bluuebunny/crossref_metadata_2025 huggingface dataset:
What does competent moral expertise look like in public health practice?
Authors: Tahzib F
Published: October 2020

Background

Public health practitioners regularly face moral dilemmas in their daily practice but they are not well prepared to deal with them. Yet, from an ethics perspective, educational programmes are often inadequate. Rather, there is a need to better understand public health ethical competencies and to develop education and training in public health ethics (PHE).

Objectives

This presentation will share findings and learning from an ESRC funded research by the UK Faculty of Public Health in collaboration with the Universities of Southampton and Bristol around the nature of competency in PHE and law. Our leading question is: What are the key ethical and legal knowledge, skills, values and attitudes necessary for PHE and law as a professional competency of the public health workforce (PHW)?

Results

We created a working list of what the competencies should look like based on the material from the competency library, comments from a panel of practitioners, experts which we convened, and own analysis that reflects subject matter knowledge, expressed skill development requirements and personal work experience. These were organized within five areas which: (i) Awareness and Understanding, (ii) Engagement and Research, (iii) Analysis and Reasoning, (iv) Evaluation and Reflection and (v) Action and Advocacy. The five areas and various issues which they cover will be described, as well as reflection and learning from some key activities and initiatives in building competency and capacity.

Conclusions

There is need to appreciate the nature of competency of PHE and build capacity and competency of the PHW through education and training programmes as key element of public health training curricula.

Key messages

There are distinguishing features in teaching, learning and practice of PHE compared to clinical ethics. To implement PHE competencies into practice and in public health curricula requires better understanding of practice and the political mandate of public health.
Stigmatizing policies’ influence on HIV risk through their effect on internalized homonegativity and health behaviors among men who have sex with men in Europe
Authors: Stojanovski K , King E , Amico K R , Eisenberg M , Geronimus A , Schmidt A
Published: October 2020

Background

Men who have sex with men (MSM) in Europe are most affected by HIV disparities. Complex systems theory proposes that many health behaviors and risks arise from numerous cascading and interacting processes. Our aim was to explore how stigmatizing policies at the European country-level create pathways to HIV risk and disparities among MSM in Europe.

Methods

We used data from the 2017 European Men Who Have Sex with Men Internet Survey (EMIS-2017). The anonymous online survey recruited 126,090 European MSM. We assessed condom use with steady & non-steady partners as the outcome. Condom use was categorized from zero to 10 (10 or more partners). Abuse was scored zero to three and internalized homonegativity from zero to six. We used the International Gay and Lesbian Association's Rainbow Index as the main predictor, which ranks European countries' laws and policies regarding LGBTQ+ legal protections from zero (worst) to 100 (best). We used structural equation and multi-level modeling for analyses.

Results

The mean Rainbow Index score was 50.8 with a range from 6 to 88. The Rainbow Index scores were the highest in Western European (mean=62.5), then Central European (mean=45.9), then Eastern Europe (mean=21.4) (p < 0.000). Unadjusted regression models suggested that for every one-unit improvement in the Rainbow Index the number of condomless sexual acts with steady sexual partners was reduced [β=-0.0012, 95% CI (-0.0016, -0.0009)]. The unadjusted structural equation model showed that the relationship between the Rainbow Index and condom use with steady partners was mediated by 30% because of internalized homonegativity (p < 0.000).

Conclusions

The policy context influences HIV risk, especially through the policies' effects on condom use. HIV research and prevention efforts must recognize that structural determinants can shape people's risk for HIV and that the best individual and local efforts may be undermined by structural factors such as policies.
A sustainable ECHI-shortlist
Authors: Tijhuis M , Ombrellaro K , Petrauskaite I , Vaidelauskaite A , Daňková S , Van der Wilk E , Gissler M , Palmieri L
Published: October 2020

Background

The European Core Health Indicators (ECHI) list provides a 'snapshot' of European public health (including care). It is the result of consecutive EU-wide projects in response to a 1998 European Commission (EC) call to establish an indicator list as the core of the EU public health monitoring system. The current list contains 88 indicators, a large part of which have been implemented and used across the EU. Using ECHI to internationally compare public health aspects adds value to national health information. Currently, EC maintains a tool in which the indicators can be consulted. However, no formal governing entity exists. The aim of this study, under the Joint Action on Health Information (InfAct), is to explore the future of the policy guiding role of the ECHI list, the process of adapting and innovating the list and the role of current member state initiatives in this.

Methods

Relevant technical information, available via 'doc(umentation) sheets' dating from 2012, was subjected to an update process. Potential improvements in content (additions, deletions, and adjustments), overall balance and policy relevance were suggested by health information experts (via survey and expert meetings). This work will be expanded in the near future of InfAct.

