bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of policy measures to promote a healthy diet and physical activity: The PEN Project
Authors: Ahrens W
Published: October 2020

Issue

There is a knowledge gap regarding the effectiveness of policies to change the upstream drivers of health-related behaviours like physical activity (PA) and food choice in a favourable direction.

Description of the problem

No systematic evaluation of policy interventions across Europe is currently being conducted, thus little information on the merit or utility of policy interventions is available and no guidance on how to address this gap exists.

Expected Results

PEN will provide tools to evaluate and benchmark policies addressing PA, unhealthy diets and sedentary behaviour (SB) while accounting for existing health inequalities. From February 2019 to January 2022, a multi-disciplinary research network from Europe and New Zealand will interact with policy makers and experts in policy development, implementation and evaluation to (1) assess public policies with potential influence on food and PA environments, (2) foster a harmonised pan-European surveillance system, (3) model the population level impact of policies, (4) evaluate facilitators and barriers of policy implementation processes, (5) give recommendations for an equity and diversity perspective in these policies. It will refine appropriate research designs and methods for the quantification of policy impact.

Lessons

PEN has adopted the INFORMAS approach to monitor, benchmark and support public and private sector actions in selected European countries to increase healthy food environments and reduce obesity and NCDs and their related inequalities. PEN has expanded this approach to develop a PA policy environment index. It has advanced the roadmap for a harmonized European surveillance system and derived a set of indicators for dietary, physical activity and sedentary behaviours including their upstream drivers.

Key messages

PEN strives to achieve implementation of evidence-based policies in different cultural or socio-economic settings with focus on vulnerable groups. PEN will give recommendations on how research designs and methods for the quantification of policy impact can be improved.
Unguided online Cognitive Behavioral Therapy for insomnia in General Practice: a mixed method study
Authors: Van Der Heijde C , El Fassi S , Hilverda F , Vonk P
Published: October 2020

Background

Sleep contributes to physical, cognitive and emotional restoration. Sleep problems may eventually cause physical and mental dysfunctions. Insomnia symptoms are the most common, leading to insufficient sleep. Unguided online interventions for insomnia merit further study, because of their potential for care avoiders and their potential cost-efficiency in General Practice settings. The research question is which factors contribute to its' effectiveness and intention to use.

Methods

A mixed method approach was implemented with patients with insomnia symptoms of a General Practice in Amsterdam. Semi- structured in-depth interviews were administered after completion of an online CBTI of five sessions (N = 7 females; age from 30 to 54) A questionnaire was administered (N = 118; female: 68%; [Mean age = 24.5, sd = 7.8]) Severity of insomnia was measured with the ISI. Regression analysis was deployed in a prediction model to predict intention to use unguided online CBTI based on the Technology Acceptance Model.

Results

The interviews revealed that the level of knowledge, duration of the intervention and severity of symptoms contributed to the effectiveness of online CBTI. Additionally, therapeutic support is needed to convert knowledge into action. Unguided CBTI is more suitable for individuals with onset or milder insomnia symptoms. Results of the questionnaire indicated that the severity of symptoms predicted the intention to use. F(8, 110) = 14.36, p = .000; β = 0.20, t(113) = 3.01, p = 0.003.

Conclusions

These findings indicate a healthcare challenge: online unguided CBTI is perhaps more suitable for individuals with onset or milder symptoms, however they are less inclined to use such an intervention. Therefore, their awareness of potential CBTI treatments should be increased. Furthermore, the level of knowledge and capability to transfer that knowledge into action should be considered in order to determine the amount of support an individual needs.

Key messages

Unguided online CBTI has potential for insomnia patients in a General Practice setting; awareness of this should especially increase amongst those with less severe symptoms. Online CBTI for insomnia should also take into account, the level of knowledge and capability to transfer that knowledge into action to determine its content and communication.
Health and urban planning policy: mistaking symbolism for outcomes in New South Wales (Australia)
Authors: Lilley D , de Leeuw E
Published: October 2020

Background

During a Government review of the New South Wales urban planning system in the early 2010s, health and planning advocates were successful in having the term 'health' included in two objects of the NSW Planning Bill 2013. While the Bill was not ultimately passed into law, numerous studies have since been published celebrating these inclusions, and the processes through which they were achieved. This research set out to critically examine this optimistic interpretation of events and outcomes.

Methods

Two methods were employed in this research. First, comparative analysis of the existing law and the Planning Bill was conducted. This included a review of how health and like terms are used. Second, critical analysis of published interview data with stakeholders involved in the preparation of the draft legislation was conducted, to explore the motivation for including health, and the expected outcomes of doing so.

