bluuebunny/crossref_metadata_2025 huggingface dataset:
The neighborhood age structure and mental health
Authors: Verspoor E , Beenackers M A , Ouder Groeniger J , Noordzij J M , Van Lenthe F J
Published: November 2019

Background

Against the background of urbanization and aging and the aim to design age-friendly cities, it is crucially important to understand whether and why older adults’ health may benefit from being surrounded by older peers mainly, or by residents from all ages. We assessed the association between neighborhood age structure and mental health and the mediating role of social neighborhood perceptions.

Methods

Survey data were obtained from 1255 older adults aged 65 years and over, participating in the Dutch GLOBE study. The neighborhood age structure, measured in 2011, was defined as the Herfindahl-Hirschman index to assess homogeneity in the age composition (range from 0-100, a higher score indicating more homogeneity) and percentages of different age groups in a neighborhood. Mental health was measured in 2014 by the Mental Health Inventory-5 score, ranging from 0 to 100, where a higher score indicates better mental health. Perceptions of neighborhood social cohesion, feeling at home in a neighborhood, and social participation was assessed in 2011. Linear regression models were used to assess the association of neighborhood age composition with mental health. Causal mediation analysis was used to assess the potential mediating role of social neighborhood perceptions.

Results

A more homogeneous neighborhood age structure was associated with better mental health status. Feeling at home in a neighborhood partly mediated the association, whereas social cohesion and social participation did not mediate the association. While a higher percentage of children in the neighborhood was associated with better mental health, a higher percentage of elderly in the neighborhood was associated with lower mental health status.

Conclusions

The neighborhood age composition is a promising, but currently insufficiently understood, entry point for policies addressing the challenge of growing urban and aging European cities.

Key messages

The neighborhood age composition is a promising, but currently insufficiently understood, entry point for policies addressing the challenge of growing urban and aging European cities. Feeling at home in a neighborhood partly mediated the association between neighborhood age structure and mental health; social cohesion and social participation did not mediate the association.
The impact of the economic crisis on the mental health of Portuguese primary-school children
Authors: Costa D , Cunha M , Ferreira C , Gama A , Rodrigues A M N , Rosado-Marques V , Nogueira H , Silva M R G , Padez C
Published: November 2019

Objective

To measure the impact of the economic crisis on the mental health correlates of Portuguese children attending primary school during 2016.

Methods

Cross-sectional analysis of primary school-aged children and their parents (n = 1157), conducted in public and private schools of three Portuguese districts. Parent reports of children mental health symptoms (Strengths and Difficulties Questionnaire - SDQ) and children self-reports of health-related quality of life (KIDSCREEN-27) and depressive, anxiety and stress symptoms (Depression, Anxiety and Stress Scales, Children version - DASS-C), were compared according to a set of yes/no questions on how the economic crisis changed the normal aspects of routine life (e.g. During the financial crisis did you had to use savings? Started buying cheaper food?). Linear regression models were fitted for the SDQ, the KIDSCREEN-27 and the DASS-C as dependent variables adjusted for children sex, socioeconomic status and district of residence.

Results

Affirmative answers to the crisis impact questions were associated with more frequent psychosocial functioning problems in children, with poorer self-reported health-related quality of life and with more frequent symptoms of depression, anxiety and stress.

Conclusions

Portuguese children mental health correlates show significant worse scores for those whose parents declared having to change daily routine habits as a result of the recent macroeconomic financial crisis, compared to those who did not change habits. Public Health programs should be developed to mitigate the potential negative impact of the financial crisis to the mental health of children.

Key messages

A negative impact on children mental health was observed as a result of the economic crisis. Public health programs designed to mitigate the impact of the economic crisis should include primary-school aged children.
Effectiveness of the Children of Divorce Intervention Program in the Netherlands
Authors: Klein Velderman M , van Dommelen P , Pannebakker F D , Reijneveld S A
Published: November 2019

Background

Many children experience parental separation and divorce. This experience is likely to negatively affect their wellbeing, conduct, psychological adjustment and social relations. Prevention of these problems thus has major priority but effective intervention programmes are still rare. This study therefore aimed to assess the effects of a 12-session preventive group intervention “Dappere Dinos™” for 6 to 8 year old children.

Methods

We performed a quasi-experimental study (registered as NTR 6788) on 105 children participating in the intervention group, 37 children with separated parents not participating (’divorce controls’) and 138 children from intact families (’intact controls’). Outcomes regarded children’s positive functioning (Parent Evaluation Form; Pedro-Carroll & Cowen, 1989), emotional and behavioral problems (Strengths and Difficulties Questionnaire; Goodman, 1997), and wellbeing (Cantril ladder, Cantril, 1965).

