bluuebunny/crossref_metadata_2025 huggingface dataset:
Culturally sensitive diabetes education supporting ethnic minorities with type 2 diabetes
Authors: Hempler N F , Laursen D H , Glümer C
Published: November 2019

Background

Ethnic minorities of non-Western origin are at higher risk of type 2 diabetes and diabetes complications, compared to the general population. Diabetes education programmes are essential to support people with diabetes to initiate and sustain behaviours needed to manage their condition throughout their lives. However, shaping diabetes education that provide culturally sensitive education that is acceptable to and supports diabetes self-management among members of ethnic minorities is needed.

Objectives

In this study, we develop and evaluate a culturally sensitive diabetes education programme in a community health setting, focusing on Arabic, Urdu or Turkish languages (n = 100). The programme aims to support ethnic minorities with type 2 diabetes in making health-promoting decisions about their care. Also, it will produce knowledge about methods and tools to improve content and format, and about the skills of those delivering the education. Using design-based research, the development comprised three phases: needs assessment, co-creation and testing. The target groups were actively involved in all phases.

Results

The needs assessment was based on fieldwork, workshops and interviews with the target groups and educators. Data showed that self-blame and learned helplessness undermined health-promoting decisions in the target groups. Also, a lack of clear roles between educators and peer educators, and a limited focus on goal setting in the educational setting was observed. The needs assessment informed the development of a 6 week group-based programme, supported by 11 dialogue tools. Preliminary findings show a high level of programme acceptability and participation as well as engagement in diabetes and care in the target groups.

Conclusions

By actively involving the target groups, health care professionals and as well as health services directly engaged with the target group, the outcomes of the programme are likely to be relevant to individuals and institutions.

Key messages

This study gives voice to ethnic minorities with type 2 diabetes through the co-creation of a diabetes education programme aiming to support health-promoting decisions. Innovative and involving methods are highly relevant to develop acceptable and effective diabetes education programmes targeting ethnic minority groups.
Migrants’ social determinants of health: living conditions, violence exposure, access to healthcare
Authors: Spoel E , Accoe K , Heymans S , Verbeeren P , de Béthune X
Published: November 2019

Background

WHO and some other authors consider migration as a social determinant of health. MdM identifies it being composed of different factors such as living conditions, exposure to violence and access to healthcare.

Methods

We analysed a comparative quali-quantitative survey in 4 locations, in Niger, Morocco and Tunisia, based on questionnaires and focus groups, with basic statistical tests and a complementary qualitative analysis.

Results

461 migrants were interviewed, 59% women, median age 28 year, 98.5% sub-Saharan African origin, 63% with no legal documents.

46% travelled for more than 6 months, 47% stayed in the country of interview more than 12 months, even if most of them wanted to go on. 83.8% faced violence during their life, 61% during migration.

58% of violence was psychological in nature, confiscation of money and/or documents, or violence by police or army. The types of violence’s vary according to gender and localization. Only 39% did not face barriers to access to healthcare. The 3 main barriers are financial, lack of understanding of the health system and discrimination. 50% of migrants considered their health status as medium, bad or very bad, what is insufficient for such a young population.

Conclusions

Some events are always part of migration: long duration, violence, barriers to access healthcare, with an overall negative impact on health. Recommendations: Authorities should address the structural factors of violence against migrants. The health needs of migrants should be taken into account in policies at all levels. Health services should always consider migrants’ needs: determinants of health, mental health, consequences of violence and difficult access to healthcare. Research needs: What are the specific social determinants of health in migration?

Key messages

The health status of migrants seems to get worse along the road. Some migration events should be considered as social determinants of health and addressed by health services.
Self-reported health conditions among refugees and asylum-seekers (AS) in Italian hosting centres
Authors: Bertoncello C , Fonzo M , Zanovello S , Ferretti S , Brunetta R , Gallo G , Baldo V
Published: November 2019

In recent years, Italy has been facing an increase in migration flows. Migrants are vulnerable: understanding underlying conditions is essential to provide suitable assistance. We investigated health conditions of AS arrived in 2014-2016 and living in hosting centres in northeast Italy. AS filled in a multi-language questionnaire. Demographic characteristics, self-reported health status and travel conditions were recorded. Logistic regression (adjusting for age, sea/land arrival, marital status, education level), χ2 and Fisher’s test were used (significance at .05). 216 AS were included, of which 98% males and 91% aged 15-34; 72% arrived by sea, of which 96% from West Africa (WA), while 94% of land arrivals were from the Indian Subcontinent (IS). 62% experienced health problems after arrival. This condition was significantly associated with sea arrival (aOR 2.9), married status (aOR 3.1) and higher education levels. Most problems involved GI tract (13%), teeth (17%) and skin (25%), being AS from WA (31%) more affected than IS (10%). STDs and alcohol were considered as health threats by more than 30% of AS, while smoking, diet and drugs were ignored; 27% and 23% declared to smoke and consume alcohol, respectively, with no substantial change compared with pre-arrival habits. 88% considered their current health good/satisfactory. While anxiety seemed to affect 10% of AS, 30% reported symptoms of depression, especially those arrived by sea (aOR 3.1) and with higher education. However, physical (94%) and mental (88%) health was considered improved/stable after arrival. Perceived health is overall good. However, AS by sea, with higher education or experiencing family breakdown suffer more from both physical and mental issues, especially depression. Long waiting times to grant refugee status and partial fulfilment of life expectations may worsen health conditions. Customised solutions in hosting centres may be encouraged, considering travel conditions and cultural background.