Results

Peer-reviewed updates of the doc sheets included aligning with meta information from relevant data collecting bodies and reviving web links. A process to guide content changes to the list is in development, balancing sustainability and updates for public health policy. Online background ECHI information is disseminated via ECHI.eu.

Conclusions

Health information experts still consider the ECHI shortlist important for EU health policy, but it needs to be modernized and promoted. A formal structure is needed to ensure the highest value to EC and MS health policies. The future distributed research Infrastructure on population health (DIPoH) may host the shaping and governing the ECHI, in liaison with EC and MS.
Incorporating intersectionality into quantitative research methods in public health
Authors: Bauer G , Scheim A
Published: October 2020

Introduction

The use of intersectionality as an explicit theoretical framework in quantitative public health research is relatively recent, and has involved a wide array of study design and statistical methods. As best practices have not been identified, guidance for research design and analysis is needed.

Methods

We draw on a review of the literature and our own methods publications to present an overview of key considerations in approaching public health research from an intersectional perspective.

Results

Key considerations differ for descriptive studies of intersectional inequalities and analytic studies of potential causes of those inequalities, as research methodologies and their strengths and limitations differ. For descriptive studies, considerations include specification of intersectional groups, multiplicative vs. additive scale for analysis of effects and interactions, limitations of data sets, whether all intersectional groups are of equal interest, and choosing statistical methods. For analytic studies, considerations include whether potential causal factors are relevant and measurable for all intersections or are specific to some, variable measurement, different options in standardization or control of confounding, and statistical analysis methods.

Discussion

We present considerations in incorporating intersectionality frameworks, and provide tools for conceptualizing intersectionality-informed quantitative public health research.
14.L. Workshop: Determinants of family mental health
Authors:   Organised by: EUPHA Public mental health section,   Chair persons: Jutta Lindert – EUPHA-PMH, Johan Bilsen – EUPHA-PMH
Published: October 2020

Over the past decade, the demographic composition of the population is rapidly changing. This has a huge impact on family members, especially on youth (10-25years). Youth is a formative period in which young people might be especially vulnerable. Multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Promoting psychological well-being and protecting youth from adverse experiences and risk factors that may impact their potential to thrive in later life are critical for their mental health not only during adolescence but also in adulthood. Supportive environments in the family, in the wider community and at a global level are important. Multiple factors determine mental health outcomes in youth. Violence (including wars and conflicts, child abuse and harsh parenting), and socioeconomic problems are risks to mental health of youth. In order to address the mental health needs of vulnerable youth and families with youth, increasing knowledge about factors influencing mental health in this age group is imperative.

This international workshop will be focused on addressing mental health issues of families and youth. The presentations will focus on 1) self-identified mental problems in a rural area of Germany (Marta Natan); 2) the factors associated with child abuse and the consequences of child abuse in a representative sample from Norway (Gertrud Sofie Hafstad); 3) transit experiences and mental health of unaccompanied refugee children (Ilse Derluyn) and 4) suicidal behaviour and violence among young people (Marija Jakubauskiene).

Key messages

Determinants of youth mental health can be identified to address common mental disorders in youth. Youth and family mental health cannot be fully addressed without the dignity that is upheld by human rights.
FoodEx2 enhances the harmonization of food consumption, composition and carbon footprint databases
Authors: Ferreira de Sousa R , Padula de Quadros V , Balcerzak A , Bevere T
Published: October 2020

Introduction

FoodEx2 is a food classification and description system developed and maintained by the European Food Safety Authority (EFSA). It is currently used at global level with the support of the Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO) to harmonize datasets in the FAO/WHO Global Individual Food consumption data Tool - FAO/WHO GIFT. This is an open access online platform hosted by FAO and supported by WHO, for collation and dissemination of individual quantitative food consumption data, especially from low- and middle-income countries.

Objective

To demonstrate FoodEx2's usefulness in global harmonization of food description in food consumption datasets and its potential in facilitating food matching for various types of food data.

Methodology

Information was gathered from data owners of food consumption datasets and others who were trained to use FoodEx2, and on the number of datasets that have initiated or completed their data harmonization process, as a result of the FAO/WHO/EFSA collaboration.

Main Findings

Over 50 data owners of food consumption data and/or food composition tables (FCT) have been trained in data re-categorization with FoodEx2. As a result, 6 FCT and 25 food consumption datasets from 18 countries were or are being coded with FoodEx2, and out of those, 30 datasets are or will soon be disseminated through FAO/WHO GIFT in the form of infographics and microdata. Additionally, at least 3 databases of greenhouse gas emission (GHGE) estimates of foods have been mapped with FoodEx2.