Results

In contrast to the dominant narrative, this research found that the use of health rhetoric acted as a smokescreen to disguise the financial and economic interests of powerful stakeholders. Health was not defined, and there were no additional requirements to consider health in planning and assessment processes. Had the Bill been passed it may have had a negative impact on health, as it gave the appearance of acceding to health advocates, and in so doing may have silenced them, though without any substantive means of achieving health outcomes.

Conclusions

The authors of the dominant narrative have homed in on and celebrated symbolic change, while downplaying both the cynical and transactional nature of the policy process, and ignoring the lack of substantive or outcomes-oriented change. This results in a misleading assessment of the way forward for the inclusion of health in urban planning, and should act as a cautionary tale to those of us committed to improving the social determinants of health via policy reform in sectors other than health.

Key messages

Health advocates need to be alert to the ‘dark arts’ of public policy development and avoid mistaking symbolism for the attainment healthy policies and outcomes. The inclusion of health rhetoric in urban planning policy is insufficient to attain health outcomes. Attention must also be paid to planning and assessment processes, impact assessment in particular.
Participatory development of the food literacy intervention “GUSTO” for older adults in Germany
Authors: Zastrow F , Neher K , Hassel H
Published: October 2020

Background

Healthy aging is one of the major challenges currently faced by an aging population. Food literacy (FL) refers to the ability to apply knowledge and practical skills regarding healthy and sustainable nutrition into everyday life. The project “GUSTO” is sponsored by the Bavarian State Ministry of Health and Care and aims to contribute to enjoyable aging by developing the nutritional skills of people aged 65 and over. This community-based program comprises independent working groups of older adults guided by peer moderators. The FL intervention is developed in cooperation with the target group.

Methods

The nutritional situation of older adults was first established through a literature research. The results of this research were compared to the “self-perceived food literacy scale” by Poelman et al. (2018) and the “nutritional framework for literacy courses” by Johannsen et al. (2019). The resulting data provided a basis for focus group discussions carried out in six municipalities, supported by local practice partners. In six guided focus group discussions, a number of recurring themes were identified and summarized.

Results

The focus groups consisted of a total of 44 people between 62 and 88 years of age (average age: 73.1 ± 6.1 years). 22.7 % were men. The group discussions revealed resources used and barriers encountered in terms of FL and interests of older adults. It was evident that, due to the high density of information available, the participants found it difficult to identify reliable information and to implement it in their everyday life. At the request of the focus groups, topics such as the best before date and the use of food waste were added to the intervention.

Conclusions

Older adults find it challenging to identify reliable nutritional information and implement it in their everyday life. With the help of the participatory approach outlined in this study, target group-related issues can be identified and taken into account in the intervention.

Key messages

Older adults can be involved in the development of an FL intervention. A participatory approach allows target group-related issues and specific needs to be taken into account in the intervention.
Associations of mental illness with smoking and vaping in university students in New Zealand
Authors: Wamamili B , Wallace-Bell M , Richardson A , Grace R C , Coope P
Published: October 2020

Background

People with mental illness have higher smoking prevalence, and vaping is generally higher among smokers than non-smokers. However, data on associations of mental illness with smoking and vaping in New Zealand (NZ) is lacking. This study examines associations of history of mental illness (HMI) with smoking and vaping in NZ university students.

Methods

Data came from a March 2018 national cross-sectional study. χ2 tests compared patterns of smoking and vaping in students with and without HMI. An HMI was defined as a diagnosis, or treatment for depression, anxiety or nervous disorder, or other mental health condition in the previous 12 months. Logistic regression model assessed the association of an HMI with smoking and vaping.

Results

1622 students were included: 82.7% aged <25 years, 17.3% ≥25 years; 38.6% male, 61.4% female; 7.8% Māori, 92.2% non-Māori; 18.1% reported an HMI. Of respondents, 50.5% (95% CI 48.0-53.0) reported ever, 10.0% (8.6-11.6) current and 5.0% (4.0-6.2) daily smoking. Students with HMI were significantly more likely to report ever (p<.001), current (p=.008) and daily smoking (p=.014) than those without HMI. 36.7% (34.3-39.1) of students reported ever, 6.7% (5.5-8.0) current and 2.5% (1.8-3.4) daily vaping. Students with HMI were significantly more likely to report ever (p<.001), current (p=.002) and daily vaping (p=.022) than those without HMI. The full model containing all predictors was statistically significant, χ2 (5, N = 1621) = 34.843, p < .001. Female gender: OR 0.55 (0.41-0.73); current smoking: OR 1.76 (1.19-2.60), and current vaping: OR 2.07 (1.32-3.25) were significantly associated with an HMI.

Conclusions

There were strong associations between an HMI and smoking and vaping (controlling for age, gender, ethnicity). These findings extend earlier work on the relationship between smoking and mental illness by demonstrating similar associations in university students, and generate new information on HMI and vaping.