Key messages

Migrants’ health in hosting centres is good; AS by sea, married and with higher education are more at risk, especially as regards mental health; depression warning signs must not go unnoticed. AS in hosting centres represent a heterogeneous population: they may benefit from a more tailored assistance, considering differences in travel conditions, cultural background and life expectations.
Significance and challenges of assessing health literacy among migrants
Authors: Berens E M , Mensing M , Klinger J , Carol S , Schaeffer D
Published: November 2019

Background

People with a migration background account for a large part of the population in many European countries. Although health literacy - knowledge, motivation, and competencies to process health information - is a key determinant of health, research on health literacy specifically among migrants in Europe is scarce. The aim is therefore to review and further develop the concept and assessment of migrant-specific health literacy for future use in a migrant health literacy survey (HLS-MIG) in Germany.

Methods

A literature search in Pubmed was performed in April 2019 to identify studies regarding health literacy, health outcomes and knowledge among migrant populations in Europe. A special focus was put on the conceptualization and operationalization of health literacy among migrants.

Results

So far, health literacy among migrants has mostly been measured using general health literacy measurement tools, that is, performance-based and self-assessment instruments as the HLS-EU-Q. Migration-specific competences, such as finding information about health in mother tongue, or outcomes of deficient HL have so far received little attention, except for e.g. the GMK-12, developed as a complement to the HLS-EU-Q16 in the Austrian context.

Conclusions

The use of performance-based instruments in the local language primarily provides information about existing linguistic deficits, but hardly on competencies and abilities in dealing with health information. General self-assessment tools, on the other hand, allow the identification of such competences, difficulties and challenges. However, it is necessary to take greater account of migration-specific competences, habits and obstacles in the future, in order to develop tailored interventions for individuals and organizational aspects, supporting health information processing among migrants. Furthermore, studies also need to pay attention to migrant specific health problems and prerequisites.

Key messages

Research focussing on migrant health literacy is scarce. More attention needs to be paid to migrant specific competencies, habits and challenges.
Improving access to health of Migrants in France. Qualitative assessment of a national guide
Authors: Hamel E , Karrer M
Published: November 2019

The National Public Health Agency and the Committee for the healthcare of persons in exile are providing, in the service of professionals, a Practical Guide for the care and the accompaniment of Migrants Foreigners living in precarious conditions, in France. The 2015 edition of this guide has been subjected to qualitative assessment in order to gather information regarding its use, the way it is perceived by its users, as well as their subsequent expectations, in order to design a new version that is more adapted to their needs.

The study was carried out in December 2018 by an independent market research institute with the following design: 24 face-to-face interviews, whose duration was 1h30min, involving current users or past users: 6 working in structures specialised in accommodation for migrants, 6 in health care facilities, 6 in municipal or departmental social service facilities.3 focus groups, of 7-8 people, whose duration was 2H30min, involving potential future users of the guide.

The recruitment of the participants took place in 3 cities as well as the overseas departments.

The findings show: the legitimacy of this guide which is co-produced by an official national agency and an association recognized for its expertise.the interest of a transversal and multi-professional approach which allows to better grasp the social, legal and medical support and carethe need for information and operational resources

This assessment underlines the relevance of the content and the symbolic importance of this guide which ’materializes’ the needs in terms of access to the rights and health of migrant people, often overlooked by professionals and administrations. It is thus a vehicle of vocational training and advocacy on this subject. The study provides concrete ways of optimization, particularly via digitalization, in order to cope with the rapid obsolescence of information, the availability of local directories and the need for exchange of professional practices.

Key messages

A national guide co written by a national agency and an association is a relevant tool to draw attention to migrants needs. Qualitative assessment highlighted the operationnal and symbolic role of this guide to foster cross professionnal work.
Strategies to enhance follow-up response in a cohort study with Berliners of Turkish descent
Authors: Krist L , Dornquast C , Reinhold T , Solak S , Durak M , Keil T
Published: November 2019

Background

Follow-up participation and retention are essential in long-term cohort studies. Loss to follow up may reduce the power of statistical analyses and external validity. The aim of this analysis was to evaluate the response after different contact methods in a cohort study with Berliners of Turkish descent and to compare characteristics of participants with those of non-participants.