Results

Analyses showed that children’s positive functioning after participating in Dappere Dino’s increased according to mothers (MΔpre-post(SD) = 0.26 (0.32); p < .001). Also, children’s overall emotional and behavioral problems decreased after participation (MΔpre-post_mother(SD) = -2.02 (4.55); p < .01; MΔpre-post_trainer(SD) = -1.07 (4.34); p < .05; MΔpre-post_teacher(SD) = -1.64 (3.54); p < .01). Children’s wellbeing increased after participation (MΔpre-post_mother(SD) = 0.77 (1.02); p < .001; MΔpre-post_trainer(SD) = 0.69 (0.94); p < .001), or stayed the same (MΔpre-post_teacher(SD) = 0.19 (1.03); p = n.s.). No such changes were found in the two comparison groups.

Conclusions

After parental divorce, a 12-session preventive group intervention Dappere Dino’s™ for 6- to 8-year-olds can be efficacious in promoting children’s emotional well-being and positive functioning, and reducing their emotional and behavioral problems.

Key messages

Given the high prevalence of divorce and the potential risk for child well-being and functioning, prevention of problems for these children and helping them adapt to the divorce are major priorities. After parental divorce, preventive group support can be efficacious in promoting children’s emotional well-being and positive functioning, and reducing their emotional and behavioral problems.
Mental wellbeing among the oldest old, living in nursing home or at home
Authors: Ådnanes M , Melby L , Kaasbøll J , Kalseth J
Published: November 2019

Background

People 80 plus are the fastest growing age-group in Europe. While research is focusing on health deficiencies and losses and need for medical care and follow up, life conditions and mental health of older people are fields with insufficient knowledge. The promotion, maintenance, and improvement of well-being in this group is a great public health concern. This study aimed to explore differences in perspectives of what contributes to mental wellbeing (MWB) within three groups of persons 80 plus: 1) living at home, 2) living at home and attending day center some weekdays, 3) living in nursing home.

Methods

A qualitative approach was followed, with six focus groups - two in each of the three categories. 35 persons were recruited from senior community centers, adult day care centers, and nursing homes. Data was assessed using qualitative content analysis.

Results

The preliminary results from our study show significant variations between the three groups of participants in their perspectives on what contributes to MWB for them. In group 1 and partly group 2, engagement in fruitful or inspiring activities and insightful experiences with friends strongly associated with MWB. While the relevance of these factors also was mentioned by participants in group 3, they at the same time pointed at the limitations of living in a nursing home. Staying healthy and maintaining independence positively contributed to MWB in all three groups, however highly relatively, based on the person’s actual health situation. Having close relationships with family and friends were considered important in all three groups.

Conclusions

Perspectives on what contributes to MWB among persons 80 plus varies a lot as they control for what is possible based on own health and functionality, but also on what is accessible depending on institutional limitations. While such conditions are partly accepted, there is a potential for better MWB, simply based on more and/or better initiatives.

Key messages

Perspectives on what contributes to mental wellbeing among the oldest old varies a lot based on health and functionality, and on what is possible and accessible within institutions for elderly. There is a potential for better mental wellbeing based on more and/or better initiatives.
Elderly drivers with dementia – how do experts and relatives assess their safety risk?
Authors: Reime B , Pilgram N , Bertsche T
Published: November 2019

Background

Demographic change increases the proportion of car drivers over the age of 70. With increasing age, the likelihood of developing a form of dementia increases. In Germany, about 1.6 million people suffer from dementia. Surveys among dementia patients showed that about two-thirds said they held a valid driving licence and just under half reported still actively driving. We explored whether and to what extent motorists with dementia are putting road safety at risk and how relatives deal with the driving behaviour of their elders.

Methods

Semi-structured qualitative interviews were conducted with seven experts from the fields of police, gerontology and geriatrics as well as with 16 relatives of patients with different stages of dementia. All interviews were then transcribed. The analyses based on the qualitative content analysis (Mayring 2015) with MAXQDA.

Results

The experts regarded elderly drivers with dementia as a public health relevant safety risk. Among those elders who are affected by dementia the awareness of the problem often is limited and not rarely they are characterized by an unsafe driving style. Experts from Austria and Switzerland supported the concept of a mandatory dementia assessment for elderly drivers while experts from Germany did not. Relatives reported very similar descriptions of their elderly’s driving characteristics. Furthermore, the cognitive and motor limitations associated with dementia often are not noticed by both patients themselves and their relatives.

Conclusions

Representative studies are needed to test which measures, such as a mandatory dementia check from retirement age, are likely to improve the safety of older drivers with dementia. Family doctors and GPs should address and educate dementia patients in relation to their risk of accidents. Relatives should receive information material on how to communicate with their elderlys on this topic to maximize safety while avoiding conflict.

