bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity of sources of information used for the identification of Wilson’s disease in the Registries
Authors: Cavero Carbonell C , Moreno Marro S , Barrachina Bonet L , Páramo Rodríguez L , Guardiola Vilarroig S , Zurriaga O ,   Regional Population-based Registries of Rare Diseases,   Rare Diseases Research Institute
Published: November 2019

Background

Objective: to determine the sources of information used by the Regional Population-based Registries of Rare Diseases (RD) (RRD) for the identification of the Wilson’s Disease (WD) during the period 2010-2015, and to evaluate the validity of these sources.

Methods

A cross-sectional study was conducted involving 14 different Spanish Regions and the RD Research Institute. Possible cases with WD diagnosis included in RRD were identified with codes 275.1 in ICD9CM or E83.0 in ICD10 (unspecific codes referring to ’Disorders of copper metabolism’), and they were confirmed or not through a validation process in which clinical documentation was reviewed. Each Region sent their database to the coordinator (Valencian Region), which calculated the positive predictive value (PPV) for each source used individually and for the combination of two sources.

Results

995 records were identified and reviewed. 444 were confirmed, 475 were discarded and 76 were considered as possible. The PPV for all sources was 44.6%. The Hospital Discharge Database (CMBD) stands out as the main source of detection of possible cases with a PPV of 42.1%, followed by the Orphan Drugs Registry (ODR) with a higher PPV (80.8%) and by the Mortality Registry with a lower PPV (16.7%). The Clinical History of Primary Care (PC) obtained a VPP of 55.8%, but was only used in three Spanish Regions. The PPV for the combinations of two sources of information was 94.5% for the CMBD with the ODR, 91.5% for the ODR with PC and 73.9% for the CMBD with PC.

Conclusions

Although CMBD has been the most widely used source, its PPV is not the highest. However, the ODR is the source with the highest PPV. The introduction in 2016 in the CMBD of the Spanish version of the ICD10 which includes a specific code for the WD (E83.01) is expected to improve this value. Cases identified by both (CMBD and ODR) may be automatically validated due to the high PPV obtained.

Funding: Fundació Per Amor a l’Art and Obra Social “la Caixa”

Key messages

Wilson’s disease is one of the 10 Rare Diseases included in the Spanish Registry of Rare Diseases but the validity of sources of information hadn’t been studied. The introduction in 2016 in the Spanish Hospital Discharge Database of the Spanish version of the ICD10 will improve the validity of the sources of information used by the Registries of Rare Diseases.
Use and perceptions of electronic cigarette by the adult population in France in 2017
Authors: Quatremère G , Pasquereau A , Guignard R , Andler R , Richard J B , Nguyen Thanh V
Published: November 2019

Background

E-cigarette (EC) use is controversial because its benefit-risk ratio is still unclear. Since its introduction on the French market at the beginning of the 2010’s, French health authorities have published cautious recommendations. The study aims at describing uses and perceptions about EC among the adult population.

Methods

Santé Publique France’s Health Barometer, the French national public health agency, is a cross-sectional random survey conducted annually by phone, on a representative sample of the population aged 18-75 y/o in Mainland France. Descriptive analysis and logistic regressions were performed to analyze data collected from the 25,319 respondents of the 2017 edition.

Results

In 2017 in Mainland France, 3.8% of the population used an EC, 2.7% on a daily basis. Among EC daily users, 60.4% were men, 57.9% had a bachelor degree or higher qualifications. Less than 1% of EC users were never-smokers, 50.3% were daily or occasional smokers, 49.5% were former smokers. The number of daily ex-smokers who did quit smoking ( > = 6 months) and believed that vaping has helped them to, was estimated to be 700,000 since EC has been available in France. EC was perceived as equally or more harmful than regular cigarette by half of the population (51.5%), a proportion that has increased since 2014 (43.4%). Daily smokers perceived EC as more harmful, while being an EC user from high socioeconomic status was associated with the perception that EC is less harmful. The bans on EC in places where smoking is prohibited and on sales of EC to minors (<18 y/o) were appreciated by 66.9% and 77.5%, respectively.

Conclusions

These results show that in France, EC is strongly related to current or past smoking habits. A significant number of ex-smokers believe that EC has helped them quit smoking. Sociodemographic differences in the perception of EC harmfulness suggest social inequalities in access to information.