Key messages

Significant numbers of students may have an HMI. Students with an HMI have higher prevalence of smoking and vaping than students without an HMI.
Incidence, and mortality associated with primary postpartum haemorrhage in northwest Ethiopia
Authors: Tiruneh B , McLelland G , Plummer V
Published: October 2020

Background

Primary postpartum haemorrhage remains the primary cause of maternal mortality, in low-resource countries such as Ethiopia. National datasets about the incidence of primary postpartum haemorrhage are often limited, incomplete or unavailable.

Objective

This study was designed to determine the incidence and mortality associated with primary postpartum haemorrhage following in-hospital births in Ethiopia.

Methods

A cross-sectional study design, this study was an audit of 1060 maternity care logbooks (medical records) of discharged women. The data were abstracted from December to May 2018/2019 using systematic random sampling technique. The tool used was the Facility Based Maternal Death Abstraction Form, adapted from the Maternal and Perinatal Death Response Team of Ethiopia. Data were entered and cleaned then analysed using SPSS version 25. Bivariate logistic regression was fitted. Adjusted odds ratio with 95% confidence interval was used to determine the statistical significance.

Results

The incidence of primary postpartum haemorrhage was nearly 9.0% (95% CI: 6.91, 10.73). Of these, there was 7% maternal mortality. Unique to women in Ethiopia health facility referrals of women in labour (AOR: 2.13; 95% CI: 1.19, 3.80), birth attended by final year medical students (AOR: 3.59; 95% CI: 1.89, 6.84), women who were discharged at six hours following birth (AOR: 3.50; 95% CI: 1.24, 9.91) were associated with primary postpartum haemorrhage (p < 0.05).

Conclusions

This study found that the reported incidence of primary postpartum haemorrhage was relatively low, however, the associated deaths of women found was comparatively high.

Key messages

The increased maternal mortality appears to be associated with the three delays model ‘delay in seeking care’; ‘delay in reaching health care’ and ‘delay in receiving quality care’. Maternal mortality and morbidity in Ethiopia are influenced by delays in deciding to seek care, delay in reaching the health facility, and delay in receiving quality care.
Guidelines for Trustworthy AI application in clinical trials
Authors: Leventi N , Vodenitcharova A , Popova K
Published: October 2020

Issue

Innovative information technologies (IIT) like artificial intelligence (AI), big data, etc. promise to support individual patient care, and promote public health. Their use raises ethical, social and legal issues. Here we demonstrate how the guidelines for trustworthy AI, can assist to answer those ethical issues in the case of clinical trials (CT).

Description

In 2018 the European Commission established the High-Level Expert Group on Artificial Intelligence (AI HLEG). The group proposed Guidelines to promote Trustworthy AI, with three components, which should be met throughout the system's entire life cycle, as it should be lawful, ethical and robust.

Trustworthiness is a prerequisite for people and societies to develop, and use AI systems. We used a focus group methodology to explore how the guidelines for trustworthy AI can assist to answer the ethical issues that rise by the application of AI in CTs.

Results

The discussion was directed to the seven requirements for trustworthy AI in CTs, by questions like:

Are they relevant in CTs as a whole? Would they be applicable to the use of IIT as AI in CTs? Are you currently applying part, or all, of the proposed list? In the future, would you attach some, or all, of the proposed list? Is the administrative burden of applying the requirements justified by the effect?

Lessons

It was recommended that:

the guidelines are relevant in the conduct of the CT; planning and implementation of CTs using IIT, should take them into account; ethical aspects and challenges are of the utmost importance; the proposed list is a very comprehensive framework; particular attention should be paid where more vulnerable groups are affected; the administrative burden is acceptable, as the effect exceeds the resources invested.

Key messages

IIT are becoming increasingly important in medicine, and requirements for trustworthy IIT, and AI are necessary. Appropriate instrument in the case of the CTs are the provided by AI HLEG guidelines.
Lesson learned from an outbreak of invasive meningococcal disease: how HTA could have provided an evidence-based approach for public health response
Authors: Miglietta A
Published: October 2020

During 2015-2016 an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) occurred in Tuscany, a Region in Central Italy. Sixty-two cases with 13 deaths (13%) were recorded. Regional Authorities responded through a mass immunization campaign targeting all the age groups by offering free of charge a single dose of the tetravalent (ACWY) meningococcal conjugate vaccine or monovalent meningococcal C conjugate (MCC) vaccine. Nevertheless, the response was fragmented and the campaign did not reach the risk-population groups (i.e. men who have sex with men), that were identified only when a Regional outbreak investigation was implemented. Also linkage between cases (i.e. attending the same gay-venue) were identified at a second stage, not allowing prompt max-prophylaxis interventions. In such a situation, an evidence-based approach as Health Technology Assessment, could have informed public health emergency preparedness and response planning processes, i.e. by identifying through early warning alert systems similar ongoing clusters in Europe among specific population-groups and consequently better targeting the immunization campaign. The objective of this presentation is to explore through a practical example how HTA could provide an evidence-based approach for public health response during a real outbreak underlining lesson learned.
What is the value of digital health?
Authors: Jani A
Published: October 2020