Key messages

The prevalence of elderly drivers with dementia is unknown. Representative studies are needed to test best practice appoaches for harm reduction in drivers with dementia.
Risk factors of addictive behavior in adolescents in Tunisia
Authors: Ghali H , Ben Cheikh A , Khefacha Aissa S , Tourki Dhidah M , Bhiri S , Kaabi Y , Ben Othman W , Ben Rejeb M , Said Latiri H
Published: November 2019

Background

Adolescence is a period of physical, psychological and sociocultural transformation, but also of curiosity and experimentation. In Tunisia, the levels of use of some psychoactive substances, especially alcohol, tobacco and cannabis, remain high among adolescents, despite progress in regulatory efforts to limit access to these products by minors, and regular prevention campaigns. We aimed to determine the prevalence of addictive behavior among students in the region of Sousse and to specify the risk factors.

Materials/Methods

We conducted a cross-sectional epidemiological study in two public schools in the governorate of Sousse during the 2017/2018 school year. All students in each class were included when they agreed to participate in the study. The data was collected by anonymous self-questionnaire, then processed and analyzed using the SPSS version 20 software.

Results

In total, 294 students participated in this study with a mean age of 17.03 ± 1.51 years. A female predominance was noted (56.1%). The prevalence of addictive behavior was 52% (95% CI = [45.9% - 57.8%]). In univariate analysis, male gender, advanced age, and repeating the study year were significantly associated with addictive behavior (p = 0.014, p < 10-3, p = 0.004 respectively). However, multivariate analysis showed that the probability of addictive behavior decreased in students who read books frequently (OR = 0.6, 95% CI = [0.37 - 0.96], p = 0.03). The only independent risk factor associated with addictive behavior was age (OR = 1.34, 95% CI = [1.14 - 1.59], p < 10-3).

Conclusions

The findings have implications for identifying protection factors and risk factors for addictive behaviors, and the development of primary prevention strategies derived from such factors.

Key messages

Our results highlight the need to better understand behaviors at risk in Tunisia and the perceptions of prevention policies among students. Knowledge of related factors is important for prevention program planning.
Could Euroqol 5 Dimension questionnaire predict the characteristics of a hospitalization?
Authors: Cuccaro C , Kundisova L , Nante N
Published: November 2019

Background

Health related quality of life (HRQL) reflects how a particular state of health could influence individual wellbeing. Pathologies have a significant impact on the life, but the same conditions can be perceived differently so subjective evaluation by patient can be a valuable help to the doctors.

The aim of the study is to describe how the HRQL may correlate with some clinical conditions.

Methods

A cross-sectional study was conducted in January-March 2019 in a private clinic. The Euroqol-5 Dimension (EQ-5D) questionnaire is a measure of quality of life to capture physical, mental and social functioning of patients and it was submitted at the time of admission. Examined variables were: age, sex, hospitalization period, EQ-5D index, EQ-5D dimensions (mobility, self-care, activity, pain, depression) and mini-mental state examination (MMSE). The sample was divided into subgroups for age (S1:<75 years, S2:>75) and for presence of problems (with or without). Statistical analysis was conducted using Stata 12.

Results

A total of 59 patients were admitted, but only 33 (69.7% females) received the EQ-5D questionnaire. Average age was 80.2±12.3, higher for females (p = 0.02). The average length of stay was 12.7±9.4 days. The mean of EQ-5D index for the patients was 0.36±0.27 (S1:0.38±0.26; S2:0.27±0.3) and it did not seem to be significantly correlated with variables. The frequency of the EQ-5D dimensions problem stratified by age group was: mobility 96.97%(S1 21.21%, S2 75.76%), self-care 90.91%(S1 21.21%, S2 69.7%), usual activity 93.94%(S1 21.21%, S2 72.73%), pain 87.88%(S1 18.18%, S2 69.7%), depression 66.66%(S1 15.15%, S2 51.51%). The length of stay showed a significant correlation with pain(Spearman r=-0.45, p = 0.018) and depression(r = 0.46, p = 0.015).

Conclusions

The majority of patients showed low level of EQ-5D index which is reflected in a low level of perceived HRQL. Pain and depression are the two dimensions that have shown a possible correlation.

Key messages

The EQ-5D index does not appear correlated to variables such as sex, age and length of stay. Depression and pain could be two important factors influencing a patient’s admission and its length.
General practitioners, pregnancy and addictions in France in 2015
Authors: Andler R , Cogordan C , Pasquereau A , Buyck J-F , Nguyen-Thanh V
Published: November 2019

Background

Tobacco smoking and alcohol drinking during pregnancy result in serious health hazard for both the baby and the mother. In France, about 17% of pregnant women smoke and 20% consume alcohol. General practitioners (GPs) can have an active role in preventing those behaviors as they often interact with pregnant patients: one quarter of French pregnant women have had at least one antenatal visit with a GP. The aim of our study is to describe French GPs’ practices (screening and counseling) toward pregnant patients regarding tobacco smoking and alcohol drinking.

Methods

In 2015, a telephone survey was set based on a stratified random sampling of metropolitan France GPs. A representative sample of 1,414 French GPs completed the study.

