bluuebunny/crossref_metadata_2025 huggingface dataset:
Variation in uptake of Healthy Start Food Vouchers in the Six Health and Social Care Partnerships
Authors: Salim E , Scott S
Published: November 2019

Background

The primary aim of this study was to assess the difference in uptake levels of Healthy Start Food Vouchers, a means tested benefit to afford nutritious food, between 6 Health and Community Partnerships (HSCP) in Greater Glasgow and Clyde (GGC). Our secondary aim was to explore possible reasons for the observed variation.

Methods

Routinely collected Healthy Start data for the months of August to September 2017 were obtained from the UK Department of Health. Postcode sectors were matched up with their corresponding HSCPs in GGC. Analysis looked for associations between uptake rates and various HSCP area-based characteristics.

Results

Large variations were observed within GGC. Chi-square test showed a significant association between uptake and HSCP area (P < 0.0005). Trend analysis of uptake with area deprivation (P = 0.001) and resource allocation (P < 0.001) was also significant. Subjective analysis of trend direction suggested that uptake increased with deprivation and resource allocation of the HSCP.

Conclusions

Significant trends were found and the observed patterns suggested that the relationship between uptake rates and HSCP area is more complex than the geographical characteristics alone. Future studies need to look at the difference in management and awareness of the voucher scheme between Maternity teams in HSCPs.

Key messages

There is significant variation in the uptake of means tested benefits with some areas having a nearly forty percent of eligible individuals not receiving available support. A qualitative approach is required to determine the causes of low uptake rates of benefits and improve the effectiveness of maternity teams in different areas.
Intrapersonal/interpersonal factors related to alcohol use and smoking cigarettes among juveniles
Authors: Gajdosova B , Orosova O , Janovska A
Published: November 2019

Background

While there is consistent evidence that an early initiation of smoking and alcohol consumption is associated with a whole range of future negative outcomes, relatively little attention has been directed at a specific population of very young adolescents (10-12 years old). This study aimed to explore the relationships between alcohol use, smoking and intra/interpersonal factors among primary school pupils.

Methods

In this study (APVV-0253-11, APVV-15-0662) a representative sample of 572 early adolescents from a stratified random sample of 12 primary Slovak schools (50.1% boys, Mean age=12.49; SD = 0.59) was used. The respondents indicated their lifetime prevalence of smoking SM and alcohol use AU (dichotomized: 0-not used, 1-used) which was used as an outcome variable. Expectations of the effect of smoking and alcohol use (positive or negative), self-control and cigarette and alcohol refusal were used as the independent variables. Binary logistic regressions were performed and carried out separately for boys and girls.

Results

All 4 models were statistically significant for males (AU = 15.318, p < 0.01, 9.8%, SM = 17.807, p < 0.01, 9.8%) and also for females (AU = 25.204, p < 0.001, 16%, SM = 47.05, p < 0.001, 24.7%). The models showed that for boys there were significant associations between smoking refusal and smoking cigarettes 95%CI=0.845-0.97 and alcohol refusal and alcohol prevalence 95%CI=0.78-0.95. For girls, significant associations were found between smoking refusal and smoking cigarettes 95%CI=0.75-0.92, alcohol refusal and alcohol prevalence 95%CI=0.72-0.95, positive expectations 95%CI=1.04-1.20, negative expectations 95%CI=0.78-0.94, self-control 95%CI=0.91-1.00 and alcohol prevalence.

Conclusions

This study supports the importance of the specific role of refusal skills for both genders as well as the importance of the role of expectations and self-control with respect to gender differences.

Key messages

Implementation of the findings regarding the importance of specific refusal skills towards alcohol use and smoking among both genders might be important for effective targeting of prevention programs. The results show a similar trend regarding smoking which was observed among both genders but this was not seen in alcohol use.
Adolescent suicide behaviour profiles: comparing unplanned attempts, planned attempts and ideation
Authors: van Duin C , Catunda C , Heinz A , Willems H
Published: November 2019

Background

Suicide is the second leading cause of death for young people worldwide. A significant amount of suicide attempts is known to be unplanned, but research on unplanned attempts among adolescents is limited. As knowledge on the profile of unplanned suicide attempts is crucial for effective prevention efforts, this study aims to characterize and compare three suicide behaviour profiles among adolescents: planned attempts, unplanned attempts and ideation without attempt.

Methods

Data from the 2014 Luxembourgish Health Behaviour in School-aged Children study was used. 879 adolescents aged 12 to 18 years old are included in this study. Data was gathered using paper questionnaires. ANOVAs with Games-Howell post-hoc tests were conducted for 18 independent variables, using the suicide behaviour variable as the dependent variable.

