bluuebunny/crossref_metadata_2025 huggingface dataset:
The COMPARE Data Hubs
Authors: Amid Clara , Pakseresht Nima , Silvester Nicole , Jayathilaka Suran , Lund Ole , Dynovski Lukasz D , Pataki Bálint Á , Visontai Dávid , Xavier Basil Britto , Alako Blaise T F , Belka Ariane , Cisneros Jose L B , Cotten Matthew , Haringhuizen George B , Harrison Peter W , Höper Dirk , Holt Sam , Hundahl Camilla , Hussein Abdulrahman , Kaas Rolf S , Liu Xin , Leinonen Rasko , Malhotra-Kumar Surbhi , Nieuwenhuijse David F , Rahman Nadim , dos S Ribeiro Carolina , Skiby Jeffrey E , Schmitz Dennis , Stéger József , Szalai-Gindl János M , Thomsen Martin C F , Cacciò Simone M , Csabai István , Kroneman Annelies , Koopmans Marion , Aarestrup Frank , Cochrane Guy
Published: November 2019

Data sharing enables research communities to exchange findings and build upon the knowledge that arises from their discoveries. Areas of public and animal health as well as food safety would benefit from rapid data sharing when it comes to emergencies. However, ethical, regulatory and institutional challenges, as well as lack of suitable platforms which provide an infrastructure for data sharing in structured formats, often lead to data not being shared or at most shared in form of supplementary materials in journal publications. Here, we describe an informatics platform that includes workflows for structured data storage, managing and pre-publication sharing of pathogen sequencing data and its analysis interpretations with relevant stakeholders.
Stenting of modified Blalock–Taussig shunt in adult with palliated pulmonary atresia and ventricular septal defect: a case report
Authors: Illner Julia , Reinecke Holger , Baumgartner Helmut , Kaleschke Gerrit
Published: November 2019

Background

Adults with complex congenital heart disease palliated with systemic-to-pulmonary artery shunts have become rare and represent a particularly challenging patient group for the cardiologist. One of the complications and causes of severe clinical deterioration during long-term follow-up are progressive obstruction or total occlusion of the shunt. The risk for surgical intervention is frequently high and catheter intervention may be complicated by complex anatomy and shunt calcification.

Case summary

We report the case of a 47-year-old man with uncorrected (palliated) pulmonary atresia and ventricular septal defect who presented with progressive cyanosis (oxygen saturation 69%) and decreasing exercise capacity. Computed tomography revealed a totally occluded modified left Blalock–Taussig (BT) shunt and a severely stenosed central shunt (Waterston–Cooley) in a patient with confluent but hypoplastic pulmonary arteries and multiple major aortic pulmonary collaterals. Due to a high operative risk, an interventional, percutaneous approach was preferred to re-do surgery. From a radial access the calcified BT shunt could be crossed with a hydrophilic guidewire. Then, a rotational thrombectomy, balloon dilatation, and bare-metal stenting at the proximal and distal anastomoses were performed. Post-interventionally, peripheral oxygen saturation increased from 69% to 82%. Clopidogrel was administered for 1 month after bare-metal stenting. At 1-year follow-up, the BT shunt was still patent on echocardiography and exercise tolerance markedly improved.

Discussion

This case highlights the benefit of percutaneous rotational thrombectomy followed by stenting of chronically occluded systemic-to-pulmonary artery shunts for further palliation in adult patients with complex congenital heart disease not suitable for surgical repair.
Bridging towards the future of public health in Europe (II). Can we and how do we ensure Health in All EU Policies?
Authors:   Moderators: Josep Figueras, European Observatory on Health Systems and Policies
Published: November 2019

The plenary will continue the debate on The future of Public Health in Europe introduced in the previous plenary, tackling the role of the EU and its institutions in ensuring that health is addressed in all EU policies. The EU is firmly committed to implementing the 2030 Agenda and the Sustainable Development Goals through its range of institutional mechanisms. Incoming Commission President von der Leyen has pledged to refocus the European Semester ‘to make sure we stay on track with our SDGs’. These developments, together with the broad recognition of the central role of health in the SDGs and the momentum given by the new EU policy cycle presents a unique window of opportunity to critically reappraise the role of health in the EC, which, at least, on paper makes for an ideal Health in All Policies institution.

The first keynote by Director General Anne Bucher, DG SANTE, will draw on the ‘hot of the press’ results of the November 2019 State of Health in the EU exercise, including the EU Country Health Profiles and the Commission Staff Companion Report. She will highlight the main health and health system challenges faced by EU Member States—ranging from the burden posed by preventable mortality to the vaccination crisis and the resilience of the health workforce.

Prof. Scott Greer’s keynote will contend that to tackle these challenges we need to go beyond Public Health Article 168 and its subsidiarity corset. He will speak to the need to proactively employ the much stronger (health) policy tools within the large body of EU law underlying the internal market and to draw on the EU’s newfound role in fiscal governance such as through the European semester. Prof. Greer will draw on the innovative results of the new edition of the seminal study ‘Everything you always wanted to know about European Union health policies but were afraid to ask’ which will be distributed to participants.