The panellist Anant Jani will discuss about: What is the value of digital health? There is much hope and hype surrounding the potentially transformative effect that digital health tools can have in health and care systems but it is very difficult to ascertain the true value that digital health tools currently deliver or could deliver in the future. Compounding this uncertainty is the diverse, large and ever-changing digital health landscape - there are currently over 300,000 health and care apps on the market place in comparison to the less than 2000 drugs health and care systems normally have to deal with. In this session, we highlight how the quadruple value framework, recently endorsed by the EU Commission, can be used to help rationalize the digital health ecosystem by promoting the interventions that have the greatest potential to promote primary, secondary or tertiary prevention while optimising resource utilisation.
Determinants of child resilience in poverty: findings from the Taiwan Birth Cohort Study
Authors: Chiang L , Wang C J , Chiang T L
Published: October 2020

Background

Poverty has adverse effects on child health. While children in poverty face greater health challenges, some still achieve positive health outcomes. This is in part due to their resilience when facing adversity. Identifying the factors that foster child resilience can aid in developing strategies to promote child resilience and reduce the harmful effects of child poverty. This study aims to identify the biological and social factors of resilience among children in poverty from birth to age 12.

Methods

Data for the analysis came from the Taiwan Birth Cohort Study, a nationally representative sample of 17,354 children who completed six waves of interview surveys between 2005 and 2017. Our sample included 4,570 children who experienced poverty from birth to age 12. The primary outcome variable was child resilience, defined as impoverished children who maintained good health outcomes over the 12-year survey period. Multiple logistic regression was used to examine the factors of child resilience.

Results

Of the 4,570 children, 36.1% always had good health despite experiencing poverty before the age of 12. An easy temperament (OR = 2.5, 95% CI: 1.9-3.0), female (OR = 1.1, 95% CI: 1.0-1.3), a birth weight greater than 2,500 grams (OR = 1.6, 95% CI: 1.2-2.1), having a foreign-born mother (OR = 1.5, 95% CI: 1.2-1.7), receiving breast milk after birth (OR = 1.3, 95% CI: 1.1-1.5), and good parent-child interaction at 3 years of age (OR = 1.4, 95% CI: 1.2-1.7) were associated with child resilience. Early parent-child interactions can moderate the effect of children's birth weight on later resilience.

Conclusions

Our findings indicated the factors associated with child resilience in the context of poverty, suggesting that supporting breastfeeding and nurturing parent-child relationships are effective public health actions to foster child resilience. Future research is needed to unravel the underlying mechanisms of biological factors associated with child resilience.

Key messages

Breastfeeding after birth and high-quality parent-child interaction can lead to positive adaptations to child poverty. Children with difficult temperaments, boys and those born at low birthweight are more vulnerable to poverty and should be targeted for building resilience against poverty.
Social vulnerability and heat on emergency medical services in San Antonio, Texas, 2015-2018
Authors: Zottarelli L K , Xu X , Sunil T S
Published: October 2020

Background

A burgeoning body of research indicates that excessive heat is a leading weather-related cause of fatalities in the United States. The average annual heat-related deaths in the U.S. are about 1,500, which are more than deaths resulting from all natural disasters combined. Extreme heat conditions are also associated with non-fatal medical complications. More importantly, socially and economically disadvantaged or vulnerable populations can face greater exposure to health risks during extreme heat events. The purpose of this study is to investigate the effects of excessive heat and community-level social vulnerability on morbidity in San Antonio, Texas, from 2015 to 2018.

Methods

Heat Index data were collected from the San Antonio International Airport weather station, including the dates from May 1, 2015 to September 30, 2018. Social vulnerability was measured by the Centers for Disease Control and Prevention's Social Vulnerability Index at the zip-code level. Morbidity was gauged by the number of Emergency Medical Service incidents. Sixty-two zip codes in the San Antonio area were analyzed for the 612 constrained calendar days from May 1 to September 30, 2015-2018. Three time-stratified case-crossover negative binomial regression models were estimated to examine the independent effects of Heat Index and Social Vulnerability Index as well as the interaction effects of Heat Index and Social Vulnerability Index on the rate of Emergency Medical Services incidents.