Results

Unplanned attempters report higher levels of parental and classmate support (p < 0.01), fewer health complaints (p < 0.001), higher life satisfaction (p < 0.01) and a more positive body image (p < 0.01) than planned attempters and ideators. Unplanned and planned attempters are younger than ideators (p < 0.01) and report more substance use and physical fighting than ideators (p < 0.01).

Conclusions

Unplanned attempters report better health (behaviour) and more social support than planned attempters and ideators. Unplanned attempters and planned attempters have higher levels of risk behaviour than ideators. Prevention efforts should be mindful of similarities and differences between the behaviours, and identify and address at risk adolescents accordingly.

Key messages

Unplanned attempters have better health (behaviour) and more social support than planned attempters and ideators. Results are incorporated in the Luxembourgish national plan for suicide prevention.
Social capital and students’ health: results of the splash study
Authors: Backhaus I , Kawachi I , Ramirez A , Jang S , Khoo S , Al-Shamli A , Po-Hsiu L , Begotaraj E , Fischer F , Torre G La
Published: November 2019

Background

Universities around the world are challenged with rising rates of mental health problems among their students. Cumulative evidence demonstrated that aspects of the social environment, including social capital, play an important role in mental health. This study aimed to determine the prevalence of depressive symptoms among university students from across the globe and to investigate whether social capital was associated with depressive symptoms in university students.

Methods

A cross-sectional study was conducted in Albania, Brazil, Germany, Italy, Malaysia Oman, South Korea, Switzerland, Taiwan and the USA in 2018/2019. Data were obtained through self-administered questionnaire, including questions on sociodemographic characteristics and depressive symptoms. The BDI-S was used to assess the presence of depressive symptoms. Multilevel analyses were conducted to assess the relationship between social capital and depressive, adjusting for individual covariates (e.g. perceived stress and health behaviours) and country-level characteristics (e.g. democracy type).

Results

A total 3894 students participated. Out of all participants almost 47% presented clinically relevant depressive symptoms. The prevalence of depressive symptoms was highest among students identifying as other than male or female (48.7%), among students with low socioeconomic status (59.5%) and among students with low levels of cognitive (65.3%) and behavioural social capital (57.0%). Even after adjustment in multilevel logistic regression analyses, depressive symptoms remained significantly associated with low levels of cognitive social capital (OR = 1.49, 95% CI: 1.06 to 2.10) and low level of behavioural social capital (OR = 1.36, 95% CI: 1.08 to 1.71).

Conclusions

Social capital may play an important role in mental health problems in the university setting. The study identified significant opportunities for future research and health promotion strategies among students.

Key messages

Key factors associated with depressive symptoms among university students were low levels of behavioural and cognitive social capital. Health promotion programs targeting young persons with depressive symptoms should include effective components of social epidemiology such as social capital.
Obesity prevention - is school an effective place? A systematic review
Authors: Kula A , Liersch S , Krüger K , Walter U , Hagen A
Published: November 2019

Background

Juvenile and childhood obesity or overweight are associated with various secondary diseases and physical limitations, as well as with the effects of discrimination and social exclusion. The early prevention of obesity remains a key area of action worldwide. Schools are considered as a classical setting. The analysis focuses on the effectiveness of interventions, the identification of effective components and conditions as well as barriers. The aim is to provide a differentiated presentation of the current study situation.

Methods

The systematic literature search in eleven databases included studies in English and German published in 1990 to 2015. A control group and posttest data were obligatory. Evaluated outcome measures must map effects on the prevalence of obesity (e.g., BMI, body fat percentage, waist-to-hip ratio). Included full texts were evaluated with the instrument ROBINS-I. Due to the heterogeneity of studies (especially in terms of design, intervention and outcomes) results were analysed qualitatively.

Results

48 primary studies were included of which most studies report data on changes in mean BMI over time, and show predominantly (small) effects in favour of the intervention. Almost all identified interventions include behavioral measures, most of them combine the fields of nutrition and physical activity, with behavioral prevention being overrepresented in particular in activities addressing nutrition.

Conclusions

The results allow the conclusion, that school-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. There is clear evidence that the effects achieved tend to be maintained beyond the intervention. There are also clear indications for the cost-effectiveness of school-based obesity prevention. The studies from this field of research have clearly gained in quality over the years and are now flanked by health economic analyses.

Funded by DIMDI

Key messages

School-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. In order to fully realize its potential, school-based measures to prevent obesity should be accompanied by interventions at other levels, like the health-promoting design of living environments.
Satisfaction with health and oneself and the Unplugged program among Slovak Schoolchildren
Authors: Orosova O , Gajdosova B , Benka J
Published: November 2019

Background

The investigation of protective factors and intervention effects on health are important issues of prospective studies. The aims of this study were to explore the changes in schoolchildren’s satisfaction with their health and themselves (SH) following their participation in the Unplugged program (PU).