The following panel will debate on the practical implementation and political economy questions arising from the plenary’s postulates. Prof. John Middleton, ASPHER’s president, will address the implications for the Public Health profession such as training in public health leadership, overhauling public health competencies or indeed the understanding of the public health profession itself. The second panellist will address the political economy implications of bringing health across EU policies and how to bypass the complexities of working across policy sectors in the EU institutions. The panel will actively interact with the participating audience through a range of innovative ways.

Panellists

Anne Bucher

DG SANTE, European Commission

Scott L. Greer

Health Management and Policy, University of Michigan

John Middleton

The Association of Schools of Public Health (ASPHER)
Equality of Opportunity and Mortality in Europe
Authors: Gugushvili A
Published: November 2019

Background

This study investigates if intergenerational equality of opportunity is linked to mortality in 30 European countries. Equality of opportunity may lead to greater returns on health investments, and, consequently, improvement of health outcomes. In turn, a perceived lack of fairness in the distribution of life chances and limited possibilities for upward intergenerational mobility can cause anxiety among individuals and gradually compromise their health.

Methods

We used information on parents’ and their 163,467 children’s Socio-Economic Index of Occupational Status from a large survey data-set to generate three complementary measures of equality of opportunity and linked them to administrative data on total, gender- and cause-specific mortality rates derived from the national statistical offices.

Results

We found that lower equality of opportunity, measured by the attainment of individuals from the lowest and highest quartiles of socio-economic status and by the overall intergenerational correlation in socio-economic status, was related to higher mortality rates, particularly in relation to diseases of the nervous system and the sense organs, diseases of the respiratory system, and external causes of mortality. Our measures of equality of opportunity were more consistently linked with mortality of men than women.

Conclusions

Equality of opportunity may be an important explanation of mortality that warrants further research. Measures that aim at facilitating intergenerational social mobility can be justified, not only due to normative considerations of equality of opportunity, but also in terms of individuals’ chances to enjoy healthy lives.

Key messages

Intergenerational equality of opportunity was more consistently linked to mortality of men than that of women. Our key message is that equality of opportunity is not only fair but it is also good for health.
Food insecurity and social determinants of students’ low adherence to the Mediterranean diet
Authors: Tsiampalis T , Petralias A , Linos A
Published: November 2019

Background

Despite the fact that the Meditteranean diet is highly beneficiary for people’s health, there are many factors which cause disparities in the level of adherence. The aim of the present work was to investigate the effect of household food insecurity (FI) on adherence to the Mediterranean diet (AMD), to explore the participants’ characteristics modifying the studied relationship and find the social determinants of students’ low adherence to the specific dietary pattern.

Methods

A cross-sectional study with 140 schools and 4,242 students was conducted in Greece (2017-2018). Especially designed and validated instruments were used to record students’ sociodemographic characteristics, household’s FI status and students’ AMD. Analysis of Variance (ANOVA) and Covariance (ANCOVA) was used to investigate the effect of FI and to identify the significant social determinants of students’ AMD, according to students’ school grade.

Results

After adjusting for other characteristics, students whose both parents are born in other countries, spend at most 4 hours/week on TV/electronic games, live in the regions of Peloponnese, Central Macedonia or Attica and attend primary schools adhere more to the Mediterranean diet, while higher level of physical activity and lower FI are significantly associated with better AMD. Parents’ educational level in nursery schools (p = 0.002) and employment status in nursery schools (p = 0.012) and in high schools/ lyceums (p = 0.008) were found to modify significantly the studied relationship in the univariate analysis, while school grade (p = 0.013) and physical activity (p = 0.088) were found to modify the studied relationship in the multivariable analysis.

Conclusions

Several demographic, socioeconomic and lifestyle characteristics were significantly associated with students’ AMD. Thus, emphasis should be given on the design of special programs to reduce household FI and intervene in the rest characteristics.

Key messages

Researchers and policymakers should consider food insecurity as important risk factor for school-aged children, particularly for those who live in poverty. Emphasis should be given on the design of special low-cost programs aiming to reduce food insecurity.
Metabolic syndrome among Ghanaian migrants and their homeland counterparts: the RODAM study
Authors: van der Linden E L , Agyemang C
Published: November 2019

Background

Metabolic syndrome (MetSyn) is a major risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). T2D and CVD are a major burden among African populations both in Africa and in high-income countries. However, it is unknown whether the prevalence of MetSyn shows geographical differences between a homogenous population residing in different settings in Africa and Europe.

Methods

We used data from the cross-sectional multi-centre Research on Obesity and Diabetes among African Migrants (RODAM) study that was conducted among Ghanaians aged 25-70 years residing in rural and urban Ghana and in Amsterdam, London and Berlin (n = 5659). MetSyn was defined according to the 2009 harmonized definition. Geographical locations were compared using age-standardised prevalence rates and prevalence ratios (PRs), adjusted for age, education, physical activity and smoking.