Results

Screening for alcohol consumption at least once for every patient was done by 61% of GPs and for smoking by 82% of GPs. Counselling to quit alcohol consumption was done by 77% of GPs while counselling to quit smoking was done by about 90% of them. GPs’ practices were significantly better among those who had more recent ongoing training. Regular drinkers GPs were less likely to systematically screen for alcohol use and GPs’ alcohol use frequency was adversely related to recommending quitting. Current and former smokers GPs were less likely to recommend quitting to pregnant patients smoking over 5 cigarettes per day.

Conclusions

Screening for alcohol use and smoking during pregnancy is not yet systematic among GPs in France. GPs’ prevention role with pregnant patients could be emphasized, potentially through initial and ongoing trainings adaptation. Besides, as regular alcohol use and smoking are related to unwanted practices, prevention for the benefit of GPs could be even more fruitful.

Key messages

Screening for alcohol use and smoking during pregnancy is not systematically done by French GPs. GPs’ prevention role with pregnant patients could be emphasized, potentially through initial and ongoing trainings adaptation.
Out of country tobacco purchases decrease despite a price increase and plain packaging in France
Authors: El-Khoury F , Gomajee R , Torregrossa H , Bolze C , Melchior M
Published: November 2019

Background

The introduction of new anti-tobacco measures in France (plain tobacco packaging, higher prices) might encourage smokers to buy their tobacco from other sources than tobacco shops. We examine whether these measures increased the likelihood of smokers purchasing tobacco abroad, depending on their driving distance from the border of a neighboring country with lower tobacco prices.

Methods

DePICT is a two-wave cross sectional national telephone survey examining the French population tobacco-related perceptions and behaviors before and after the introduction of the new measures in 2017. Smokers were asked whether they bought tobacco from abroad in the last 12 months. Shortest driving distances to neighboring countries’ border were calculated using Google Maps (<100 Km, 100-200 Km, 200-300 Km, >300 Km and Ile-de-France (IDF)). Data was weighted to be representative of the population living in France. Multivariate regressions, adjusted on socio-demographic characteristics as well as substance use behaviors, were carried out.

Results

Compared to smokers living at more than 300 Km from a border, those living near a border, and in IDF were significantly more likely to have bought tobacco from abroad (<100 Km: ORadjusted = 3.98; 100-200 Km: ORadjusted = 2.04; 200-300 Km: ORadjusted = 1.47; IDF: ORadjusted = 1.32). Smokers in wave 2 (n = 929) were significantly less likely than those in wave 1 (n = 1238) to have bought tobacco abroad (ORadjusted = 0.81 [95% CI: 0.69-0.96]). It was mainly smokers who were in a driving distances of 100-200 Km, and 200-300 Km who were significantly less likely to buy abroad across the 2 waves (respectively ORadjusted = 0.56 [95% CI: 0.34-0.92] and ORadjusted = 0.50 [95% CI: 0.27-0.92]). Supplementary analyses showed that it was mainly for men and smokers born in France that the decrease was significant.

Conclusions

Our results suggest that the new anti-tobacco measures did not increase out of country tobacco purchases by smokers.

Key messages

The introduction of new anti-smoking measures (increase in price, plain tobacco packaging) did not increase the likelihood of smokers purchasing tobacco from abroad. It was mainly male smokers and smokers born in France that had a decreased likelihood of purchasing tobacco from abroad after the introduction of new anti-tobacco measures.
Characterization of alcohol consumption patterns among older adults in Ireland
Authors: Guzman V , McEvoy C T , McHugh-Power J , Kenny R A , Feeney J
Published: November 2019

Background

Identifying the factors associated with hazardous drinking patterns and problem drinking is imperative to develop appropriate intervention strategies for alcohol harm reduction among the older population. The aim of this study was 1) To explore the patterns of alcohol consumption among older adults in the Republic of Ireland, and 2) To establish possible predictors of hazardous and problem drinking in this population.

Methods

A cross-sectional analysis was carried out on samples of individuals aged >50 years at Wave 3 of The Irish Longitudinal Study on Ageing (N = 4948). Hazardous alcohol consumption was defined as drinking above Irish guidelines [women >11 Standard Irish Drinks (SD)/week; men >17 SD/week], and/or having at least one heavy drinking episode per week (>6 SD/day). Problem drinking was defined as a score of > 2 on the CAGE instrument. Regression analyses investigated outcome differences according to socio-demographic and health characteristics. Sampling weights were applied to account for differential non-response.

Results

The prevalence of drinking patterns was 13% for lifetime alcohol abstainers, 8% for former drinkers, 26% for occasional drinkers and 53% for weekly drinkers. Among weekly drinkers 25% exceeded the guideline threshold, 23% had at least one heavy drinking episode per week and 16% had an alcohol problem according to the CAGE. In fully adjusted models, hazardous drinking and problem drinking were associated with younger older adults, male sex, current or past smoking, higher levels of stress and/or social isolation.