Key messages

Electronic cigarette users in France are few and most of them are smokers or former smokers. The perception of electronic cigarettes harmfulness depends on sociodemographic and smoking status.
West Nile virus infections in France, July to November 2018
Authors: Ramalli L , Grard G , Beck C , Gallian P , L’Ambert G , Desvaux S , Jourdan M , Ortmans C , Paty M-C , Franke F
Published: November 2019

In July 2018, one autochthonous case of West Nile virus (WNV) infection was identified in Nice, Provence-Alpes-Côte d’Azur (Paca). We investigated to determine the potential place of infection and the extent of viral circulation in the area, in order to guide control and preventive measures. In affected areas, we raised awareness of health professionals on WNV infections, substance of human origin safety relied on nucleic acid testing for WNV and on deferral of blood donors indicating minimum one night of stay in the areas for 28 days. Equine, wild bird and entomologic surveillance activities were reinforced. The human arboviruses national reference laboratory (NRL) retrospectively tested samples from hospitalized individuals from June 1st with meningitis and encephalitis around Nice. We tested negative suspected autochthonous cases of chikungunya and dengue infections notified since July in Paca and presenting WNV compatible symptoms. Measures were adapted along identification of additional cases.

We identified 27 autochthonous cases, with onset of symptoms between July 7th and November 12th: 24 in Paca, 2 in Corsica and 1 in Occitanie. Seven cases presented neuroinvasives symptoms, 18 flu-like symptoms and 2 were asymptomatic. One blood donation and 2 organs tested positive for WNV. The animal NRL identified 13 equine cases (1 in Paca, 5 in Corsica and 7 in Occitanie) and 4 infected raptors with nervous symptoms (3 in Paca and 1 in Corsica). Genomic characterization of the virus identified a strain belonging to the lineage 2 among 2 raptors. No virus was found in mosquitoes captured in affected areas.

Since 2000, six episodes of WNV transmission were reported in France but none with this extent. For the first time, the lineage 2, circulating in Italy and other European countries, was isolated in France which might be changing epidemiological situation. Therefore, surveillance activities should be revised in order to promptly secure blood products.

Key messages

We describe the most important episode of West Nile Virus transmission identified in humans in France. In 2018, West Nile virus lineage 2 was isolated for the first time in France which might change the epidemiological situation in the country.
Diabetes surveillance in Germany – strategy for the dissemination of results
Authors: Reitzle L , Paprott R , Schmidt C , Heidemann C , Baumert J , Du Y , Scheidt-Nave C , Ziese T
Published: November 2019

Background

Diabetes mellitus is a non-communicable disease with high public health relevance in Germany. Therefore, the Robert Koch Institute startetd to establish a national diabetes surveillance system in Germany in 2016. Essential part of a surveillance system is the dissemination of health information to the relevant stakeholders to facilitate its translation into action.

Methods

For the development of the dissemination strategy, different sources of information were used. First, an online-survey combined with structured web-research explored dissemination approaches in the international context. Secondly, a workshop with public health experts from seven countries highlighted best practice examples. Based on this information, a dissemination strategy was developed in close alignment with the scientific advisory board of the diabetes surveillance including experts from politics, prevention research, regional health reporting, physicians/diabetologists and public health scientists.

Results

Three main questions were identified to be considered in the dissemination of health information: Which audience group is addressed? Which content is relevant to this group? What is the preferred format to communicate the information? Therefore, a diabetes report will be generated focusing on health policy makers summarizing the key information on the disease dynamic. A website containing all information including a visualization tool should facilitate access for stakeholders. Additionally, awareness needs to be raised using social media, classical media and direct interactions with relevant stakeholders.

Conclusions

In alignment with different stakeholder groups, the diabetes surveillance developed a dissemination strategy considering international best practice examples and innovative ideas for health data visualization. The next steps are to refine the dissemination strategy based on feedback from the different stakeholder groups to ensure the use of the provided information.

Key messages

A dissemination strategy for the diabetes surveillance has been developed in a participatory approach including experts from various stakeholder groups. Next steps include the refinement of the dissemination strategy and its formats based on stakeholders feedback requirements.
Early osteoporosis diagnosis improves post-hip fracture outcome
Authors: Lavranos G , Manolopoulos P P , Xenophontos P , Vogazianos P , Tsioutis K , Dardavessis T , Johnson E O
Published: November 2019

Background

Hip fracture is associated with mortality and high rate of hospital re-admission after discharge. Osteoporosis screening and treatment have been shown to lower the risk of hip fractures. The aim of this study was to assess whether osteoporosis treatment also improves the post-hip fracture overall outcome.

Methods

All patients over the age of 65 that sustained a hip fracture at a tertiary University Hospital were approached to enroll in the study. The patients were informed of the context of the study, all queries were answered and an informed consent was signed by the patients in the presence of one of the investigators. The data were collected over an 8 month period from October 2017 to June 2018 and the cohort was followed up until February 2019. Recorded outcomes included mortality, re-admission and unscheduled hospital visit.