Results

In men, the age-standardised prevalence of MetSyn was 8.3% in rural Ghana and showed a positive gradient through urban Ghana (23.6%, PR = 1.85, 95% confidence interval 1.17-2.92) to Europe, with the highest prevalence in Amsterdam (31.4%; PR = 4.45, 2.94-6.75). In women, there was a rural to urban gradient in MetSyn prevalence (rural Ghana 25%, urban Ghana 34.4%, PR = 1.38, 1.13-1.68), but small differences in MetSyn prevalence between urban Ghanaian and European Ghanaian women (Amsterdam 38.4%). The prevalence rates of the individual MetSyn components showed a positive rural-urban-Europe gradient. However, compared to their urban and European counterparts, a low HDL-C level was significantly more prevalent among rural Ghanaians.

Conclusions

MetSyn and its components are highly prevalent in Ghana as well as in Ghanaian migrants in Europe. To understand the mechanisms driving the geographical differences in MetSyn, further research is needed, thereby aiming for the reduction of T2D and CVD prevalence in SSA populations.

Key messages

Metabolic syndrome is more prevalent in urban compared to rural Ghana, and even more prevalent in Ghanaian migrants in Europe. Its components show the same positive gradient, expect for low HDL-C, which shows a negative gradient.
Hyperuricemia And Estimated Cardiovascular Risk Among Migrant and non-migrant Africans
Authors: Agyemang C , Mannens M A M , Henneman P , Beune E , Meeks K , Requena-Mendez A
Published: November 2019

Objective

In the advent of rapid urbanization, migration and epidemiological transition, the extent to which serum uric acid (sUA) affects cardiovascular disease (CVD) risk among Africans is not well understood. We assessed differences in sUA levels and associations with estimated CVD risk among migrant Ghanaians in Europe, and non-migrant Ghanaians in rural and urban Ghana.

Methods

Baseline data from 633 rural, 916 urban and 2315 migrant RODAM study participants (40-70 years) were analyzed. Hyperuricemia was defined as sUA >7mg/dl in males and >6mg/dl in females. Elevated CVD risk was defined as pooled cohort equation estimates ≥ 7.5%. Logistic regressions were used to assess differences in hyperuricemia and associations with estimated CVD risk. Receiver operator curves were used to calculate sUA cut off values that maximised likelihood of elevated CVD risk.

Results

Prevalence for hyperuricemia in rural, urban and migrant participants were 17.4%, 19.1% and 31.7% for men, and 15.9%, 18.2% and 33.2% for women, respectively. Hyperuricemia was positively associated with elevated CVD risk among rural residents(adjusted OR for men 2.88, 95%CI, 1.20-6.88, 5.32, 95%CI, 2.86-9.95 for women), urban residents(1.26, 95%CI, 0.59-2.69 for men, 2.41, 95%CI, 1.56-3.73 for women) and migrants(2.39, 95%CI, 1.57-3.64) for men, 3.74, 95%CI, 2.78-5.02 for women). SUA cut-off values were 6.8mg/dl in men and 5.2mg/dl in women.

Conclusions

Our study shows variations of sUA levels in different African contexts. Hyperuricemia is associated with elevated estimated CVD risk in both migrants and non-migrants. Further studies should identify factors driving associations between SUA and CVD risk in Africans.

Key messages

Hyperuricemia is a risk factor for cardiovascular risk in both migrants and non-migrants. Cardiovascular risk is seen at low levels of serum uric acid levels in Africans.
Vaccination status of migrant populations in EU/EEA countries and implications for VPD control
Authors: Hargreaves S , Himmels J , Nellums L B , McGuire E , Friedland J S
Published: November 2019

Background

Migrant populations in the EU/EEA are increasingly being associated with outbreaks of vaccine-preventable diseases (VPDs), including the large-scale measles outbreak currently ongoing across Europe; however, it is unclear to what extent migrants represent an under-immunised group in the European context and implications for VPD control. Ensuring high levels of vaccination coverage is a key priority for all countries through the European Vaccine Action Plan, with EU/EEA Member States committed to eliminating measles and rubella, sustaining polio-free status, and controlling hepatitis B infection. We synthesised existing EU/EEA data to assess under-immunisation in migrants (defined as foreign born) residing in EU/EEA countries.

Methods

We did a systematic review and meta-analysis (PROSPERO CRD42018103666) in accordance with PRISMA guidelines. Inclusion criteria were primary research studies pertaining to vaccination status (measles, mumps, rubella, diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b [Hib]) in migrants residing in all EU/EEA countries. Pooled prevalence (95% CIs) were calculated for the meta-analysis using a random effects model.

Results

56 studies met our criteria (14 EU/EEA countries); 36 studies, which included data from 80,432 migrants, were included in the meta-analysis. Vaccination status of migrants for key VPDs varied substantially, with pooled immunisation coverage well below the herd immunity threshold (HIT) targets for measles 80% (95% CI: 73-87%; HIT 92-95%), mumps 65% (95% CI: 48-82%; HIT 75-86%), and diphtheria 51% (95% CI: 29-73%; HIT 83-86%). Polio type 1 and 2 coverage was high (97% [95% CI: 95-98%]; 95 [95% CI: 92-97%], respectively).

Conclusions

Migrants represent an under-immunised group in Europe, thus a high priority group for catch-up vaccination. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and/or control of key VPDs.

