that this type of prenatal monitoring could also reduce maternal and perinatal risk.

Such intervention has never been tested in France and moving away from a prenatal monitoring model based on individual monitoring towards a group model requires overcoming significant cultural barriers. Before being able to test the impact of a complex intervention such as group prenatal care for migrant women and wider deployment, we set up a pilot study with the aim of precisely defining the intervention and preparing and documenting its implementation process in three different sites using qualitative and quantitative approaches. It is also to evaluate its acceptability for women who participate in these groups as well as for professionals.

In addition to presenting this pilot study at this workshop, the objective of this presentation is also to highlight the importance of contextual considerations in the design of the intervention or its implementation in the particular context of intervention aimed at improving migrant populations' health.
Motrial: An international database of public health trials
Authors: Ninot G
Published: October 2020

Background

Trials and intervention studies are the most reliable source of evidence on the effectiveness, safety, and cost-effectiveness of interventions aimed to prevent, care, or cure health conditions. The number of these pragmatic trials has increased exponentially since 2000 in the field of non-pharmacological interventions (NPIs) such as behavioural interventions. The methodology was improved, optimized, and standardized with the contribution of several international organisations such as CONSORT, SPIRIT, TIDieR, PRISMA, and IBTN. Meta-analyses and systematic reviews are more conclusive nowadays.

The main difficulty in carrying out systematic reviews in public health and behavioral interventions is the exhaustivity of queries. Publications are not always identified in classic biomedical databases (e.g. PubMed, Embase) or discipline databases (e.g. PsycINFO). Publishing platforms offer a new format to authors such as Open Access journals (e.g. PLOS One, Scientific Reports, Helyion, JAMA Network Open), Open Archives (e.g. ARXIV, HAL), or independent supports sourced from the academic and research community (e.g. The Conversation). Data collection for relevant study articles is more and more difficult, fastidious, and at risk of biases.

Results

The Plateforme CEPS, which has the general goal of encouraging intervention studies on NPIs, has created in 2018 a search engine that makes it easier to find relevant trials. Motrial distinguishes the main publication from secondary publications and duplicates. It indicates whether the trial has been declared to an ethics committee, registered to the competent authorities, and received funding. This academic search engine in English is free. Each request can be saved, modified, and completed.

Conclusions

The open science and collaborative meta-search engine Motrial helps researchers to find relevant articles of pragmatic studies assessing public health and behavioural interventions (www.motrial.fr).
22.E. Workshop: The planet, economic growth and ourselves: evidence from population health trends in rich countries
Authors:   Organised by: UCL (UK),   Chair persons: Eric Brunner - United Kingdom, Lucinda Hiam - UK
Published: October 2020

Sustainable Development Goal 8 (SDG8) calls for sustainable economic growth, and this is essential for improving population health in developing countries. However, SDG8 also raises a vital and poorly addressed question for rich countries. Is it possible for population health to continue to improve rather than stagnate or even worsen over long periods of zero or low economic growth? The Preston curve, relating average income per person to life expectancy at one point in time, shows the association across countries is highly nonlinear, but does not assess the longitudinal relationship within countries.

In the past decade of low growth and austerity, long-term increasing life expectancy trends in UK and USA have stalled. The reasons for the interruption in health improvement are disputed, and include increased socioeconomic and geographic inequalities, such as early disadvantage, and deaths of despair. If the pattern of low growth and stagnant health trends was repeated across rich countries, there would be reason for concern that continuing population health improvement was incompatible with an environmentally sustainable economy.

The workshop will examine evidence from G7 countries on trends in health and health inequalities over the past 40 years. The headline health indicators are life expectancy, lifespan variation, all-cause and cause-specific mortality and self-rated health. The workshop will bring together recent findings from two distinct research networks, based in UK, Japan and Sweden. The research has been conducted independently, yet is highly complementary in respect of population health trends in the context of the SDG8 policy question: is it possible that rich countries could thrive, absent of economic growth?