Methods

In 2012-2013, Berliners with a Turkish migration background were recruited for this cohort study that initially aimed to examine recruitment strategies. The participants were contacted again 5 years later via postal mail and were asked to complete a questionnaire on the onset of new diseases and health care utilization. Written reminders, phone calls, and home visits were used to increase the response. Study documents were available in German and Turkish language. In descriptive analyses, we examined the response rate in relation to the recruitment approach. A regression analysis was conducted to investigate associations between individual, socioeconomic, and medical factors and the response.

Results

Out of 560 contacted persons, the neutral non-response (unknown address or death) was 13.6%. Of the remaining 484, 234 persons participated in the follow-up (women: 63.1%, mean age±SD: 49.8±12.6 years). The response was 16.1% after the first invitation letter, 24.2% after phone calls, 33.3% and 42.1% with a first and a second reminder letter, respectively, and 48.3% after home visits. The participants had more often German citizenship and a higher net income at baseline than non-participants. Migration generation, age, sex, education, and chronic diseases were not associated with participation (preliminary results).

Conclusions

In our participants with a migration background, every additional contact effort including home visits further increased cohort retention. Investing in comprehensive retention efforts may lead to studies that are more valid to examine the health of migrants.

Key messages

Investing in different contact efforts including reminder letters and home visits can improve follow-up response in longitudinal studies. Retention strategies should be used in longitudinal studies to increase statistical power and external validity.
Family conflict mediates the relationship between past violence and wellbeing among female refugees
Authors: Okenwa Emegwa L , Saboonchi F
Published: November 2019

Background

Past exposure to violence has been suggested to have a lasting effect on subjective well being (SWB). Similarly, family conflict is another known predictor of SWB. Research shows that refugee women exposed to gender based violence (GBV) before resettlement may also face post-resettlement family conflicts due to socio-cultural factors, changes in social network and migration-based shifting gender roles. This study examines the role of family conflict as a likely mediator between past exposure to violence and SWB among Syrian refugee women in Sweden.

Methods

A total of 452 women out of a random sample of 1215 Syrian refugee women in Sweden responded to a questionnaire survey in Arabic. Variables include Past violence i.e. exposure to any of torture, physical or sexual violence preflight or during flight before arriving Sweden; Post-resettlement distressing family conflicts i.e. feeling disrespected or unimportant in the family or distressing conflicts; SWB was measured by WHO-5 wellbeing index. Maximum likelihood estimation with Robust standard errors and bias corrected bootstrapped 95% confidence intervals for all estimates.

Results

Total effect of past violence on SWB was significant (Estimate = -6.63; CI= -12.73 - -0.46). Similarly, family conflicts were associated with decreased SWB (Estimate = -3.80; CI= -5.17 - -2.40), and past violence exposure increased family conflicts (Estimate = 0.57; 0.13 - 1.08). The total effect of violence exposure on decreased SWB was decomposed into a direct and an indirect effect (mediated via family conflicts). The indirect effect via family conflicts was significant (M= -2.19; C1= -4.30 - 0.59), while decomposing rendered the direct effect non-significant (Estimate= -4.44, CI= -10.51 - 1.52).

Conclusions

Post-resettlement distressing family conflicts mediate the effect of prior exposure to violence on reduced SWB among refugee women.

Key messages

Past violence exposure reduces refugee women’s SWB via aggravated family conflicts implying the need for family targeted interventions to improve SWB of female refugees previously exposed to violence. Strategies to improve subjective wellbeing among female refugees should include screening for and addressing all forms of previous and ongoing GBV.
The benefits and challenges of cash transfer programmes in Greece, with a focus on protection
Authors: Rodgers F , Abbara A , Omar M
Published: November 2019

Introduction

This qualitative study evaluates cash transfer programmes (CTPs) in forcibly displaced populations, specifically in Greece. There is a focus on protection, encompassing health, gender, child protection and disability. The Greece Cash Alliance, run by the United Nations High Commissioner for Refugees (UNHCR), currently supports 63,853 individuals with cash via a pre-paid card. This study provides insight into challenges encountered by implementers of cash programmes in Greece, and the potential protection issues faced with the changing climate of the cash programme in Greece.

Methods

A literature review of academic and grey literature and semi-structured key informant interviews with stakeholders including Non-Governmental Organisation and United Nations agency staff were performed. Key informants were identified through purposive sampling. An inductive thematic approach was taken in analysis.