Conclusions

Our findings serve as a starting point to monitor trends of alcohol consumption among older adults in the Republic of Ireland. Our results highlight areas of opportunity for targeted screening and public interventions that seek to reduce alcohol harm among this population.

Key messages

In the Irish context, older adults who are younger, male, current or past smokers, with higher levels of stress and/or social isolation are more likely to engage in hazardous alcohol consumption. Our characterization of drinking patterns highlights areas of opportunity for targeted screening and public interventions that seek to reduce alcohol harm among older adults in Ireland.
Description of low back pain attendances in French ED
Authors: Forgeot C , Viudes G , Noel G , Fouillet A , Caserio-Schönemann C
Published: November 2019

Background

Low back pain (LBP) is one of the leading contributors to disease burden worldwide [1]. In 2018, French health care insurance launched a population awareness campaign in order to promote effective behaviour change in France. Because LBP acute episodes often lead to emergency visits, Santé publique France, the French Public Health Agency and the Federation of Observatories for Emergency Medecine, performed a pre-campaign situational analysis of LBP in the French emergency department (ED) involved in the OSCOUR® network.

Methods

The OSCOUR network is part of the French syndromic surveillance system SurSaUD® [2] coordinated by Santé publique France since 2004. In 2017, the system collects daily individual data from about 700 ED representing 92% of the French ED attendances. Those data contain demographic, administrative and medical information including discharge diagnosis coded according ICD-10. ED attendances with a diagnosis related to LBP were analyzed from 2014 to 2017. Temporal distribution of LBP attendances, hospitalizations after discharge and stay duration in ED services were also analyzed.

Results

From 2014 to 2017, 504 ED were included in the analysis and LBP represented 1.12% (N = 481,291) of ED all visits. This proportion remained stable over the period. 60% of LBP attendances concerned 18 to 50 years old adults and almost 10% were hospitalized after discharge. This proportion increased with age to reach 43% for the 85 years old and more. LBP attendances were more frequent on Monday. Median stay duration were almost 3 hours but increased with age and for hospitalized patients.

Conclusions

The broad coverage of the ED OSCOUR® network on the whole territory and the strong partnership between epidemiologists and clinicians enable Santé publique France to produce reliable results which are also consistent with ED physician’s perception. Finally those results can be used as a reference contributing to evaluate potential benefits of this campaign.

Key messages

This description of low back pain ED attendances is consistent with emergency physicians perception on field and can be used as a reference to evaluate potential benefits of the prevention campaign. The national coverage of the ED OSCOUR® network and the strong partnership with emergency physicians enable Santé publique France to produce relevant description on the main causes of ED attendances.
Hypertension and body mass index in a population of 19-year-old men in Poland
Authors: Hubert-Lutecka A H L , Binkowska-Bury M B B , Chmiel Z C , Hejda G H
Published: November 2019

Background

Hypertension is a main yet potentially modifiable cardiovascular risk factor. It is the most widespread disease of the 21st century, especially in highly industrialized societies. It is estimated that hypertension affects about 25% of the adult population in the world and reaches a ceiling of 32% and another 30% of the adult population is characterized by pressure values classified as pre-hypertensive. The prevalence of hypertension is geographically diverse and closely depends on economic and socio-cultural conditions. The relationship between hypertension and obesity is the subject of many studies that explicitly confirm the occurrence of positive coincidence.

Methods

The study was observational-retrospective, and included a group of 17 282 men, aged 19, from the southeastern region in Poland. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense.

Results

Hypertension was found at 0.6%, weak body structure at 0.8% and obesity co-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents. The underweight concerned almost 7%, and the overweight and obesity of 25% of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.

Conclusions

Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight. Excessive body weight significantly more often affected people with a higher degree obesity co-existing with cardiorespiratory insufficiency, affecting of the system and men with hypertension. Excessive body weight was seen in a considerable percentage of males studied and was significantly associated with the prevalence of hypertension and obesity co-existing with cardiorespiratory insufficiency, but not affecting of the system.

Key messages

The assumed observation contribute to the presentation of selected indicators of health status and their relationship with hypertension in a large population of 19-year-old men. Data obtained this way, enrich the state of knowledge about the growing problem of hypertension and they can be a valuable ground for developing educational and preventive programs for Public Health.
Trends in tuberculosis incidence rates in the Region of Sousse (Tunisia) from 1992 to 2016
Authors: Sahli J , Mellouli M , Limam M , El Ghardallou M , Mtiraoui A , Zedini C , Ajmi T
Published: November 2019

Introduction

In 1993, the World Health Organization declared that tuberculosis is a public health emergency of global concern. All efforts were made in accordance with the Millennium Development Goals (MDGs) to reduce the burden of Tuberculosis. The MDG framework built into national priorities and development strategies has, in fact, strengthened epidemiological surveillance and the use of reliable data to make decisions based on objective data. These data are essential for planning, managing the activities of the National Tuberculosis program, monitoring and ongoing evaluation of its performance. In this context, we conducted this study to trace the trend of Tuberculosis incidence rate recorded in the Sousse Region between 1992 and 2016.