Key messages

The relation between economic growth and population health is a vitally important consideration, as policy makers strive to meet climate change targets. Among G7 countries, recent trends in health and health inequalities are both adverse (USA, UK) and favourable (Japan) indicating that low growth can be compatible with improving population health.
Conceptualizing resilience in health systems: results from 30 countries
Authors: Karanikolos M , Maresso A
Published: October 2020

The analytical framework used in the 2019 EU Country Health Profiles defines resilience as “health systems' capacity to absorb disturbance created by changing environments, sudden shocks or crises, and to adapt and respond effectively with the provision of needed services”. These challenges can be driven by changes or shocks in supply (economic shocks, growing shortages in available resources, technological innovations) or demand (demographic changes, public health threats like the Covid-19 pandemic). The Profiles analyse relevant policy measures to assess whether countries are well prepared to face health system shocks and strains.

Methods

The framework distinguishes three dimensions of resilience: Ensuring long-term stability of resources: the capacity to protect or generate adequate financial, physical and human resources, as well as information necessary to address a variety of major challenges.Responding efficiently: the ability to manage the health system with limited resources, through achieving efficiencies, while not sacrificing key priorities, benefits, access or entitlements.Strengthening governance: the capacity to steer the system in order to adapt it quickly to new objectives and priorities and to respond to major challenges through key governance tools.

The profiles use a harmonised approach to analyse the degree of resilience in each country across these three dimensions through a range of quantitative and qualitative indicators.

Results

A matrix clusters the findings from the 30 Country Profiles in 2019 (pre Covid-19 outbreak) and identifies common resilience-related challenges and risks facing EU Member States. The matrix also captures examples of countries that are successfully deploying resilience-building policy strategies.

Conclusions

The evidence shows that resilience is a necessary condition for health systems to mitigate the impact of adversities, as well as respond effectively to both foreseen and unforeseen challenges.

Panelists

Josep Figueras, Moderator, European Observatory on Health Systems and Policies Federico Pratellesi, DG SANTE, European Commission Guillaume Dedet, Health Division, OECD, Paris, France Anna Maresso, European Observatory on Health Systems and Policies, University of Technology Berlin, Germany
Evaluation of a pilot project to increase influenza vaccine coverage in patient with chronic diseases
Authors: Pinsonneault L , Demers K , Dagenais P , Baron G
Published: October 2020

Background

Chronic diseases are a major risk factor for influenza morbidity and mortality. However, influenza vaccine coverage in people with chronic diseases remains low, around 43%, in Quebec, Canada. Various strategies are being tested to improve the vaccination rates for this population.

A pilot project was implemented in a rheumatology outpatient clinic during the 2018-19 season to improve vaccination access in this often-immunosuppressed group of patients. All patients having an appointment at the clinic during the vaccination period were systematically invited to see the nurse and offered vaccination if they met the program criteria, namely if they were taking immunosuppressive drugs.

Methods

Implementation and results of the project were evaluated using mixed methods. Data on vaccination were collected from the nurses' forms and from a patient self-administered questionnaire. Data on implementation was collected through the patient questionnaire and semi-directed interviews with the clinic physicians, the clinic nurse and managers.

Results

A total of 1135 patients were evaluated by the nurses during the project and 427 completed the patient questionnaire. Total vaccination rate amongst patients seen by the nurses was 63%. Based on patient questionnaires results, vaccination was increased by 46%, as compared to the previous year (52% in 2017-18 vs 76% in 2018-19). The project was well received. Key elements of its success were integration in regular clinic activities, support for the initiative by patients and professionals and some logistic aspects such as preloaded syringes. Barriers were mostly related to excess workload and vaccine management.

Conclusions

Overall, the project improved vaccination coverage and was considered a success. Lessons learned were used to adjust and spread this initiative to more outpatient clinics using personnel dedicated for vaccination rather than using the clinic nurse. A phase II project was done and evaluated in 2019-2020.

Key messages

Increasing timely access to vaccination helps to increase influenza vaccine coverage. Managers should plan for the increased workload on clinical and clerical personnel when implementing systematic vaccination offer.