Results

The overall mortality rate of elderly patients after a hip fracture was 12.3% (n = 24) after a 6 month follow-up period. The overall event rate of elderly patients after a hip fracture was 29.7% (n = 58) after a 6 month follow-up period. Only 3% of patients were already on osteoporosis treatment. However, patients on treatment for osteoporosis had a favorable outcome with no deaths and significantly less overall events (p < 0.0001).

Conclusions

Early osteoporosis screening and treatment in the elderly can not only prevent falls and fractures, but also improve outcome in case a hip fracture does occur.

Key messages

Osteoporosis treatment improves outcome after a hip fracture. Despite relevant guidance, osteoporosis screening in the elderly remains suboptimal.
Roma origin as a factor for high level of adolescent fertility and abortion rate in European Union
Authors: Kamburova M , Georgieva S , Tsanova D , Stoyanova E
Published: November 2019

Background

Adolescence is a vulnerable phase in human development. Adolescent girls from Roma origin, especially younger girls, are particularly vulnerable because they face the risks of premature pregnancy and childbirth. The study aims to evaluate the association between Roma origin of mothers and prevalence of adolescent fertility and abortion rate in EU member states.

Methods

A correlational study was conducted and data on prevalence of adolescent fertility and abortion among adolescent girls (per 1000 live births) were extracted from European database “Health for all”. The means of variables in different countries were compared and Pearson’s correlation coefficients with share of Roma population were calculated. Data processing was performed by SPSS v.24.

Results

Increasing trend in premature childbirth has been observed in parallel with the increase of share of Roma population within countries, significantly more expressed in South-East member states. The mean adolescent live birth rate in the countries with highest proportion of Roma population was 5.6 times higher as compared to the mean for those with lowest proportion of Roma population. The highest level of proportion of live births to mothers aged less than 20 years was found in Romania (9.8%) and Bulgaria (9.5%). At the same tame proportion of Roma population in those countries is highest: Bulgaria (4.7%) and Romania (2.5%). The relation of adolescent fertility rate with share of Roma population shows significant positive correlation (r = 0.804, with 2-tailed significance p = 0.000). As far as the correlation of abortion among adolescent girls with the Roma origin is concerned, it is inverse and not significant.

Conclusions

Our results indicate significant correlation between share of Roma population and adolescent live birth in EU member states. A holistic approach is needed in which socio-economic development and education of Roma girls leads to further reduction of adolescent childbirth and abortions in EU.

Key messages

Adolescent girls from Roma origin in EU face the risks of premature pregnancy and childbirth more expressed in South-East member states and significant positive correlation for it was found. Bulgaria is the country with highest share of Roma population (4.7%) and in the second place according proportion of live births to mothers aged less than 20 years (9.5%) in the EU in 2015.
A public health campaing – health promotion in Roma minority population in the City of Zagreb
Authors: Polic-Vizintin M , Škes M , Marić Bajs M , Šostar Z , Portolan Pajić I , Tucak J
Published: November 2019

Background

Researchers into health inequalities consistently show disadvantages in health status for various ethnic minority groups. Socially and economically Roma are one of the most vulnerable and disadvantaged groups. The Roma population of Zagreb approximates 2.755 according to the 2011 census. “Health promotion in Roma minority” is public health initiative undertaken in the City of Zagreb in 2018.

Objectives

The aim was to recognize the need for early risk factors prevention, to increase health literacy and to improve access to health-care in Roma minority.

The stakeholders involved in this program were Roma NGOs, Andrija Stampar Institute of Public Health, local Medical Centre and City office for health. The role of Roma activist was inportant for including Roma population.

Results

In order to assess the health status and health-related lifestyle attributes a multidisciplinary approach was carried out including a total of 141 members of the Roma minority living in three different quarters. Activities included preventive exams, conducted workshops “Reproductive health”, “Access right to health-care”and “Healthy lifestyles”. Hypertension was found in 15,6% Roma using standard diagnostic criteria (i.e. BP ≥ 140/90 mm Hg). High blood shugar was found in 16,3% Roma. Screening mammography exams were also carried out including 73 Roma women over 50. BI-RADS 3 category was found in 17 women (23,3%) and BI-RADS 4 + 5 category was found in one woman.

Conclusions

The multisectoral collaboration and the involment of Roma activist could help to achieve better inclusion of Roma population, better perception of the health messages and behavioural changes. Health sector should promote and advocate for healthier lifestyle, but community and policy are to support and complement the actions. Access to health care cannot be discussed in isolation from other problems this population group experiences, such as poverty, restricted access to education and social exclusion.