Results

Main emerging themes included the benefits and challenges of CTPs and their role in protection. Challenges included the mobile, heterogenous population and benefits included economic development in Greece and restored choice to beneficiaries. With regards to protection, informants reported a positive impact through allowing refugees to meet their basic needs and prioritise other needs and CTPs providing consistent access to refugees which could allow identification of protection risks. However, protection was not considered in the design of all CTPs.

Conclusions

Due to the multi-sectoral nature of the response, there is no standard integration of protection into cash programmes. Cash programming offers unique, regular contact with beneficiaries and chances to identify protection risks that are not always utilised due to minimal staff training in protection. Cash assistance in Greece allows people to meet their basic needs and gives people space and funds to prioritise other needs such as health and education, inherently improving their protection status.

Key messages

With cash assistance growing in popularity in humanitarian programming, consideration of protection is important as it can improve the health, safety and dignity of beneficiaries. In Greece the cash programme was only designed to meet basic needs but broader effects on protection were seen.
Living conditions, diet and lifestyle of Asian and African undocumented immigrants in Athens, Greece
Authors: Awais S , Sarwar Shah S G
Published: November 2019

Aim

To study the living conditions, diet and lifestyle of undocumented migrants of Asian and African origin living in Athens, Greece.

Methods

An exploratory study involving a snowball sample of 200 participants who completed a questionnaire survey administered by hand at a non-governmental day-care facility for homeless immigrants in Central Athens. Response rate 60 % (120 / 200 surveys returned).

Results

Participants were mainly male (96%), aged 20-40 years (84%) and unmarried (61%) with secondary school education (33%). Participants were from different countries of South Asia (81.7%), Middle East (5%) and Africa (11.5%). 26 % of participants arrived in Greece in the last 12 months and travelled on average for 52 days (median 30 days) from their home countries to Greece. The majority of participants (69%) were without a White Card (formerly the Pink Card) for asylum applicants. Their living conditions included homeless / on streets (13%) and living in a shared house (82%) or basement (13%). Participants had access to a kitchen (77%), toilet (77%), water (76%), electricity (78%), heating (53%), refrigerator (76%), TV (68%), computer (43%) and car (7%). Dietary intake and habits revealed that 86% of participants had normal to very good appetite, 52% ate two meals a day and 38% ate breakfast daily but 35% (n = 42) did not eat any breakfast the whole week. The diet included chicken meat (83%), red meat (63%), eggs (60%), white bread (79%), wholemeal bread (33%), rice or noodles (79%), potatoes (74%), vegetables (77%), fresh fruit (66%), dry fruits and pulses (50%) and dairy products (65%). Lifestyle wise, 59% of participants were non-smokers, 13% took recreational drugs and 77% did not allocate any time for daily exercise.

Conclusions

Undocumented migrants from Asian and African countries take perilous journeys to Europe for a better life but they have very poor social and economic status, which negates the main reasons of leaving their home countries.

Key messages

Undocumented migrants from Asian and African countries take perilous journeys for a better life in Europe. Undocumented migrants have a very poor social and economic status in Greece.
Self-help as a relief strategy for Turkish family caregiver of people with dementia? A Scoping Review
Authors: Tezcan-Güntekin H , Özer-Erdogdu I , Yilmaz-Aslan Y
Published: November 2019

Background

The number of dementia patients with a migration background is rising in the process of demographic change in Germany. For people with a migration background, care is usually provided at home and is accompanied by an increased burden on relatives. Alleviating support services are rarely used.

Methods

The scoping review on burden and self-help as a relief strategy for Turkish family caregiver of people with dementia includes the databases PubMed, Livivo, CINAHL and Web of Science and is completed by a ’by hand’ analysis in Google and Google Scholar. A total of 24 publications were included in the analysis.

Results

Family caregiver of Turkish origin show a high degree of willingness to assume responsibility for care, show knowledge deficits with regard to support services and are exposed to heterogeneous burdens. People with a migration background hardly make use of self-help. Self-help as a relief strategy could be strengthened by needs-oriented and culturally diverse services.

Conclusions

There is a need for action to improve domestic care for people with a migrant background. This requires the involvement of stakeholders such as those in need of care, caring relatives and professional carers. Self-help for people with a migration background can be activated and promoted with target group-oriented approaches. The support measures should be designed to be sensitive to diversity and correspond to the heterogeneity of the users and their life situations.

