bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of hospital deaths declared as garbage codes in Belo Horizonte, Brazil, in 2017
Authors: Corrêa P , Ishitani L , Lansky S , Santos M , Teixeira R , França E
Published: October 2020

Background

Improving the quality of causes of death (COD) is vital for defining adequate public policies. In Brazil, one third of deaths are reported as having a cause that is not useful for public health analysis of cause-of-death data, the so-called garbage codes (GC). The investigation of these deaths is one of the strategies that could improve the quality of mortality statistics in the country.

Methods

For all GCs identified in 2017 in the routine mortality information system from Belo Horizonte city, Brazil, municipal health professionals collected information about the final disease obtained from hospital records or autopsies in a standardized form. A trained physician analyzed this information and filled in a new death certificate (DC). The DC that originally showed a GC as an underlying COD was categorized into GC reclassified when the garbage cause changed to a specific cause after investigation. Causes of death derived from the reclassified GCs were analyzed to assess the impact on the mortality profile before and after the investigation.

Results

In Belo Horizonte, 1,395 deaths out of 3,038 registered as garbage codes were investigated, with a 35% reduction in deaths due to these causes. There was an increase in deaths from ischemic heart diseases, Alzheimer's disease, chronic obstructive pulmonary disease, hemorrhagic and ischemic stroke, and violence.

Conclusions

The investigation of deaths from garbage codes modified the mortality profile and improved its quality, providing direction for more assertive public health policies. Strategies for training physicians to report specific causes of death is another strategy that could improve the quality of mortality data.

Key messages

This study proved to be a feasible strategy in improving the quality of causes of death in mortality statistics and should be incorporated into the surveillance routine activities in Brazil. The evaluation of the GC investigation is an important instrument in helping management of health interventions aiming at better quality of information and more qualified health services.
Using cross-sectoral data linkage to understand the health of people experiencing multiple exclusion
Authors: Tweed E , Leyland A , Morrison D , Katikireddi S V
Published: October 2020

Background

People affected by the intersection of homelessness, drug use, and/or serious mental illness have high rates of mortality and morbidity. However, they are often missed from routine information sources on population health, such as surveys and censuses. In many countries, administrative data are available which could help address this knowledge gap. We created a novel virtual cohort using cross-sectoral data linkage in order to inform policy and practice responses to these co-occurring issues.

Methods

Individual-level data from local authority homelessness services (HL), opioid substitution therapy dispensing (OST), and a psychosis case register (PSY) in Glasgow, Scotland between 2011-15 were confidentially linked to National Health Service records, using a mix of probabilistic and deterministic linkage. A de-identified dataset was made available to researchers through a secure analysis platform. Demographic characteristics associated with different exposure combinations were analysed using descriptive statistics.

Results

Linkage created a cohort of 24,767 unique individuals with any one of the experiences of interest between 2011-15. Preliminary results suggest that 89.2% of the cohort had one experience; 10.6% two; and 0.2% all three. The most common combination was HL & OST (n = 2,150; 8.7%), with other combinations much less frequent (HL & PSY, n = 279, 1.1%; OST & PSY, n = 188, 0.8%; HL & OST & PSY, n = 51, 0.2%). The odds of male gender increased with number of exposures (2 exposures, OR 2.1, 95% CI 1.9-2.2; 3 exposures, OR 4.1, 95% CI 2.3-7.2), but there was little difference in age. Work is ongoing to incorporate into the cohort additional datasets on criminal justice involvement.

Lessons

Administrative data linkage is a feasible approach to understanding the health of people affected by multiple exclusionary processes, but requires robust and timely governance. Our initiative can support service planning and evaluation of future policy or service changes.

Key messages

We describe the creation and characteristics of a novel virtual cohort of people affected by multiple exclusionary processes, using record linkage of administrative datasets. Cross-sectoral linkage has international potential for enhancing public health intelligence, especially for population groups who may be missed from surveys and censuses.
Contacts with health services during the year prior to suicide death in France (2013-2015)
Authors: Laanani M , Imbaud C , Tuppin P , Poulalhon C , Jollant F , Coste J , Rey G
Published: October 2020

Background

This study was designed to describe contacts with health services during the year before suicide death in France, and to compare the prevalent mental and physical conditions in these people to those of the general population.

Methods

Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals, national health insurance general scheme beneficiaries (i.e. 76% of the population living in France), aged 15 years or older, who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population.

Results

The study included 19,144 suicide decedents. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room (46.2% of suicide decedents consulted a general practitioner during the month before death, 16.7% attended an emergency room). During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold (SPR 95% CI: 7.7-8.1) more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3, 95% CI: 3.1-3.6) and epilepsy (SPR=2.7, 95% CI: 2.4-3.0).