Conclusions

Increased harmonization with FoodEx2 would enhance the consistency and reliability of nutrient intake assessments. Harmonization with FoodEx2 is being used to assess the environmental impact of diets and help identifying sustainable food consumption patterns.
16.F. Workshop: Expanding coverage and improving quality: health reforms and policy learning across North America
Authors:   Organised by: North American Observatory on Health Systems and Policies (NAO),   Chair persons: Suszy Lessof - Belgium, Greg Marchildon - Canada
Published: October 2020

Health systems globally share challenges with expanding coverage while increasing quality. This workshop organized by the North American Observatory on Health Systems and Policies (NAO) will draw on the results of major health system studies of Canada, the United States (US) and Mexico. The NAO is a partnership of researchers, governments, and health organizations in the three countries, promoting evidence-informed health system policy decision-making. It works with the European Observatory on Health Systems and Policies and other global affiliates. One of the NAO's activities is co-publishing, with the European Observatory and the University of Toronto Press, full-length books about the health care systems in each of the three countries, modeled after the European Observatory's Health System in Transition (HiT) book series that includes full-length treatments of the systems in 70 countries. In 2020 new books will be jointly released in all three countries (Canada's third edition, the US's second, and Mexico's first). This workshop has two overarching

Objectives

first, to describe the recent health policy developments to provide insights into the successes and challenges of the three North American countries' health systems; second, to explore the potential for policy learning across the three countries with shared challenges but quite different institutional, political and economic contexts. Lead authors of each of these studies will deliver a short presentation describing the major public health and health system challenges faced in their country, and providing an analysis of recent health sector reforms. A panel discussion will follow, facilitated by the chairperson, that will start with a speaker that brings an international perspective to comment on the areas of convergence and divergence in health sector reforms in North America with those taking place across the European region. Each of the lead authors will then respond to the questions and comments raised, and will take questions and comments from the participants. This workshop brings together leading health system and public health scholars from Canada, the US, and Mexico for the first time at this international conference, which will provide participants with an opportunity to learn about these complex and ever-changing health systems and to engage in rich and lively discussion.

Key messages

In-depth health system studies provide the opportunity to identify lessons that may be transferable across national boundaries. Comparing recent health reforms in the three largest North American countries provide insight into policy learning across high- and middle- income contexts.
The Public Health Workforce in Portugal in 2019
Authors: Moreira de Sousa A , Moreira M , Cabral M
Published: October 2020

While the slogan of a fit for purpose workforce pushes us to consider qualitative aspects, there are still quantitative aspects that need further consideration. In some planning and forecast processes, greater quantitative detail should be considered. We use an example from Portugal to explore this matter in the Public Health workforce (PHW). In 2019, for the first time, all Public Health Units (PHU) were supposed to fill in a plan of action on a public online platform. This included some self-reported data on their PHW.

We have used this data to explore which and how many professionals were available in each of the PHU, also having in mind their percentage of work hours dedicated to the PHU and their gender. For this analysis, we have used Microsoft Office Excel 365, R 3.6.1, RStudio 1.2.5033, and ArcMap 10.7.1.

Of the 55 PHU in Portugal, 12 (21,8%) did not publish their Plan, 2 (3,6%) were released without being correctly filled, and 3 (5,4%) with substantial data regarding their human resources being incomplete. In total, the plans identified 220 public health medical specialists, 130 medical residents, 184 nurses, 136 secretaries, and 314 other professionals. From the reported data, there was an average of the percentage of week hours dedicated to the PHU of 82,8% for medical specialists, 71,8% for nurses, 89,8% for secretaries, and 92,1% for other professionals. In what concerns gender distribution, women represented 60,9% of medical specialists, but only 52,6% of PHU coordinators, 55,5% of medical residents, 86,4% of nurses, 83,7% of secretaries, and 77,7% of the remaining professionals. There were considerable differences between PHU in these results.

These results might differ from formal administrative data. However, due to being reported from the PHU themselves might portrait a more realistic picture of the local public health workforce. These results underline the importance of the hours dedicated to the PHU in the planning and forecasting of the PHW.

Key messages

The % of time PH professionals dedicate to their Unit should be included in Workforce planning. Greater adherence to the Portuguese public platform for action plans is needed.
Task shifting and health professionals: a European policy analysis
Authors: De Caro W , Corvo E
Published: October 2020

Issue

There is now a growing interest by public health and health policy leader worldwide in task shifting within health professionals. Nurses represent the largest health workforce. Research has displayed that higher level of nursing competencies leads to better outcomes for patients and for the organization. Advanced and specialistic nursing and prescribing nurses is common in anglophone countries but is still in development in other countries and do not have a stable legislative recognition.

Methodology

We carry out a review of policy documents, models, and frameworks at European level to identify best practices to implement within the Italian context, with particular attention to nursing task shifting in order to set up Advanced Practice Nursing. Following the EU taxonomy, the analysis was carried out in order to classify the different approaches under the three main areas: enhancement, substitution/delegation and innovation.

