bluuebunny/crossref_metadata_2025 huggingface dataset:
Recognition and Participation of Colorectal Cancer Screening in Turkey: Meta-analysis of Literature
Authors: Aydoğan S , Metintaş S , Önsüz M F
Published: November 2019

Background

The aim of the study was to perform a systematic review and meta-analysis of studies about the proportion of recognition of fecal occult blood test (FOBT) and colonoscopy (CS) methods and participation to them in any period of life for colorectal cancer (CRC) screening in Turkey.

Methods

PubMed, Web of Science, Google Scholar, Turkey Citation Index and YOK Thesis Center databases were screened both in Turkish and English language to identify relevant studies and key words ’colorectal cancer’, ’colon cancer’, ’cancer screening’, ’information’, ’attitude’, ’behavior’, ’awareness’ and ’Turkey’ were. Criteria for inclusion in the analysis were; conducted in Turkey, original and cross-sectional, conducted CRC risky groups (having CRC in the first degree patients and 50 and above age), studies that give the number of participants and number of taking FOBT and CS screening in any period of their lives and/or the number of knowing them. The studies that met the criteria were read as double blind. The data were entered into the Open Meta Analyst demo program. Because of p < 0.001 in the heterogeneity test, random effects model was used in group analysis of the articles. The proportion and 95% confidence interval of knowing and taking FOBT and CS were calculated from the total number of cases.

Results

A total of 1176 articles were reached in first review. Duplications and inappropriated studies were eliminated, and 52 studies were selected. Eight studies about recognition FOBT, 16 about participation FOBT, 9 about recognition CS and 17 about participation CS were taken in analysis. After analysis it was found that 1315 of 4334 individuals (19.3%, 95%CI:6.6-32.1) recognized to FOBT, 1174 of 6825 individuals (13.2%, 8.0-18.5) participated to FOBT, 2197 of 5728 individuals (31.7%, 18.2-45.2) recognized to CS and 913 of 8860 individuals (10.0%, 8.1-12.0) participated to CS.

Conclusions

The proportion of recognition and participation to FOBT and CS were found less than expected.

Key messages

The proportion of recognition and participation CRC screening methods is low in risky groups. Awareness and participation of screening should be increased in risky groups.
Examining multi-layer constraints on activity engagement among older adults
Authors: Lee S
Published: November 2019

Background

Social and cognitive activities motivate the older adults to develop individual aspirations, newfound sources of pleasure, and engagement in later life. The current study aimed to examine a wide range of factors that might impede older adults’ participation in activities, and to provide strategies to manipulate the constraints in the promotion of active ageing.

Methods

We used data drawn from a sample of the Survey of Health, Ageing, and Retirement in Europe (SHARE) wave 7.0. The study sample comprised 48,742 European elderly, aged between 65 and 105 years (54% female). Multiple questionnaire items were used to assess various constraints including socio-demographic factors, personality, social supports, health and psychological indicators. Activities included social and cognitive activities and also moderate physical activities. A series of regression analysis was performed to examine the hypothesized relationships between study variables.

Results

Those older adults who reported negative perception of neighborhood environment (p < .001), poor health (p < .001), chronic diseases (p < .001), and frequent loneliness and depression (p < .001) were less likely to participate in social and cognitive activities. Moderate-level of physical activities were strongly related to the health variables (p < .001) and social supports (p < .001). Among the demographic variables, age was highlighted as the most predictable factor for the decreased participation in activities.

Conclusions

In order to promote diverse forms of activities in later life, we should be better-informed about different nature and variability of the constraints among the older adults. Improving accessibility to the activities such as ageing-friendly facilities and home-oriented social service and recreation programs can help older adults more engage in daily activities.

Key messages

Older adults experience varied constraints on social, cognitive and physical activities. Public health should improve accessibility to diverse forms of activities in later life.
Beliefs About Medicines: Differences in cholesterol treatment adherence among the Visegrad countries
Authors: Boruzs K , Fekete Z , Dombrádi V , Bányai G , Nagy A , Horne R , Bíró K
Published: November 2019

Background

Raised cholesterol is a risk factor for cerebrovascular and cardiovascular diseases. New cholesterol guidelines highlight more personalized risk assessments and new cholesterol-lowering drugs for people at the highest risk for cardiovascular disease.

Methods

The aim of our study was to investigate the possible differences in the beliefs about the necessity and concerns regarding lipid-lowering drugs among the Visegrad Group countries. For this the Beliefs About Medicines Questionnaire (BMQ-Specific) was used. The statistical analyses included 235 Czech, 205 Hungarian, 200 Polish, and 200 Slovak respondents, all of who were taking cholesterol lowering drugs.