Key messages

Migrants represent an under-immunised group in Europe and a high priority group for catch-up vaccination campaigns. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and control of vaccine-preventable diseases.
1.E. Workshop: Comparative Public Health: Politics, science, and professionalism
Authors:   Organised by: University of Michigan Chair persons: Marleen Bekker - EUPHA (PHPP), Karine Chevreul - France
Published: November 2019

Look around EUPHA, or any other public health conference. Public health is difficult to define, in theory and in practice. Its boundaries are all blurred, whether with medicine, schools, environmental protection or workplace safety inspectorates. Too often, we overstate the similarities between public health systems among countries. Efforts to promote networks, good practice, and even basic coordination have been undermined for decades by misunderstandings born of different educational, organizational, financial and political systems. The lack of comparison, and comparative political analysis in particular, also means that countries can have very similar debates about the proper nature and scope of public health, an about who is to blame for deficiencies, without awareness of when they are distinctive and when they are actually part of larger trends.

This project aims to identify and explain variation in the scope and organization of public health systems in selected high-income countries. Based on a formalized comparative historical analysis of Austria, France, Germany, Poland, the United Kingdom and the United States, researchers in the study first mapped the various axes of divergence: workforce composition, organization, levels of government, relationship to medicine, and the extent to which public health encompassed adjacent areas such as environmental health and occupational health and safety. For each country we then followed both case studies (communicable disease control including vaccines, HIV/AIDS, tobacco control, diet and nutrition, occupational health and safety) as well as the legislative history of the public health field in order to identify its changing organization and scope. It then identifies the relative role of historical legacies, changing science, burden of disease and politics in explaining patterns of both divergence and convergence.

This workshop presents four country specific case studies (France, Germany, United Kingdom and the United States) that identify the most important forms of variation and the political, scientific and professional drivers of convergence and divergence.

Key messages

Political organization and scope as images of public health are grossly under-researched and nonexistent in a comparative nature. Understanding the scope and organization of public health in different countries will permit better lesson-drawing and identification of relevant and effective levers of change.
The United States: A system built on fragmentation
Authors: Jarman H.
Published: November 2019

Background

The United States is effectively a laboratory for ways to produce public goods, such as public health, on the cheap. Its c. 90,000 governments compete for residents, businesses, taxes, development, and jobs while also trying to compensate for the lack of universal health care coverage. They all have structural incentives to provide services as cheaply as possible. The effects are diverse and poorly mapped. They can mean innovation in organizational forms, a different and typically less expensive skill mix among the workers, poor quality, or simple under provision. The exact mix can often be hard to identify. It can also mean extreme responsiveness to funding from higher levels of government such as the states or federal government.

Methods

A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results

The distinctively expansive scope of US public health actions is largely due to the country’s failure to establish a universal health care system, and the diversity of US public health tasks reflects local adaptation of tens of thousands of governments. This means that public health in the United States retains much of the activity it had in, for example, the UK before the establishment of the US. In particular, and even in states that accepted the Medicaid expansion in the Affordable Care Act (ACA), local public health departments provide a substantial amount of direct care and fill in for gaps in health care provision.

Conclusions

The US public health system is highly fragmented like the governments that run it, and therefore diverse. Reflecting the failures of the US health care system, it carries out many more tasks that in other countries are seen as health, especially primary, care.
Higher Education Students’ Mental Health Problems: Results from the Norwegian SHOT study
Authors: Bøe T , Hysing M , Sivertsen B
Published: November 2019

Highly educated people have better health than those without education. The number of young adults pursuing higher education is increasing; In 2015 almost half the Norwegian adult population had completed higher education (1). Studies have investigated horizontal stratification (i.e. differentiation within higher education) effects on labor market outcomes, but few have studied health returns from education (2). Data stem from a recent national student health survey from 2018 for higher education in Norway (the SHoT2018-study; N = 50 054, response rate = 30.8%). We examined the associations between level of ongoing education (One-year program, Bachelor, Master, longer professional education) and mental health problems measured with Hopkins Symptoms Checklist (HSCL-25; 3. There was a pattern of decreasing symptoms of mental health problems with level of study program, F (5,49782) = 103,34, p < .001. The results formed a monotonic relationship; each level of increased education was associated with significantly less mental health problems. There was no difference between the Masters and professional programs. We found evidence of horizontal stratification of mental health problems in this large sample of Norwegian college and university students. The observed association may have three explanations; causality may run from schooling to health (4), it may run from health to schooling (5), or both may be determined third factors. Further studies should investigate mechanisms such as stigma and social status in relation to the observed associations (6,7).