Conclusions

General practitioners and emergency departments have frequent contacts with suicide decedents during the last weeks before death and are at the forefront of suicide risk identification and prevention in individuals with mental, but also physical conditions.

Key messages

Mental and physical conditions are more common among suicide decedents than in the general population, and contacts with primary care services are frequent in the last weeks prior to suicide. Primary care services (general practitioners and emergency rooms) should be targeted for suicide preventive interventions.
The lead up to tobacco plain packaging policy in Turkey
Authors: Selamoğlu M , Fawkes S , Önal A E , Gleeson D
Published: October 2020

Background

Research shows tobacco plain packaging (TPP) is effective in reducing the attractiveness of tobacco products, effectiveness of tobacco packaging and increases the impact of health warnings. Since Australia introduced TPP in 2012, several other countries have adopted similar legislation, and more have begun preparations for introducing it. Turkey first announced its intention to proceed with TPP in 2011, however prior to the eventual passage of legislation in December 2018 there were many false starts and delays. This study (conducted in 2018 before TPP legislation was passed in Turkey) explored the barriers and facilitators to introducing legislation.

Methods

A qualitative study design was employed using a single case study approach. Publicly available documents relevant to TPP in Turkey were analysed and interviews with key informants from academics, bureaucrats in government ministries and non-government organisations (NGOs) were conducted in 2018.

Results

Barriers such as changes to the government, tobacco industry opposition and the economic crisis appeared to contribute most to the delays in introducing TPP. Despite the barriers Turkey had faced, TPP legislation managed to reach the political agenda primarily through the collaborative advocacy efforts of NGOs, academics and the leadership of particular tobacco control advocates.

Conclusions

TPP legislation was approved by the Turkish government on the 5th December 2018 and has been in force since the 5th January 2020. Implications for the wider uptake of TPP include the importance of building effective coalitions and raising public awareness.

Key messages

The tobacco industry opposition can be defeated by tobacco control advocates working together. Turkey’s experience should be considered by other countries who are willing to implement TPP.
Digital health information seeking of migrant populations – a scoping review
Authors: Dratva J , Zysset A
Published: October 2020

Background

As societies and health systems are increasingly digitally transformed, many health information are provided digitally. Digital health information may reduce barriers to health systems known to be more common in persons with a migrant than native origin. We performed a scoping literature to evaluate evidence on digital information seeking by migrant populations.

Methods

In January 2020 we conducted a literature search (Web of Science, MEDLINE, CINAHL) using terms and synonyms for migrants, health, digital media and information seeking, limited to publications in English. Two researchers independently rated first titles and then abstracts for suitability, obtaining consensus at each step. Primary target group, health topic and related life phase, country, and primary study question were extracted from remaining manuscripts. Data on digital health information seeking will be extracted from full texts.

Results

After title and abstract screening 41 from 315 articles remained. 25 articles focused primarily on migrant populations, 16 ran analyses by migrant status or ethnicity. Dominant populations were Latinos, Hispanics and Asians. Studies were performed in North America (n = 32), Europe, Asia and Australia (each n = 3). Seven papers were on maternal and child health, four on child and adolescent and 30 on adult health. Use of digital technologies is very frequent in most migrant populations. Impact of digital health information vs. traditional information was seldom investigated. In Adults general health, HIV and Cancer were most frequent topics. Further data on impact, preferences, barriers, and context will be presented.

Conclusions

Studies indicate frequent use of digital health information both on general health and specific health topics. The many North American studies indicate an advanced digital transformation of health promotion and care. Full texts will further reveal potential and limitations of digital information seeking and services for migrants.

Key messages

Digital health information seeking is common in migrant populations. Data on digital health information seeking is as heterogenous as migrant populations themselves, current evidence is limited to allow recommendations on design and implementation of such services.
Traffic-borne pollution as a risk factor for acute vascular events: a population study in Milan
Authors: Magnoni P , Murtas R , Russo A G
Published: October 2020

Background

Traffic-borne noise and air pollution have both been associated with cardiovascular and cerebrovascular diseases, albeit with inconsistent findings and issues of collinearity/mutual confounding. The present study aims at evaluating the role of long-term exposure to traffic-borne pollution as a risk factor for acute vascular events in a highly urbanized setting.

Methods

This is a population-based retrospective dynamic cohort study including all residents aged >35 years in the municipality of Milan over the years 2011-2018 (N = 1087110). A noise predictive model and a NO2 land-use regression model were used to assign mean values of traffic noise at the day-evening-night level (Lden, dB) and NO2 concentration (µg/m3) to the residential address of each subject. Cox proportional hazards models were performed to assess the incidence of acute vascular events, with adjustment for potential confounders (age, sex, nationality, a socio-economic deprivation index) and sub-analyses for different outcomes (acute myocardial infarction, ischemic stroke, hemorrhagic stroke).