Results

After comparing the answers of the citizens of the Visegrad Group countries, no statistically significant difference could be found regarding the concerns about the lipid-lowering drugs. However, related to the beliefs in necessity, a significant difference was shown between Poland and Hungary for the benefit of Polish participants. These results suggest, that the citizens of Visegrad Group countries do not differ regarding their beliefs about the fear of the treatment, while the beliefs about benefits are the most emphasized among the Polish citizens and less among the Hungarian citizens.

Conclusions

While policy makers in the Visegrad Group countries can use the same strategy to address the concerns regarding cholesterol lowering medication, the reasons behind the difference in the beliefs in necessity should be further investigated in order to implement country specific interventions.

The research was funded by the GINOP-2.3.2-15-2016-00005 project which is co-financed by

the European Union under the European Regional Development Fund.

Key messages

No differences exist regarding the concerns for cholesterol lowering medication among the Visegrad Group countries. Concerning necessity significant differences were observed among the same countries, which prompts further research questions.
Relationship between perception of emotional home atmosphere and fruit and vegetable consumption
Authors: Hunsberger M , Elsayed H A G
Published: November 2019

Objective

Consumption of fruits and vegetables (FV) among adolescents falls below recommendations in many Western countries. The impact of socio and emotional aspects of family life on adolescent dietary behavior may contribute to this, yet remains under-investigated. This study examines the association between adolescents’ perceptions of emotional home atmosphere (EHA) and their FV consumption frequency.

Design

A food frequency questionnaire was used to assess FV consumption frequency. EHA was assessed by an eight item measure with three subscales: perceived home warmth, strictness and relational tension. EHA subscales were used as binary variables: a score equal to or above the median value was considered as a higher perception while a score below the median was considered as a lower perception of the EHA in question. Country differences in meeting the European 5/day recommendations are described. Further, the association between EHA and FV consumption frequency is investigated using multiple linear regression.

Setting: Regional examination centers in eight European countries.

Subjects: 3196 adolescents aged 12-18 years.

Results

The mean FV consumption frequency was 3.27(SD = 2.84) times/day. Only 16.1% of boys and 18% of girls in our study sample met the recommendation of 5 times/day. After controlling for age, sex, education level of the parents and country of origin, perceived home warmth was associated with a 16% higher FV consumption frequency (P < 0.001; 95% CI 9- 22).

Conclusions

FV consumption frequency was suboptimal in the survey areas. Interventions targeting perceived warmth as a component of EHA could potentially have a positive effect on adolescents’ dietary behavior.

Key messages

The home atmosphere may be an important driver of fruit and vegetable consumption. Fruit and vegetable consumption is often suboptimal and efforts should be made to target adolescent consumption behaviors.
Developing a regional strategy to disseminate physical activity promotion in childcare centers
Authors: Müller M , Hassel H
Published: November 2019

Background

Despite increasing efforts to promote physical activity (PA) in childcare centers, compliance with PA guidelines remains low. QueB is an intervention to promote children’s and teachers’ capabilities for PA. In QueB1 (2015-2018) a significant increase in children’s and teachers’ PA (steps/hour) in 12 childcare centers in Germany was achieved. The aim of QueB2 (2018-2021) is to establish strategies to disseminate the intervention in one region and to gain access to hard-to-reach childcare centers.

Methods

A regional system of multipliers is built up in a participatory process. Structured discussions with stakeholders (childcare consultants, supervisors) are conducted to find out what role they can play in accessing hard-to-reach childcare centers and what support they need for that. In addition, workshops with teachers from different childcare centers are organized to identify their needs and to create a regional peer-to-peer network.

Results

PA plays only a small role in the work of childcare consultants and supervisors. However, they could give a first impulse as they have regular contact to different childcare centers. Therefore, they need a simple assessment tool that helps them identify childcare centers’ need for support and some tailored information material they can share. In addition, the idea of “PA champions” was developed: Teachers from childcare centers that have already taken part in QueB will be qualified as peer-to-peer-counselors and invite other teachers for work shadowing or to join the network.

Conclusions

Strategies to disseminate PA promotion in childcare centers have to involve peers as well as regional multipliers. A simple assessment tool that helps identify childcare centers’ needs and an online toolbox with diverse supporting material for multipliers and childcare centers are developed.

Key messages

QueB2 will result in regional structures that support the PA promotion of childcare centers. The involvement of peers and multipliers is the key to meeting the needs of childcare centers.
Food and lifestyle education at primary and secondary school: an Italian project on health promotion
Authors: Messina D , Tarroni M , Catarsi L , Balestri C , Messina G , Nante N
Published: November 2019

Background

Nutrition and life styles have a crucial role as health determinants. In particular, an intervention on eating habits and physical activity/inactivity does heavily influence obesity and overweight prevention, alongside associated diseases. Preteen and teenage profile is critical for developing the state of health in adulthood, and it is heavily determined by the sociocultural family background. For this reason, school could become an important actor in health promotion, in the form of coordinated and cross-disciplinary courses about food and behaviors. The aim of the study is to verify the effect of an intervention of food education in several schools.