Methods

This study was carried out as a cluster randomized controlled trial (1195 participating schoolchildren, Mean age=11.52; 47.4% boys) with data collection conducted immediately before PU implementationT1, immediately after the implementationT2 then 3 monthsT3, 12 monthsT4, and 18 months after the implementationT5. The schools were randomly assigned to either an experimental (EG, n = 540) or control group (CG, n = 655). EG was exposed to PU consisting of 12 lessons (http://www.eudap.net/). The effect of participating in PU, gender, and self-efficacy (SET1) were explored in relation to changes in SH in both EG and CG. GLM Repeated Measures were used for the data analyses.

Results

There was a significant main effect of time on SH, F(4, 1096)=6.685, p < 0.001. The contrast analysis revealed that SH was significantly lower at every follow-up when compared to SH at T1. There was a significant interaction effect SHxSE, F(4, 1096)=2.868, p < 0.05. The contrast analysis revealed that SH was significantly lower at T2 than at T1 among the schoolchildren with a lower level of SE. Finally, the SHxSExPU interaction was significant F(4, 1096)=2.779, p < 0.05 and the contrast analysis revealed that SH was significantly higher at T5 than at T1 among those participants of PU with a higher level of SE.

Conclusions

The findings generally suggest that while there was a decrease of SH among schoolchildren between T1 and T5 a long-term effectT5 of PU was found among the program participants with higher levels of SE who were able to maintain higher level of SH.

Key messages

Schoolchildren’s satisfaction with their health and themselves was found to generally decrease in time during the 22 months when Unplugged was implemented and evaluated. A long-term effect of Unplugged was detected among program participants with higher levels of self-efficacy who were able to maintain higher level of satisfaction with their health and themselves.
Perception of Social Gender Roles in Medical Faculty Students
Authors: Aygar H , Atalay B Isıktekin , Zencirci S Akbulut , Unsal A , Arslantas D
Published: November 2019

Background

“Gender equality’’ is the fifth of the Sustainable Development Goals put forward in order to ensure the development in all areas. Medical faculty students, who will be a doctor, should practice with a gender equality perspective and shape their views and attitudes with equality in mind which will have an important part in the adoption of equality by society. The aim of the study was to evaluate the perception of social gender roles in medical students.

Methods

This cross - sectional study was performed with all students in Eskisehir Osmangazi University Faculty of Medicine. The questionnaire includes sociodemographic characteristics and Gender of Perception Scale(PCS) to measure perception of social gender roles. The scores that can be taken from the scale are ranged from 25 to 125, and high scores indicate that perception of gender is positive and equality. Mann Whitney U, Kruskal Wallis were used in univariate analysis; multivariate linear regression was used in multivariate analysis.

Results

The study group consisted of 1023 (84.3%) students in the study group, 52.8% were females and their ages ranged from 17 to 30 and the mean was 21.36 ± 2.06. The PCS scores ranged from 32 to 125 and the mean was 108.07±16.58. Multivariate linear regression analyzes were performed to determine the factors associated with the PCS. According to the results of last model sex, living with grandparents until the age of 18, region of the majority of life and parental attitudes were found to be related to perception of social gender roles (F = 29.602, R2=0.170, p < 0.001).

Conclusions

The perception of gender of medical students was found to be positive. Sex and the characteristics of the social environment were related to perception of gender. In order to raise awareness on gender equality, it might be useful to ensure integration in the medical education curriculum.

Key messages

Factors that can be changed, such as the social characteristics of the living environment, were found to be related to perception of social gender roles. Ensuring gender equality, one of the Sustainable Development Goals, is important for medical students who will be a role model for society.
Education and T2DM: the role of differential exposure and susceptibility to overweight and obesity
Authors: Mathisen J , Jensen A K G , Andersen I , Andersen G S , Hvidtfeldt U A , Rod N H
Published: November 2019

Background

There is a clear educational gradient in type 2 diabetes and differential exposure and susceptibility to overweight and obesity across educational groups may explain part of this gradient. Previous studies have mainly addressed differential exposure to overweight/obesity, even though the pathways are highly intertwined. We take advantage of novel methodological developments to assess the simultaneous contribution of both pathways. We further compare these analyses to more traditional approaches.

Methods

A prospective cohort of 53,159 Danish men and women, aged 50-64 years at enrollment in 1993-1997, were followed for a mean of 14.7 years. We used national register data to ascertain education and incident type 2 diabetes. Overweight/obesity was determined by BMI. Using a marginal structural approach and a three-way effect decomposition, we estimated rate differences of type 2 diabetes by education and decomposed these into direct, indirect and mediated interactive proportions. We compared this approach to traditional and separate approaches to mediation and interaction analysis.