Results

A total of 27282 subjects (2.5%) had an acute vascular event. Models using NO2 yielded inconsistent results. When using Lden as a proxy of traffic intensity, there was a positive trend in risk with increasing levels of exposure, with an optimal cut-off for dichotomization set at 70 dB (HR 1.025, 95% C.I. 1.000-1.050). The association was observed specifically for ischemic stroke (HR 1.043, 95% C.I. 1.003-1.085) and hemorrhagic stroke (HR 1.036, 95% C.I. 0.969-1.107). When stratifying by age group and sex, a remarkable effect was found for hemorrhagic stroke in men aged <60 (HR 1.439, 95% C.I. 1.156-1.792).

Conclusions

Living close to high-traffic roads was found to exert a small but tangible effect on the risk of stroke. The varying effects observed for specific outcomes and in different age and sex groups are likely due to different pathogenetic mechanisms at play, which warrant further investigation.

Key messages

Residential proximity to roads with high traffic intensity (mean traffic noise level over 70 dB) is a risk factor for stroke, especially for hemorrhagic stroke in middle-aged men. Further interventions aimed at reducing traffic intensity in highly urbanized cities may be justified in order to reduce morbidity and mortality from stroke.
Prevalence, awareness and control of hypertension among Tunisian adults, 2016
Authors: Cherif I , Ben Mansour N , Rejaibi S , Zoghlami N , Saidi O , Skhiri A , Ben Slama F , Ben Romthane H , Turki Z , Aounallah-Skhiri H
Published: October 2020

Background

Hypertension is becoming increasingly frequent mainly in low and middle income countries. We aimed to assess the prevalence, awareness and control of hypertension among Tunisian adults and identify associated factors with hypertension control.

Methods

Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. Adults (age≥18 years old) were interviewed using an individual questionnaire, then three blood pressure measurement were performed. Participants were considered hypertensive if they were previously diagnosed or had a systolic blood pressure (SBP) ≥140mmhg and/or a diastolic blood pressure (DBP) ≥ 90mmhg during the survey. Were considered under control, treated persons with SBP<140 mmhg and a DBP<90 mmhg. A weighted binary logistic regression was used to assess associated factors with hypertension control. Input model variables were: sociodemographic variables, comorbidities and lifestyle factors.

Results

In this study, 8908 adults were enrolled with a mean age of 42.8±0.2 years old and a sex ratio (M/F) equal to 0.96. Among respondents, 29.3% (95% CI: 28.2-30.5) had hypertension, 60.7% (95% CI: 58.7-62.6) of them were unaware of their disease and only (29.5%, 95% CI: 28.2-30.5) of treated patients had a controlled hypertension. In multivariate analysis, eating more than five fruits and vegetables per day was independently associated with a better hypertension control (AOR=1.7, 95% CI: 1.1-2.5). In addition, participants living in northern Tunisia were more likely to have a controlled hypertension than those living in the south (AOR=1.9, 95% CI: 1.2-2.9).

Conclusions

Almost third of Tunisian adults were hypertensive. Low level of awareness and control of hypertension were found in this study. This highlights the urge to reinforce hypertension screening interventions and to strengthen educational programs on this disease with a focus on blood pressure monitoring and healthy lifestyle measures.

Key messages

Tunisian adults had a low level of awareness and control of hypertension. Reinforcing hypertension screening interventions and increasing awareness about healthy lifestyle measures are recommended.
Puberty problems among ART children born 1985-2015 in the Nordic countries – CoNARTaS cohort data
Authors: Klemetti R , Perry B , Aaris Henningsen A K , Pinborg A , Opdahl S , Romundstad L V , Bergh C , Wennerholm U B , Tiitinen A , Gissler M
Published: October 2020

Background

Children born after ART (Assisted reproductive technology) are known to be at increased risk for adverse outcomes, but there are little data on health of older children. The aim of this study is to examine puberty related outcomes of ART children as available in existing health care registers, using Nordic data.

Methods

The CoNARTaS cohort contains data on 121 746 ART children and 6 538 411 naturally conceived children born in Denmark (1994-2014), Finland (1990-2014), Norway (2002-2015) and Sweden (1985-2015). All data were obtained from national health registries, disease-specific quality registries and other nationwide databases. Puberty problems were defined by using ICD-10 codes and classified as any problems, late and early puberty and unspecified problems. Cox regression adjusted for maternal age, parity, plurality, maternal diabetes and maternal smoking were made, separately for girls and boys.