Key messages

Self-help for migrants must be flexible and user-oriented. Diversity-sensitivity in self-help could address people who are difficult to reach.
Connecting Older Adults and Their Families through Social Technology
Authors: Mueller J , Foran H
Published: November 2019

Background

Older adults often face problems with social isolation, which is a risk factor for poorer mental and physical health. New forms of social technologies (e.g., WhatsApp) provide opportunities to facilitate social connectedness with family members. Understanding older adults’ behaviors and perceptions related to digital communication tools can inform the development of interventions to increase the adoption of these tools for social communication. This study aims to evaluate attitudes and barriers to as well as facilitators of social technology reported by grandparents and grandchildren. The secondary aim is to examine the associations between social technology use and health and well-being outcomes and to identify what factors mediate the use of social technology.

Methods

In this cross-sectional study, 144 grandchildren (Mage=26.53, SD = 9.17; 81.9% female) were recruited through student mailing lists. Grandparents were invited either through their grandchild or by the research team and recruitment is expected to be completed by September 2019. Three main groups of variables were examined: health and well-being outcomes, social support related outcomes and social technology related outcomes.

Results & Conclusions

Grandchildren reported very positive attitudes toward social technology as expected. Greater social technology use was associated with better psychological (r =.26, p =.002) and subjective well-being (rs =.20, p =.023), higher psychosocial flourishing (r =.41, p <.001), social support (rs =.22, p =.009) and social connectedness (r =.39, p <.001). Social technology use was not correlated with health, the grandparent-grandchild relationship, loneliness and depression at the bivariate level. Barriers to social technology are security concerns, threat to privacy and constant availability. Facilitators include increased contact, dealing with geographic boundaries and information seeking. Results from grandparents will also be presented.

Key messages

Social technology has potential to enhance older adults’ lives by facilitating better family relationships, building social support, reducing loneliness and through this improve health and well-being. More research is needed in this area to understand benefits or potential harms and dynamics between younger family members and older adults in use of social technology.
Role of Social Media in vaccination debate about HPV: the VAC Medi+Board study
Authors: Artus D , Larson H , Kostkova P
Published: November 2019

Background

Whilst it has long been known that anti-vaccination sentiment is widely disseminated through digital networks, 2019 has seen seismic shifts in the landscape. As viral videos originating on Youtube spread across social networks, HPV vaccine uptake tumbled in a number of countries. In Japan, the government came under sufficient pressure that they de-recommended HPV vaccine, seeing a 70% uptake rate in 2013 fall below 1%. However, there have been some reports of successful interventions - a recent campaign run by the HPV Alliance in Ireland has seen a rate back up to a national average of around 75%. A combination of hard-hitting personal testimonials, social media and traditional media looked to promote the HPV vaccine.

Methods

Social media platforms such as Twitter enable near real-time understandings of vaccine sentiment and information flows at scale. VAC Medi+Board project developed an innovative approach for Twitter data collection, integration, analysis and visualisation to support rapid responses through identifying key influencers and flashpoints in articles about vaccination going viral.

Results

This pilot study evaluated the debate about HPV on Twitter in a period of several month and developed methods for analysis and visualisation of the content, key influencers, information diffusion throughout the network and size of audience. Through complex network analysis, VAC Medi+Board piloted identification of individuals for targeted public health interventions to combat misinformation.

Conclusions

In this talk, we will present the VAC Medi+Board HPV study and explore the challenges and opportunities that social media can provide for public health policymakers.

Key messages

Analysis and graphical visualisation of HPV debate on Twitter to support targeted public health interventions at real-time. Contributing to better understanding the role of social media in the complex picture of vaccines hesitancy.
ZIKA: improved surveillance and forecast of Zika virus in Brazil
Authors: Kostkova P , Pinheiro dos Santos W , Massoni T
Published: November 2019

Background

The devastating consequences in neonates infected with Zika virus make controlling the spread of the virus and its vectors (Aedes mosquitoes) an urgent challenge. Mobile technology has been successfully used to support routine surveillance of mosquito populations conducted by the community health workers (health agents). Mobile real-time surveillance data also provides a ground truth for calibrating early-warning and prediction systems.

Methods

The ZIKA app supports the health agents in routine surveillance of properties with risk of mosquito breeding, recommends the most optimal route to visit the assigned properties, and includes gamification features, such as badges, to reward healthcare agents for successfully completing the surveillance tasks. Secondly, the project developed a model of the vector population spread using neural networks and artificial intelligence methods combing data from healthcare agents and mosquito ovitraps from the period 2009-2014, with climatic and weather data, calibrated by the real time data from the ZIKA app.

Results

The results from testing sessions demonstrated the app could replace the very time consuming paper-based systems and provide an improved surveillance data available at real time, for seamless reporting to the regional authorities. Using the 2009-2014 dataset, the neural network model successfully predicts mosquito occurrence in the high risk regions of the city of Recife.

Conclusions

The ZIKA mobile app provides a much improved surveillance of the mosquito populations and real-time data for the public health authorities responsible for rapid response. The AI early warning model successfully predicts mosquito populations using healthcare agents data, weather and climatic data.