Results

Compared with high education, medium education was associated with 316 (95% CI: 268-363) extra cases of type 2 diabetes per 100,000 person-years, and low education with 454 (95% CI: 398-510) extra cases. Differential exposure to overweight/obesity accounted for 29% (95% CI: 24-36) and 37% (95% CI: 31-45) of the cases in the medium and low educational levels, respectively, while differential susceptibility accounted for 6% (95% CI: 3-10) and 9% (95%CI 4-14). Traditional approaches suggested stronger effects of both pathways.

Conclusions

Differential exposure and susceptibility to overweight/obesity are both important pathways in the education-type 2 diabetes association, and the results emphasize the importance of addressing them simultaneously.

Key messages

Lower educated groups are more exposed and susceptible to the adverse effects of overweight/obesity with regard to type 2 diabetes, suggesting a large preventive potential. Future studies could benefit from estimating both differential exposure and differential susceptibility to better understand social inequality in type 2 diabetes and other health outcomes.
Standardization of the Cancer Health Literacy Test – 6 in a non-cancer populations
Authors: Dumenci L , Siminoff L A
Published: November 2019

Background

The Cancer Health Literacy Test-6 (CHLT-6) was originally developed in a cancer population to identify persons with limited cancer health literacy (LCHL). There is no instrument to identify individuals with LCHL in non-cancer populations such as caregivers and epidemiologic samples. This study aims to test if the CHLT-6 can be used to identify persons with LCHL in non-cancer patient populations. The CHLT-6 was administered using a hand-held touch-screen computer.

Methods

A patient sample of 512 persons was used to test the CHLT-6 measurement structure and externally validate the test. English speaking, aged 18 or higher, and no history of cancer diagnosis were used as eligibility criteria. Participants were recruited from health fair grounds, primary care clinics, and community centers in the Mid-Atlantic region of the U.S.A. Consistent with the analysis of the developmental sample, discrete latent variable modeling was used as the underlying measurement structure of the instrument.

Results

Two classes were clearly separated by the CHLT-6 items. Measurement invariance tests showed equivalence of conditional probabilities between gender, race/ethnicity, and educational groups. There were significant group differences in prevalence of LCHL. The CHLT-6 was externally validated using race/ethnicity, education, and income. Overall results were very similar to those reported in the cancer population.

Conclusions

The CHLT-6 is the first and only instrument to identify individuals with LCHL using a discrete latent variable framework. Measurement invariance tests provided empirical evidence that labels used to describe latent classes (i.e., limited and adequate cancer health literacy) have the same meaning between gender, race/ethnicity, and educational groups. Persons self-described as African Americans and low educational attainments have a high probability of belonging to the LCHL class.

Key messages

There is a strong support for psychometric properties of the CHLT-6 in a cross-validation sample. This study provides empirical basis for using the CHLT-6 in non-cancer populations.
Economic burden of cardiovascular diseases from 2012 to 2017 based on French national claim database
Authors: Nicolas M , Pestel L , Rivière S , Rachas A , Gastaldi-Menager C
Published: November 2019

Background

The purpose of this study was to assess the economic burden of cardiovascular diseases (CVDs) in France by analysing the structure and the growth of expenditure attributed to these diseases between 2012 and 2017.

Methods

For each year, 11 CVDs were identified from SNDS data using algorithms based on long-term disease registry and hospitalization diagnoses, applied to the population of national health insurance general scheme beneficiaries. The individuals’ expenditure (26 different items) reimbursed for hospitalisations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to each considered groups of diseases based on the average expenditure by disease calculated for individuals with only one disease. To analyse trends, we applied the same methodology from 2012 to 2017.

Results

In 2017, of the €140.1 billion reimbursed, €14.0 billion (10.0%) were attributed to the care of 4.0 million people with a CVD (7.0% of the population). Short-stay hospitalisations accounted for 33% of this total expenditure. This proportion was higher for acute CVD (coronary syndrome: 64%, stroke: 56%, heart failure: 65%, pulmonary embolism: 69%) but also for valvular heart disease (50.0%). Medications represented almost 13% of the expenditure attributed to all CVDs, and up to 25% for chronic coronary heart disease. Disability pension essentially concerned sequelae of stroke (12% of the expenditure attributed to this disease). Between 2012 and 2017, the total expenditure attributed to CVDs increased by 3.3% per year, mainly due to the annual mean increase of the number of patients over the period (+3.1%).

