bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital media: How to adapt digital media to promote health of young people?
Authors: Durand D , Vassieux L , Dodet J-F , Millot I
Published: November 2019

A priority of the French government health section is to promote strategies to develop teenager and young adult abilities to manage their own health. Interventions must be based on digital tools on how to improve it. The Pass’santé Jeunes (PSJ) is a regional measure based on a global, positive, community approaches, and on peers interventions. Managed by the Agence Régionale de Santé since 2013, and lead by the Instance Regional d’Education et de Promotion pour la Santé, this program consists of the provision of two portals: Pass’santé Jeunes and Pass’santé pro.

This project aims to renew prevention approaches with youths, and to develop a common culture around efficient intervention strategies with professionals for linkage in digital practices. This initiative has been developed and collaborated with the targeted public, parents, and professionals. We queried the opinions of a youth panel, and requested advice of experts to assure relevance and veracity of the information. Websites were then created for professionals to locate information to support their missions.

Analysis of the actual uses of the PSJ were conducted by the University of Burgundy in 2016. Results showed much of the research leaning toward the creation of a prevention tool. For alignment with internet use by youths, we adapted the variety of media (quizzes, videos, apps...). In 2018, the average monthly audience of both sites increased significantly.Greater utilization of these resources is explained by increased awareness by professionals and prevention missions of health students.

In the health sector, challenges exist in understanding digital practices of youth and professionals, therefore it is important to play a key liaison role. First identified as an informational medium, these devices are now real resources for meeting and circulating knowledge.Prospects for 2020 are to redirect these tools to the 0-8 years age group, adapt them to situations of disability, and expand to the pregnancy period.

Key messages

In line with digital practices of youth, the PSJ relies on innovative communication supports, available in different formats (videos, quizzes, games, apps...). Beyond an informational tool for the young, the PSJ turns out to be a tool of knowledge brockering. It facilitates networking, implementation of activities, and improving health practices.
Children and digital devices: a survey on risk perception and use
Authors: Covolo L , Roncali J , Zaniboni D , Mapelli V , Ceretti E , Gelatti U
Published: November 2019

Background

Paediatrics associations in different international contexts recommended avoiding the use of screen media in children ages 0-2 years and limiting the use to one hour per day for children ages 2-5 years. In the light of these guidelines, the aim of this study was to investigate risk perception in the general population and use of digital devices (DD) in preschool children.

Methods

We carried out a cross-sectional study on 3115 Italian subjects including parents and non-parents, using an online survey. Parents answered questions about their children’s DD use. We used multiple linear regression analysis to assess the potential predictors of devices’ use in preschool children.

Results

Overall 74% of sample think that the use of DD by preschool children is a risk for health. They perceive risks, such as having eye irritation (83%), having sleep disorders (65%) more than benefits, e.g. communicating with distant relatives (47%), and learning new words (40%). Parents of preschool children represent the 74% of all parents (N = 1869). The 56% of parents with only 0-2 years children think that is not correct the use of DDs in toddlers, however the 25% of them allow their children to use them. The mean time use reported is 63±57 minutes. Among parents who have also children from 2 to 5 years, the 89% think it is correct the use of DD up to a maximum of one hour a day for children aged 2-5 years. However, the 58% of them allow their children to use it more than one hour. The mean time use reported is 61±52 minutes. Parents without a job, having low education level, with more than one child and having children ages 3 and older, are more prone to allow the use of DD to their children.

Conclusions

There is a discrepancy between risk perception and real attitude on DD use in children by parents. Public health actions must aim to increase awareness about a conscious use of DD in children considering the spread of DD in the society and younger people.

Key messages

The discrepancy between risk perception and actual behaviour means an underestimation of health impact of digital devices use in children. Health professionals are very concerned about the health risk of digital devices use in children. Considering the large use of digital devices, public health actors must pay attention to this matter.
Global Burden of Disease Study: overview and experience from England
Authors: Newton J
Published: November 2019

Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Changes in patterns of adolescent substance use from 1988 to 2011 in Sweden: a latent class analysis
Authors: Evans B , Kim Y , Hagquist C
Published: November 2019

Background

Prevalence rates of adolescent substance use have shifted over time, although potential changes in nuanced patterns of substance use remain unexplored. We examined patterns of adolescent substance use in Sweden and changes in these patterns between 1988 and 2011. Furthermore, we investigated whether gender and internalizing problems were associated with substance use and whether these associations changed over time.