Results

There are a number of reports and policy documents suggesting that task shifting is a way to improve health management, however to a mixed extent. Results show that task shifting has a domino effect. It impacts on the whole organization in terms of social and financial sustainability, quality of care, and general strength of the health systems. According to the results, Task shifting could potentially play a big role in the crucial transformation of health systems worldwide, however, it is still strongly influenced by a medically centered approach.

Conclusions

In the light of the results, there is an overall lack of clarity and well-developed policy approach by policymakers about task shifting competencies. Recent occurrences in terms of overwhelmed hospitals and health systems in general has clearly displayed the need to a major transformation and update of traditional models and regulatory frameworks of delivery of care and cure.

Key messages

Task shifting for health professionals is the future. task shifting is crucial in emergency and primary care.
Delays in the diagnosis of pulmonary tuberculosis in critical and non-critical areas in Portugal
Authors: Leite A , Soares P , Santos J , Nunes C
Published: October 2020

Background

Delays in diagnosing tuberculosis lead to longer infectious periods, posing a challenge in tuberculosis control. This is particularly relevant in high incidence areas (critical). Thus, the objectives of this work were to characterize tuberculosis diagnosis delay and its components (patient delay and health delay) in incidence critical and non-critical areas in Portugal, as well as associated factors.

Methods

Notified cases of pulmonary tuberculosis diagnosed due to symptoms (passive screening) in the Portuguese Tuberculosis Surveillance System were analysed (2008-2017). Patient, health and overall delays were calculated. Factors associated with each delays' components were identified utilising Cox regression, while adjusting for sex, age and education level. Analyses were stratified by area type (critical and non-critical).

Results

Median (1st-3rd quartile - Q1-Q3) delays in patient, health and overall delay in critical areas were: 40 (Q1-Q3: 21-76), 8 (Q1-Q3:1-31), and 65 (Q1-Q3: 40-105) days, respectively; similar delays in non-critical areas were 32 (Q1-Q3:16-63); 9 (Q1-Q3: 1-34) and 58 (Q1-Q3: 35-98), respectively. More recent cases, adults younger than 65 years and alcoholic presented longer patient delays (both areas); healthcare professionals and patients with HIV infection presented shorter patient delays (only critical areas). Tuberculosis high-risk groups (males, alcohol dependency, homelessness, community residency) presented shorter health delays in both areas; drug use also presented shorter health delays but only in critical areas. Existing comorbidities was associated with longer health delays in both areas.

Conclusions

Patient delays increased between 2008 and 2017. Groups with longer/shorter delays differed between delay type and area type. Intervening in tuberculosis diagnosis delays requires different action for critical and non-critical areas, targeting health literacy from the general population and training of healthcare professionals.

Key messages

Delays in diagnosing in Portugal are mainly driven by delays in patient seeking care and are longer in areas of higher tuberculosis incidence. Intervening in tuberculosis diagnosis delays in Portugal requires different action in different areas, targeting health literacy in the general population and training of professionals.
Selectively permeable national borders: An ethnographic study of a pre-entry TB screening centre
Authors: Potter J L
Published: October 2020

Background

The securitisation of borders against the threat of invading microbes, carried by immigrant bodies, is not a new phenomenon. Tuberculosis (TB), transmitted through coughing, has been a core member of the infectious diseases deemed important to control for more than a century. Following evidence suggesting airport screening for TB using chest x-rays was ad hoc, ineffective and costly, the UK - following in the footsteps of other high-income, low TB-burden countries - moved to pre-entry screening of migrants for TB. Thus the 'biosecuritisation' of immigrant bodies was shifted off-shore. Since 2014, pre-entry screening for TB has been a mandatory part of the visa application system for those moving to the UK for a period of 6 months or longer from high-incidence countries. This ethnographic study explores how pre-entry screening is experienced by migrants.

Methods

Data was drawn from a project exploring migrants' experiences of accessing healthcare. This involved a focused ethnography, comprising 180 hours of field work over four weeks including interviews with clients and staff, in a pre-entry TB screening centre in India in 2017. During this time over 1000 individuals were screened for active pulmonary TB as part of their visa application. In addition, 14 in-depth interviews were conducted with migrants diagnosed with TB in the UK. Foucault's concept 'governmentality' and sociological theories of bordering were used alongside thematic analysis to analyse the data.

Results

This study reveals the previously undocumented harms experienced by individuals who are required to undergo pre-entry screening for TB. Through the 'biosecuritisation' of some, but not all, off-shore bodies; some, but not all, off-shore TB; some, but not all, infectious diseases; pre-entry screening becomes a border force, reinforcing global inequities and racialised hierarchies. In this context, I argue pre-entry screening makes UK citizens live while letting 'others' die.