Key messages

ZIKA project developed a mobile app to improve surveillance of mosquito population in tropical regions of Brazil. ZIKA early warning system, using AI neural networks, has the potential to predict the risk of mosquito populations in high risk urban locations.
Healthcare digital services in Italy: good practices across Regions
Authors: Zuccarino S Z , Guidotti E G , Cassano M C , De Rosis S D R , Ferrè F F
Published: November 2019

Background

In Europe, digital transformation of healthcare is one of the agenda priorities. Institutional websites and mobile applications (APPs) have been increasingly adopted by healthcare organizations for communication and service delivery. This study aims at describing the state of art and the variability of healthcare digitalization in Italy.

Methods

The study focuses on 144 active websites of public healthcare organizations (i.e. Local Health Authorities and Teaching Hospitals) of 11 out of the 21 Regional healthcare systems in Italy. The research investigates whether the healthcare organizations provide e-booking and e-paying for outpatient visits through their website/APP and whether citizens are informed of this opportunity. Researchers independently analyze the websites taking the user’s perspective, by adopting a common grid. Data refers to December 2018.

Results

The majority of items analyzed show a high variability within and among Regions. The provision of online services patients can benefit of change across the same territory. Almost 76% of the LHAs/hospitals allow for e-booking of outpatient visits and e-paying is available for 84% of them. The adoption of APPs for healthcare is not homogenous. Some Regions develop a specific regional tool (e.g. Apulia, Lombardy) providing uniform access to digital services to their resident population while in other Regions, public healthcare providers can implement their own APP (e.g. Liguria, Veneto).

Conclusions

Our findings suggest that centralizing digital services - at least at regional level - can enhance healthcare digitalization in Italy, avoiding jeopardized and unequal provision of digital services. Further research should investigate the actual use of these services by citizens and the reasons of variability.

Key messages

Italy is in delay in digital transformation of healthcare. Our study supports the identification of good regional practices, which could endorse the implementation of future actions.
How aligned are the WHO European Region policy documents to the Sustainable Development Goals?
Authors: Nogales K N , Abrantes A A
Published: November 2019

Background

The 2030 Agenda for Sustainable Development presents an unprecedented opportunity to apply an ecological perspective in public health. It’s success relays on the capacity to interpret and translate embodied principles into policies and actions. Regional policy document (PDs) guide the actions taken by the World Health Organization (WHO) and the Member States. This study aims to explore the alignment between these tools and the health-related Sustainable Development Goals (SDGs) in the WHO European Region.

Methods

PDs were identified scanning the contents of the 2015-2018 Sessions of the Regional Committee for Europe - the WHO decision-making body. 17 PDs endorsed during this period were directly included. 39 Progress reports were scanned to find additional valid PDs. The Final list included 32 items. A content analysis of the PDs was used to establish alignment to 64 health-related SDGs targets.

Results

Preliminary results found that each PD aligned to multiple targets within and beyond SDG 3. 24 PDs addressed all targets of SDG 3. A gap within target 3.b was identified (development of medicines and vaccines). Three PDs dealt with health issues outside SDG 3: target 2.1 and 2.2 (end hunger and malnutrition), 15.8 (prevent and reduce the impact of invasive species), and 16.2 (end violence and abuse against children). Five crosscutting PDs aimed to reduce the impact of social, economic and environmental determinants of health on specific population groups, aligning to several targets at the time. Gaps in Target 8.7 (eradicate forced labor) and 14.2 (protect marine and coastal ecosystems) were found.

Conclusions

PDs have the potential of contributing to several targets simultaneously, linking health to diverse aspects of sustainable development. The SDGs open the possibility for multisectoral actions. PDs invite decision-makers to venture into unconventional policy fields to address public health concerns raised by climate change and sustainable development.

Key messages

Policy documents are a valuable instrument to advance the 2030 Agenda as they enjoy the commitment of Member States and guide the action taken by international and national decision makers. The ecological perspective in public health promised by the 2030 Agenda demands actions beyond SDG 3, to address the health dimension of all aspects of sustainable development.
Physical activity and self-perceived health of women in the Province of Vojvodina
Authors: Milijasevic D , Mijatovic Jovanovic V , Susnjevic S , Ukropina S , Tomasevic T
Published: November 2019

Introduction

Women suffer from many diseases that are associated with low level of physical activity. The aim of this paper was to estimate the association between physical activity and self- perceived health of women in the Province of Vojvodina.

Methods

Research was conducted as a cross-sectional study on a sample of 1356 women aged 20-65 years in Vojvodina, as a part of the National Health Survey in Serbia, 2013. Physical activity was analysed through 3 domains of physical activity - as leisure time physical activity, walking and cycling for transportation and physical activity at work. Univariate and binary logistic regression was used to estimate the association of poor self-perceived health as dependent variable with 3 domains of physical activity. Multivariate model were adjusted for age, type of settlement, DHS Wealth Index, education and employment status.