Conclusions

These results demonstrate the high economic burden of CVDs in France with a detailed analysis of expenditures and their main drivers. The developed tool will help decision makers to monitor the burden of these diseases but also to provide stake holders with a better understanding of trends and regulating actions.

Key messages

Economic burden of CVD in France is high: 10% of healthcare expenditure. Implementation of public health policy to prevent CVD and control risk factors must be a priority.
Characteristics of hospitalizations with influenza diagnosis, France, 2012-2017
Authors: Pivette M , de Lauzun V , Nicolay N , Scanff A , Hubert B
Published: November 2019

Background

Seasonal influenza surveillance in France is based on several data sources (ambulatory data, emergency department and intensive care unit (ICU) admissions, laboratory data, mortality). However, the data do not provide a complete measure of the impact of the epidemics on the hospital system. The objective of the study was to describe the characteristics of influenza hospitalizations from the French national hospital discharge database (PMSI) between 2012 and 2017 and to precise the burden of influenza by age group and by season.

Methods

All hospitalizations in metropolitan France with at least one ICD-10 code related to influenza (J09, J10, J11) as a principal, related or associated diagnosis between 1 July 2012 to 30 June 2017 were extracted from the PMSI. For each season, the total number of hospitalizations, admissions to ICU, incidence and lethality rates, lengths of stay and classification in diagnosis-related groups were described by age group.

Results

During the 5 seasons, 91 255 hospitalizations with an influenza-diagnosis were identified. The incidence varied significantly between seasons, from 12.7/100 000 in 2013-2014 to 45.9/100 000 in 2016-2017. A high number of cases was observed in elderlies in 2014-2015 and 2016-2017, marked by the circulation of A (H3N2) virus. The proportion of hospitalizations with an admission in ICU was 10%, and was higher in the 40-79 age group (19%). Lethality increased steadily with age, from 0.5% under 20 years to 10% in 80 years and older. Length of stay also increased with age. Significant regional disparities were observed, with higher incidence rates in South-Eastern France each season.

Conclusions

The analysis of influenza hospitalizations from the PMSI provides important elements on influenza burden, not available in the current surveillance systems. An annual analysis, stratified by age group, would provide an indicator of the impact of the epidemics on hospital system at the end of each influenza season.

Key messages

Important influenza incidence variations were observed between seasons by age groups. Severity and impact of influenza (mortality, ICU, length of stay) varied significantly by age group.
Community use of antibiotics and development of bacterial resistance: a case-control study in Italy
Authors: Ferrante G , Massari M , Da Cas R , Pantosti A , Pezzotti P , Moser V , Pagani E , Aschbacher R , Traversa G
Published: November 2019

Background

Antibiotic resistance is now a global emergency. An increasing number of infections are becoming difficult to treat and lead to longer hospitalizations, higher medical costs and increased mortality. The aim of this study is to assess, in a population at low prevalence of use of antibiotics, whether a previous use of these drugs is associated with the occurrence of clinically relevant resistance of E.coli to fluoroquinolones (FQs), one of the most widespread and critical bacteria resistance in Italy.

Methods

Through a data linkage of databases of the health information systems of the Province of Bolzano (Italy) a case-control study was carried out using 2016 data. All subjects for which the resistance of E. coli to FQs was tested by the regional microbiology reference laboratory were included in the study. Those with a positive FQs-resistant E.coli isolate were defined as cases (n = 409), while the others were considered controls (n = 933). For each subject the total number of prescriptions of any antibiotics and the total number of prescriptions of FQs in the previous year were detected through a record linkage with the drug prescription database. Information on potential confounding factors (age, gender, number of hospital admissions, days of hospitalization, number of surgeries, diagnosis of chronic diseases) were obtained from the database of hospital admissions. Multivariate logistic regression analysis was used to study the association between previous use of antibiotics (any and FQs only) and development of E.coli resistance to FQs.

Results

It was observed that for each unit increase in the number of prescriptions of any antibiotic, the probability for E.coli to develop FQs resistance significantly rises by 16%. This probability is much higher (45%) if the prescribed antibiotic is a FQ.

Conclusions

This study confirms the association between previous consumption of antibiotics and the onset of resistance even in an area with a low prevalence of use.

Key messages

The results of this study reiterate the need to prescribe and dispense antibiotics only when they are really needed. Health information systems allows to study the role of antibiotic use in the development of bacterial resistance, providing useful information for audit interventions among healthcare professionals.
Changes in mortality inequalities by marital status in Lithuania during 2001-2014
Authors: Sauliune S , Mesceriakova-Veliuliene O , Kalediene R
Published: November 2019

Introduction

Health inequalities have emerged as a big issue of public health in Lithuania. Recent studies have demonstrated increasing mortality differentials between marital status groups, occurring mainly due to a decline in mortality of the married populations.