Key messages

Pre-entry screening marks migrants as ‘other’ in a global, racialised, hierarchy of TB risk that ignores intra-country heterogeneity, obfuscating solutions that might reduce inter-country inequities. The global health security agenda must consider the experiences of those caught up in its policies and practices in order to ensure disease control does not do more harm than good.
Pulmonary tuberculosis incidence, trends and predictions in Monastir, Tunisia (2000-2030)
Authors: Ben Nasrallah C , Zemni I , Kacem M , Dhouib W , Bannour R , Grira S , Ben fredj M , Abroug H , Belguith Sriha A
Published: October 2020

Background

Tuberculosis (TB) continues to be one of the infectious diseases with the highest morbidity worldwide. The lung is the most commonly involved organ, but lesions can occur in other body systems. This study aimed to describe incidence and trends of pulmonary tuberculosis (PTB) over a period of 18 years in Monastir and to estimate predictions for 2030.

Methods

We carried out an observational study from 2000 to 2017. Data were collected by the regional direction of primary health care. Incidence was estimated by the crude incidence rate (CIR) and the age standardized rate (ASR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results

A total of 997 patients were recorded with 486 cases of PTB (48.95%). Sex ratio was 2.85. The median age was 40.5 [IQR 28-56] years old. PTB ASR was 5.71/100,000 inhabitants (inh). CIR was the highest among the eldest cohort aged more than 60 years (12.65/100,000 inh) and the lowest among youth aged less than 19 years (1.01/100,000 inh). We established a negative trend of PTB over 18 years (b= -0.032; p < 10-4) in all age cohorts. PTB would be decreasing by 2030 with an estimate incidence rate of 1.83/100,000 inh.

Conclusions

The decline of PTB may be a sign of TB control program effectiveness in Monastir. Thus, the challenges for the future are to maintain PTB towards decreasing.

Key messages

Our study highlighted the impact of TB control strategies in Tunisia. Our findings play a key role in estimating whether the WHO’s End TB strategy targets can be achieved by 2030.
Electronic cigarettes and respiratory diseases in Russian Tobacco Control Policy evaluation survey
Authors: Gambaryan M H , Popovich M V , Starovoytov M L , Drapkina O M
Published: October 2020

Background

Though electronic cigarettes (EC) and heated tobacco products (HTP) are marketed as harm reduction products, the evidence is that like smoking, their use is dangerous for the lung health.

Aim

To explore the associations between EC and HTP use and major respiratory diseases (RD).

Methods

Cross-sectional data of adult representative sample from Russian Tobacco Control Policy Evaluation Survey are analysed, based on multistage sampling in 10 Russian regions in 2017-2018, stratified by smoking status: n = 11625: 6569 smokers, 2377 former smokers, 2679 never smokers. Self-reported formerly diagnosed RD as outcome indicators were analysed in relation with ever EC and HTP use, and current EC use, including HTP. Multiple logistic regression is employed; odds ratios (OR) with 95% CI adjusted by smoking status and socio-demographic factors.

Results

Chronic bronchitis (CB) was reported by 14% respondents, COPD-by 4.3%, asthma-by 3.1%, emphysema-1.5%, lung cancer-1.1%, tuberculosis (TB)-1.3%. Ever EC use was prevalent in 9.3%, HTP use-in 3.3%, and current EC use-in 2.5% of population. The prevalence of ever EC and HTP use and current EC use was higher among current smokers (13%,4.4%,3.5%), compared to former smokers (7.4%,3.4%,3.5%) and never smokers: 2.2%, 0.7% and 0.6% respectively, (p<.001). Ever HTP users had 2.5 times higher chances of CB: OR 2.52(95%CI 1.9-3.3), and 4 times higher chances of COPD: OR3.97(95%CI 2.8-5.7). The risk is even greater in case of dual EC and tobacco use in current smokers: OR 3.0(95%CI 2.2-4.1) and 4.2(95%CI 2.8-6.3) respectively. Current EC use was significantly associated with asthma: OR 2.9(95%CI 1.5-5.8) and OR 5.0(95%CI 2.6-11.3) in current smokers, lung cancer: OR 4.9(95%CI 1.6-14.8) and 7.2(95%CI 1.9-27.4); and TB:OR4.1(95%CI 1.7-11.6) and 5.4(95%CI 1.6-17.9) respectively.

Conclusions

EC and HTP use independent from smoking may increase the risk for major RD, combined with tobacco smoking the risk of RD is even greater.