Key messages

The empowerment is an outcome of health literacy, but does not automatically lead to empowerment. Individual’s social and cultural context must be in focus. The involment of Roma activist could help to achieve better results.
Understanding discrimination faced by transgender people in the health and social care settings
Authors: Dziewanska-Stringer C , D’Souza H , Jager E
Published: November 2019

Background

This session reports on a literature review from a study aiming to identify whether there is a positive correlation between inclusive legal gender recognition procedures, and well-being of transgender people within the EU. The review explores socio-demographic/economic profiles of transgender people, and forms of discrimination faced.

Methods

The review is based on 47 peer-reviewed articles and 11 grey literature reports, provides analysis concerning sociodemographic/economic positions of transgender people, and an overview of discrimination faced.

Results

The focus is discrimination within health & social care, how this leads to unmet health needs and a lower sense of wellbeing within the trans population. Due to actual, or expected, discrimination, some trans individuals will not disclose their gender identity in a healthcare context, or may avoid using such services altogether. Mental health was a focus of many of the studies, with prevalence of depression, self-injury, and suicidal thoughts being higher for this group. Fewer studies reported on the physical health status, with some studies finding that transgender people had low health status. Studies suggest that professionals may treat trans people in an insensitive or inappropriate way, largely due to a lack of knowledge/ignorance, for example health & social care staff often had little knowledge of trans people and their health & wellbeing, how to appropriately address them, and how to support their care. Trans individuals may also be treated in a discriminatory way in the context of trans-specific healthcare, for e.g within a gender unit due to a non-binary gender identity.

Conclusions

Discrimination has a negative impact on health & wellbeing, specifically mental health, mainly due to discrimination trans people face.This has a negative effect on actual/future health & well-being, as it translates into fear of seeking care, and postponing/avoiding care, due to actual or expected poor treatment.

Key messages

The review contributes to an evidence base to address discrimination faced by transgender people, however there is a lack of evidence found in the area of EU transgender health and wellbeing issues. The study seeks to confirm a positive correlation between inclusive LGR and well-being of transgender people in the EU, which can help contribute to improving their quality of life.
Adolescents’ alcohol use after liberalisation of alcohol sales in Finland in 2018
Authors: Rimpelä A , Lindfors P , Kinnunen J M , Katainen A H
Published: November 2019

Background

Adolescents’ alcohol use and binge drinking decreased in Finland since 2001 while the proportion of those who did not drink, increased until 2017. The 2018 Alcohol Act (entered 1 March) allowed retail stores sell all alcoholic beverages containing up to 5.5% alcohol by volume (previously 4.7%, beer and cider). Alcopops, assumed popular among adolescents, are now available in retail stores for those ≥18 years. We study changes in adolescents’ alcohol use and type of alcohol beverages until 2019.

Methods

Data from Adolescent Health and Lifestyle Survey (AHLS) has been collected biennially from nationally representative samples of 12-, 14-, 16- and 18-year-old Finnish adolescents. The data collection of the 2019 survey is going on and continues until June. Approximately two thirds of the expected responses (N = 2666) has arrived by the end April.

Results

According to our preliminary results, among girls abstinence slightly decreased from 2017 to 2019 and the increasing trend levelled off. Among boys, abstinence stayed at the same level from 2017 to 2019 among 12- and 14-year olds, decreased among 16-year-olds and increased among 18-year-olds. The decrease in monthly alcohol use had levelled off in 2017 and the use stayed approximately on the same level in 2019 as in 2017. Changes in type of alcoholic beverages will be ready in June and will be presented in the conference.

Conclusions

One year after the liberalisation of the Alcohol Act, no increase in adolescent alcohol use was observed, but the decreasing trend seems to have levelled off, while a small decrease in the proportion of those who do not drink at all seems likely.

Key messages

In a short run under-aged alcohol use has not increased after the liberalisation of the Alcohol Act. However, abstinence has slightly decreased.
Mutual Learning in Cancer Control Policy Implementation: Interviews With Local Policy Makers
Authors: Bakker L , Kiasuwa Mbengi R
Published: November 2019

Many policy recommendations in the field of cancer control are developed at the EU level, but insights on the practical implementation are lacking. However, European Member States encounter similar barriers when implementing and could learn from each other. Our aim is to facilitate this, through a mutual learning platform, developed in the framework of the EU Joint Action on Cancer Control, iPAAC.

A first step is to collect examples of implementation experience in the field of prevention, screening, diagnose and treatment, organisation of care and cancer information systems and to identify the key contextual features of the country (legal framework, healthcare systems, etc.). Therefore, in-depth interviews with national policy makers, administrators and experts of 20 EU Member States are carried out. A second step is to translate their experiences into factsheets, which will the core of the mutual learning platform.