Methods

This is a longitudinal study of the registered data of tuberculosis cases in Sousse between 1992 and 2016. For the trend analysis the software JOINPOINT version 4.5.0.1 was used. This software offers the closest possible regression model of the different points and gives an annual percentage change (APC) with a 95% confidence interval.

Results

The highest TB incidence rates was recorded in 1993 (85.66 cases per 100 000 inhabitants). Between 1992 and 1997, there was a significant downward trend of TB incidence (APC = -23.2; 95% CI [-28.8, 1]). Between 1997 and 2004 the trend was stable. Between 2004 and 2016, there was a significant upward trend (APC = 8.3; 95% CI: [4.3, 12.4]).

Conclusions

At the national level, between 1992 and 2002, tuberculosis experienced a fall in incidence rates, as a result of an improvement in the socio-economic level and the organization of tuberculosis control. Since 2004, the trend has been rising. Increased tuberculosis control is advocated to end tuberculosis by 2030 in line with sustainable development goals.

Key messages

After a significant decrease, the tuberculosis incidence has increased significantly since 2004. The tuberculosis prevention efforts should be intensified to reverse the current trend.
Evaluating equity in healthcare: pilot implementation of a self-assessment tool
Authors: Chiarenza A , Domenig D , Cattacin S
Published: November 2019

Background

Several sets of standards aiming at improving access and quality of care for service users have been published in recent years. Certain standards focused on improving healthcare providers’ responsiveness to specific target groups. The general goal of this research was to improve organisations’ awareness of equity standards that are not focused on specific groups, but on all contributing factors that put vulnerable groups at risk of exclusion. The specific objective was to evaluate the degree of compliance with a set of equity standards in 52 health care organisations from 16 countries.

Methods

A self-assessment tool (SAT) was developed to allow healthcare organisations to measure their capacity to provide equitable care for service users. The SAT indicates the main areas that should be addressed: equity in policy; equitable access and utilisation; equitable quality of care; equity in participation; promoting equity. A cross-sectional survey addressing participants from pilot-organisations was used for data collection, concerning both the self-reported compliance score with the standards, as well as the additional information provided to support the score assigned. Data were analysed quantitatively as well as qualitatively.

Results

The findings confirm that healthcare providers do invest in improving equity in the access and delivery of services to vulnerable groups. However, many health organisations have inadequate strategies to address inequities and are insufficiently engaged in improving equity in participation and promoting equity outside the organisation.

Conclusions

The participating organisations reported a significant impact from use of the self-assessment tool: some received the support from regional/national authorities to continue working on improving equity in healthcare; others linked the equity standards to existing performance-measurement strategies; others invested in new frameworks to improve service users engagement.

Key messages

The implementation of the SAT contributes to a self-reflective process, involving health professionals and managers, in which gaps and potential improvements are identified. Pilot organisations utilised the SAT as part of a process of increasing their awareness of equity issues and changing their organisational culture.
Pre-exposure prophylaxis in a sexual health clinic for Men who Have Sex with Men in Portugal
Authors: Ribeiro S , Rocha M
Published: November 2019

Background

Pre-exposure prophylaxis (PrEP) is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals. Recognizing the increasing use of informal PrEP in Portugal, CheckpointLX, a community clinic targeted for MSM in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This study aims to characterize PrEP users attending CheckpointLX before formal PrEP introduction in Portugal, and those who were referred to PrEP in the National Health Service (NHS) following formal approval of PrEP.

Methods

Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database. Medical care followed EACS recommendations for PrEP eligibility, initiation and follow up. For formal PrEP, the General-Directorate for Health’s PrEP guidelines checklist was used.

Results

Until the end of May 2018, CheckpointLX had a total of 90 appointments for Wild PrEP, of which 64 (71%) were first time visits. As for the 380 service users referred to the NHS, most were Portuguese (N = 318, 84%), and the mean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria (N = 59, 83%).

Conclusions

PrEP delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration, in the scope of broader preventive sexual health care. Much remains to be done in Portugal to ensure that PrEP is available to those who need it the most. Offering PrEP at community clinics could be a first step.

Key messages

Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria for PrEP. PrEP delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration.
Trough community mobilization to better health for all Balkan’s Roma
Authors: Bikovski Z
Published: November 2019

Issue

The Roma community in all Balkan countries faces a lot of barriers in the implementation of their health right. They face inequalities in healthcare, prejudices, stereotypes and informal payments, charged by health professionals. They also have lack of access to information about ongoing changes in the health sector. Because of lack of education, poverty or some traditional barriers, Roma usually delay on Doctors treatment or improperly used a medical therapy. Roma community also faced and with populism activities related to them who exist just on the paper, without implementation.