Key messages

The use of Electronic cigarettes and heated tobacco products, independent from smoking, may increase the risk for major respiratory diseases. Prevalence of EC and HTP use is higher among smokers, compared to former and never smokers; combination of EC and HTP use with tobacco smoking makes the risk of respiratory diseases even greater.
Impact of clinical symptoms on the disability of patients with schizophrenia (Bulgaria, 2018-2019)
Authors: Veleva I , Yankulovska S , Velikova K , Valkova M , Grancharova G
Published: October 2020

Background

According to Global Burden of Disease Studies (1990-2017), schizophrenia causes globally 1.1% of DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). It is the 8th leading cause of DALYs in 15-44 years of age (WHR 2001). The aim of the study was to assess the impact of clinical symptoms on disability in hospitalised patients with paranoid schizophrenia (PS).

Methods

The study includes 108 patients treated in Psychiatric Clinic of Pleven University Hospital: 66 males and 42 females, mean age 38.9±10.0, duration of disease 12.8±8.2 years; mean onset of disease at 24 years (Me = 25 and Mo = 22). The research protocol was approved by University Ethical Committee. The disease burden was assessed by Positive and Negative Syndrome Scale (Ð ANSS), and level of disability - by 36-item self-administered WHO Disability Assessment Schedule 2.0. Pierson's r. was used for the relationship between both variables. Data processing was performed by IBM SPSS v.24.

Results

The average burden of disease based on Ð ANSS was 71,8±5,1. The increase of symptoms' burden leads to worsening in “participation in society” (r = 0.561), “life activities-household” (r = 0.554), “getting along with people” (r = 0.539). Positive symptoms correlate higher with “getting along with people” (r = 0.549), “life activities-household” (r = 0.578), “participation in society” (r = 0.623), and negative symptoms - with “participation in society” (r = 0.526) and “life activities-household” (r = 0.476). Symptoms of disorganisation have highest impact on “life activities-household” (r = 0.807),”getting along with people”(r = 0.556), and “participation in society” (r = 0.649. All correlations were significant at p = 0.0001. “Getting around” has no relation with disease burden.

Conclusions

Disorganisation symptoms and negative symptoms strongly affect the overall psychosocial functioning, while positive symptoms have less impact on it.

Key messages

Appropriate treatment schemes directed to negative symptoms would contribute to decrease of disability level in patients with paranoid schizophrenia. Prevention and rehabilitation in PS patients should emphasise promotion of professional and personal development for minimising of disease impact on overall social functioning.
Education as a contradictory determinant of mental health between migrant and national adulthood
Authors: Sesti F , Minardi V , Baglio G , Bell R , Goldblatt P , Marceca M , Masocco M , Carrozzi G , Fateh-Moghadam P , Marmot M
Published: October 2020

The Social Determinants of Health (SDHs) are well known for their interaction on health outcomes and they can have a stronger impact on migrant health whom have higher probability to live in precarious living and working conditions compared to the hosting population. Migrant health is a public health issue which has to be considered taking into account the SDHs and complementary, including cultural issues is fundamental for addressing health equity in the society as a whole. Recognising this challenge, this study aims to evaluate the interactions between education and mental health of resident population in Italy, including Italians and immigrants.

This study examined the respondents in 2014-17 to the Italian “Progressi delle Aziende Sanitarie per la Salute in Italia” (PASSI) surveillance system. The sample of 118,639 respondents is composed by the residing working adults aged 25-69 with Italian citizenship (n = 112,345) and foreign citizenship (n = 6,294). Looking at SDHs, if for Italians high level of education appears to be a protective factor of mental health in accordance with the international evidence (adjPR: tertiary education 0,87 95%IC 079-0,97), among immigrants higher level of education it is more associated with the presence of depressive symptoms (adjPR: tertiary education: 1.77 95%IC: 1.19-2.63). Longer the length of stay in Italy for PFPM immigrants higher the risk of depressive symptoms: adjPR for 10+ years: 5.1 95%IC: 1.29-4.3.

The data show that high education could represent a risk factor for mental health of immigrants. Considering that health is related to the nature of society as well as to access to technical solutions, multicultural societies require culturally oriented interventions for tackling health inequities. This means developing evidence-based policies in order to tackle health inequalities in the population as a whole, including culturally oriented measures in the larger framework of developing diversity sensitive services.