The aim of the study - to determine changes in inequalities in mortality from major causes of death by marital status in Lithuania during 2001-2014.

Methods

Individual records from population censuses conducted in 2001 and 2011, National Mortality Register (period of 2001-2014), and Population Register (period of 2001-2014) have been linked using personal identification number. Study included those aged 30+. Mortality rates from cardiovascular diseases, cancer, external causes and digestion system diseases by the marital status (married and unmarried - never married, the widowed and the divorced) were calculated per 100 000 person years and standardized by age. Inequalities in mortality were assessed calculating rate ratio, while trends in it - conducting the Joinpoint regression analysis.

Results

Mortality from all analyzed causes of death among males and females in 2001 and 2014 was statistically significantly higher in unmarried compared to married. Inequalities in mortality by marital status increased statistically significantly in Lithuania throughout the period of 2001-2014 from cardiovascular diseases, cancer and external causes. The most significant increase in inequalities by 3.3% (p < 0.05) on average per year was estimated from external causes among males. Inequalities in mortality from digestion system diseases did not change significantly throughout the study period.

Conclusions

Inequalities in mortality by marital status increased significantly in Lithuania throughout the period of 2001-2014 with the most significant increase from external causes.

Key messages

Mortality from all analyzed causes of death among Lithuanian males and females in 2001 and 2014 was statistically significantly higher in unmarried compared to married. Inequalities in mortality by marital status increased significantly in Lithuania throughout the period of 2001-2014 with the most significant increase from external causes.
Public health monitoring in Sweden focusing on inequality – a developmental work
Authors: Engström K , Makenzius M , Olsson G , Lindqvist N
Published: November 2019

Issue/problem

The overarching goal of the Swedish public health policy is to create the right societal conditions for good and equitable health throughout the population, and to reduce avoidable health inequalities within a generation. Relevant health topics and dimensions of inequalities in health should be monitored to enable effective interventions on the local, regional and national level. To achieve this a strong national health monitoring system (HMS) is central.

Description of the problem

The objective was to develop a high quality HMS to monitor a broad perspective of public health and its determinants, complemented by a more focused monitoring system of inequalities in health, with relevance on the local, regional and national level. A theoretical framework was developed and empirical mapping of relevant indicators conducted. An expert group was consulted and a country assessment of how to monitor health inequalities was carried out within the Joint action Health Equity Europe project. The developmental work started in 2018 and is not yet completed.

Results

A web-based monitoring system has been implemented to cover the broad perspective of public health and its determinants. All indicators are reported at the national level and, when possible, degradable at the local and regional level. In addition, a report with a focus on inequalities in health on a national level is published annually, and a longitudinal indicator-based comparative study, with results from Sweden’s 21 regions and 290 municipalities was published in 2019.

Lessons

General public health and inequalities in health may need to be monitored in different ways. To enable effective interventions, consideration must be given to at what level - local, regional or national - policy decisions are made.

Key messages

High quality health monitoring enables effective interventions. To reduce inequalities in health focused monitoring is required.
The applicability of methods for assessing comorbidities: The Cumulative Illness Rating Scale (CIRS)
Authors: Napolitani M , Kundisova L , Messina G , Nante N
Published: November 2019

Introduction

It is essential to compare the results of medical care in patients suffering from multiple, and complex diseases. CIRS is a risk adjustment tool useful for assessing patients’ comorbidities although it needs to be used with precision following guidelines. The aim of this research is to assess whether organised seminars, planned to motivate the clinicians for correct data compilation, have an effect on the concordance of scores on the CIRS scores.

Methods

A prospective, pilot study started in November 2018 on a sample of 49 patients admitted to a private clinic between December 2018 and February 2019. In the context of a seminar, an Resident Physician in Public Health (RP), distributed and explained the CIRS guidelines to the clinicians. CIRS scores were then calculated by the ward physicians and compared with those of the RP who successively analysed the same medical records. The inter-rater agreement was calculated through Cohen’s kappa coefficient (κ), using Stata 14.2.

Results

Concordance was excellent or almost perfect or substantial for 8 out of 14 categories: heart disease (k = 0.82), genitourinary disease (k = 0.90) blood pressure category (p = 0.72), sense organs (k = 0.75), upper gastrointestinal system (k = 0.70), lower gastrointestinal system (k = 0.76), musculoskeletal system and skin (k = 0.66), central nervous system (k = 0.69), endocrine system and breast (k = 0.63) and psychiatric diseases (k = 0.63). The agreement was moderate for the respiratory system (k = 0.48) and for the liver (k = 0.57), and was fair for Severity Index, Comorbidity Index and the vascular system (k = 0.24, k = 0.38 and k = 0.28 respectively).No Concordance in renal diseases (k = 0.00).