Methods

The sample included all 15-16-year-old students in Värmland County, Sweden (N = 20,057). Survey data were collected eight times between 1988 and 2011 and analyzed as four cohorts (1988/1991, 1995/1998, 2002/2005, 2008/2011). We measured alcohol, tobacco and inhalant use and internalizing problems.

Results

A latent class analysis showed that a three-class model fit the data best (i.e. non/low use, experimental use, and polysubstance use classes). Class- and item-response probabilities changed over time: fewer adolescents exhibited riskier substance use patterns in the later cohorts. Boys were more likely than girls to be in the polysubstance use class compared to the non/low use class across all cohorts (all ps < .001). Gender differences in experimental use differed across the cohorts. Adolescents who reported more internalizing problems were more likely to be included in the experimental and polysubstance use classes compared to the non/low use class (all ps < .001) and this effect did not change over the study period.

Conclusions

We extended the research on trends in rates of substance use by mapping how patterns of substance use changed over time as well as how the effects of gender and internalizing problems shifted. While fewer adolescents exhibited riskier patterns of substance use in the later cohorts, these patterns were associated with experiencing more internalizing problems across the study period. Prevention efforts could be more effective by targeting patterns of substance use rather than prevalence rates.

Key messages

We tested whether patterns of adolescent substance use changed from 1988 to 2011 in Sweden. Fewer adolescents showed riskier substance use patterns in the late 2000s than in the earlier study years. Gender differences shifted over time for experimental use but not polysubstance use. Internalizing problems were consistently associated with riskier substance use patterns across the study period.
Lifestyle of young adults – changes and accumulation
Authors: Jääskeläinen T , Koponen P , Lundqvist A , Borodulin K , Koskinen S
Published: November 2019

Background

Young adulthood is a pivotal period for many lifestyle factors becoming established and later affecting health. However, current knowledge on key lifestyle factors among young adults is limited. This study aimed to examine the lifestyle of Finnish young adults and the changes in their lifestyle between the years 2000 and 2017. Further, the accumulation of health promoting and endangering lifestyle factors was evaluated.

Methods

The study is based on nationally representative data on young adults (aged 18 − 29 years) from the Health 2000 Survey (n = 1894; 90% participated) and the FinHealth 2017 Study (n = 1162; 54% participated). Lifestyle factors were assessed in the interview and by questionnaires. The five key lifestyle factors (use of vegetables, smoking, physical activity, sleep and alcohol consumption) were dichotomized for the evaluation of the accumulation. Weighted prevalences were analyzed by logistic regression taking into account the sampling design and non-response.

Results

In 2017, 32% (95% CI 25, 41) and 52% (95% CI 45, 60) of young men and women used fresh vegetables daily, respectively. In men, the prevalence had decreased in 2017 compared to 2000 (p < 0.01). The prevalence of daily smoking had decreased (p < 0.01) being 11% in both sexes in 2017. In men, the prevalence of the daily use of snuff had increased from 3% (95% CI 2, 5) to 8% (95% CI 5, 14) in 2017 (p = 0.01). In both years, three out of four were physically active at leisure-time and nine out of ten slept at least six hours per day. In 2017, half of the young adults reached 4 to 5 (maximum) health promoting factors whereas 17% (95% CI 11, 24) of men and 12% (95% CI 8, 18) of women reached only 0 to 2.

Conclusions

There have been both favourable and unfavourable changes in the lifestyle of young adults during the last decades. The accumulation of health promoting and endangering lifestyle factors was observed indicating needs to versatilely prevent risks for major public health problems.

Key messages

Many health-endangering lifestyle factors are comparatively common in young adults. It is important to prevent the accumulation of health-endangering lifestyle factors in young adulthood to lower the risks for major public health problems in future.
Sexual orientation openness and depression symptoms: A population-based study
Authors: van der Star A , Pachankis J E , Bränström R
Published: November 2019

Background

Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for depression than heterosexual individuals. Lack of openness about one’s sexual orientation is a suggested source of these disparities, but it has been linked to both positive and negative mental health. Few population-based studies have explored the association between openness and depression, and potential mediators and moderators of this association, including social support and sexual orientation-based victimization.

Methods

Swedish respondents to the 2014 wave of the European Health Interview Survey were used to identify a population-based sample of self-reported sexual minorities. All individuals reporting a nonheterosexual identity (and a matched sample of heterosexuals) were invited to participate in a follow-back study in 2016 (n = 320). A total of 191 (59.7%) individuals completed the survey, of whom 80 reported a gay, lesbian, bisexual, or other nonheterosexual identity.