Two types of examples of experiences came up: firstly, implementation plans or frameworks and secondly, practical solutions to implementation challenges. These last relate to different barriers encountered: the industry lobbies; stakeholder’s involvement; avoid and tackle social inequalities; evaluation of programs; introduction and financing of innovations, digitalization, organization of the health care system, etc. The results also include a series of reported challenges for which further policy support or knowledge is needed.

The results clearly show that similar challenges exist and are solved in different EU countries. Through translating the examples of implementation experience into factsheets, countries can learn from each other. Besides the factsheets, the mutual learning platform will provide contextual features which allow and support translation into the local context.

Key messages

By conducting in-depth interviews with health policy makers, common challenges in the implementation of cancer control policy, as well as solutions to overcome them, came up across EU Member States. Through the provision of concrete examples on how to overcome implementation barriers, we facilitate mutual learning between the EU Countries to improve cancer control and benefit to public health.
EnCLASS: an innovative project merging 2 international surveys (HBSC/ESPAD) among French students
Authors: Godeau E , Ehlinger V , Spilka S
Published: November 2019

Problem

For two decades, France has taken part in two “competing” school-based, cross-national surveys exploring the health behaviors and well-being of adolescent (Health Behavior in School-aged Children (HBSC) survey, 11-13-15 year-olds) and their substance use (European School Project on Alcohol and other Drugs (ESPAD), 15-16 year-olds).

Description of problem

Since 2010, French data is provided at national level by grade rather than age. This allowed providing a continuous observation of health behaviors among adolescents, looking at the temporal spread of substance use and providing a better understanding of the role of school as a setting for adolescents’ health. But the difficulty of participating every 4 years in two big surveys remained.

Effects of changes

In 2018, France decided to conduct the 2 surveys in a unified and simultaneous way across middle- and high-school. This project is called ’National Survey in Middle- and High-school for Adolescents on Health and Substances’, EnCLASS, explicit acronym easy to pronounce and remember in French. If the main objective of “merging” these surveys is to improve the monitoring of health behaviours and substance use throughout adolescence, it also allows a significant gain regarding preparation, coordination and organization of the fieldwork, hence of overall costs, while ensuring perfect comparability of data at international level.

Evolution of data visualization on substance use will be used to illustrate the challenges and improvements of such a process, based on data collected in 2018 among more than 20,000 representative secondary-school students.

Lessons

In addition to a greater facility of interpreting and reading findings, presenting data throughout secondary school grades improves its impact and use in a public health perspective and allowing identifying operational targets for prevention and health promotion in schools, as classes are their main settings.

Key messages

EnCLASS is unique in Europe, it ensures an excellent comparability of data at international level while providing an innovative national monitoring of adolescent health behavior, including drug use. Further, by its improved quality, perspective and relevance, EnCLASS can contribute to Public health policies analysis regarding school-students in France in a less expensive and better way.
Trust in health care systems Arab minority, Jewish immigrant and non-immigrant
Authors: Pinchas-Mizrachi R , Daoud N
Published: November 2019

Background

The objective of this study was to examine the level of trust towards Israel’s health care services (HCS) among Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish citizens. Previous studies have shown that minorities and immigrants have less trust in health care system (HCSys), which might represent a barrier in access to, and utilization of HCS.

Methods

We obtained cross-sectional nationwide census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust in the HCSys based on a survey question: ’Do you have trust in the healthcare system?” We conducted logistic regression analysis within and between the study groups to compare levels of trust, after adjustment for different relevant covariates in different models.

Results

Compared to non-immigrant Jews, Arabs had higher trust in the HCS (odds ratio (OR)=3.08, 95% confidence intervals (CI)=3.06,3.10) and compared to non-immigrant Jews, immigrant Jews had more trust (OR = 1.96, 95% CI = 1.94,1.98), even after adjusting for gender, age, education level, religiosity level, perceived discrimination, self-rated health status, HCS use, and having private health insurance. The variables that predicted trust in the HCSys were different in each ethnic group.

Conclusions

Contrary to our hypothesis and to previous research, Arab and immigrant Jewish respondents in our study had greater trust in the HCS compared to non-immigrant Jews. This might relate to different expectations among our study groupsof the patient-caregiver relations which might affect the access to and utilization of HCS and finally might affect the quality of care.