Results

Both Heat Index and Social Vulnerability Index are significantly and positively associated with the rate of Emergency Medical Services incidents. Additionally, while Heat Index increases the rate of EMS incidents, the rate is even higher as social venerability becomes more pronounced.

Conclusions

As the number of excessive heat days increases and San Antonio continues to have extreme disparities by location, there will be an effect on health systems, including emergency medical services.

Key messages

Excessive heat and community-level social vulnerability are significantly and positively associated with emergency medical service incidents. There is a significant and positive interaction effect of heat and social vulnerability on emergency medical service incidents.
Social determinants of depression: association with age, gender and primary health care model
Authors: China J
Published: October 2020

Background

Depression is one of the most common mental disorders worldwide and is a major contributor to the overall global burden of disease. The social determinants of age, gender and access to a primary health care physician have been identified as significant determinants of variability in the prevalence of depression. This research evaluates the association between depression and these social determinants in the city of Almada, in Portugal.

Methods

This cross-sectional study reports the one-month prevalence (December, 2015) of depression and its association with age, gender and access to a primary health care doctor in Almada's primary health care population. Data was collected from the 'Information System of the Regional Health Administration' (SIARS) database. The diagnostic tools used for the identification of cases were the ICPC-2 codes 'P76: Depressive Disorder' and 'P03: Feeling Depressed'. An odds ratio was applied as an association measure.

Results

Regarding gender and age: women are more likely to develop depression than men (OR 3.21) and the age group of 40-64 years is more likely to develop depression compared with other age groups (OR 2.21). The odds of being affected by depression for patients with a permanent primary health care physician, compared with users without a permanent primary health care physician, are higher (OR 2.24).

Conclusions

The patterns of association of age and gender, uncovered in this dataset, are consistent with previously reported findings for other Western countries. The association between depression and the assignment of a permanent primary health care doctor is highly significant. This finding suggests the existence of a higher detection rate of depression in patients with a permanent doctor and adds weight to the need to implement health policies that guarantee a primary health care physician for each patient.

Key messages

The age and gender gap in depression calls for stronger public health and intersectoral strategies to promote and protect mental health, in community-based settings. Reducing barriers and enhancing access to high-quality primary medical care must be a cornerstone of mental health policies.
Lifestyle risk Factors for early versus late onset dementia: A systematic review and meta-analysis
Authors: Berselli N , Adani G , Filippini T , Vinceti M
Published: October 2020

Background

Dementia is a widely prevalent and growing condition, affecting nearly 10% of people aged 60 years and older. It is a leading cause of disability entailing important economic and social costs for the population, so much so that it has been defined as a “global public health priority' from WHO in 2016. Dementia can be divided into two forms according to age of onset of the first symptoms: Early Onset Dementia (EOD - < 65 years) and Late Onset Dementia (LOD, ≥ 65 years). The differences between the two forms, and if they could be considered as separate diseases, are still not well understood. The aim of this meta-analysis was to determine if environmental-lifestyle risk factors of dementia may differ between EOD and LOD.

Methods

Literature databases were searched to June 2020, to retrieve studies assessing the impact of modifiable factors in patients who had developed the first symptoms of dementia before (for EOD) or after (for LOD) 65 years. Data were then meta-analysed in order to understand the overall impact of the single factors on EOD and LOD separately.

Results

The results show different effects for some risk factors as alcohol consumption (OR 2.8, 95%CI: 2.2-3.4 for EOD and OR 1.2, 95%CI: 0.9-1.5 for LOD) and brain injuries (OR 1.4, 95%CI: 1.2-1.6 for EOD, and OR 1, 95%CI: 0.6-1.4 for LOD), which appear to have more impact on EOD compared with LOD. No association with smoking for both forms of dementia emerged. The other factors considered, such as low educational attainment, socio-economic status, closeness of magnetic field, appear to have similar impact on the two forms of dementia.

Conclusions

These results suggest that there may be a difference, in terms of modifiable risk factors, between the two forms of dementia, even if more research is needed on this issue.

Key messages

There may be different risk factors determining EOD versus LOD onset. By modifying some environmental and lifestyle factors we could delay or prevent the onset of dementia.
Working towards evidence-informed policy: Public health report Stockholm
Authors: Bartelink V , Yacaman Mendez D , Lager A
Published: October 2020

Issue

Public health problems and interventions are often addressed in sub-optimal ways by not prioritizing them based on the best available evidence.

Description of the Problem

The public health report 2019 for the Stockholm region aims to inform decision makers, politicians, and public health workers about the risk factors and diseases that account for the biggest part of the burden of disease with a clear focus on high quality evidence and communication of main messages. How did the public health report 2019 affect public health policy in the Stockholm region?

Results

The public health report 2019 influenced agenda setting, resource allocation and priority setting in the Stockholm region.