1 OECD. (OECD Publishing, 2015), 2 Conti, G. et al. Am. Econ. Rev. 100, 234-238 (2010), 3 Derogatis, L. et al. Behavioral science 19, 1-15 (1974), 4 Grossman, Michael et al. in Handbook of the Economics of Education (eds. Eric A Hanushek & F. Welch) 1, (Elsevier, 2006), 5 Currie, J. J Econ Lit 47, 87-122 (2009), 6 Marmot, M. (Bloomsbury, 2004), 7 Hagquist, C. E. I. Eur J Public Health 17, 21-26 (2007)

Key messages

Increasing numbers of young adults pursue higher education, it is therefore important to investigate educational inequalities within higher education. College students pursuing higher education (masters or professional programs) have fewer mental health problems relative to college students enrolled in higher education, but at lower levels.
Depressive symptoms, neuroticism and participation in breast and cervical cancer screening in the UK
Authors: Niedzwiedz C L , Robb K A , Katikireddi S V , Pell J P , Smith D J
Published: November 2019

Background

Globally, more than 2 million women are diagnosed with breast or cervical cancer every year. Depressive symptoms and personality traits have been implicated in cancer-related mortality, but the potential mechanisms through which these associations may operate are not well understood. We aimed to assess how depressive symptoms and neuroticism are associated with participation in breast and cervical cancer screening.

Methods

273 402 women in the UK Biobank cohort who were eligible for breast cancer screening (aged 50-70 years) and/or cervical cancer screening (<65 years) at baseline recruitment (2006-10) and those with follow-up data (2014-March 19) were identified. Depressive symptoms (4 items from Patient Heath Questionnaire) and neuroticism (12 items from Eysenck Personality Inventory Neuroticism Scale) were self-reported at baseline. The primary outcomes were reporting being up to date with breast and cervical cancer screening. For prospective analyses, patterns of screening participation from baseline to follow-up were derived. Logistic regression was used to analyse associations, adjusted for potential confounders.

Results

More severe depressive symptoms (range 0-12) were associated with reduced screening for breast (OR = 0.960, 95% CI: 0.950,0.970) and cervical cancer (OR = 0.958, 95% CI: 0.950,0.966). Prospective analyses revealed higher baseline depressive symptoms were related to decreased cervical cancer screening at follow-up (OR = 0.955, 95% CI: 0.913,0.999; equivalent to a difference of 4.08% between the highest and lowest depressive symptom score), but not with breast cancer screening. Results for overall neuroticism were inconclusive, but individual neuroticism items including anxiety and nervousness were related to increased screening participation.

Conclusions

More severe depressive symptoms may act as a barrier for cancer screening participation and could be an indication for more proactive strategies to improve uptake.

Key messages

Women with more severe depressive symptoms are less likely to be up to date with their breast and cervical cancer screening, which may exacerbate existing health inequalities. Interventions to increase screening participation among women with poor mental health may be merited.
Socioeconomic trajectories and risk of hospitalization in the Moli-sani Study cohort
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Persichillo M , De Curtis A , Cerletti C , Donati M B , de Gaetano G , Iacoviello L
Published: November 2019

Background

A life course approach was used to explore the impact of socioeconomic status (SES) on risk of hospitalizations for all-cause and for cardiovascular disease (CVD).

Methods

Longitudinal analyses on 19,999 subjects apparently free from CVD and cancer, recruited in the Moli-sani Study, Italy (2005-2010). Low and high SES in childhood, educational attainment (low/high) and SES during adulthood (measured by a score including material resources and dichotomized as low/high) defined the trajectories over life course. First hospital admissions were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression.

Results

Over a median follow up of 7.3 y, we ascertained a total of 7,594 all-cause and 2,539 CVD hospitalizations. Poor childhood SES was associated with 11% and 17% increased risk of all-cause and CVD hospitalizations, respectively. Among subjects with poor childhood SES, an upward trajectory in education was associated with lower risk of hospital admission for all-cause (HR = 0.85; 95%CI 0.76-0.94) and CVD (HR = 0.78; 0.64-0.95), as opposed to subjects remained stably low (low education and adulthood SES). Individuals with high childhood SES, but not educational achievement, were at 26% increased risk of hospitalization for any cause, as compared to the stably high SES group, while failure to achieve both educational and material advancements was associated with 37% higher risk of CVD hospitalization.

Conclusions

In a large sample of healthy adults, social mobility (educational and/or material upward trajectories) was associated with lower incidence of hospital admissions for all-cause and CVD.

Key messages

Social mobility may counterbalance the negative health burden associated with low early-life SES. High SES in childhood poorly affects hospitalization risk if no additional achievements across life course occur.
Outsourced management service to guarantee safety and cost-effectiveness in pediatric cardiac surgery
Authors: Ceradini J , Corsetti T , Brusco C , Mazzaccara A , Raponi M
Published: November 2019

Background

Children’s hospitals deal with young patients, who have greater variability than adults, therefore size of the medical devices ranges from the newborn to the adult-like patient. This complexity is associated with higher costs to ensure safety and logistics. In June 2014 Bambino Gesù Children’s Hospital (OPBG) adopted an outsourced service for medical device acquisition and stock records for the execution of cath-lab and heart surgery interventions.

Goal

To evaluate the services effectiveness multi-dimensionally in terms of cost saving, safety, outcomes and operator satisfaction. We measured costs and indicators in pre and post intervention. Materials and methods. We compared the years from 2013 to 2017 in terms of cost-related device and prosthesis consumption, including mean costs per intervention using ANOVA with Tukey’s Post-hoc test. To evaluate the clinical proxy outcome we calculated the pediatric index of mortality for each year.