Conclusions

Overall, the agreement of the scores between RP and clinicians was good, and it was possible to analyse the main weaknesses and difficulties of the clinicians. Subsequent seminars will be done to increase over time the concordance of the surveys.

Key messages

Organized seminars, planned to motivate clinicians to correctly compile the CIRS scores, were effective. The inter-rater agreement was good. Subsequent seminars will be done to increase over time the concordance of the surveys.
Assessment of the e-health system in the Kaunas City Outpatient Clinic
Authors: Kaseliene S , Blazeviciute L , Mesceriakova-Veliuliene O
Published: November 2019

Background

The Lithuanian National Electronic Health (e-health) System was only launched in 2015. The aim of this study is to evaluate the e-health system in the Kaunas City Outpatient Clinic using a system of balanced performance indicators.

Methodology

The survey was carried out from October until December, 2018, at the Kaunas City Outpatient Clinic (Lithuania). The study included 264 medical staff members and 384 patients.

Results

62% of the patients and 100% medical staff of the clinic used various e-health system services. The most often used services by the patients were SMS reminder (75.5%), online registration (70.8%) and electronic prescription (59.3%). The physicians took the most advantage of assigning electronic prescriptions (88.2%), filling the sickness certificates (78.9%), booking laboratory tests and receiving their results electronically (63.9%). Majority of the medical staff and patients stated that the e-health services are of high quality (77.6 and 89.5%, respectively), reliable (86 and 90.8%) and have a wide spectrum of services (75.3 and 93.7%). The most common problems that patients faced when using the e-health system services were the malfunctions and failures of the system (68.9%) or missing health data of the patient (59.7%). According to the medical staff, e-health system technologies do not cover the needs of employees in full extent (95.1%), also, the e-health system is still not completely reliable (97.7%). Only 56.7% specialists stated, that they have enough skills to work with the e-health system, 77.7% would like to improve their professional qualifications in this field. The Clinic used the funds of the institution, municipality or EU structural funds to develop the e-health system, update the computer equipment and software, and acquire licenses.

Conclusions

More efficient and effective e-health services and developing the capacity of the e-health usage are required to promote high-quality health care in Lithuania.

Key messages

Although majority of the patients and medical staff members use various e-health system services and are satisfied with their quality, there still are problems with the operation of the system. Specialists feel the lack of skills to work with the e-health system.
Training on health communication and social media: European public health residents’ perceptions
Authors: de Nard F , De Vita E , Quattrone F , Thomas R , de la Torre L
Published: November 2019

Background

Theoretical knowledge about health communication (HC) and expertise in planning, implementation and evaluation of HC interventions are essential tools for Public Health (PH) specialists. In the social media (SM) era, specific abilities and digital communication skills are gaining importance.

Objective

Our aim is to describe European PH residents’ perceptions regarding their training in the HC field, with a focus on SM. We piloted a survey using Google Forms during the European Network of Medical Residents in PH (EuroNet MRPH) meeting in Turin, April 2019. We then spread the survey to other PH residents across Europe in July 2019. The survey consists of 25 questions (Likert scales from 1=strongly disagree to 5=strongly agree, or multiple-choices) divided in 5 thematic sections (HC theory, public speaking, traditional media based HC, SM based HC, HC impact evaluation). Questions aim to map HC topics covered in residency educational programs, learning methods, and the perceived importance of HC skills.

Results

The study included 114 residents from 10 countries (37% Italy, 23% Portugal, 10% UK, 9% Spain, 8% France, 13% other). Participants perceived they receive the best training in the areas of public speaking, impact assessment and HC theory (median 3, IQR 2-4). Conversely, for traditional and SM based HC, training was perceived as unsatisfactory (median 2, IQR 1-4 and 1-3 respectively) with self-education as main learning method (51%). Public speaking and traditional HC were identified as the most important HC skills for PH specialists (median 5, IQR 5-5), while less importance was attributed to SM based HC (median 3,5, IQR 3,25-5).

Conclusions

Despite SM are playing a crucial role in public HC, specific training seems to be scarce in this sample. Although residents perceive SM based HC skills as important, they consider them less important than other HC skills. Further analysis is needed in order to explore the perceived relevance of SM in PH residents training.