Lessons

We identified the following facilitating factors in the process, of which most also are supported in scientific literature, in chronological order: 1) understanding the policymaking context to be aware of windows of opportunity, 2) establishing relationships with relevant policymakers, engage with them routinely in the decision-making process, and being accessible for questions, 3) doing high-quality research by considering the latest scientific literature, multiple data sources and involving academic experts in the field, 4) communicating clear and relevant messages for generalists by translating research into easy-understandable texts and attractive figures, and 5) active dissemination of the report through multiple channels. In addition, the following barriers were identified: 1) the timeframe of the policymaking process was not in line with the research process, and 2) involving politicians in an early stage can potentially harm the objectivity of research in media messages.

Key messages

By focussing on major problems, high quality evidence and clear messages a public health report can contribute to more evidence-informed policy making. Engaging decision makers in the process of public health reporting is critical for the impact on agenda setting, resource allocation, and priority setting.
Managing occupational stress: should we consider the sociodemographic groups of health workers?
Authors: Dudutienė D , Juodaitė-Račkauskienė A , Stukas R
Published: October 2020

Background

An essential part of occupational stress management is identifying target groups and developing a wellbeing program that tailors organisational interventions to the specific needs of the target groups. The study aimed to explore whether psychosocial risk determinants and organisational intervention objects differ across employees' groups based on sociodemographic factors in a public healthcare institution.

Methods

Using a cross-sectional study design, paper questionnaires were delivered to all health workers (n = 690) of the Lithuanian primary healthcare institution; the response rate 68%. The questionnaire contained items related to sociodemographic groups (gender, age, job seniority, education, occupational status), 14 psychosocial risk determinants, and 10 organisational intervention objects. Nonparametric tests for comparisons of the groups were used.

Results

The results showed that differences by gender were not statistically significant except for one organisational intervention object. Only 3 organisational intervention objects had mean rank scores differing statistically across age and job seniority groups; 5 objects - across education groups and almost all objects - across occupational groups. Regarding psychosocial risk determinants, one determinant had mean rank scores differing statistically across age and job seniority groups; 4 and 6 determinants - across education and occupational groups respectively. Statistical significance was considered with p-value < 0.05 and 95% confidence interval.

Conclusions

The findings showed that different psychosocial risk determinants and organisational intervention objects were emphasized by different sociodemographic groups of health workers in the institution, but they did not impact groups in the same measure. Therefore, it is crucial to start by determining the risk group's specific needs before developing and implementing stress management programs.

Key messages

The study contributes to bridging the gap between theoretical knowledge and practical solutions in occupational stress management at public primary healthcare settings. The study has proposed a way of diagnosing psychosocial risks and of tailoring interventions to all health workers of the public primary healthcare institution by using a simple and robust tool.
The virus and its images - Metaphorical genealogy of the risk society
Authors: Luz L
Published: October 2020

The research has the challenge of building a genealogy of the images produced within the risk society and establishing a relationship between the concept of risk and the imaginary. As a theoretical framework, we will have Gilbert Durand's theory unrolled in the Anthropological Structures of the Imaginary. As a corpus of analysis, we will make a case study regarding visual representations of the risks, specifically, of diseases caused by viruses such as HIV, SARS, H1N1, Ebola and Coronavirus. In the study the concept of risk will be analyzed in a broad way, from a philosophical, communicational and anthropological reasoning of the term, to an instrumental conceptualization for the field of Risk Communication. For that, we will analyze constellations of images that metaphorically represent the risks and their effects. One of these effects are narratives and practices produced by the risk society that least caution about hazards, and that, however, act in the production of chronic, stigmatized and punitive subjectivities, as Vaz (2019) predicts. One of the strategies is to consider the metaphor not only as an ornament or as something that moves the sense from one place to another. The metaphor will be observed as a producer of truths. The concept of risk is thus perceived by theorists such as Beck, Giddens and Douglas as a form of normalization that became a kind of microphysics that acts in all areas of everyday life. This contemporary form of normalization is significant in the process of oppression and identification where the relationship and life management change significantly.

Key messages

To make a scientific conceptualization for an ethic of the Communication of Risk in the contemporaneity having as a foundation the imaginary produced by the visual metaphors that describe the viruses. This study has as a challenge to know the relationships between the concept of risk and imaginary that can collaborate in the development of prevention practices in the field of Communication.
Evaluation of attitudes toward cancer and related factors in adults
Authors: Öcal E E , Ünsal A , Işıktekin Atalay B , Demirtaş Z , Arslantaş D
Published: October 2020

Background

Evaluation of individuals' attitudes towards cancer could be instructive in improving the health promoting behaviour of populations such as cancer screening and increasing awareness of cancer. The aim of the study was evaluate attitudes toward cancer and related factors in adults who applied to primary healthcare center.