Results

This first nationally representative survey of sexual orientation openness showed that only about one third of the sample reported being completely open. We found no evidence of a direct association between openness and depression or a mediating effect of social support or victimization on this association. However, social support moderated this relationship, such that greater openness was linked to higher depression among sexual minorities reporting low levels of social support.

Conclusions

Our study suggests that sexual orientation openness is not directly related to lower risk of depression among sexual minorities, but is instead dependent on access to social support. Sexual minorities might need social support for navigating the stress of open self-identification.
Influence of Physical Activity, Protein Intake and Social Network on the Frailty development
Authors: Haider S , Dorner T E , Grabovac I
Published: November 2019

Background

Frailty, a geriatric syndrome, is associated with many adverse health outcomes. Risk factors include physical inactivity, low protein intake and an inadequate social network. In this analysis we aimed to assess the influence of these factors and their combination in an 11-year-follow-up study on a Europe-wide level.

Methods

The analysed dataset included 22,226 community-dwelling robust and prefrail persons aged ≥50 years (11 countries) from the Study on Health, Ageing and Retirement in Europe (SHARE). Frailty was measured with the “Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe”. Additionally, self-reported level of vigorous physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using Cox regressions, adjusted for age, education, smoking, alcohol BMI, depression, long-term illness and each other.

Results

People who do not engage in PA, had a higher HRs for frailty development compared to people performing PA regularly [women: 1.62 (95%CI: 1.22-2.13); men: 1.83 (95%CI: 1.44-2.33)]. People with low protein intake did not have significant higher HR [women: 1.05 (95%CI: 0.80-1.37); men: 1.16 (95%CI: 0.93-1.46)]. Women with poor social network showed HRs of 1.34 (95%CI: 1.24-2.15)], men with poor social network had a HR of 0.88 (95%CI: 0.70-1.10). In general, we found that persons with a combination of two risk factors had a higher risk for frailty compared to those with no or only one. However, no significant synergy index could be found.

Conclusions

Regular PA, but also adequate social networks seem to be important factors in frailty prevention.

Key messages

Sufficient PA and satisfaction with social network were shown as modifiable factors to prevent frailty in an 11-year-follow-up study. A combination of two risk factors was associated with a higher risk for frailty compared to one, however, with no significant synergy index.
2.N. How to Advocate Scientific Evidence to Decision-makers?
Authors:   Organised by: EUPHAnxt, Global Health Next Generation Network, EUPHA (PHPP) Chair persons: Viveka Guzman - Ireland, Keitly Mensah - France
Published: November 2019

Public health research aims to change the world, or at least contribute to the development of healthier and more equitable societies. However, the availability of health information does not inherently lead to its increased use in policy and decision-making. Significant gap remains between the knowledge of public health researchers and the actions taken by decision-makers. Various tools and mechanisms can help to increase the use of scientific evidence in policy development by making policymakers appreciate, understand and incorporate such scientific information into policy decisions. As part of this process, it is crucial that researchers and public health practitioners acquire the ability to translate their knowledge and become skilled on communicating the evidence effectively.

To this aim, we will present firstly a WHO approach for that on the basis of EVIPNet Europe. Member countries have benefited of EVIPNet Europe’s capacity building efforts, its training workshops, coaching and mentoring schemes, leading to increased knowledge and skills in view of identifying, accessing, appraising, synthesizing and communicating the best available evidence. The presentation will focus on the ways to trigger tangible changes at policy and legislative levels.

The second presentation will give more specific information about the process of real-life applications. Main question will be “How to advocate scientific evidence to decision-makers in the frame of evidence-informed policy-making?”. The presentation will help the participants to analyze to whom they are targeting, what their interests are and how to communicate scientific information to a decision-maker effectively.

Last but not least, common challenges of evidence-informed policy-making process in health care and ways to tackle them will be presented. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science.

The workshop will engage participants interactively and leave time for answering their questions at the end.

Key messages

Public health professionals can influence health policies, if they learn strategies in communicating scientific evidence to decision-makers effectively. Providing correct skills to researchers when communicating about and advocating for the scientific evidence with policymakers will enhance the impact of evidence on policy making.
The health impact of heat waves in Europe: insights from national plans and key informant interviews
Authors: Vanderplanken K , van Loenhout J , van den Hazel P
Published: November 2019

In Europe, heat waves and extreme heat are known to cause an increase in morbidity and mortality. Moreover, climate change is expected to increase the number and intensity of heat waves, particularly in urban areas. In order to limit the negative health impact of heat waves, many European countries have developed heat health plans.

The SCORCH project has reviewed the national heat plans of 20 European countries. In addition, face-to-face interviews were conducted in 9 countries, involving key stakeholders who partake in the development, implementation and/or diffusion of the plans.