Results

36 508 children had diagnoses related to puberty problems, of which 591 were ART-children including IVF (in vitro fertilization) and ICSI (intra cytoplasmic sperm injection). In total, ART children had increased risks for any pubertal problems (adjusted HR 1.60, 95% CI: 1.47-1.74), late puberty (1.57, 95% CI: 1.31-1.89) and early puberty (1.63, 95% CI: 1.46-1.82). The effect was similar for girls (1.61, 95% CI: 1.46-1.78) and boys (1.55, 95% CI: 1.33-1.81), but girls had more diagnoses related to early puberty (66.2%) and boys with late puberty (48.8%). ICSI was associated with higher risk (2.01, 95% CI 1.74-2.31) than IVF (1.46, 95% CI: 1.30-1.65), but the difference between fresh and frozen embryo transfer remained statistically insignificant.

Conclusions

Both girls and boys born after ART had the increased risk for pubertal problems. However, we could not adjust for all possible confounders such as infertility diagnoses or drugs used in ART. More studies are needed to confirm the findings and to find out reasons for the increased risks.

Key messages

Both girls and boys born after ART had the increased risk for pubertal problems. More studies are needed to confirm the findings and to find out reasons for the increased risks.
Public reporting of performance measures in long-term care in Canada: does it make a difference?
Authors: Poldrugovac M , Amuah J E , Wei-Randall H , Sidhom P , Morris K , Allin S , Klazinga N S , Kringos D S
Published: October 2020

Background

Evidence of the impact of public reporting of healthcare performance on quality improvement is not yet sufficient to draw conclusions with certainty, despite the important policy implications. This study explored the impact of implementing public reporting of performance indicators of long-term care facilities in Canada. The objective was to analyse whether improvements can be observed in performance measures after publication.

Methods

We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, while the other 8 are privately reported. We analysed data from the Continuing Care Reporting System managed by the Canadian Institute for Health Information and based on information collection with RAI-MDS 2.0 © between the fiscal years 2011 and 2018. A multilevel model was developed to analyse time trends, before and after publication, which started in 2015. The analysis was also stratified by key sample characteristics, such as the facilities' jurisdiction, size, urban or rural location and performance prior to publication.

Results

Data from 1087 long-term care facilities were included. Among the 8 publicly reported indicators, the trend in the period after publication did not change significantly in 5 cases, improved in 2 cases and worsened in 1 case. Among the 8 privately reported indicators, no change was observed in 7, and worsening in 1 indicator. The stratification of the data suggests that for those indicators that were already improving prior to public reporting, there was either no change in trend or there was a decrease in the rate of improvement after publication. For those indicators that showed a worsening trend prior to public reporting, the contrary was observed.

Conclusions

Our findings suggest public reporting of performance data can support change. The trends of performance indicators prior to publication appear to have an impact on whether further change will occur after publication.

Key messages

Public reporting is likely one of the factors affecting change in performance in long-term care facilities. Public reporting of performance measures in long-term care facilities may support improvements in particular in cases where improvement was not observed before publication.
A systematic review on the barriers and enablers to shared cancer follow-up care
Authors: Sandell T , Schütze H
Published: October 2020

Background

The digital information revolution empowers individuals to lead and control their healthcare. The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care, and the need to find alternative models of care. The aim of this review was to identify the barriers and enablers to shared cancer follow-up care, and to inform a shared model of care.

Methods

Systematic review. Seven electronic databases MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic edition and Psychology and Behavioural Sciences Collection were searched for published papers between 1999 to 2019. Papers were included if they were available in full-text, English, peer-reviewed, and had a focus on cancer follow-up care. 31 Papers were included in the final review.

Results

Role clarification, communication, and technology were identified as important to shared cancer follow-up care. The lack of effective exchange of information in real-time between oncologists and general practitioners hinders the implementation of feasible and acceptable shared care.

Conclusions

While patients may prefer the oncologist-led model, their acceptance to have their general practitioner play a greater role in their follow-up care increases if their oncologist can oversee the care. Bridging the digital communication exchange between oncologists and general practitioners can support shared cancer follow-up care, whilst providing safe, patient-centred, long-term care.

Key messages

Cancer survivorship requires long-term follow-up care. Improved utilisation of digital health is imperative to develop shared-care models of care between oncologists and general practitioners. Health services need to work collaboratively to provide person centred care and to improve health outcomes.
Quick and collaborative response to teenage pregnancies in a poor semi-rural area of Belgium
Authors: Déom V , Ben Abdelhafidh L , Annez N , Glorie C , Roland M
Published: October 2020

Early pregnancies are often linked to precarious situations. Even if Belgium has seen a decrease in teenage pregnancies, in the former mining region of the Hainaut there are still twice as many births to young women under 20 compared to the national rate.