Methods

This cross-sectional study, originated from the “sCOOL FOOD” project of Monte dei Paschi Foundation of Siena, involves schools of southeastern Tuscany, Italy. The project currently engages various classes from primary and secondary schools in which year-round awareness campaigns are conducted. The activities consist in theory classes and workshops held by professionals or teachers of the school previously trained for the purpose. A same questionnaire was administered to families before and after each campaign, exploring eating habits, lifestyle and biometrics. The data analyzed so far date from October 2017 to May 2018. Wilcoxon signed-rank test was performed on the distributions of children BMI classes, defined according to IOTF cutoffs, obtained exclusively from participants who submitted both questionnaires.

Results

308 paired records of data were collected as mentioned above. We found that, after the campaign, children BMI classes distribution shift towards reduction was statistically significant (z=-2.053; p < 0.05).

Conclusions

Since the intervention was able to influence a childhood health determinant, it could be an opportunity to compensate those family dynamics that could lead towards health disadvantages in adulthood.

Key messages

A coordinated and cross-disciplinary food and lifestyle year-round education campaign at school can impact on health determinants of children. School can correct unfavorable eating and lifestyle behaviors determined by family habits.
Epidemiology of pertussis in Tunisia; results of five years 2013-2017
Authors: Bouguerra H , Hechaichi A , Atawa T , Maazaoui L , Abdeddaiem N , Zorraga M , Sakly M , Alaya N Ben
Published: November 2019

Background

Pertussis or whooping cough, is a highly contagious respiratory disease caused by a bacteria gram negative mainly Bordetella pertussis. It is globally endemic despite a high vaccination coverage. In 2014, the World Health Organization estimated the total number of affected persons to 16 million and the number of child deaths reached 190 000. Since 2012, many countries have experienced a resurgence of pertussis including Tunisia. Our objective was to describe the epidemiological situation of pertussis in Tunisia from 2013 to 2017.

Methods

Our study was a retrospective descriptive study based on data of the surveillance system of Mandatory Reporting Diseases in Tunisia from 2013 to 2017. Data were collected using the declaration standardized forms which included in addition to the socio-demographic data, information regarding vaccination status, date of onset of symptoms and laboratory results (culture and PCR). Data entry was using EpiData and data analysis using SPSS-20.

Results

During the study period, a total of 252 cases were notified. Males were more affected (55.1%). Age was in average 89 days (3 months). Almost the third were hospitalized in Intensive Care Unit (32.2%). Most cases were reported during 2013 and 2014 (35.7% et 55.5% respectively) and the lethality rate reached 7.2% in 2014. Half cases were notified in the Grand Tunis region. PCR was positive in 74.1% of the cases and bacterial culture was positive in 14.3%, isolating Bortedella pertussis. Vaccination status was mentioned in 70.5% of the cases: it was up-to-date in only 35.7% of the cases and incomplete in 9.8% of the cases.

Conclusions

Our results showed that pertussis has known a considerable increase the last years, especially in 2013 and 2014. This prompts us to be more vigilant regarding this disease, which has been neglected the last decades. Education of population as well as health professionals is extremely important, particularly the importance of vaccination and preventive measures.

Key messages

From 2013 to 2017, number of pertussis cases in Tunisia varied with a considerable increase in 2013 and 2014. With the increase of pertussis cases and severity, preventive measures should be taken especially the importance of vaccination.
Changes in disease burden in Poland, 1990-2017: a systematic analysis for the GBD Study 2017
Authors: Ganczak M , Miazgowski T , Kozybska M , Kotwas A , Korzeń M , Rudnicki B , Nogal T , Kopec J
Published: November 2019

Background

In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The study objective was to use the GBD database to assess disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries.

Methods

The results of GBD 2017 for 1990 and 2017 for Poland were used to assess rates and trends in years YLLs, YLDs, DALYs.

Results

Between 1990 and 2017, age-standardized YLL rates for all causes declined in Poland by 46.0%, YLD rates declined by 4.0%, and DALY rates by 31.7%. Greater relative declines were observed for females regarding YLLs/YLDs. There was a decrease in communicable, maternal, neonatal and nutritional disease DALYs (48.2%); DALYs due to non-communicable diseases (NCDs) decreased 2.0%. In 2017, Poland performed better than CE as a whole (ranked 4th for YLLs, 6th for YLDs and 5th for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In both 2017 and 1990, the leading cause of YLLs and DALYs in Poland was ischemic heart disease (IHD), of YLDs - low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although the order was different. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990 and 2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios (OER) were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65 and 2.03 respectively).