Combined, the national plans and interviews provide insights in the different types of warning systems, the scales of implementation, the stakeholders involved and their responsibilities and the vulnerable populations that are targeted. Moreover, we are able to evaluate the processes outlined in the national plans, and identify certain strengths and weaknesses. These results will support the development of heat wave plans for countries that currently do not have such plans yet.
Slowing improvements in life expectancy across European Economic Area countries
Authors: Ford J , Steel N , Aasheim E , Devleesschauwer B , Gallay A , Morgan D , Schmidt J , Ziese T , Newton J
Published: November 2019

Background

Life expectancy improvements have slowed down in several European countries since around 2011. The relative contributions from changes in specific conditions (e.g. cancers) and broader risk factors (e.g. smoking or austerity) remain unclear. We aimed to explore the different potential causes in 17 European Economic Area (EEA) countries.

Methods

We compared Global Burden of Disease (GBD) study estimates for life expectancy, years of life lost (YLLs) and population attributable fractions (PAFs) for risk factors, for 2005-2011 and 2011-2017 for 17 EEA countries. Three countries with the largest absolute improvements and three with the smallest were selected for analysis by gender, age, condition and risk factors.

Results

Norway, France and Belgium had the largest improvement in life expectancy (+1.5, +1.2 and +1.2 years respectively) from 2011 to 2017, and Germany, Iceland and the UK the smallest (+0.1, +0.2 and +0.2 years). Life expectancy reduced slightly for women aged over 80 in Germany and UK, men aged over 50 in Germany, and for men in all age groups up to 90 years in Iceland. Norway, France and Belgium saw faster improvements in YLLs from lung cancer and Norway and France for COPD in both men and women, and from self-harm in men, after 2011 than before. PAF for tobacco declined faster after 2011. Germany, Iceland and the UK saw slower improvements in cardiovascular disease and in Germany and the UK lung cancer. In Iceland, YLLs for cancers, self harm, respiratory disease, cirrhosis and dementia all worsened after 2011. PAF for tobacco remained high or declined less after 2011 in all 3 countries. PAFs for alcohol and drug use remained high in Iceland and UK.

Conclusions

Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies, but national differences in data availability may affect results. Further research is needed into the ‘causes of the causes’, such as the 2008 economic crash in Iceland.

Key messages

Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies. Norway, France and Belgium had the largest improvement in life expectancy from 2011 to 2017, and Germany, Iceland and the UK the smallest.
The Impact of Refugee Women’s Accommodation on Maternal Health Care Provision
Authors: Kasper A
Published: November 2019

Background

About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women in Germany are currently of childbearing age. The maternity period requires specialized care. Maternal health care professionals monitor the physiological processes of maternity and the psychosocial well-being in order to allow an uncomplicated transition to maternity. On arriving in Germany there are different types of accommodation for refugee women: 1) shared reception centers (e.g. tents, containerbuildings, gyms), 2) collective shelters for particularly vulnerable refugees and 3) private apartments. Depending on the woman’s accommodation maternal health care professionals are confronted with different situations and conditions in providing care for these women. The aim is to analyze the impact of refugee women’s accommodation on maternal health care provision and professional’s actions.

Methods

Structured expert interviews were conducted with maternal health care professionals. The interviews were analyzed following the standards of qualitative thematic analysis with a special focus on refugee women’s accommodation and its impact on maternal health care provision.

Results

The accommodation situation does impact the provision of maternal health care as well as the actions and doings of maternal health care professionals. On the one hand there is a change in tasks, which are no subject to original maternal health care, such as organizing transportation. On the other hand there are challenges in actually executing particular maternal health care actions, such as taking the medical history or performing examinations where there is no or little privacy.

Conclusions

Accommodation conditions impact maternal health care provision in various ways. Therefore an enhancement of housing for refugee women may improve maternal health care provision and therefore maternal health for refugee women.
The Challenge of Digital transformation in Public Health in Europe?
Authors: Velez-Lapão L
Published: November 2019

Background

Healthcare systems are facing many challenges, from demographics to multi-morbidities that are associated with increasing the demand for more services. The new technologies are thought to be a solution to these problems. However, to address these problems with digitalization of healthcare it will imply the combination of proper use of technologies, aligned with integrated working-processes and skilled professionals.

Methods

This study provides a scoping review on existing public health digital services and aimed to identify the main digitalization challenges, from competencies to technology use. The databases of Pubmed and Ebsco were searched.