Results

In 2013-2017 we performed a mean of 1985 (ds 140) procedures per year with devices, the sample is homogeneous in size and clinical complexity. The trend shows a solid decrease of expenses after the service introduction: we observed a reduction of 20% of the mean consumption per intervention between year 2013 and year 2017 (1707€ vs 1391€) P < 0.001. For what concerns outcomes we noticed a reduction of Standardized Mortality Ratio index from 0.51 to 0.27 (CI 0.18-0.42) in 2014-2017.

Discussion

Outcome indicators excludes any increase of risk following the adoption of the service. The hospital pharmacy did not receive any reports regarding incidents attributable to the service. The nurses evaluated the service positively regarding the availability, traceability of the devices and decrease of the warehouse work.

Conclusions

Outsourced service has been cost saving, safe and well accepted by operators and in our opinion is replicable also in other highly complex pediatric hospital settings.

Key messages

Children hospitals are associated with higher costs to ensure safety and logistics in surgery and cath-lab with medical devices. Outsourced management service can promote cost saving and safety.
Area deprivation and notifiable infectious diseases in Germany: A longitudinal small-area analysis
Authors: Rohleder S , Stock C , Maier W , Bozorgmehr K
Published: November 2019

Background

Socioeconomic inequalities may affect the infectious disease incidence. We studied the association between area deprivation and incidence of notifiable infectious diseases in Germany to understand spatio-temporal patterns and the effects of societal factors on disease epidemiology.

Methods

Using national surveillance data of 401 districts from 2001 to 2017, we examined the incidence of infectious diseases using spatiotemporal Bayesian regression models. We analyzed eight disease classes: blood-borne viral hepatitis, gastrointestinal, vaccine preventable, vector-borne, zoonotic, other bacterial, other infectious, and overall burden of infectious diseases. As explanatory factors we considered area deprivation (measured by the German Index of Multiple Deprivation), fraction of non-nationals, sex, age, and spatiotemporal effects.

Results

A risk gradient across deprivation quintiles was observed for the overall burden of infectious diseases. The relative risk (RR) for gastrointestinal diseases in areas with medium and high deprivation relative to low deprivation was 1.65 (95%-credible interval [CrI] 1.01-2.54) and 2.64 (1.22-4.98), respectively. The RR for vector-borne diseases was 1.89 (1.27-2.73) in districts with high deprivation compared to areas with low deprivation. Lower risks in highly deprived areas relative to low deprived areas were identified in vaccine-preventable diseases (RR = 0.39; 0.14-0.88) and zoonoses (RR = 0.69; 0.48-0.96). For blood-borne viral hepatitis, other bacterial, and other infectious diseases no association with area deprivation was observed. Spatial risks of infections were predominantly concentrated in eastern parts of Germany and changed marginally over time.

Conclusions

The risks of infections tend to be higher in more deprived areas and in eastern parts of Germany, but they varied by class of disease. Our results can guide measures of infectious disease control and prevention by considering spatial risks and deprivation.

Key messages

Area deprivation has both positive and inverse associations with the incidences of infectious diseases in Germany. Regions with increased risks may benefit from targeted public health measures. Spatial risks of infections tended to be higher in eastern regions of Germany. Disparities in the incidence of infectious diseases may be still present between western and eastern Germany.
Discrimination of people living with hiv/aids: a survey with dentists in Abidjan, Côte d’Ivoire
Authors: Guinan J C , Meless G D , Sangaré A D , Danho-Da V , Kouassi B S , Datté A S , Samba M , Bakayoko-Ly R
Published: November 2019

Background

Despite several decades of fighting HIV infection, discrimination against people living with this infection persists, even among health professionals. Understanding the determinants of discriminatory attitudes of dentists is a first step towards access to oral health care and improved care for people living with HIV (PLHIV).

Objectives

To analyse the determinants of discriminatory attitudes towards people living with HIV among dentists in Côte d’Ivoire.

Methods

A cross-sectional survey was conducted among dentists in Abidjan in 2016. In addition to socio-professional characteristics, a questionnaire collected information on their knowledge about HIV (transmission, hiv-related oral diseases) and their individual perception (fear of being contaminated, cross-contamination...). The chi2 test for independent sampling was used to identify factors associated with discriminatory attitudes (threshold α = 5%).

Results

A total of 120 dentists were interviewed: 61.3% from the public sector; 56.7% men; 54.2% in couple; 53.3% had participated in continuing education on HIV; 29.2% did not know HIV-related diseases and transmission modes and 69.2% reported fear of being infected during care; 44.2% reported informing staff of the patient’s HIV status. The proportion of dentists with discriminatory attitudes was estimated at 69.2%. The main associated factors were: female gender (p = 0.001), living in couple (p = 0.000), lack of knowledge of the risk of HIV transmission after a blood exposure accident (p = 0.000), the law protecting people living with HIV in Côte d’Ivoire (p = 0.009) and fear of being infected (p = 0.000).

Conclusions

The results of this study show that the determinants of discriminatory attitudes among dentists result from their lack of knowledge of the disease, justifying the need to strengthen their continuing education on HIV/AIDS infection.