Conclusions

Improvement in Health in Poland has been observed since 1990. In 2017 the country outperformed CE as a whole for YLLs, YLDs and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining.

Key messages

In the light of dramatic shortage/aging of the workforce and low public health expenditure, the observed rise in NCDs and between-gender inequalities pose a challenge for the Polish health-care system. To minimize the gap between Poland and Western Europe, an integrated response, which addresses the causes of death and ill-health, particularly those for which rates have increased, is urgently needed.
Daylight saving time and acute myocardial infarction: a meta-analysis
Authors: Manzoli L , Flacco M E , Bravi F , Carradori T , Cappadona R , Fabbian F , De Giorgi A , Manfredini R
Published: November 2019

Background

The current evidence on the effects of daylight saving time (DST) transitions on major cardiovascular diseases is limited, and available results are conflicting. We carried out the first meta-analysis aimed at evaluating the risk of acute myocardial infarction (AMI) following DST transitions.

Methods

We searched MedLine and Scopus up to December 31, 2018, with no language restriction, to retrieve cohort or case-control studies evaluating AMI incidence among adults (≥18y) in the week following spring and/or autumn DST shifts versus control periods. A summary relative risk of AMI was computed after: (1) spring, (2) autumn, (3) both transitions considered together versus control weeks. Stratified analyses were performed by gender and age. Data were combined using a generic inverse-variance approach.

Results

Seven studies (>115,000 subjects) were included in the analyses. A significantly higher risk of AMI (Odds Ratio: 1.03; 95% CI: 1.01-1.06) was observed in the two weeks following spring or winter DST transitions. The risk increase was however significant only after the spring shift (OR: 1.05; 1.02-1.07), while AMI incidence in the week after winter DST transition was comparable to control periods (OR 1.01; 0.98-1.04). No substantial differences by age or gender emerged.

Conclusions

The risk of AMI increases modestly but significantly following DST transitions, supporting the proposal of DST shifts discontinuation. Additional studies fully adjusting for potential confounders are required to confirm the present findings.

Key messages

The risk of acute myocardial infarction increases modestly but significantly following DST transitions. Although preliminary, our findings support the proposal of DST shifts discontinuation.
Association of nationality and education with oral health: a screening programme in Northern Italy
Authors: Del Pin M , Varadi G , Pascut S , Tito R , Dovier A , Covre C , Honsell F , Valent F , Parpinel M , Brusaferro S
Published: November 2019

Background

Socioeconomic status (SES) has been proposed as an important determinant of oral health outcomes. The aim of this project is to assess the association between nationality, parents’ educational level and oral health in a sample of children in Udine, Italy.

Methods

Between February and May 2018, in the context of a screening programme carried out to evaluate the oral health status in 6-year-old children, parents filled out a questionnaire investigating behavioural, socioeconomic and demographical factors. For each child the number of decayed, missing and filled deciduous teeth (dmft) and caries prevalence (CP) were assessed.

Results

The screening was conducted on 976 children, 705 (72%) Italian (I) and 271 (28%) foreign residents (F). Not-Italian nationality significantly increased the CP (F: 59.32%; I: 32.74%; RR: 1.81 [95% CI: 1.57-2.10]; Risk Difference: 26.59 [95% CI: 19.98-33.19]) and dmft median value (F: 2±5; I:0±1; p < 0.0001). Stratified by level of education, the differences between I and F were significant when both parents had low educational level (CP: RR = 1.62 [95%; CI: 1.00-2.62]; dmft: F = 5±5; I = 0±3; p < 0.05) and when both parents had high school education (CP: RR = 1.45 [95%; CI: 1.14-1.84]; dmft: F = 2±6; I = 0±2; p < 0.001). Otherwise, when both parents had university degree, nationality did not increase significantly the outcome (CP: RR = 1.17 [95%; CI: 0.91-1.50; p > 0.1]; dmft: F = 0±2; I = 0±0; p > 0.1).

Conclusions

The analyses suggest that being a foreign resident is a risk factor for lower child oral health. Moreover, parents’ educational level seems to be an effect modifier: when parents had a university degree there was no significant difference between Italians and foreign residents, otherwise the lower the level of education, the greater the difference between the categories. These data may help to identify particularly vulnerable groups and to develop preventive strategies.

Key messages

These findings confirmed the presence of a vulnerable population (foreign residents) in which socioeconomic factors had stronger associations to oral health than Italian citizens. Further research may be useful to identify both protective and risk factors associated with different nationality, in order to evaluate specific interventions in low-SES groups.
Population health indicators availability at regional level across the European Union
Authors: Costa C , Freitas A , Santana P
Published: November 2019

Background

The availability of reliable and comparable data at the regional level is extremely important to measure regional health inequalities. The aim of this research is to assess the data availability of the indicators included in EURO-HEALTHY’s Population Health Index (PHI), a multidimensional tool developed to measure population health across European regions.