Colfontaine is one of the poorest cities in Belgium. Last year, one of the local high schools counted 10 pregnant teenagers out of 450 students. Médecins du Monde was already present in the city at the time with a mobile health clinic called the Médibus. In response, we carried out a mapping of the local sexual and reproductive health actors. The lack of accessibility to social and health structures capable of welcoming teenagers anonymously and free of charge quickly emerged as a problem, the nearest family planning center being located 30 minutes away by bus.

In September 2019, in partnership with 5 local health actors, we decided to reshape the Médibus into the Adobus in order to offer family planning consultations, health promotion and harm reduction activities at the high school once a week.

In addition to offering health information services, we also aim to detect teenagers experiencing vulnerable situations such as addiction, violence, gender issues and refer them to appropriate services. Halfway through the project, we met 430 teenagers in 14 afternoons. The most common reasons for consultation (N = 310) were questions related to contraception for 29% and to sexually transmitted infections for 24,5%. 70,9% of teenagers received condoms and 13 girls were tested for pregnancy. One girl received a morning-after pill. 3 teenagers with addiction problems and 17 victims of violence were detected. The teams referred 18 teenagers to other services.

The success of this outreach project confirms the need for information regarding sexual and reproductive health for teenagers living in precarious situations as well as the need to develop reachable and affordable sexual and reproductive health services in semi-rural areas.

Key messages

Outreach is an efficient approach to respond to teenagers’ needs in poor semi-rural areas. Outreach facilitated the detection of early pregnancies, addiction and violence issues among teenagers.
Development and validation of the dental vulnerability scale in the primary health care setting
Authors: Palacio D , Mafra A C C N , Bonfim D , Rebustini F , de Oliveira D B , Martins A C F , de Mendonça J M T , Miraglia J L , Pereira A C
Published: October 2020

Background

Offering equitable access to dental care remains a challenge and methods to risk-stratify individuals to prioritize care could help to attain that goal. The interaction of multiple risk factors associated with oral disease vulnerability can outweigh protective factors conferring resilience and resistance to individuals and their communities; however, there is no validated instrument for measuring oral disease vulnerability. Hence, the objective of this study was to develop a Dental Vulnerability Scale (EVO) for primary health care (PHC) and evaluate its content validity and internal structure.

Methods

This was a psychometric study conducted in São Paulo, Brazil, in 2019. During content validation, 172 items were evaluated by a panel of 40 judges with diverse background and with the application of the Content Validity Ratio (CVR), considering a critical CVR value> 0.26. During the internal structure evaluation, the EVO was applied to a sample of 1227 individuals in the PHC setting and the results were analyzed using Exploratory and Confirmatory Factor Analysis, in addition to the application of 3 reliability indicators (Cronbach's alpha, McDonald's Omega and Greatest Lower Bound).

Results

The CVR was 0.33 for relevance and 0.39 for clarity, resulting in 41 items. The final EVO was composed of 4 dimensions (general health, oral health, infrastructure and health services) with a total of 15 items. Factor loadings ranged from 0.37 to 0.96, with R-squared values ranging from 0.14 to 0.91. The reliability indicators values were α = 0.64, ω = 0.99 and GLB=0.82. The Goodness of fit were NNFI = 0,95, CFI = 0,98, GFI = 0,96 and AGFI = 0,97. The EVO instrument was considered valid to be used among oral health professionals in the PHC setting.

Conclusions

The EVO showed satisfactory psychometric properties and could be employed by health professionals and managers to plan actions and*inform* policies related to oral health.

Key messages

The EVO could be used to risk-stratify individuals in the PHC setting. The EVO could help to inform oral health policies.
Urban rural paradox -when easy access to mammography services does not mean active participation
Authors: Padilla C , Prajapati N , Soler Michel P , Vieira V M
Published: October 2020

Introduction

The detection of breast cancer in its latent stages through mammography screening can improve patient's chances of recovery. However, geographic variation in mammography participation remains. Our objectives were first to assess whether the geographic accessibility of mammography-screening services influences mammography-screening participation and second to estimate the extent to which geographic variation in the use of cancer screening can be explained by spillover effects between adjacent areas, while controlling for covariates.

Methods

Mammography-screening services participation rates were calculated, for women aged 50-74 years who live in Lyon metropolitan area and did a mammography between 2015-2016 after being invited with a letter by the mammography screening program. We used spatial autoregressive models to estimate the extent of spatial spillover effects by applying spatial lag models. The geographic accessibility (availability, distance and affordability) on participation was evaluated adjusting on socioeconomic characteristics of census blocks.