Description of the problem

Implementation of Methodology, Social accountability and Legal Empowerment” give visible results in improving Health rights of Roma community in Macedonia. In the last three years NGOs KHAM and ESE providing mentorship to the Roma NGOs in Romania and Bulgaria. Role of the NGOs is to created power balance between Roma community and Health Authorities, and addressing problems from local to national level. Trough Legal Empowerment community learn their rights, and trough Social accountability they demand there rights and looking for changes. After three years of work we have visible results and Roma movement for health rights in Balkan region.

Results

Good practices from Macedonia was in Bulgaria and in Romania. Roma communities from Romania have progress in field of immunization of children and prenatal and antinatal care.In Bulgaria we have progress in early child development. For the very first time, Roma community sat together with Policy makers and with the arguments negotiated for better health. Details will be presented at the Conference.

Lessons

Mentoring is excellent tool for sharing the good practice between NGOs where similarities are obvious. In fact, by acting together, more pressure can be placed on the authorities to bring better policies for Roma in the region.

Key messages

Knowledge is power. Only legally strengthened communities that collaborate with each other can make changes for themselves.
The clusters and frequencies of adverse social conditions amongst the homeless people
Authors: Mabhala M
Published: November 2019

Background

A growing body of evidence identifies interconnected social indicators that can lead to homelessness. Several studies identify a catalogue of social disadvantages that starts from childhood and persist throughout the life course that leads to homelessness. Qualitative evidence indicates that their adverse childhood experiences(ACEs) and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults. However, very little research seeks to objectively investigate these issues. This study aims to use the cross-sectional study to document the cluster and frequency of adverse social conditions amongst the homeless people in North West England in 2019.

Methods

The study design was cross-sectional. We used IBM SPSS 21, with a significance level set at p < 0.05, CI 95% to analyse the data.

Results

The mean age was 39.12, range 21-64, 90.5% male. 52%(χ2= 33.4, df = 1, p = 0.001) described their health as poor, 90% (χ2= 61.85, df = 2, p = 0.001) smoked cigarette daily, 83.3% (χ2= 76.4, df = 3, p = 0.001) used drugs daily, 78.6% (χ2= 13.7, df = 1, p = 0.001) saw a doctor in preceding 6 months,

63.4% (χ2= 73.8, df = 3, p = 0.001) left school before age 16; 26.2% (χ2= 37.7, df = 3, p = 0.001) left school at 16, 11.9% (χ2= 33.1, df = 10, p = 0.001) encounterd criminal justice system at the age of 11, 28.6% (χ2= 60.8, df = 8, p = 0.001) had reprimand/caution or conviction at 17.

ACES: 57% (χ2= 34.7, df = 3, p = 0.001) experienced humiliation by adults in their household; 54% (χ2= 30.7, df = 3, p = 0.001) threatening behaviour, 50% (χ2= 26.0, df = 3, p = 0.001) physical violence in their household.

Conclusions

These early stage preliminary results indicate that adverse social circumstances that occur in childhood are disproportionately represented in homeless population.

Key messages

Homelessness is more complex than the absence of accomodation. Adverse social circumstances that occur in childhood are disproportionately represented in homeless population.
Barriers by professionals in primary care in discussing children of substance abusing parents
Authors: Van Der Meer M , Jansen D E M C , Anthonio G G
Published: November 2019

Background

Children of substance abusing parents are more at risk to develop addiction or psychiatric problems than children of healthy parents. It is therefore important to detect in an early stage, which consequences the problems of the parents might have on the child. Previous research shows that within addiction care children of substance abusing parents are not always in the picture. However for early detection it is at least as important to discuss the influence of parental substance abuse on the children in primary care: early detection of problems in children contributes in starting prevention or treatment programs in a timely manner, so that the chance that a child grows up safely will increase.

Aim

To gain insight in the barriers of professionals working in primary care and public health in bringing up the topic of children in a conversation with substance abusing parents.

Methods

A qualitative design was used. 15 interviews have been conducted with participants consisting of primary care and public health professionals in the Netherlands. By discussing several themes, information on the barriers experienced by the professionals were obtained, written down and analyzed.

Results

The results are being analyzed at this moment, but will be ready to present at the congres in November. The interviews will show which barriers are experienced by the participants. Based on literature the expectation is that the barriers can be divided in three categories: barriers on the content of care, moral dilemma’s and organizational barriers.

Conclusions

The results of this study will provide insight in the barriers of professionals in primary and public health on discussing the circumstances of children of substance abusing parents. Knowing these barriers might serve as input for interventions to remove these barriers and for recommendations to improve so that children of substance abusing parents receive (preventive) care earlier.