Methods

Three consecutive steps where implemented: i) assessment of data availability and reliability of the indicators for the regional level and for the last year with data available; ii) application of a protocol to solve cases of missing data and assure the database completeness and iii) development of an availability scoring system, ranging from 0 (no data available) to 1 (all data available), by indicator and EU region.

Results

A set of 39 population health indicators were assessed. The mean availability is 0.8, ranging from 0.46 (worst) to 1 (best). Indicators such as ’Unemployment’, ’Higher education’, ’Ageing index’, ’Teenage motherhood’, ’Victims in road accidents’, ’Fatality rate’, ’Life expectancy’ and ’Infant mortality’ present the highest scores (>0.95). ’Daily smokers’, ’Pure alcohol consumption’, ’Number of rooms per person’ and access to ’Public water supply’ and ’Wastewater treatment’ present the lowest availability scores (<0.60), mostly due to the availability at the national level only.

Conclusions

This study provides a comprehensive assessment of data availability of population health indicators from multiple areas of concern, at the EU regional level. The results highlight the urgent need for sub-national data in several domains that are important to close the health gap between and within countries. Still, as data collection in EU is driven by a policy derived framework, it is essential to give awareness to the regional scale, prior to the policy development.

Key messages

There is an urgent need for sub-national data in several domains that are important to close the health gap between and within countries. As data collection in EU is driven by a policy derived framework, it is essential to give awareness to the regional scale, prior to the policy development.
How effective is AAL? Results from an RCT among older persons in Austria
Authors: Schmidt L , Majcen K , Löffler K , Schuster E , Augustin T , Murg S , König C , Steiner J
Published: November 2019

Background

Many older people wish to remain in their own environment for as long as possible; an aim shared by the wider community. Here the results of the RegionAAL study (Steiermark, Austria) are reported.

Methods

An RCT was implemented to evaluate a programme of interventions (e.g. medication, drink and physical activity reminders, automatic light systems, watches to detect falls, video telephone with carers). Data was collected via quantitative questionnaires at baseline, 6 months and 1 year regarding quality of life and carers’ burden.

Results

111 persons and 104 carers took part in the intervention group; 110 participants and 100 carers in the control group. Participant characteristics were similar at baseline. Average age was 76 years. Around 1/3 were formal carers. A tendency for more persons in the control group to require assistance after one year could be observed. The subscales autonomy and participation of the WHOQOL-OLD showed some significant declines in the control group (no deterioration in the intervention group). No differences between study arms regarding general health, chronic conditions or hospital admissions were observed. Expected reduction in worry among carers could not be observed, although there was a tendency for some aspects of burden to be reduced. The interventions did not lead to a reduction in carers’ workload; neither did the carers see any direct improvement of their situation.

Conclusions

Some technologies such as cognitive games on the tablet, portable door bell and automatic light sensor were positively assessed. The participants in the intervention group scored better on autonomy and participation subscales than the control group; the intervention group also fared somewhat better regarding independence. The technologies had little influence on general health states or quality of life of participants or carers. Further good quality studies are needed before AAL technologies are considered as a public health initiative.

Key messages

AAL may reduce aspects of worry among carers and prevent age-related decline in autonomy, participation and independence among older persons but not have an effect on general health status or burden. AAL has only a very limited impact upon general health status or quality of life of older persons and the general burden experienced by carers.
Visualising Q - from the bootstrap to interactive graphics
Authors: Staines A , Gauttier S , Connolly R , Davis P , Connolly J , Weston D , Boilson A
Published: November 2019

Introduction

The MIDAS (Meaningful Integration of Data Analytics and Services) project is developing a big data platform to maximize the use of health & social care data. The goal is to link data sources to support senior managers & policy makers in delivering services. The project includes 4 case studies, in 4 countries. As part of the evaluation, we need to understand the perspectives of the users, developers, and senior managers involved, and to see how these change over time. We employ Q-methodology, an objective mixed method for the study of human perspectives, to do this. In this paper we describe the use of bootstrap methods, and visualizations to assist in the execution and interpretation of the first round of our Q study.

Methods

A concourse of 36 items was developed from the literature, a logic model for the project, and a series of semi-structured interviews with project participants. Sixteen people (3 female, and 13 male) took part in the Q study, six developers, five managers, two health professionals, and 3 others. The 36 statements on the concourse were ranked online, by each participant, using the HTMLQ software, in order of their agreement with each statement. These are then subjected to a form of factor analysis, but by person, not by statement, using the qmethod package in R.

For each Q-sort 1,000 bootstrap replications were done, using sampling with replacement. A range of visualisations were prepared, using ggplot2.