Results

17 papers were selected, and the three main priorities were identified. First, it will highlight the challenges associated with the digitalization of healthcare, the second the implementation of digital services, considering a method to design online service, the third the impact of digitalization on healthcare workforce performance. An overview of the major effects of transformative technologies (e.g. eHealth services, Internet of Things solutions, Artificial Intelligence) on the healthcare workforce will be addressed. Moreover, to what extent is the digital transition affecting formal qualifications of public health professionals? What are the major implications of technological change for future skill needs and competences of the public health workforce? Finally, the discussion examines the challenges of digitalization for public health services in Europe.

Conclusions

Proper digitalization of healthcare will enable changes in the paradigm of healthcare delivery as well as in the mechanism for patients’ participation and engagement. The sustainability of healthcare will depend on how efficient we will make digital-services design.

Key words

Digital health, Public Health, Digital Transformation, Public Health professionals, Europe
Q-Methodology Evaluation of a European Health Data Analytic End User Framework
Authors: Staines A , Boilson A , Connolly R , Davis P , Connolly J , Weston D , Gautier S
Published: November 2019

Background

MIDAS (Meaningful Integration of Data Analytics and Services) project is developing a big data platform to use a wide range of health and social care data to support better policy making. As part of the project evaluation, we have used Q-methodology, a well established approach, to understand the perspectives of the individual participants on their needs and how the MIDAS system is meeting them, at its current stage of development.

Methods

We defined a concourse of 36 statements relevant to project implementation and goals, by working from a logic model for the evaluation, and structured interviews with project participants. This was delivered online to participants. Analyses were done in the qmethod package. The first q-sort was done at 14 months into the project.

Results

16 people took part, 6 developers, 5 managers, 2 health professionals and 3 others. Three factors were identified in the data. These were tentatively labelled ‘Technical optimism’, ‘End-user focus’ and ‘End-user optimism’. These loaded well onto individuals, and there were few consensus statements. There were significant differences in perspectives between different groups of participants. In particular, two of the developers held opposite perspectives to most other participants on the third perspective identified. This was drawn to the attention of the participants, and a more intensive process of communication was set-up, seeking to reduce the divergence.

Conclusions

A Q-methodological approach to evaluating the implementation of a large and complex health ICT system showed considerable divergence between the perspectives of users, developers, and managers. Such divergences can lead to project failure. Q-methodology is a valuable tool has seldom been used in public health research.

Keywords: Q-Methodology, Public Health, Data Analytics, Decision Support.
Workshop: Impact of nutrition on non-communicable chronic diseases: a global perspective
Authors:   Organised by: EUPHA (FN), EUPHA (CHR) Chair persons: Tatjana Buzeti - EUPHA (FN), Iveta Nagyova - EUPHA (CHR)
Published: November 2019

Non-communicable chronic diseases (NCDs) represent a public health issue due to their profound impact on population health. Major NCDs risk factors, including obesity, hypertension and diabetes, represent a threat of gigantic proportion, while intervention to prevent NCDs remains of paramount importance in order to decrease their burden over the next decades. Among others, quality of diets has changed substantially and a global shift to unhealthy diet high in calories and highly processed foods mainly due to the rapid urbanisation, increasing incomes, and inadequate accessibility of nutritious foods has been observed. As the burden of NCDs across the worlds remains unacceptably high, the international policy framework should aim to develop evidence-based policy approaches to reduce such burden globally.

In this context, the EUPHA Sections on Food and Nutrition and on Chronic Diseases aim to propose a joint workshop to provide the latest updates from leading scientists and experts involved in global health research, with a special focus on NCDs and nutrition-related risk factors.

The objectives of the present workshop are the following: To quantify the burden and temporal trends of non-communicable chronic diseases risk factors (such as obesity, elevated blood pressure and diabetes) all around the globe, with a focus on European countries; To assess the impact of nutrition-related risk factors on non-communicable chronic diseases; To explore socio-economic and cultural correlates to dietary changes in developed and developing countries; To discuss the usage of instruments aimed to identify best practices in food policies to prevent junk food consumption.

Organizing the present workshop would provide an important occasion for gathering experts in the field and sharing opinions with the audience in light of the presented results. All publication discussed have been published recently, others are ongoing projects, thus providing a unique opportunity to discuss about potential advocacy activities and policy approaches in the context of a EUPHA conference.