Key messages

Exceptionally, in Israel, the Arab minority and Jewish immigrants have more trust in the health care system compared with non-immigrant Jews. More research is needed to understand how trust among minority groups relates to the patterns of utilization of HCS and raises question regarding the quality of care.
Predictors of Late Presentation for HIV among HIV-positive Tajik Migrants to the Russian Federation
Authors: Bromberg D J , Tate M M , Alaei K , Karimov S , Saidi D , Alaei A
Published: November 2019

Between 800 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants in to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV upon their return to Tajikistan. This study uses data from the Tajikistan Ministry of Health surveillance system. The dataset contains all new known HIV diagnoses between 2006 and 2018. At time of diagnosis, patients are interviewed by staff of AIDS centers, complete routine intake forms and complete medical exam and related forms by doctors. HIV-positive returned migrants who had lived in the Russian Federation (n = 770) were included in final data-analysis after data cleaning. Data were analyzed using three logistic (logit) models. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 10.3% (95% CI: 5.5-15.3). The saturated multivariate model showed that when holding all study variables constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 9.5% (95% CI: 2.6-16.9). The parsimonious multivariate model showed that when current age and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 6.3 (95% CI: 1.1-11.8). Even when other potential predictors are included in the logistic model, only age and length of time abroad remain statistically significant. The results of this paper suggest that if the Russian Federation were to adopt a reciprocal policy, it might improve treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis.

Key messages

Structural factors are the strongest predictors of HIV late presentation among returned Tajik migrants to the Russian Federation. Further research is needed to explicate the causal pathways of the associations found in the present analysis.
Prenatal exposure to extra vitamin D from fortification and risk of developing coeliac disease
Authors: Moos C , Duus K S , Frederiksen P , Heitmann B , Andersen V
Published: November 2019

Introduction

Few studies have examined the role of maternal diet in relation to development of autoimmune diseases such as coeliac disease (CD). In Denmark, cancellation of mandatory vitamin D fortification of margarine in June 1985 provides this opportunity. This study examined if prenatal exposure to extra vitamin D from food fortification or season of birth were associated with a decreased risk of developing CD later in life. If low prenatal vitamin D levels are a risk factor, there are immediate, cheap and easy public health implications.

Methods

This register based study has a partially ecologic design. The two entire cohorts were created using information available from the Danish birth registry and development of CD (ICD-8 269 ICD-10 K90) over 30 years was retrieved from the Danish National Patient Register. Logistic regression analysis was used to generate odds ratios and 95% confidence intervals.

Results

There was a lower odds ratio of developing CD (OR: 0.811 95% CI 0.655; 1.003) from the exposed birth cohort adjusting for sex and season of birth. There was a significant season effect particularly for children born in autumn (OR 1.6 95% CI 1.16; 2.21) and born summer (OR 1.5 95% CI 1.1;2.1) when compared to children born in winter.

Conclusions

The results indicate a potential protective effect of a small extra intake of vitamin D from food fortification by pregnant women in relation to the risk of their offspring developing CD. This conclusion is further supported by the results showing that summer born children, where first half of gestation occurred during the dark winter season, had a higher risk of CD. This research lends support for the reconsideration of vitamin-D food fortification in Denmark.

Key messages

Exposure to even a small amount of vitamin D prenatally may protect against developing coeliac disease later in life. Association between season and CD indicates that vitamin D may play an important role in relation to fetal programming.
The Evaluation of Stigmatization and Related Factors in Students of Health-Related Faculties
Authors: Pala S Çalışkan , Öcal E E , Aydoğan S , Demirtaş Z , Atay E , Oktar D , Mutlu A , Önsüz M F , Metintaş S
Published: November 2019

Background

Individuals with disabilities are the people in which health inequalities are mostly experienced. Stigmatization of disabled people reduces their participation in society and causes insufficient health care. Not stigmatize disabled people by health care providers is important to eliminate this insufficiency. The aim of the study was to determine the stigmatization level and communication related factors of students educated in health-related faculties.

Methods

This cross-sectional study conducted in 873 university students who educated in health-related faculties. The level of stigmatization was measured with Disability Stigma Scale(DSS) including the items used in study performed by Mclaughlin et al. The questionnaire consists of sociodemographics and items of contact with disabled persons(CDP) scale.

Results

The mean age of study group was 20.19 ± 1.63, and the 71% were female. The prevelance of stigmatization for disabled people was 33.7%. Of 62.3% study group scored below the mean score from CDP scale. In univariate analysis, the prevelance of stigma was higher in the male group (p < 0.001), low education level group (p < 0.005) and low communication level group (p = 0.020). In multivariate analysis, the risk of stigma for disabled people increases 2.1 times (OR;95% CI, 1.53-2.85) in male group, reduces 0.70 times (0.53-0.93) in high education level parents group and reduces 0.98 times (0.97-0.99) in high communication level group.

Conclusions

It was concluded that stigmatization against disabled people is very important issue for investigation and intervention in males, parents with low education groups and low communication level groups.