Results

Visualizations of bias and variability showed modest levels of both, suggesting that the Q-method model fitted well. Interactive visualizations of the factors, and respondents, were done. These showed distinct clusters of respondents, with divergent perspectives on the project. These assisted in making final decisions, both on the number of factors to report on, and the interpretation of those factors.

Further use of advance visualisations is recommended for future Q-studies.

Funded by the European commission under contract 727721

Key messages

Q methodology is useful across many areas of public health, and is a valuable way of studying individual perspectives. Modern statistical visualisation tools can enhance the interpretation of Q methodology studies.
Sickness absence and disability pension sequences before and after a bicycle crash; a Swedish study
Authors: Kjeldgård L , Stigson H , Alexanderson K , Friberg E
Published: November 2019

Background

In recent years, bicycle injuries have increased, yet little is known about impact of such injures on sickness absence (SA) and disability pension (DP). The aim was to explore the long-term patterns of SA and DP among injured bicyclists.

Methods

A longitudinal register-based study was conducted, including all individuals aged 18-59 years and living in Sweden, who in 2010 had incident in- or specialized out-patient healthcare for injuries sustained in a bicycle crash. Information about sociodemographics, the injury, SA, DP, and deaths were obtained from several nationwide registers. Weekly SA/DP data for four years: one year before and three years after the crash were used in sequence and cluster analyses. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with each sequence cluster.

Results

Among all 6465 individuals injured in a bicycle crash 2010, five clusters were identified: No SA or DP (60.2%), Immediate SA (17.7%), Episodic SA (15.3%), Part-time DP (1.6%), and Full-time DP (5.2%). Compared to the cluster No SA or DP, all other clusters had high ORs for female sex, older age, living in small cities/villages, and inpatient care. Immediate SA also had high ORs for cyclists who sustained a fracture (OR 5.53; CI 4.47-6.83), dislocation (3.26; 2.29-4.65), sprains and strains (2.29; 1.68-3.10), and internal injuries (4.39; 1.95-9.90). Episodic SA had high ORs for other traumatic brain injury than concussion (6.27; 2.23-17.64) and injuries located in the spine and back (3.52; 2.12-5.86), torso (1.78; 1.29-2.45), upper extremities (1.95; 1.54-2.46), and lower extremities (1.85; 1.43-2.41).

Conclusions

Having SA in direct connection to the crash was associated with type of injury, in contrast to Episodic SA where the injured body region was of more importance, in particular other traumatic brain injuries and injuries to the spine and back.

Key messages

This nationwide study of new bicycle crashes found five clusters of sickness absence (SA) and disability pension (DP) sequences; No SA or DP, Immediate SA, Episodic SA, Part-time DP, and Full-time DP. The type of injury was more important for SA in direct connection to the crash, while the injured body region was of more importance for continued and repeated SA up to three years after the crash.
Prognostic and Predictive biomarkers in a Mediterranean cohort (Review from Atena Project)
Authors: Rubba F , Gentile M , Scamardo M S , Iannuzzo G , Panico C , Pacilio M , D’Onofrio G , Panico S , Rubba P , Triassi M
Published: November 2019

Background

Atena project involved 5,062 women aged 30 to 69 years living in the area of Naples. The purpose of this study is to investigate the causes of those chronic diseases that have a major impact on the female population. As a part of the design (scheduled in 2002-2004). After 10 years, in 228 women, some biochemical measurements were performed.

Methods

This systematic review and meta-analysis biomarkers were evaluated in studies nested into the Atena cohort. Studies were searched using MEDLINE/PubMed. The search was performed by entering individually or in combination: Atena, Mediterranean woman, biomarkers. The preferred reporting of systematic reviews and meta-analysis (PRISMA) guidelines were used for the review. Studies selected for this review are conducted in the Atena project Cohort and reported the study of biomarkers. Disagreements on data extractions between the two investigators were solved by consensus. The extracted data were entered and analyzed using REVMAN software. The original articles were described using forest plot and table. Heterogeneity was computed by Cochran’s Q test.

Results

The search strategy retrieved 13 potential articles, 11 were screened as full text articles and 6 were included in the pooled estimates. Among the articles included, biomarkers chosen as predictors were Lipids, Hcrp, as prognostic where predictive of IMT; and cycle length and LPa as predictive of an augmented LDL cholesterol mean. According to the comparability of data presented, for the first comparison we selected 3 of the 5 studies that assed IMT, for the second we selected 2 of the three studies that analyzed for LDL mean. Results were shown into forrest plots. The pooled estimates verified the potential of biomarkers as predictor of IMT, the significance seemed lower for prediction of LDL cholesterol.

Conclusions

Both results, consistent with the multifactor profile of the CV risk, identify the impact of secondary prevention according to biochemical profiles.