Key messages

The workshop will provide insights on the current burden of NCDs risk factors. The workshop will focus on dietary risk factors, their socio-economic determinants, and strategies to implement a healthy and sustainable diet globally.
Transnationalism and Caring for Migrant Families with Young Children
Authors: Merry L , Sicard V , Hibbert N
Published: November 2019

Background

Migrant families’ transnational ties may contribute to their hardships and/or may be a source of resiliency. A care approach that acknowledges these transnational ties may foster a positive identity and give coherence to experiences. We conducted an integrative review to determine if there is evidence that health and social services supporting migrant families with young children consider transnational ties during care with these families.

Methods

We searched 15 databases to identify relevant literature including empirical research and discussion papers reporting on a health or social program, service, intervention or care experience of migrant families during early childhood (pregnancy to age five) in a Western country (i.e., Canada, US, Europe or Australia). Information regarding if and how the intervention/service/program/care addressed transnationalism, were extracted and synthesized.

Results

Over 34,000 records were screened; 296 articles met inclusion criteria. Most literature was from the US. Care, programs and interventions examined included prenatal classes, doula support, maternity care, postpartum home visits, breastfeeding support, nutrition and feeding counseling, and parenting and early childcare programs. There is evidence that care-providers empathize and offer information on family reunification processes for families dealing with separation from loved ones and are open to and accommodate cultural traditions (e.g., feeding and parenting practices) originating from the home country; otherwise there is little evidence that transnational ties are addressed during care.

Conclusions

Significant knowledge gaps remain regarding whether and how care-providers’ take into account transnational ties, including distance care-giving of children or elderly, use of health services abroad, and receipt of advice and support from family back home, which may affect their relationships with families and/or the effectiveness of their interventions.

Key messages

Significant knowledge gaps remain regarding whether and how care-providers’ take into account transnational ties in early chilldhood care. More research is needed on transnationalism and the health and social care of migrant families.
Ethical challenges associated with health-related big data research
Authors: Ienca M
Published: November 2019

Big data trends in biomedical and public health research hold promise for improving prevention, enabling earlier diagnosis, optimizing resource allocation, and delivering more tailored treatments to patients with specific disease trajectories. At the same time, due to their methodological novelty, algorithmic complexity and reliance on data mining for knowledge generation, big data approaches raise ethical challenges. This talk presents an overview of the major ethical challenges associated with health-related big data research. These include demarcating the boundary between personal health data and non-health data, re-defining the notion of private information, sustaining trust in health data sharing, preventing data-driven discrimination and ensuring a fair distribution of benefits and burdens among all stakeholders. Case studies from dementia research and public mental health will be discussed to illustrate these challenges and provide an ethical assessment. Furthermore, this talk will provide an overview of the normative proposals that have been recently advanced to align health-related big data research with established regulatory frameworks such as data protection regulation, regulation on human subject research and ethics review. Based on this analysis, suggestions will be made on how to maximise the benefits of big data for public health while minimizing ethical risks.
Deindustrialisation, Foreign Investment and Social Development: Mortality in the Hungarian Rustbelt
Authors: Scheiring G
Published: November 2019

Background

Many nations are experiencing deindustrialisation. A common strategy to cope with this is encouraging foreign investment. We still know little about the health impact of such industrial transformations, especially their role in the postsocialist mortality crisis.

Methods

Utilising a novel dataset constructed over two years covering 52 towns, 550 companies and 42,800 subjects, using multilevel survival modelling I test how deindustrialisation and foreign investment affect mortality in medium-sized towns in Hungary. I group towns into severely, and moderately deindustrialised (1989-1995), and into state ownership, domestic private and foreign ownership dominated categories (1995-2004). A retrospective cohort study in these towns collected data on vital status of respondents. I use multiple robustness checks and sensitivity analyses to reduce selection bias and endogeneity.

Findings

Deindustrialisation is associated with significantly higher odds of mortality for men between 1989 and 1995 (OR = 1. 16; p < 0.01). Foreign investment was not associated with mortality in any of the models for the 1989-1995 period. Between 1995 and 2004, women living in towns dominated by state ownership had a significantly lower risk of mortality compared to those living in towns dominated by foreign investment (OR = 0.79; p < 0.05) or domestic private ownership (OR = 0.74; p < 0.01). Foreign investment was associated with higher income growth in both periods; however, this was not associated with better health results.

Conclusions

Severe deindustrialisation was a crucial factor behind the post-socialist mortality crisis for men. The indirect economic benefits of foreign investment do not translate automatically into better health; in fact, women living in towns dominated by foreign investors appear to have a higher risk of dying. Foreign investment might promote economic growth but in itself cannot mitigate the health impact of severe deindustrialisation.