Key messages

Dentists discrimination towards people living with HIV infection result from their lack of knowledge about the infection. It’s essential to strengthen their knowledge about HIV in order to improve access to care for people living with HIV.
The Economic and Mental Health Impact of IAPT: Pragmatic Trial in Three English Regions
Authors: Toffolutti V , McKee M , Clark D M , Stuckler D
Published: November 2019

Background

Improving Access to Psychological Therapies (IAPT) programme is the English’s major initiative for treating anxiety and depression, currently provided to over 1 million people. We tested whether IAPT could reduce healthcare costs and improve employment in persons with long-term chronic conditions.

Methods

Stepped-wedge design of two cohorts covering 560 patients each with depression and/or anxiety and comorbid long-term physical health conditions, namely diabetes, chronic obstructive pulmonary disease (COPD) and cardio-vascular disease (CVD) from three areas in Thames Valley (Berkshire, Oxfordshire and Buckinghamshire) for the period March 2017 - August 2017. Panels were balanced. Difference-in-difference models were used and intention-to-treat analysis.

Results

Based on the step-wedge modelling, IAPT treatment decreased costs by £497 (95% CI: -£770 to -£224) total per person (pp) (from £1266 pp before starting the treatment to £768 pp since the treatment started)in the first 3 months. Results also showed a decrease by about 5.55 [95% CI: -6.35, -4.75] (-4.18 [95%CI: -4.91, -3.45]) points per person in the PHQ9 (GAD7). Our results show that IAPT increased the probability to an employment for those who were unemployment by about 7.92% (95% CI: 0.94% to 14.9%).

Conclusions

IAPT treatment significantly reduced healthcare utilization and costs among persons with chronic conditions. It also significantly increased the probability of employment.

Key messages

IAPT treatment significantly reduced healthcare utilization and costs among persons with chronic conditions. IAPT was significantly associated with increased probability to find employment for those unemployed.
Mental illness prevention in post-ACS men: A partcipatory action research
Authors: Jbilou J , Talbot F
Published: November 2019

Background

The prevalence of social determinants of health (i.e. rurality, low education and poverty) among men put them at an elevated risk for comorbid cardiac disease and mental illness. While, men are particularly vulnerable to mental illnesses (i.e. depression, anxiety) after an acute coronary syndrome (ACS), they are typically averse to seeking medical care, especially for mental health issues. Targeting interventions to at-risk population groups is a well documented approach. However, little in the literature presents how to prevent mental illness in cardiac men. This study aims to develop, implement and pilot a psychoeducational program tailored for post-ACS men.

Methods

A mixed method including a scoping review, a qualitative study and a quasi-experimental pilot study.

Results

In total, 42 articles were retrieved to extract key components of cardiac men-sensitive psychoeducation programs. We led 22 focus groups and 14 semi-structured interviews (119 men in total). The mean age was 51.2 years [45-77]. We integrated the gathered data gathered from the scoping review and the qualitative study to develop a psychoeducational program (3 group sessions). The pilot study involved 48 men who completed the baseline, the 3-month and the 6-month data collections. We observed 80% of compliance. Findings show a significant improvement in PHQ-9, GAD-7, IES-R, CSI and EQ-5D scales. We also observed changes in the CMNI-22, a measure of attitudes, beliefs, and behaviors associated with both traditional and non-traditional masculine gender roles. Men appreciated the time flexibility (sessions were scheduled based on participants’ availability) and the responsiveness of the sessions (content was discussed based on their needs and interests). Life partners were invited and 65% attended to all sessions.

Conclusions

The program was a success and we expect to transform it into a peer-led intervention to improve its delivery in the community and its accessibility for rural and remote areas.

Key messages

At-risk population-sensitive approaches are key for compliance and effectiveness. Group sessions are effective approaches to improve men’s mental heatlh literacy.
Economic burden of cancer from 2012 to 2017 based on the French national claim database (SNDS)
Authors: Verboux D , Pestel L , Nicolas M , Lesuffleur T , Rachas A , Gastaldi-Menager C
Published: November 2019

Background

The aim of this study is to assess the economic burden of active cancer in France and to analyze structure and trends of expenditure between 2012 and 2017.

Methods

Using information about 57 millions of individuals from the general scheme insurance database (86% of the French population) and applying 5 specifically developed medical algorithms (for lung, colon, breast, prostate and other cancers), we identified all people with active cancer. All reimbursed expenditure (hospitalization, ambulatory care, disability/sickness benefits) were extracted for each individual. To analyze trends, we applied the same methodology from 2012 through 2017.

Results

In 2016 (results for 2017 will be available for the conference), among the 137 billion euros reimbursed by the general assurance scheme, 13 billion (10%) were related to active cancer and 1.2 million people were concerned (2% of the population). About 2.3 billion euros (2%) were related to breast cancer (189,000 people), 1.4 billion euros (1%) for colon cancer (123,000 people), 1.4 billion euros (1%) for lung cancer (77,000 people) and 1 billion (0.8%) for prostate cancer (167,000 people). Hospitalizations represented the main expenditure for colon (71%), lung (61%) and breast cancer (56%). Concerning prostate cancer, hospitalizations stood for 36% while ambulatory care represented 62%. From 2012 to 2016, the expenditure related to active cancer increase by 4.4%/year due to both an increase in patients and in the average annual cost per patient (both +2.2% per year). Focusing on breast cancer, average expenditure increased by 3.2% per year from 10,700€ per year per patient to 12,200€ per year per patient.