Key messages

For some groups of population, such as migrants, high education could represent a risk factor for mental health. Developing diverse sensitive policies is needed in order to tackle health inequities in the population as a whole.
Monitoring the implementation of national climate action plans (NDCs) using the WHO CaRBonH tool
Authors: Spadaro J V , Mudu P , Kendrovski V
Published: October 2020

One crucial area of work of the WHO European Centre for Environment and Health has been the assessment of the health effects associated with the use of fossil fuels, both directly through the generation of local air pollution and indirectly by contributing to global environmental and climate change. The WHO European Centre for Environmental Health in Bonn has developed various decision support tools to calculate both the health burdens of local pollutants and the benefits of selected interventions. A key outcome has been the recent development of a simplified calculation tool, Carbon Reduction Benefits on Health (CaRBonH), capable of estimating the health, carbon and economic benefits of selected mitigation interventions. CaRBonH allows quantification of the physical and economic consequences on human health achieved through improvements in country-level air quality from domestic carbon reductions, specifically the policy mitigation actions and measures as reported in the NDCs submitted by the Conference of the Parties to the UNFCCC in support of the objectives as set out in Article 2 of the Convention. The work of improving and updating the CaRBonH tool, based on feedback from users, and the process of extending the geographical scope of the tool to account for countries outside the WHO EURO region, will be discussed in this session.
Gender responsive health promotion and NCD prevention – challenges and solutions in Kyrgyzstan
Authors: Graeser S , Djamangulova T , Aidaralie R , Matovic-Miljanovic S
Published: October 2020

Reaching men is one of the challenges related to targeted health promotion. Societal factors, concepts of masculinities, and gender norms have a strong influence on preventive and health behavior of men. Targeted health promotion and prevention has to consider gender-specific differences in language and information sources to spread preventive messages but often fail to be effective. In Kyrgyzstan, non-communicable diseases account for 80% of mortality, including cardiovascular diseases, and raised blood pressure is the second most common disease for men. The NCD prevention and control project in Kyrgyzstan, funded by the Swiss Agency for Development and Cooperation (SDC), aims to facilitate behavioral change towards healthier lifestyles by taking a gender-responsive approach to support the utilization of NCD related primary health care services for men. The gender-responsive intervention considers gender roles, norms, and inequalities, understands men's health needs, and pattern of preventive behavior to develop interventions. Data from project studies yielded that for men family members were the primary source of information about NCDs, risk factors and prevention. An assets-based approach is taken, building on the male role in a life-course perspective and a positive approach to the role of men as fathers. In 2019, an intervention, combining a school competition for children with a voucher system for preventive services for fathers and male relatives was conducted. In total, 80,416 males were reached and visited primary health facilities for preventive services (which averaged 20% of the male population over 18 years old); 18,364 (23%) men were newly detected with high blood pressure. Medical workers were made available during special hours to provide men with a consultation. During their visits, all men were screened for risk factors and received a consultation based on PEN protocol 1 and 2. Lessons on gender sensitivity have been learned from this experience.
Communication between health professionals and their influence on the coordination of care
Authors: Mendes M F M , Samico I C , Hartz Z M A
Published: October 2020

Background

Problems linked to the coordination of care may represent a lack of communication between levels of care and reflect diagnostic errors, duplication of tests and unnecessary hospitalizations. This study aims to understand the role of communicational relationships between professionals and their influence on coordination between levels of care.

Methods

An evaluative and qualitative nature research. 24 interviews were carried out, with primary care physicians and specialists, institutional supporters and managers of a public health network in Pernambuco, Brazil. The content thematic analysis worked out sought to identify synergies and contradictions in the relationships between the actors.

Results

Knowledge about the role of primary care was incomplete, not being understood its primary role as a care provider. The primary care physician was not recognized as the responsible physician by most professionals. The specialists considered the references poorly filled out and showed a lack of confidence in the primary care physician, who in turn revealed that he did not receive any counter-reference and difficulty in contacting a specialist. Few articulation mechanisms have been reported between levels and the use of informal communication mechanisms. The managers acknowledged the existence of problems, but highlighted the commitment of management in the actions for organizing the network. The “goodwill” of the professionals was considered an articulation facilitator, but not a sufficient practice.

Conclusions

The results allowed to deepen the look at the complexity of the relationships between the actors and how they can influence coordination. Since is perceived the communicational tensions and weaknesses, it is urgent to think of strategies that establish institutionalized spaces for meetings and dialogues that allow articulation among professionals.

Key messages

The study analyzes communicational relationships between primary and specialized care professionals and their influence on the coordination of care. Strategies for mutual collaboration are mandatory.
Importance of work and diagnosis for economic well-being of disability pensioners
Authors: Polvinen A
Published: October 2020

Background

Disability pensioners' economic well-being is weaker than that of the same-age population on average. Approximately 80 per cent of the partial disability pensioners continue working alongside a pension. The same figure for full disability pensioners is 10 per cent. The aim of this study was to examine how working alongside a pension and how the cause of disability are associated with partial and full disability pensioners' economic well-being.

Methods

The data consisted of longitudinal register-based (100% sample of Finns) data from Statistics Finland and the Finnish Centre for Pensions. The data included 18,291 partial disability pensioners and 116,376 full disability pensioners aged 30-62 who were on a disability pension in 2017 and had received a disability pension for at least two years. Economic well-being was measured via disposable income. Linear regression analysis was used to analyze the economic well-being of disability pensioners.