Results

We found evidence of urban rural paradox. The mammography screening participation was 53.2% in residential and rural areas and 46.6% in urban and active areas, p < 0.001. Conversely to rural areas, women living in urban census blocks had high availability, lower distance to the closest mammography services, and lower mammography screening participation. Moreover, the coefficients for the spatial lag are significant and positive. The positive spatial lags indicate that screening utilization rates are determined by knowledge spillovers and geographic proximity between adjacent areas.

Conclusions

This study makes an important methodological contribution to measure access to services and better understand the variety of community contextual factors that drive mammography use decisions; which is a critical component of health care planning and equity almost everywhere.

Key messages

Evidence of urban rural paradox in mammography screening participation. Screening utilization rates are determined by knowledge spillovers and geographic proximity between adjacent areas.
Validation of mobile Decision Support System for scheduling age-appropriate immunizations
Authors: Ali R F , Hossain Z , Siddiqi D , Abdullah S , Shah M T , Chandir S
Published: October 2020

Background

The prevalence of missed opportunities for immunization among children is estimated to be 32.2%. The introduction of new vaccines in EPI schedule and lack of training of frontline health workers (FHWs) on the guidelines for number and spacing of doses and manual construction of vaccine schedules based on a child's age deteriorates efficiencies of FHWs, especially in forecasting catch-up schedules. We have designed and tested the validity of an innovative Decision Support System Application Programming Interface (DSS-API) which will automatically generate an age-appropriate immunization schedule for a child.

Methods

Using a multi-country setting approach, DSS was deployed in six immunization facilities of Pakistan and Bangladesh between July 2019 to April 2020. Details of all visiting children were recorded in database. Information on date of birth and past immunization history was used by the DSS-API to determine an individualized age-appropriate immunization schedule. These schedules were compared to the gold standard's outputs calculated by an immunization expert.

Results

A total of 6,241 vaccination events were recorded from all the sites. Using area under the curve, the calculated sensitivity of DSS to determine age-appropriate immunization schedule was found between 99-100% for the individual EPI vaccines, while the specificity of the DSS algorithm was found between 98-100%.

Conclusions

DSS is a feasible feature that can be incorporated in Digital Immunization Registries to accurately schedule routine and catch-up immunizations and can effectively reduce Missed Opportunities for Immunizations by assisting FHWs through automatic construction of immunization schedules.

Key messages

DSS-API is a unique application that can improve process efficiencies of frontline health workers by automatic generation of accurate age-appropriate catch-up vaccine schedules. DSS has the potential to reduce missed opportunities for immunization (MOI) and improve immunization coverage and timeliness among children aged under 2 years.
“Sometimes I don’t have a pulse, and I’m still alive!” Healthcare providers on digital health techs
Authors: Tomasella F , Morgan H M
Published: October 2020

Background

Digital health technologies (DHTs) are increasingly becoming an integral part of our lives, healthcare field included. The WHO recently has even released the first digital health guidelines for worldwide intervention. Commercially available DHTs (e.g. smartphones, smartwatches, apps) may hold significant potential in healthcare, upon successful and constructive integration. Literature on the topic is split between enthusiasm for the potential benefits, and concerns about reliability and effectiveness. Little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they believe the main issues for implementation may be. This study aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public.

Methods

Nine HCPs volunteered to take part in semi-structured interviews. Data were thematically analysed adopting a pre-constructed framework (deductive approach) based on current (April 2019) literature and the findings from the first two interviews.

Results

The following main themes were identified and explored in detail: HCPs' experience, perceived knowledge and views on DHTs; advantages and disadvantages; barriers towards healthcare implementation and solutions; future perspectives. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this included factors such as time/resources availability; colleagues' mindset; lack of evidence of effectiveness for practice; privacy/data security concerns.

Conclusions

The potential advantages of DHTs' adoption in healthcare are substantial - e.g. patient autonomy, time/resources saving, health and behaviour change promotion. However, future research is warranted focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs.

Key messages

We explored healthcare providers’ views on the role of commercial digital health techs in clinical practice. Despite some privacy and reliability concerns, commercial digital health techs show promise.
Is the technical quality of root fillings associated with socioeconomic status?
Authors: Raittio E , Huumonen S , Suominen A L
Published: October 2020

Background

Socioeconomically better-off tend to receive better care, and to benefit more from care they receive, than the less well-off. The technical quality of root fillings can be assessed radiographically. Our aim was to investigate differences in the technical quality of root fillings according to socioeconomic status not studied before.