Results

One of twelve women was physically active in leisure time 150 minutes and more (8.1%), 50.0% of women walked for transportation 150 minutes and more weekly, while 16.5% cycled 150 minutes and more weekly. Women who never walked for transportation had 9.17 time higher chance to self-perceived their health as poor compared to those who are active 150 minutes and more weekly (OR = 9.17; 95%CI 4.16-20.18), while women who are inactive at work had 1.74 higher chance to self-perceived their health as poor compared to working active women (OR = 1.74; 95%CI 1.14-2.66).

Conclusions

Physical activity at work and in the form of walking for transportation showed as predictors of poor self-perceived health.

Key messages

Regular physical activity can improve womens’ health and help prevent many of the diseases and conditions that are major causes of death and disability for women around the world. Physical activity can contribute to building self-esteem and confidence and can provide a vehicle for social integration and equality for women in society.
European Public Health Master program – public health support worldwide
Authors: Kocot E , Szetela A , Sowada C , Bochenek T , Lecoq M
Published: November 2019

Background

In 2006 a joint European public health master course EuroPubHealth was created by a group of European universities, coordinated by the EHESP in Rennes. The EPH Program is co-funded by the Erasmus+ Programme of the European Union.

Objectives

One of the objective of the EPH Program is to support public health development through education of specialists from different parts of the World. To see the scope of this support, the data of candidates and students were analyzed, mainly in terms of their country of origin and background.

Results

A total number of candidates is growing significantly: it was 319 in 2006 and 609 in 2018. In 13 intakes over 5100 candidates from 156 countries applied, 331 of them (from 77 countries) became students. Most of candidates were from Africa (42% in total and 10% from Nigeria only) and Asia (33%). Looking at students’ group the structure is different - 28% students were from Europe and 25% from Asia; Africa took only 10% study places.

The most frequently occurring backgrounds of candidates and students in years 2013-2018 were medicine (over 20%), public health (about 12%) and biological sciences (10% of candidates and 16% of students), but it varied greatly depending on the origin: e.g. there were only 7% of physicians among candidates from USA, and nearly 30% among Africans and Asians. Nearly 20% students had a background not directly related to medicine and biology, so they formed very diverse groups.

Conclusions

Over 70% EPH students came from outside Europe, over 180 public health specialists from Asia, Africa and South America were educated. Now, many of them work on public health development in countries with very high needs in this area, supporting local communities.

Key messages

The EPH Program helps to develop public health on all continents. The interest in education in public health is very big - people interested in education are from very different countries and their background is not always connected directly with human health.
Citizens’ perspectives on genomic sciences and direct-to-consumer genetic tests: systematic reviews
Authors: Hoxhaj I , Stojanovic J , Tognetto A , Sassano M , Calabrò G E , Boccia S
Published: November 2019

Background

Past decades have witnessed enormous progress in the field of genetics and genomics, and yet a low level of awareness among general public has been described. Our aim was to explore the general populations’ knowledge, attitudes and behaviors towards genomic sciences, with a focus on direct-to-consumer genetic tests (DTC-GTs). DTC-GTs are genetic tests ordered directly by the public, without the involvement of a healthcare provider.

Methods

Two systematic reviews were conducted related to citizens’ knowledge, attitudes and behaviours. Firstly, we updated the current literature on DTC-GTs by searching PubMed, Web of Science, Embase, Scopus and Google Scholar. Studies published in English from October 2014 to January 2019, conducted in Europe were included. Secondly, we searched PubMed, Web of Science and Embase to review English and Italian studies on genomic sciences from 2003 to 2019.

Results

In the systematic review on DTC-GTs, we included six studies from Italy, Greece, Germany, The Netherlands and Switzerland. European citizens had an overall low level of awareness and a very small proportion of them had personal experience with DTC-GTs. More than half of the participants were interested in undergoing a DTC-GT, mainly for knowing the risk predisposition to a common disease such as cancer or cardiovascular disease. Concerns were raised about tests’ validity and utility as well as data privacy. In the systematic review on genomic sciences, 55 studies were included. The data extraction process is still in progress and our preliminary results indicate low levels of awareness on genomics.

Conclusions

Our findings showed that European citizens have a modest level of awareness and a high interest in DTC-GT. Understanding the citizens’ perspectives toward genomic sciences may contribute to the development of educational programs related to their needs.