Key messages

Communication with disabled people is a very important factor that could be modified and improved for reducing the stigmatization about disabled people. Intervention studies are needed for reducing stigmatization against disabled people in students educated in health-related faculties to eliminate inequalities in health.
Family environment risk factors for overweight in childhood
Authors: Duleva V , Chikova-Iscener E , Rangelova L , Dimitrov P l
Published: November 2019

Background

One of the current public health problems in Bulgaria is the high prevalence of overweight and obesity in childhood. The family environment affects many aspects of children’s health and well-being. The unfavourable socio-economic characteristics of the family environment might be a risk for overweight and obesity in childhood.

Methods

A national representative survey was conducted in Bulgaria in 2016 as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). 3379 schoolchildren were recruited. The average age of the sample was 7.7 years, equally distributed by gender - girls 50.11% (n = 1693) and boys 49.89% (n = 1686). The data from the filled in Family form was analysed with SPSS using descriptive statistical methods.

Results

The study identified the following risk factors of the family environment for the development of overweight in childhood: the proportion of parents with elementary or primary education was significant - about a quarter, nearly one third of the surveyed households were experiencing financial difficulties, 14.1% of the women and 11.6% of the men were unemployed in the last 1 year. There was a high incidence of co-morbidity among family members: hypertension - 27.7%, diabetes mellitus - 14.4% and hypercholesterolemia - 13.6%. Among the surveyed parents 28.4% of the women and 68% of the men were overweight. Only 13.5% of the parents estimated the weight status of their child as overweight (with objectively measured overweight among 29.2% of the recruited children). A significant proportion of the children were not breastfed (17.3%) or the duration of exclusive breastfeeding was not optimal for 67.8% of the exclusively breastfed children.

Conclusions

Identifying family risk factors associated with overweight in childhood is important for the public health and provides opportunities to develop policies for improvement of the nutritional and health status of children.

Key messages

To tackle the childhood obesity epidemic the family risk factors should be addressed. The awareness of the children and parents should be raised through targeted information materials and campaigns.
School connectedness and adult depressiveness, longitudinal study of the Northern Swedish Cohort
Authors: Gunnarsdottir H , Hensing G , Hammarström A
Published: November 2019

Background

The aim of this study was to use Bronfenbrenner’s ecological theory to investigate adolescents’ school connectedness and family climate as potential predictors of depressiveness in adulthood.

Methods

The data are from the Northern Swedish Cohort and the sample consists of 481 women and 526 men born 1965 that participated in data collection at four time points, at age 16, 21, 30 and 43. Multivariate linear regression was used to examine the associations between school connectedness and family climate and depressiveness, respectively.

Results

Poor school connectedness was found to be associated with depressiveness up to mid adulthood and social/material adversities in adolescence were found to expand this association in young adulthood.

Conclusions

This study show that poor school connectedness can have long lasting effects on mental health. Thus, mental health promoting initiatives with holistic approach aiming at enhancing both sense of belonging in school, peer relations and academic achievements are needed. The study accentuates the complex processes determining mental health and propose a theoretical approach appealing for public mental health research. To advance the knowledge of the mechanisms behind the associations between proximal processes and depressiveness in adulthood, additional life-course studies are called for.

Key messages

Poor school connectedness can have long lasting effects on mental health. Initiatives aiming at enhancing both sense of belonging in school, peer relations and academic achievements are needed.
The status of compliance with guidelines of cancer screening in Japan
Authors: Kono K , Matsuda K , Machii R , Saika K , Takahashi H , Nakayama T
Published: November 2019

Background

The Ministry of Health, Labour and Welfare (MHLW) establishes screening recommendations specifying screening methods, age, and interval for gastric, colon, lung, breast, and cervical cancers. Screening programs are provided via local healthcare departments (LHD), who are responsible for managing programs and reporting the screening status through a survey annually.

Methods

We analyzed screening status provided by LHDs in fiscal 2017 in regards to appropriate screening age and interval. Briefly, current recommended screening age by MHLW is followed: colon, lung, breast cancer screening are age 40 years and older, and cervical cancer for aged 20 and older, and gastric cancer for aged 50 and older. Screening intervals are gastric, breast, and cervical cancer screening are two years, and colon and lung cancer screening are one year.

Results

The survey was completed by 1736 LHD (response rate: 99.9%). Regarding age-appropriate compliance, in cervical cancer, 96.4% of LHDs reported following recommended target age, while compliance was lower for lung, colon, breast, and gastric cancers at 79.4%, 75.7%, 60.2% and 4.2%, respectively. High compliance with recommendations for screening interval was identified for colon (99.7%) and lung (98.7%) cancers; this was substantially less for breast, cervical, and gastric cancer screening at 39.8%, 34.1%, and 4.6%, respectively.