Key messages

Deindustrialisation is a significant contextual health risk factor. Spontaneous market processes, such as foreign investment, do not automatically reduce the detrimental health effect of plant closures.
Right-wing populism and self-rated health in Europe: a multilevel analysis
Authors: Backhaus I , Kino S , La Torre G , Kawachi I
Published: November 2019

Background

Individuals who hew to a conservative political ideology have been previously reported to have better self-rated health compared to liberals. No studies have examined whether the correlation between right-wing ideology and health also holds for populism, a brand of politics that is gaining momentum throughout the world. We tested whether the association still holds for right-wing populists.

Methods

We analysed data from 24617 respondents nested within 18 European countries included in the 2016 European Social Survey. Multilevel analyses were conducted to assess the relationship between political ideology and self-rated health, adjusting for other individual covariates (happiness and social capital) and country-level characteristics (democracy type).

Results

Individuals who voted for right-wing populist parties were 43% more likely to report fair/poor health compared to traditional conservatives (OR = 1.43, 95% confidence interval 1.23 to 1.67). The association was attenuated after controlling for individual-level variables, including happiness and access to social capital (OR = 1.21, confidence interval 1.03 to 1.42). Higher levels of social capital (informal networks, OR = 0.40, 95% confidence interval 0.29 to 0.56; trust, OR = 0.82, 95% confidence interval 0.74 to 0.92) and happiness (OR = 0.18, 95% confidence interval 0.15 to 0.22) were protectively correlated with fair/poor self-rated health.

Conclusions

Individuals voting for right-wing populist parties report worse health compared to conservatives. It remains unclear whether ideology is just a marker for health-related practices, or whether the values and beliefs associated with a particular brand of ideology leads to worse health.

Key messages

There is a significant association between voting for right-wing populist parties and self-rated poor health. Social capital was protectively correlated with self-rated health calling for renewed attention on the effects of social capital on political ideology and health.
Does practice characteristics explain the impact of a financial incentive on antibiotic prescribing?
Authors: Anyanwu P , Costelloe C
Published: November 2019

Background

About 80% of the antibiotics prescribed in England are from primary care practices. The Quality Premium (QP) initiative that offers financial rewards on the quality of specific health services commissioned is one of the NHS England interventions to reduce antimicrobial resistance through reduced prescribing. Evaluations of the initiative suggest a reduction in antibiotic prescribing in primary care. We investigated whether the effect of this financial incentive on antibiotic prescribing is explained by variations in practice characteristics that can contribute to differences in antibiotic prescribing.

Methods

We used monthly prescribing data for 6,600 practices in England from NHS Digital for the year from April 2015 when antibiotic improvement was included as a QP priority and the preceding year. We fitted an initial linear generalised estimating equations model examining the effect of the incentive on antibiotic items/STAR-PU prescribed, adjusting for seasonality and number of months since implementation. We examined the consistency of the effect after the initial model was adjusted for variations in workforce, prevalence of co-morbidities (asthma, COPD, cancer, chronic kidney disease, diabetes), and deprivation index.

Results

Antibiotics prescribed in primary care practices in England reduced by 0.20 items/STAR-PU (95% CI:0.19-0.21) after the implementation of the initiative. This reduction flattened off in the following months with a month-on-month increase of 0.013 items (95% CI:0.012-0.013). After adjusting for practice characteristics, the immediate and month-on-month impacts remained consistent with slight attenuation of the immediate impact (0.18, 95% CI:0.17-0.18). Subgroup analyses showed the effect of the initiative was significantly more among 20% top prescribers.

Conclusions

Variations in practice characteristics are not a major explanation for the impact of the quality premium initiative on antibiotic prescribing in primary care practices in England.

Key messages

Our findings on the targeted impact of a financial incentive scheme to improve antibiotics prescribing on high prescribers are important to policymakers and antibiotic stewardship programs. Variations in practice characteristics are not a major explanation for the impact of a financial incentive scheme on antibiotics prescribing in primary care practices in England.
Modeling Carbapenemase-producing Enterobacteriaceae episodes’ evolution in France over 2010-2020
Authors: Roux J , Nekkab N , Astagneau P , Crépey P
Published: November 2019

Background

Incidence of Carbapenemase-Producing Enterobacteriaceae (CPE) episodes within hospitals is rising at an alarming rate and threaten health systems and patient safety worldwide. Their number is growing in France since 2009 associated with inter-regional dissemination and importation of international cases. This study aimed at describing the dynamics of CPE episodes in France over 2010-2016 and forecasting their evolution for 2017-2020.