Methods

This cross-sectional study was conducted in 776 people aged 18 and over who applied to primary healthcare center in 2018. The questionnaire included sociodemographic characteristics, Questionnaire for Measuring Attitudes Toward Cancer and Health Literacy Scale-European Union-Q16 (HLS-EU-Q16). Questionnaire for Measuring Attitudes Toward Cancer consists of 3 sub-dimensions and the mean score of 2.5 and above was accepted as a negative attitude. Evaluation of the data Chi-square test, multiple logistic regression and Spearman correlation analysis were used.

Results

The ages of study group ranged 18-87 and the mean was 42.0±15.4, and 52.3% were female. The frequency of negative attitudes in the study group was 14.4% for general attitudes toward cancer, 22.9% for cancer diagnosis detection/spreading sub-dimension, 24.5% impossibility of recovery/stigmatization sub-dimension, 13.4% for discrimination sub-dimension. The multiple logistic regression showed, having primary and below education levels (OR: 1.88; CI: 1.22-2.87) and having cancer diagnosis (OR: 1.88; CI: 1.10-3.19) were found as risk factors for negative attitudes toward cancer. A weak negative correlation was found between the mean scores of Questionnaire for Measuring Attitudes Toward Cancer and the scores of HLS-EU-Q16 (r:-0.189; p < 0.001).

Conclusions

Although the majority of individuals have a positive attitude in the study, due to the negative attitude in sub-dimensions, it was concluded that health education should be given and more extensive research need to be done in this area in order to increase the awareness and sensitivity of the community about cancer.

Key messages

It might be considered important the education level in showing positive attitude towards cancer. Improving health literacy could be beneficial in increasing the positive attitude towards cancer.
Strategies to empower socially vulnerable adolescents in Brazil
Authors: Alves Sarmento Soares R , Pinto de Figueiredo R , Barbosa e Melo V L , Gonçalves Rocha D , Ribeiro da Silva A , Leônidas Soares J , Sousa M F , Machado Mendonça A V
Published: October 2020

Brazil has the highest number of adolescents murdered in the world. An alarming number of these are black boys from deprived backgrounds living in the outskirts of big cities. At schools, teachers play an important role in promoting health. Thus, the University of Brasília through its Public Health Research Group has developed the training course “Strategies to empower socially vulnerable adolescents” (JAVU in Portuguese) aimed primarily at state school teachers from municipalities where social vulnerability among teenagers is either high or very high.

It is a 180-hour, 10-module distance learning course with tutor supervision which aims at contributing to the development of an inclusive and emancipating culture which is non-discriminatory, diversified and which promotes peace in school settings. Its innovative aspect is the use of the platform JAVU Topography, a catalogue of policies, programmes and services aimed at public health and education at municipal, state and federal level. By the end of the course teachers create a diagnosis that measures the extent to which these different policies or services can be applied in different educational settings to promote health.

From November 2019 to March 2020, 2953 teachers underwent training. The majority were: women (83.6%); pardos (50.2%) - a mixed race/ethnicity in former Portuguese and Spanish colonies; postgraduates (50.6%); catholic (42.6%) and earning between 1 to 3 minimum salaries (49.4%). Having access to the JAVU Topography helped make this tool a platform to spread social protection in Brazil. The theoretical and practical support is one of the main contributions of this course to actions that address health problems among adolescents.

The course formed teachers from 42 of the most vulnerable cities in Brazil, enabling access to a network of protection and allowing for the exchange of experiences through the educational platform, which better equipped these teachers to promote health in the educational setting.

Key messages

Improving the promotion of health among socially vulnerable adolescents in Brazil in their school settings. Raising awareness of networks of social protection though a social topography that aims at empowering socially vulnerable adolescents in Brazil.
Evaluation of teamwork in operating rooms in a Tunisian university hospital
Authors: Lamine H , Ammar O , Mrabet W , Tlili M A , Aouicha W , Taghouti E , Ben rejeb M , Zedini C
Published: October 2020

Background

Teamwork is fundamental to ensuring the quality of care and patient safety in operating rooms. It has been shown that the occurrence of adverse events is closely linked to a poor quality of teamwork in these settings. Thus, this study aimed to assess teamwork in different operating rooms of the university hospital of Sahloul Sousse (Tunisia).

Methods

It is a descriptive cross-sectional study with convenience sampling, conducted in operating rooms of the university hospital of Sahloul Sousse (Tunisia) between February and April 2018. The measuring instrument was the validated observation grid 'Communication and Teamwork Skills Assessment Tool (CATS) '. Teamwork is assessed through 4 domains (Situation awareness, Coordination, Communication, Cooperation). Behaviors are marked in rows each time they occur and are rated for quality in columns labeled “Observed and Good,” “Variation in Quality” (meaning incomplete or of variable quality), and “Expected but not Observed.”