Conclusions

In 2016, MLHW changed the starting screening age for gastric cancer from 40 to 50 years old, likely resulting in the lowest compliance in our analysis. Though it may take time for screening facilities to come into compliance with newer recommendations. Many LHDs provide screening without adhering to recommended starting ages, with a general tendency to provide screening at younger than recommended ages. This is a barrier to maximizing effectiveness and minimize harms of screening and warrants closer monitoring to promote efficiency in cancer screening programs.

Key messages

There is relatively low compliance with cancer screening guidelines in Japan. Establishing an environment of appropriate monitoring and support to achieve the goal of cancer screening is warranted.
Comparison of Cardiovascular Disease Risks of Actual and Perceptions of Men’s that 40-65 Years Old
Authors: Topuz İbrahim , Gozum Sebahat
Published: November 2019

Background

Turkey is among the top countries in Europe in coronary mortality in the 45-74 age range. The highest death due to disorders of the circulatory system (50.8%) that is Amasya province.

Objective

Determine related factors and to compare with actual and perceived cardiovascular disease (CVD) risks of men aged 40-65 living in Amasya.

Methods

The sample size of cross-sectional and analytical study consisted of 400 people who met the inclusion criteria. Actual CVD risks of men were calculated using HeartScore. Age, systolic blood pressure, total cholesterol measured by blood taken from the capillary and smoking status were used to calculate CVD risk. Actual CVD risk in next decade has been calculated as low, medium, high or very high. Perceived CVD risk in next decade were identified by participants as low, medium, high and very high responses. They also questioned why evaluation of perceived risk.

Results

It was determined whereas 8.3% of the males had high, 52.5% had a very high level of CVD risk. The main variables affecting actual CVD risk; diastolic blood pressure, BMI and physical activity. 13.3% of males perceived CVD risks at high and 8% at very high. The main variables affecting perceived CVD risk; age and DM. It was found that 48% and 23.8% of males perceived CVD risks lower and higher than actual CVD risk while 28.2% were accurate. Those who perceived CVD risk at a moderate, high and very high think that this is caused by diseases that increase the risk of CVD and smoking.

Conclusions

Approximately 1/2 men has very high risk of CVD. It was determined that 1/2 men perceived risks are lower with false optimism and couldn’t accurately identify risks of people older and with diabetes.

Key messages

It can be ensured that develop risk reducing behaviors and individuals with high risk of CVD can raise their awareness. The risk perceptions of males in the very high-risk group from the past to the present are important because they affect their actual risks and risk-reducing behaviors.
Increased risk of Roma for 10-year development of CVDs based on Framingham Risk Score calculation
Authors: Piko P , Fiatal S , Kosa Z , Sandor J , Adany R
Published: November 2019

Background

Increased mortality and short life expectancy of Roma are well known epidemiological findings which can be partially explained by the high prevalence of cardiovascular risk factors among them. This study assesses the prevalence of the cardiovascular disease (CVD) risk factors (age, sex, systolic blood pressure, smoking and diabetes status, elevated total and reduced high density lipoprotein cholesterol level (HDL-C)) and the estimation of 10-year risk of development of CVD (CVD in general, coronary heart disease (CHD), myocardial infarction (MI) and stroke) and that of death from CHD and CVD based on the Framingham Risk Score (FRS) in case of the Hungarian general (HG) and Roma (HR) populations.

Methods

A complex health survey incl. questionnaire based interview, physical examination and laboratory test was carried out in 2018 on the HG and HR populations. The prevalence of different cardiovascular risk factors was defined and FRS was computed and compared between the HG (n = 378) and HR (n = 386) populations.

Results

The prevalence of diabetes was significantly higher among Roma females compared to females of general population (17.8% vs. 7.7%; p = 0.001) while the average systolic blood pressure level was less elevated among Roma males (127.9 mmHg vs. 129.4 mmHg; p = 0.020). The prevalence of smoking (males: 63.1% vs. 33.7%; females: 67.6% vs. 31%; p < 0.001) and reduced HDL-C level (males: 40% vs. 25.9%, p = 0.014; females: 55.5% vs. 35.1%, p < 0.001) were significantly higher in both sexes among Roma. The 10-year estimated risk for development of CHD, MI and CVD and the death from CHD was significantly (P < 0.05) higher in both sexes among Roma compared to the general population while the average risk scores for stroke and death from CVD were significantly higher only among Roma men.

Conclusions

Our results show that both sexes in the Roma population have a significantly higher risk for 10-year development of CVD compared to the Hungarian general population.

Key messages

The Roma population have a significantly higher risk for 10-year development of cardiovascular diseases and death from them based on the Framingham Risk Score. The targeted cardiovascular interventions should be focus on reduce smoking and provide information on the recognition and treatment of diabetes and lipid disorders among Roma.