Key messages

Gain insight in barries of professionals in primary care and public health on discussing circumstances of children of substance abusing parents. input for interventions so that children of substance abusing parents receive care earlier.
Basic problems in conducting a general preventive review of persons over 18 years of age in Bulgaria
Authors: Kostadinova P S , Kostadinov S D , Stoilova I Y , Georgieva S L , Kamburova M S , Ivanova S K
Published: November 2019

Background

In Bulgaria, following the reforms in healthcare, the Health insurance model and the role of GPs have been adopted as a key figure for primary outpatient medical care. Part of the obligations of the GPs for the implementation of the individual contracts with RHIF are also the preventive examinations of the mandatory health-insured persons over the age of 18 and the formation of risk groups of the population. Since 2006, the overall prophylactic review is mandatory for all health insured persons over the age of 18, regardless of their health status. It includes a core set of activities and studies that identify both people with disabilities and patients at increased risk of developing certain socially significant diseases such as cardiovascular, malignancies and diabetes.

Material and methods

Data were collected by documents review and direct individual self-administered questionnaire among 513 persons from the Pleven region and 229 GPs from three districts in the country.

Results

Despite the mandatory nature of general checkup for all persons over ’18, annually recognizes low range (from 35.8 to 45%). It was found that people over 65 who have chronic diseases more regularly visit the GP for check-up. The main reasons for the low population coverage are: lack of time and motivation of GPs; high relative share of persons with discontinued health insurance rights (over 20%); insufficient awareness and dissatisfaction of the mandatory health insured persons about mandatory prophylactic examinations. Of the respondents, 48% do not know what activities are involved, and 39% consider that the reviews are carried out formally.

Conclusions

Prevention of health-insured persons over 18 years of age is low in scope and is mostly opportunistic. In order to optimize the health and economic impact of the prophylactic review program, it is appropriate to provide for motivation measures for both GPs and those subject to the scope.

Key messages

In Bulgaria, the range of persons over 18 years old with prophylactic examinations is low. Prophylaxis of the persons covered is mostly opportunistic.
Development of an evidence-based reference framework for care coordination interventions in France
Authors: Colombani F , Encrenaz G , Quintard B , Sibé M , Ravaud A , Saillour-Glénisson F
Published: November 2019

Background

Today, the high variability of practices, the lack of common definitions and underlying concepts increases the existing difficulty to standardise, to replicate, to transpose and to assess the coordinated care. This heterogeneity makes very difficult the evaluation of performance of care coordination. The aim of the first phase of Epock study is to develop a theoretical framework for care coordination interventions in the French health system that can be used for description, implementation and evaluation of care coordination intervention in any clinical situation.

Methods

A review of systematic reviews on care coordination interventions was conducted to identify relevant models and constitutive elements of the expected reference framework for care coordination intervention. These elements resulting from the literature review have been grouped by themes, prioritised and selected by a structured consensus method (Nominal Group Technique).

Results

Four dimensions of care coordination were identified: (a) Underlying conceptual models; (b) Care organization, care and facilitation activities; (c) Actors and tools; and (d) Effects classified according to WHO’s quality of care dimensions. Among these dimensions, 4 to 28 elements have been selected to build the reference components of care coordination in France.

Conclusions

This first reference framework for care coordination interventions in France will be used during the Epock project phase 2 as a basis for comparing practices observed in oncology. This framework could be used as of now for: practice by helping to develop job descriptions and training programmes for future care coordination professionals; piloting to measure care coordination (by developing indicators for care coordination); and research, to evaluate the impact of care coordination interventions.

Key messages

Epock is a challenging French national research project for the development of an evidence-based reference framework for cancer care coordination interventions considered as a complex intervention. Epock will provide key elements for cancer care coordination intervention effective implementations and for designing further medico-economic evaluation of cancer care coordination intervention impact.
Alcohol and cancer: risk perception among the French population
Authors: Ancellin R , Cogordan C , Richard J B , Andler R , Deutsch A
Published: November 2019

In 2015, in France, 41 000 deaths were estimated to be attributable to alcohol consumption including 16 000 deaths from cancer. 8% of all new cancer cases were attributable to alcohol. The French National Cancer Institute and Sante Public France have conducted a study on knowledge and opinions of the French population on the risks factors attributed to cancer, including alcohol consumption.

Data came from the 2015 Barometre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3771 individuals aged 15-85 years). About 88% of the respondents felt well informed about the risks of alcohol. Opinions show an important risk denial and risk relativization: e.g, 85% agreed that the principal risk with alcohol consumption are traffic accidents or violence and 75% agreed that soda and hamburgers are as bad as alcohol for the health. Those perception were higher among men, older respondents, daily drinking consumers and those of low socioeconomic status. Population’s beliefs to deny the cancer risks due to alcohol use are common in France.

These results can be used to redesign public information about the risks of alcohol.

Key messages

Population’s beliefs to deny the cancer risks due to alcohol use are common in France. It’s necessary to adress public information about the risks of alcohol.