Results

A total of 51 interventions were observed. Good coordination between the team members was noted, as well as good cooperation within the teams. A variation of quality level of communication with the patient was noted in 31.4% of cases, also communication about the context, the situation and recommendation among caregivers is not quite good with a percentage of 39.2%. Moreover, the work environment was rated as good in 84.3% of cases.

Conclusions

Some failures in teamwork were noted, hence it is important to take corrective measures for better practice and better patient management in such a complex environment, the operating rooms, where there is a strong need for team coordination.

Key messages

There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to eliminate the barriers to communication, in order to prevent adverse events.
A service evaluation of a Hospital In-reach Service for people who are homeless in South England
Authors: Blackwell-Green G , Sargeant C , Paudyal P
Published: October 2020

Background

Homelessness has increased dramatically in the last decade, with an estimated 165% increase in rough sleeping alone in England since 2010. People experiencing homelessness can often have what is referred to as the tri-morbidity; mental health, substance and or alcohol misuse and physical health problems. Hospital admission presents a potential point of intervention to address the health problems people have been experiencing, to link them in with services and as a bridge to housing. This service evaluation explored the role of a Hospital In-reach Service team for safer hospital discharge.

Methods

A qualitative in-depth interview study was conducted with six participants related to a Hospital In-reach Service team in South England. The interviews were transcribed, and analysed following Burnard's fourteen stage method. The ethical approval was obtained from Brighton and Sussex Medical School Research Governance and Ethics Committee (ER/BSMS4284/2).

Results

Three key themes were identified; the role of the Hospital In-reach Service team, barriers to, and facilitators for advocating patients' needs. The results indicate that the service team works incredibly well, building strong and trusting relationships with patients, community and hospital teams, taking a holistic approach to patient care. However, the structural discrimination against this patient group is reiterated in this study. Despite progress, there are still problems with non-specialist staff understanding this patient group's needs.

Conclusions

There is a need for clarification within Adult Social Care regarding the distribution of responsibility between hospital and community social work teams. There also appears to be a need for expansion of training for non-specialist service staff, including ward staff, discharge teams and social workers. In-reach housing services and expansion of the service team would be invaluable

Key messages

Hospital In-reach Service team in South England works incredibly well taking a holistic approach to patient care. Clarification in role of hospital and community social work teams is required for better management of this issue.
Effect of a health education intervention on intestinal parasitic infections in Bolivian children
Authors: Lastrucci V , Spinicci M , Macchioni F , Gabrielli S , Villagran A L , Gamboa H , Halleux C , Olliaro P , Caldes M J , Bartoloni A
Published: October 2020

Backgrounds

Intestinal parasitic infections (IPI) are a major health issue for children of low- and middle-income countries. Water, sanitation and hygiene (WASH) practices are crucial for preventing IPI. The aim of the study was to evaluate the effects of a school-based health education intervention on handwashing behavior and IPI prevalence in children

Methods

This is a randomized intervention trial in 8 primary schools in rural communities over the course of 3 school years; preliminary results from the first two years of the trial are here presented. Schools were randomly selected and assigned in a 1:1 ratio to intervention or control (no intervention) groups. For each school year, the intervention included 14 school-based educational sessions and 2 skit events, involving children aged 8-12 years. Knowledge, attitude and practice questionnaire and handwashing at key events was assessed at the beginning and end of each school year. IPI prevalence was assessed with repeated cross-sectional parasitology surveys 12 months apart, involving a minimum of 50 children for each school

Results

At baseline, no significant differences between intervention and control schools were present in the proportion of children who washed their hands at key events (7.2% vs 9.3%, p = 0.28), in IPI (79.4% vs 75.3%, p = 0.3) and multiple parasitic infections (MPI) prevalences (47.6 vs. 38.6; p = 0.051). At the end of the second year, the percentage of children who washed their hands at key events was significantly higher in the intervention schools (75.4% vs 12.1%, p < 0.001), and the prevalence of IPI and MPI in the intervention schools were respectively about 25% and 15% lower than in the control schools (respectively, 42.9% vs 67.8%, p < 0.001; 16.1% vs 31.6%, p < 0.001)

Conclusions

A school-based health education intervention could achieve significant changes in hand-washing behaviors and reduction in the prevalence of IPI in children. The third year survey results are needed to confirm these findings

Key messages

An health education intervention on water, sanitation and hygiene (WASH) practices can reduce the risk of IPI infection in children. An health education intervention on water, sanitation and hygiene (WASH) practices could be configured as a sustainable long-term approach to intestinal parasitic infections control in children.