Conclusions

Our study demonstrates the high economic burden of active cancer in France with a detailed analysis of expenditures. The developed tool will help to monitor the burden of these diseases and to implement public health policies.

Key messages

Active cancers account for a significant proportion of healthcare expenditure in France. Knowing this weight allows designing and implementing public policies adapted to the situation.
Quantifying the impact of adherence to screening on colorectal cancer incidence and mortality
Authors: D’Andrea E , Ahnen D J , Sussman D A , Najafzadeh M
Published: November 2019

Background

Current recommendations of The US Preventive Services Task Force (USPSTF) on colorectal cancer (CRC) screening strategies are based on models that assume 100% adherence to screening. Since adherence can largely affect the outcomes of a screening modality, we aimed to assess the comparative effectiveness of CRC screening strategies under published rates of actual adherence.

Methods

We developed an individual-level simulation model and validated it against landmark trials and USPSTF models. Then we assessed the effectiveness of colonoscopy (COL), flexible sigmoidoscopy (FS), high-sensitivity guaiac fecal occult blood test (HS-gFOBT), fecal immunochemical test (FIT), multitarget stool DNA test (FIT-DNA), computed tomography colonography (CTC), and methylated SEPT9 DNA test (SEPT9) in reducing CRC incidence and mortality. For each strategy, we also estimated the incremental life-years gained, number of colonoscopies, and adverse events.

Results

Assuming 100% adherence, FIT-DNA, FIT, HS-gFOBT, and SEPT9 averted 58 to 59 CRC cases and 28 CRC deaths; COL and CTC strategies 56 cases and 27 deaths, while FS averted 39 cases and 19 deaths per 1,000 individuals. Life-years gained were similar across FIT-DNA, FIT, HS-gFOBT, SEPT9, CTC, and COL strategies. The total number of colonoscopies was highest with COL (3,567), followed by SEPT9 (3,231), HS-gFOBT (2,584), FIT-DNA (2,079), FIT (2,067), CTC (1,691) and FS (1,538) strategies. Assuming actual adherence, SEPT9 averted 54 CRC cases and 26 CRC deaths, followed by COL with 49 cases and 24 deaths, and FIT-DNA, FIT, CTC and HS-gFOBT with approximately 36 to 41 cases and 18 to 21 deaths averted per 1000 individuals screened. Life-years gained reflected the effectiveness of each strategy in reducing CRC cases and deaths.

Conclusions

Adherence is a key factor in determining the effectiveness of CRC screening and strategies with higher expected adherence rates have the potential to reduce cancer incidence and mortality.

Key messages

Adherence has a substantial impact on screening outcomes, such as cancer incidence and mortality, and may influence selection of optimal screening strategies. Strategies with higher expected adherence rates can lead to clinically meaningful benefits compared to strategies that may have better one-time sensitivity and/or specificity.
Socio-economic position across the lifecourse and risk of breast cancer: findings from EPIC-Italy
Authors: Berger E , Krogh V , Palli D , Panico S , Sacerdote C , Tumino R , Vineis P , Severi G , Castagné R , Delpierre C
Published: November 2019

Backgrounds

Socio-economic position (SEP) is linked to many health outcomes but the link between SEP and breast cancer (BC) is complex. This study explores the relationship between SEP from early life and future risk of BC.

Methods

We used data from the Italian component of the European prospective investigation into cancer and nutrition: EPIC-Italy (up to 26,391 women). Cox proportional hazard models were used to estimate the association between measures of life course SEP (father’s occupation, educational level, highest household occupation) with risk of BC, adjusting for health behaviours (smoking, alcohol, physical activity, Mediterranean diet), height, weight and reproductive factors (postmenopausal status, age at first full term pregnancy). To mimic life course experiences, we analysed the relationship between father’s occupation and risk of BC, sequentially adjusting for SEP in young adulthood and adulthood, as well as the impact of social mobility.

Results

We observed a significant association between father’s occupation and risk of BC, where participant with low SEP had lower risk to develop BC (HR[95%CI] = 0.88[0.78; 0.99]). This association was borderline significant when we analysed educational level and highest household occupation. These associations were only slightly modified after adjustment for health behaviours, height and weight but more strongly affected by reproductive factors. However, the association between father’s occupation and BC remained borderline significant in the fully adjusted model (HR[95%CI] = 0.91[0.80; 1.03]). Stable low trajectory showed a lower risk of BC (HR[95%CI] = 0.82[0.71; 0.96]) slightly attenuated after adjusted for reproductive factors (HR[95%CI] = 0.88 [0.75; 1.03]).

Conclusions

Our findings suggest that low early-life SEP and stable low trajectory are associated with a lower risk of BC, which is partly explained by reproductive factors.

Key messages

Low early life socioeconomic position and stable low trajectory are associated with a lower risk of BC. Reproductive factors, especially age at the first full term pregnancy, explain part of these associations.