Key messages

Biomarkers studied in nested cohort stufies have predictive potential. pooled estimates may identify the impact of secondary prevention according to biochemical profiles.
Against lead poisoning: effectiveness of housing first and counselling in the home
Authors: Laporte R , de Barberini H Barberin , Jouve E , Hadji K , Gentile S
Published: November 2019

Background

Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurological development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and relocation) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration).

Methodology

A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions.

Results

151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p < 0.005; p < 0.05 and p < 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p < 0.005).

Conclusions

Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices.

Key messages

In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy. But, environmental health and access to housing first needs to be addressed for their implementation.
Atlases of variation for elective surgery to tackle wasteful care
Authors: Piso B , Buhmann V
Published: November 2019

Background

In 2017, the OECD suggested robust information systems as one of five measures to tackle wasteful care. Atlases of variation identify variations that may not be medically justified. The aim of this study was twofold: 1. to identify atlases that target variations in the provision of elective surgery and 2. to analyse the interventions that have been addressed.

Methods

We conducted an online search for atlases of variation on websites and by a selective literature search in PubMed. When necessary, we contacted public health institutes to retrieve further information. We included online and/or paper-based atlases that analysed data on elective surgery. Other atlases (e.g., epidemiological) were excluded. We transferred basic (e.g., on country, language and methods) and specific information on analysed interventions into a predefined data extraction scheme.

Results

We identified 12 international atlases that fulfilled our inclusion criteria (2 from Germany, 1 from Belgium, France, Great Britain, Norway, The Netherlands, Switzerland, Spain, Australia, New Zealand and the US). In addition to reports/factsheets, 9 atlases provide additional interactive online applications. In total, about 70 different surgical interventions have been analysed, most often the following: Interventions to treat diseases of the musculoskeletal system (11 atlases: e.g.; knee (9), hip (7) and spinal (4) surgery), diseases of the digestive system (9 atlases: e.g., appendectomy (6), cholecystectomy (6), bariatric surgery (4)), diseases of the genitourinary system (8 atlases: e.g., prostatectomy (6), hysterectomy (5)), caesarean sections (8 atlases).

Conclusions

Despite the large number of interventions, their pattern of analyses might point out known problem areas across countries. Atlases of variations cannot solve the problem of inappropriate care, but help prioritise areas of actions with the greatest need and the best chances to improve the quality of care.

Key messages

Atlases are commonly used to provide publicly available information on variations in elective surgery. The analysis of interventions across countries provides information on potentially most relevant areas.
A systematic review of factors influencing pregnant women’s future vaccination choices
Authors: Rosso A , Massimi A , Adamo G , Baccolini V , Pitini E , Vacchio M R , Marzuillo C , De Vito C , Villari P
Published: November 2019

Background

Over the last years, vaccine hesitancy has been increasing globally, leading to a decrease in vaccination coverage in several Countries, mostly in Europe. Several systematic reviews were conducted to assess the determinants of hesitancy and of vaccination choices, but none of them focused on pregnant women, which would represent an ideal population to promote correct information on vaccines.

Methods

We conducted a systematic review of studies assessing knowledge and attitudes on paediatric vaccinations, vaccination choices and their determinants among pregnant women. We searched Medline, Scopus and Web of Science, adapting search terms to the different databases, following PRISMA Statement criteria. No time limits were set.

Results

A total of 5,309 records were retrieved. After duplicates removal and title/abstract selection, 15 full texts were included in the narrative synthesis. Most studies (14/15) were quantitative surveys, 2 focused only on specific vaccines (rotavirus and HPV), 4 studies were conducted in European countries (Germany and Italy). The main factors associated with vaccine hesitancy or refusal were the fear of side effects, in particular for the most recent vaccines, the perception of a greater importance of natural immunity and a low perception of utility of vaccines, the lack of trust in health professionals, having obtained information on vaccines not from a doctor, primiparity and a low level of education (for these two last factors, with inconsistent results between studies).

Conclusions

Available evidence shows that the perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers, and that the determinants of hesitancy may vary in different contexts. Pregnant women represent a key population for the implementation of interventions aimed at increasing knowledge and acceptance of vaccinations, which should be based on an analysis of the specific context.

Key messages

The perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers. Interventions aimed at increasing knowledge and acceptance of vaccinations should be based on an analysis of the specific context.
Comorbidity associated with Severe Mental illness (The APNA study)
Authors: Aguinaga-Ontoso I , Brugos-Larumbe A , Guillén-Aguinaga S
Published: November 2019

People with severe mental illness (SMI) that includes bipolar disorder or schizophrenia die on average 10-20 years sooner than the general population. Poor mental health can negatively affect quality of life and life expectancy more so than having multiple physical illnesses. The division between health services treating mental and physical health often means that patients suffering from both physical and mental conditions are at particular risk of poor care. Although more than 50 million people in the EU suffer multiple from more than one chronic disease, it is not well know the comorbidity associated with severe mental illness.