Methods

In the Finnish Health 2000 Survey, a sample of 8 028 over 29-year-old adults was selected by a stratified two-staged cluster sampling. Of these, 6 115 (76%) underwent panoramic radiography. A total of 7 986 endodontically treated teeth were detected among 3 905 participants. The criterion for a technically inadequate root filling was a distance from the root filling to the root apex of over 3 mm or material over the apex. Education, employment status and household income were used as measures of socioeconomic status. Differences in the quality of root fillings according to socioeconomic status were investigated using the Multiple Additive Regression Tree mediation analysis, taking into account age, gender and tooth type of the root filled tooth.

Results

Almost half (47%) of the root fillings were inadequate. Root filling quality was associated particularly with age of the participant and type of tooth. Mediation analysis showed that among the over 64-year-olds, higher education or income were associated with a slightly higher probability of inadequate root filling quality (ORs 1.15-1.20, p < 0.05). Among the under 65-year-olds, age of the participant and type of tooth explained the observed variations in root filling quality according to socieconomic status, and socioeconomic status had no influence (ORs 0.99-1.02, p > 0.05).

Conclusions

Those in a lower socioeconomic status had not received poorer endodontic treatment quality. It seems that those in a lower socioeconomic status are not prone to receive poorer quality care in endodontic setting, that they tend to receive in longer and more socially complex treatments.

Key messages

Variations in the technical quality of root fillings by socioeconomic status has not been studied. Lower socioeconomic status was not associated with poorer technical quality of root fillings.
Social variations in pregnancy outcomes in Murmansk county-one of the Northernmost European provinces
Authors: Grjibovski A M , Usynina A A , Postoev V A , Kharkova O A , Odland JØ
Published: October 2020

Background

Pregnancy outcomes are widely used indicators of population wellbeing varying both between and within countries. The aim of this study was to assess social variations in preterm births and term small-for-gestation-age (SGA) infants in the Northernmost provinces of Europe - the Murmansk region - using the data from the first Russian population-based birth registry.

Methods

A registry-based study of 52 806 births in the Murmansk region for a 5-year period was performed. We studied the prevalence and social determinants of moderate-to-late preterm births (MLPTB, 224-258 days of gestation), very preterm births (VPTB, 196-223 days) and extremely preterm births (EPTB, 154-195 days) and term SGA for both weight and length births (SGAWL). Associations between social factors and pregnancy outcomes were studied by multivariable logistic regression.

Results

The prevalence of PTB was 6.9 with EPTB, VPTB and MLPTB constituting 0.3%, 0.6% and 6.0%, respectively. A total of 4.1% of infants were SGAWL. Women with primary, secondary and vocational education were 1.59 (95%CI:1.22-1.85), 1.33 (95%CI:1.20-1.48), 1.19 (95%CI:1.22-1.85) times more likely to have MLPTB than women with higher education. Corresponding values for VPTB were 1.65 (95%CI:0.88-3.08), 1.41 (95%CI:1.02-1.95) and 1.27 (95%CI:0.92-1.75), respectively. Single and cohabiting women had significantly elevated risk for MLPTB (ORs=1.47 (95%CI:1.30-1.66) and 1.39 (95%CI:1.26-1.44)) and VLPTB (ORs=2.00, 95% CI: 1.42-2.81 and 1.32, 95% CI: 0.97-1.79) compared to married women. Unmarried mothers were more likely to have SGAWL boys (OR = 1.60, 95% CI: 1.38-1.86) and SGAWL girls (OR = 1.51, 95%CI:1.31-1.76) compared to married women.

Conclusions

We observed significant social variations in pregnancy outcomes by maternal education and marital status in the Murmansk region. Registry data can be used as an effective tool for monitoring inequalities in pregnancy outcomes as indicators of social inequalities.

Key messages

We found significant social variations in pregnancy outcomes in the Northernmost province of Europe - the Murmansk county (Russia). Birth registry data can be used for monitoring of health inequalities in Russia.
Social inequality in obesity in an Eastern Mediterranean population: a national health survey
Authors: Quattrocchi A , Kolokotroni O , Demetriou C A , Charalambous A , Heraclides A
Published: October 2020

Background

This study aimed to explore socioeconomic factors associated with obesity in the Republic of Cyprus.

Methods

We interviewed 3021 Greek-Cypriots aged 25-64 years through a multistage survey. We collected self-reported information on demographics, health behaviours (physical activity, smoking, alcohol consumption and dietary intake), socio-economic characteristics (educational attainment, household income and occupational social class) and anthropometric measurements. Obesity was defined as body mass index ≥30 kg/m2. For the association between obesity and each socio-economic indicator, we conducted sex-specific Poisson's regression with robust variance, adjusting for all demographics and health-related behaviours, reporting adjusted prevalence ratios (aPR) and 95% confidence intervals (CI).