Key messages

European citizens expressed modest levels of awareness and high levels of interest in DTC-GTs, mainly for knowing the risk predisposition to common diseases. European citizens are concerned with the data privacy and DTC-GT’s validity and utility.
Perceptions of youth healthcare professionals of the concept Positive Health in the Netherlands
Authors: de Bot C M A , van Meerten E , Dierx J A J
Published: November 2019

Background

Based on public health professionals’ opinions, Huber et al. (2011) described health as a dynamic concept that has the potential to increase or decrease depending on contextual factors, yet with the broadness as the WHO definition. She proposed defining health ’as the ability to adapt and self-manage, in the light of physical, emotional and social challenges of life’. Healthcare professionals are exploring how the new concept can be further specified for various fields of healthcare. This study examines the perceptions of youth healthcare professionals to Positive Health and to what extent they experience this concept in current working practice.

Methods

A mixed-methods research has been used; both quantitative and qualitative data have been collected. A questionnaire survey (n = 97) has been done and semi-structured interviews (n = 12) have taken place to question youth healthcare professionals in public health about the positive health concept.

Results

Youth healthcare professionals find all the dimensions of positive health important. However, not all dimensions of positive health are suitable in daily practice of youth healthcare professionals in public health. The dimension ’Quality of life’ is seen as the most important dimension in terms of positive health. The concept of positive health can be applied within the workfield of youth healthcare professionals. However, the implementation of new concept should be explored.

Conclusions

This study shows that youth healthcare professionals have a positive attitude towards Positive Health. Youth healthcare professionals consider the all the dimensions important and also embed the aspects of it in their daily practice. However, the implementation of new concept should be explored.

Key messages

The Positive Health concept in youth healthcare care is promising. Positive Health gives a broader look at health.
Health promotion around the birth
Authors: Geene R
Published: November 2019

Background

With the “Child Protection Act” in 2012, the Prevention Law in 2015 and the new health goal ’Health around Birth’ in 2017, the framework conditions for health promotion and prevention in pregnancy have improved. This takes into account the fact that health behavior is essentially determined by embryonic and early childhood experiences in families.

Methods

First: Analyzing the family-related legal regulations by Early Helps and the Prevention Act as well as the health goal “Healthy Birth”; Second: Analyzing data from 153 interviews with socially disadvantaged mothers; Third: Collecting mothers’ impressions (in citations) about physiological, psychological and social coping factors; Fourth: Analyzing conceptually and within different phases of pregnancy (orientation-, self-conception-, subject conception-, anticipation- and birth phase) and postnatal phases (postpartum, family becoming, stabilization and socialization to society) phase-specific prevention needs and potentials identified as well as examples of health promotion.

Results

Pregnancy and becoming a family are associated with different coping requirements, which should be treated specifically according to phases and social conditions. A tailored analysis provides a variety of methods and approaches for health promotion, which can be offered via setting-approaches or in individual counseling and support. They can be described as parts of family health promotion, which should be designed as a joint task of the health service and child and youth welfare as well as other local actors.

Discussion

Family health promotion is a complex challenge for the actors in the care, in the social area and in the control levels. It requires an independent, scientifically justified intervention approach with method programs and institutional assignments.

Key messages

Pregnancy and becoming a family are associated with different coping requirements. It requires an independent, scientifically justified intervention approach with method programs and institutional assignments.
Determinants of health and cancer: investigating conceptions of children aged 6 to 11
Authors: Deyra M D , Gay C G , Pizon F P , Gerbaud L G
Published: November 2019

Context

Qualitative data on how children and adolescents view their health and its determinants are relatively few at the international level. This research is therefore part of a comprehensive and open-minded approach to better describe how elementary school children perceive the determinants of health and cancer.

Objectives

Our main objective is to map, from a multiphase qualitative protocol, the conceptions and systems of conceptions on the determinants of health and cancers perceived within a 6 to 11 age group.

The secondary objective is to analyze our ability to collect these healthy conceptions from children.

Methodology

Four different tools were used in four schools for 320 students: (1) “photo expression”, (2) “QC (Questions / Certainties)”, (3) “photo narration” and (4) “focus group”. This open and exploratory method, combining the use of photographs and focus groups, provided data on the experiences, stated practices and knowledge of each student. The mobilization of image mediation methods plays an essential ethical role by ensuring the distance between the theme and the child. The informative value of data from qualitative collection tools coupled with a mixed analysis methodology (qualitative and quantitative) allows us to collect dense and efficient data needed to understand the perception of determinants by elementary school students.

Conclusions

This study identifies promising methodological leads thanks to the complementarity of the different phases mobilized. It also provides us with elements of methodological understanding that can contribute to the development of prevention tools as part of the school health education journey.

Key messages

Map, from a multiphase qualitative protocol, the conceptions and systems of conceptions on the determinants of health and cancers perceived within a 6 to 11 age group. Analyze our ability to collect these healthy conceptions from children.