Methods

The study is a cross-sectional study within the APNA Study (Navarre primary health care prospective cohort) that included 470942 people over 18 years old in Navarre (Spain). Age, sex, chronic diseases diagnosis and SMI) that includes (bipolar disorder or schizophrenia were extracted. Lineal regression models for the number of chronic disease were computed. Logistic regression adjusted by sex and age, was computed for each chronic disease.

Results

Adjusting by age and sex, people with SMI have 1.47 (95% CI 1.44-1.50) more chronic diseases than people without SMI. Adjusting by age and sex, persons with SMI have a higher prevalence of comorbidity: OR = 13.29 (95% CI = 12.27-14.36). Patients with SMI have a higher prevalence of asthma OR = 1.41 (95% CI 1.21-1.64), COPD OR = 2.30 (95% CI 2.51-3.35), Type 2 DM OR = 1.50 (95% CI 1.31-1.70) hyperthyroidism OR = 1.63 (95% CI 1.26-2.10), Chronic kidney disease OR = 1.,43 (95% IC 1.10-1.88), Obesity OR = 1.68 (95% CI 1.47-1,92) and Hypothyroidism OR 1.63 (95% IC 1.43-1,85).

Conclusions

Patients with severe mental illness have a higher prevalence of comorbidity than the general population with an OR of 13.29. Health service should screen patient with severe mental illness for chronic diseases due to their high prevalence and mortality.

Key messages

Patients with severe mental illness die on average 10-20 years sooner than the general population this could be to a higher prevalence of comorbidity. Health services should screen patients with severe mental illness for chronic diseases due to their higher prevalence.
Organising preventive care and support networks: a need for citizen-centred service delivery
Authors: Fluit M , Reindersma T S , Broekhuis H , Bortolotti T
Published: November 2019

Background

There is a growing interest in providing preventive care and support services at a district level (Goodwin, 2014; Kernaghan, 2005) in a citizen-centred way, i.e., accessible, delivered seamlessly, and complying with citizens’ needs and capabilities (King & Meyer, 2006). Currently, those citizens who might need it most are not reached and services provided suffer from a lack of coherence (Kodner, 2009; Stange, 2009). This study aims to examine how local authorities organise more accessible and integrated preventive care and support services against reasonable costs at a district level.

Methods

An exploratory multiple case study approach was adopted. The unit of analysis was the organisation of the preventive care and support delivery process. Policy documents were analysed and 13 semi-structured interviews were conducted with professionals in four Dutch districts.

Results

Our findings show that three stages of the delivery process should be distinguished, as within each stage a set of specific key design decisions were taken aiming to contribute to easy access and integrated service delivery. These three stages are (a) entrance, (b) exploration of needs and capabilities, and (c) the development of care and support networks. Each case showed a unique constellation of choices on these key decisions, and explicated their motives for organising it in this way. Examples of these key decisions are: the number and location of access points, the number of different professionals involved (indicating the level of (de)coupled process), and the type of professionals involved.

Conclusions

The results show that different stages and design decisions could be identified across the four cases. These, as well as clear interfaces between the stages, can be regarded as a constellation of choices through which citizen-centred delivery could be enhanced.

Key messages

Importance of design decisions in citizen-centred delivery. Focus on multi-faceted issue of organising integration within the different stages.
DNA stable isotope probing reveals contrasted activity and phenanthrene-degrading bacteria identity in a gradient of anthropized soils
Authors: Lemmel Florian , Maunoury-Danger Florence , Leyval Corinne , Cébron Aurélie
Published: November 2019

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous soil organic pollutants. Although PAH-degrading bacteria are present in almost all soils, their selection and enrichment have been shown in historically high PAH contaminated soils. We can wonder if the effectiveness of PAH biodegradation and the PAH-degrading bacterial diversity differ among soils. The stable isotope probing (SIP) technique with 13C-phenanthrene (PHE) as a model PAH was used to: (i) compare for the first time a range of 10 soils with various PAH contamination levels, (ii) determine their PHE-degradation efficiency and (iii) identify the active PHE-degraders using 16S rRNA gene amplicon sequencing from 13C-labeled DNA. Surprisingly, the PHE degradation rate was not directly correlated to the initial level of total PAHs and phenanthrene in the soils, but was mostly explained by the initial abundance and richness of soil bacterial communities. A large diversity of PAH-degrading bacteria was identified for seven of the soils, with differences among soils. In the soils where the PHE degradation activities were the higher, Mycobacterium species were always the dominant active PHE degraders. A positive correlation between PHE-degradation level and the diversity of active PHE-degraders (Shannon index) supported the hypothesis that cooperation between strains led to a more efficient PAH degradation.