Results

The prevalence of obesity was 22% and 17% among men and women, respectively. There was a significant trend of higher obesity prevalence with increasing age as well as with being widowed in both genders and being a refugee in men. Obesity prevalence decreased with increasing educational attainment (postgraduate vs. none/gymnasium: a PRmen=0.45; 95%CI=0.25-0.82; a PRwomen=0.41; 95%CI=0.18-0.95; p-trends<0.005), and household income (>€4000/month vs. ≤€1000/month: a PRmen=0.45; 95%CI=0.26-0.81; a PRwomen=0.45; 95%CI=0.22-0.92; p-trends<0.005). Occupational social class did not show any clear association with obesity. After adjustment for health-behaviours as mediators the association between income and obesity in women was attenuated.

Conclusions

The current study highlights striking social inequalities in obesity among Cypriot men and women, characterised by a linear decrease in obesity prevalence each step up the socioeconomic hierarchy. We recommend that comprehensive and multifaceted public health interventions are considered to address income and education-related barriers resulting in higher obesity rates among specific population sub-groups.

Key messages

Among Greek Cypriot adults, obesity affects almost one in five whilst obesity prevalence shows gender-specific social inequalities. When investigating social inequalities in health, the choice of socioeconomic indicators should reflect the context of the population and gender-specific differences.
Testing a self-assessment tool for HP competencies with participants of training courses in Austria
Authors: Lang G
Published: October 2020

Background

High quality health promotion (HP) depends on a competent workforce for which professional development programmes for practitioners are essential. The “CompHP Core Competencies Framework in HP” defines crucial competency domains but a recent review concluded that the implementation and use of the framework is lacking. The aim was to develop and validate a self-assessment tool for HP competencies, which should help evaluate training courses.

Methods

A brief self-assessment tool was employed in 2018 in Austria. 584 participants of 77 training courses submitted their post-course assessment (paper-pencil, RR = 78.1%). In addition, longitudinal data are available for 148 participants who filled in a pre-course online questionnaire. Measurement reliability and validity was tested by single factor, bifactor, multigroup, and multilevel CFA. A SEM proved for predictive and concurrent validity, controlling gender and age.

Results

A bifactor model (X2/df=3.69, RMSEA=.07, CFI=.95, sRMR=.07) showed superior results with a strong general CompHP factor (FL>.65, wH=.90, ECV=.85), configurally invariant for two training programmes. On course level, there was only minimal variance between trainings (ICC<.08). Structurally, there was a significant increase in HP competencies when comparing pre- and post-course measurements (b=.33, p<.01). Participants showed different levels of competencies due to prior knowledge (b=.38, p<.001) and course format (b=.16, p<.06). The total scale had good properties (m = 49.8, sd = 10.3, 95%-CI: 49.0-50.7) and discriminated between groups (eg by training length).

Conclusions

The results justify the creation of an overall scale to assess core HP competencies. It is recommended to use the scale for evaluating training courses. The work compensates for the lack of empirical studies on the CompHP concept and facilitates a broader empirical application of a uniform competency framework for HP in accordance with international standards in HP and public health.

Key messages

The self-assessment tool provides a good and compact foundation for assessing HP competencies. It provides a basis for holistic, high quality and sustainable capacity building or development in HP.
Health labour markets: an overview of some human factors that influence demand and supply
Authors: Dussault G , Zurn P
Published: October 2020

Background

The global demand for health workers is expected to double by 2030 and it is estimated that if need is taken into account, there will be a deficit as high as 18 million according to the World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030. Combined with inequities in the access to qualified health workers, this impedes progress towards the achievement of universal health coverage, global health security and the SDGs. This paper addresses health labour market deficiencies. It aims to provide guidance for a comprehensive analysis of health labour market dynamics, including the political and social factors that, in addition to economic ones influence the behaviour of health workers and of employers.

Methods

This paper uses the material of the WHO Health Labour Market Analysis Guidebook, which is based on the most recent literature on the demand and supply of health workers and on factors that affect them. It also draws from empirical analysis conducted recently by WHO in four regions of the world.

Results

On the supply side, the paper illustrates how social norms, such as those related to gender, influence the decision to become a health professional, the choice of a specialty, the choice of a practice location, and labour market participation. As to demand, examples are given of how professional interest groups' political actions (councils, trade unions) influence the division of tasks and which types of jobs will be offered.

Conclusions

The analysis of the dynamics of health labour markets must include human factors to achieve a better understanding of the forces that drive health worker shortages and surpluses, skills-mix and geographical imbalances, and suboptimal performance and to develop effective policies to address these issues.