Key messages

Training on health communication via social media is scarce among European public health residencies. Common training programs across European residencies in PH should address this educational need. European public health residents perceive social media based health communication skills as important, but not as important as traditional media based health communication skills.
Social network and grief: a text mining analysis
Authors: Corvo E , De Caro W
Published: November 2019

Introduction

Grief represents a multifaceted response to loss. Several dimension such as physical, cognitive, social, spiritual and philosophical are involved while an individual is experiencing loss. Often bereavement and grief are used interchangeably, however they are two very different concepts, bereavement refers to the state of loss while grief is the reaction to that loss. Each individual experiences loss differently, this is often connected to the culture of the individual in terms of culture per se or religion. Furthermore loss pertains not only to the individual who is directly involved and to its family but the entire environment of the person, in terms of community for instance. How individuals live and communicate death, loss and grief on online social network seems to have a role in coping and managing the loss itself.

Methods

Text mining analysis was performed using web tools and Taltac 2.11. A text analysis of posts and discussion on open online social network was carried out in order to better detect which kind of coping activity was developed by participants. Specifically 149 losses post and more than 10.000 comments were analyzed.

Results

Loss, bereavement and grief represent one of the most relevant topics on social network. Two main themes were identified. The first is focused on religion and spiritual support in faith, while the second on emotional support and affective-type closeness in which friends (virtual or not) support other individual having previously experienced the same losses. Analysis suggests that individuals are able to support peers in a wide range of way, furthermore virtual support is easier and more straight forward with respect to traditional and face to face relationship.

Conclusions

This study display that individuals recognized a new way to be supported through social network. Individuals feel to be with close friends and at the same time to have the opportunity to live the loss by themselves without a face to face relationship.

Key messages

Social network 4 grief. Virtual friend give support.
The professional experience of a public health intern: How to promote health through a comic strip
Authors: Leuci L
Published: November 2019

Issue/problem

Public health is a complex discipline often misunderstood by medical students. The way these future professionals get to grips with this subject may impact their career.

Description of the problem

Starting in November 2018, a young public health intern, who also happens to be an illustrator, shares with us her medical journey through a comic broadcasted online. This innovative approach aims to demystify public health to medical students and could potentially raise their interest in the profession. The author started her residency training at the French Regional Authority of Health Promotion and Education (Instance Régionale d’Éducation et Promotion de la Santé - IREPS).

Results

She recounts some of her professional anecdotes: an empowerment project for struggling young people, a survey on environmental health… The chapters of her comic are periodically shared on social media to professional members and public health interns in Dijon. The French organization of Public Health Interns (Collège de Liaison des Internes de Santé Publique de France - CLISP) has been contacted to publish the comic nationally. An English translation has been considered as well. A printed edition will be distributed to medical students of the region during an introductory course in public health.

Lessons

This experiential comic strip enables the intern to conduct a self-analysis of her work. The short format of each chapter obliges the author to focus on some understandable key messages. The comic strip receives a warm welcome as well as by the professional members of IREPS, and the young and skilled co-interns who all appreciate this discipline being presented under a new light.

Key messages

The comics strip represents a great tool to transfer knowledge in public health as it is attractive and ludic. It is essential to provide a better understanding of public health.
Empowerment: a key to promote the health of people with disabilities
Authors: Lafitte S , Ferron C , Mussillier L , Poli S , L’Horset C , Masrouby M , Bidaux L , Alias F
Published: November 2019

In France, health public policies for people with disabilities are based on specific laws, recommendations and systems of reference. This population is under the responsibility of the medico-social sector, which governs specialized institutions and services. These services favor a medical approach to health focused on access to care. Their main missions are to take care of disabled people with kindness on a daily basis and to adapt the care to each person’s special needs, whatever the disability. They create links with families, organize the services offered and the living environments, administer their staff and collaborate with health professionals. As they ensure safety and health at all levels, from every individual project to collective life, they have a real opportunity to act on a set of health determinants.

The Ottawa Charter for Health Promotion refers to the empowerment and participation of the population as fundamental principles; this is also true as far as people with disabilities are concerned. With the principal stakeholders on a national level, we wrote a handbook in order to support the implementation of these principles in medico-social institutions and services: ’Promoting health and well-being in the medico-social field in cooperation with people with disabilities” and their families.

In this presentation, based on concrete examples, we will outline how the five intervention strategies of the Ottawa Charter can apply to people with disabilities, their families and their communities, especially inside specialized institutions and services. We will pay particular attention to the intervention methods and pedagogical tools which can be used to initiate or to improve the participation of disabled people in decisions, through the valuing of their experiential expertise, the development of their social skills, the strengthening of their health literacy, family-professional co-education, and cooperative strategies.

Key messages

Specialized institutions and services can promote the health of the people with disabilities they care for, by acting on the determinants of their health and by mobilizing participatory strategies. To strengthen disabled people’s participation, using their experiential expertise, developing their social skills and health literacy, and mobilizing co-education, are the best strategies.