Methods

Surveillance data of CPE episodes (imported and non-imported) from August 2010 to November 2016 were issued from the French national Healthcare-Associated Infections Early Warning and Response System. Impact of seasonality on the number of CPE episodes was analyzed using seasonal-to-irregular ratios. Seven models issued from time series analysis and three ensemble stacking models (average, convex and linear stacking) were used to describe and forecast CPE episodes. The model with the best forecasting’s quality was then trained on all available data (2010-2016) and used to predict CPE episodes over 2017-2020.

Results

Over 2010-2016, 3,559 CPE episodes were observed in France. Compared to the average yearly trend, we observed a 30% increase in the number of CPE episodes in September and October. On the opposite, a decrease of 20% was noticed in February compared to other months. We also noticed a 1-month lagged seasonality of non-imported episodes compared to imported ones. The number of non-imported episodes appeared to grow faster than imported ones starting from 2014. Average stacking gave the best forecasts and predicted an increase over 2017-2020 with a peak up to 345 CPE episodes (95% PI [124-1,158], 80% PI [171-742]) in September 2020.

Conclusions

The number of CPE episodes is predicted to rise in the next years in France because of non-imported episodes. These results could help public health authorities in the definition and evaluation of new containment strategies.

Key messages

Time series modeling predicts an increase in the number of CPE episodes in France in the next few years with a quicker rise of non-imported episodes. An increase of 30% in the number of CPE episodes was observed in September and October with a 1-month lagged seasonality impact of non-imported episodes compared to imported one.
Community Mental Health Care in Italy: Basaglia’s ashes in the wind of the crisis of the last decade
Authors: Carta M
Published: November 2019

Introduction

In 1978, Italy approved the Law 180, which required the closure of all psychiatric hospitals. The three key points were: 1) A ban on the building of new psychiatric hospitals; 2) The principle that prevention, treatment, and rehabilitation have to be provided in community services; 3) The reason for requiring involuntary treatments was no longer dangerousness: involuntary treatments could only be required if a person needed an urgent treatment and he or she did not have - in that particular moment - the capacity for taking a decision.

Discussion

Regional differences. The 1978 law has been “translated” into regional policies. The resources allocated to implement these policies were higher in the North and lower in the South Italy. The access to services and, thus, the health outcomes were found to be related to the availability of resources.

Decreases in resources

Furthermore, the total amount of resources for the national mental health system in Italy shows a constant decrease from 2001 to date. Considering the percentage of mental health expenditure on the total public health expenditure, today the European countries with an income similar to Italy spend 10% of their health budget for mental health; Italy spends half of it. In this new scenario, the Italian associations of users and families have denounced abuses during involuntary health treatments and in the so-called shelter-houses.

Lack of a scientific approach. Another critical point of the reform is the poor scientific testimony of what has been done.

Conclusions

Italy created a revolutionary approach to mental illness in a historical framework in which this country was in economic expansion and produced a great cultural expression. At that time, we were accustomed to ‘believing and doing’ rather than to questioning results. With the economic and cultural crisis, Italy has guilty neglected mental health.

Any future humanitarian approach to mental health should take this experience into account.
Improving access to integrated mental health services in community-based settings in Portugal
Authors: Cardoso G
Published: November 2019

Background

Scientific evidence has proven greater effectiveness of community-based mental health care offering a diversity of services. Among the main barriers to mental health treatment are difficulties in the access and poor integration with general health services.

Description of the problem

The current Portuguese National Mental Health Plan promoted the transition from psychiatric hospital-based care to care provided by a network of services in the community with the inpatient unit in the local general hospital. In this presentation we will describe the main aspects of the mental health reform and some figures illustrating the functioning of one of the new mental health departments.

Results

Since 2006 three large psychiatric hospitals were closed and mental health departments are now in place according to the new model.

One example, the HFF department of psychiatry, has developed an innovative comprehensive and integrated model based in the general hospital and the community, ensuring a close coordination with primary care teams and all other relevant stakeholders in the community, offering diverse answers to patients’ needs, and preventing drop-outs.

Between 2000 and 2011, the number of admissions went from 486 to 451, first admissions from 40% to 36%, and the average number of patients treated in day hospital from 12 to 24. Liaison psychiatry consultations (2713 to 3684), community teams’ visits (10,201 to 14,756), and home visits (236 to 980) have increased significantly, while rehabilitation programs were developed in two day centers in the community.

Conclusions

The Portuguese model of mental health care, based on the principles of accessibility and equity, community involvement, recovery and human rights, and continuity of care, has promoted greater accessibility, higher quality of care, and less stigma. An important integration of mental health and general health services has taken place allowing for a close collaboration between services.