Results

In 2017, the disposable income of disability pensioners who were working alongside a pension was, on average, 50 per cent higher than that of non-working disability pensioners. The median income from work was approximately 16,700 euros/year for working partial disability pensioners and 11,100 euros/year for working full disability pensioners. Adjusted regression models showed that working alongside a pension was associated with a higher economic well-being. Disability pensioners with a mental diagnosis, on the other hand, were working less often and had a lower economic well-being than others.

Conclusions

Working alongside a disability pension has a positive effect on the economic well-being of disability pensioners. Mental diagnosis, on the other hand, often leads to a lower income.

Key messages

Disability pensioners who work alongside a pension have a higher economic well-being than their non-working counterparts. Mental diagnosis was associated with working less often alongside a disability pension and a weaker economic well-being of disability pensioners.
Area deprivation is inversely associated with measles incidence: A spatiotemporal analysis in Germany
Authors: Rohleder S , Stock C , Bozorgmehr K
Published: October 2020

Background

Although measles is endemic in all WHO European regions, very few studies have directly analysed socioeconomic inequalities in disease incidence of measles. We examined the spatiotemporal association between socioeconomic deprivation and measles incidence considering relevant demographic and geographical factors at district level.

Methods

We conducted a longitudinal small-area analysis using nationally representative data of 401 districts from 2001 to 2017. We used Bayesian spatiotemporal regression models to assess the potential effects of area deprivation on measles incidence, adjusted for relevant demographic (district population size, sex, age, and proportion of non-nationals) and geographical factors (north-south-west-east effect) as well as spatial and temporal effects. We computed risk ratios (RR) for deprivation quintiles (Q1 - Q5), and district-specific adjusted relative risks (ARR) to assess the area-level risk profile of measles in Germany.

Results

The risk of measles infection in areas with lowest deprivation quintile (Q1) was 1.58 times higher (95%-credible interval [CrI] 1.32-2.00) than in those with highest deprivation (Q5). Areas with medium-low (Q2), medium (Q3), and medium-high deprivation (Q4) had higher adjusted risks of measles relative to areas with highest deprivation (Q5) (RR: 1.23 (0.99-1.51), 1.05 (0.87-1.26), and 1.23 (1.05-1.43), respectively). We identified 22 areas at high risk and 56 at medium-high risk for measles infections, with highest area-level risks in south-western Germany.

Conclusions

Socioeconomic deprivation in Germany is inversely associated with measles incidence, with elevated risk for measles infections in areas with higher socioeconomic status. Our findings contribute to current global and national debates on measles elimination strategies, and demonstrate the importance of spatial modelling techniques in identifying socioeconomic inequalities and spatial risk patterns of measles for public health actions.

Key messages

Socioeconomic deprivation is inversely associated with measles incidence in Germany, with higher risk of infection in areas with highest socioeconomic status. The social, spatial, and temporal patterns of elevated risk of measles infection require targeted public health action and policy to address the complexity underlying measles epidemiology.
Developing thresholds for intervention recommendation and treatment success after orthopedic surgery
Authors: Kuklinski D , Geissler A
Published: October 2020

Background

Patient reported outcome measures (PROMs) are increasingly used to monitor recovery paths and the outcome of orthopedic procedures. One of the focus areas is endoprosthetic joint care. Unfavorable post-surgery PROM scores might indicate adverse recovery paths. As of now, an adequate definition of thresholds for recommending an adaptation of therapy does not exist. The same is true for thresholds defining treatment success.

Methods

To address this research gap, minimal clinical improvement differences and patient acceptable symptom states are estimated using anchor-based methods. Moreover, to better capture the variance in patients' recovery paths, we calculate thresholds for subgroups of patients exhibiting similar pre-operative PROM scores. For this purpose, we use patient data from two German hospitals, covering roughly 6,000 total hip and knee replacement patients treated between 2016 and 2018. Patients answered standard PROM (WOMAC, EQ-5D) and tailored patient satisfaction questionnaires prior to surgery as well as three and twelve months after surgery.

Results

Whereas we found similar threshold values for total hip and knee replacement patients at the 12 months mark, threshold values after 3 months are systematically better for hip patients than for knee patients. Moreover, we find that thresholds depend on pre-surgery PROM scores. Patients with low pre-surgery scores recover slower, patients in mid-quartiles show large score improvements, and patients in the highest quartile show only mild improvements.

Conclusions

The study shows that when defining thresholds, it should not only be discriminated by indication but also by patient's pre-surgery condition. This pre-surgery condition can best be described by pre-surgery PROM scores. Further, to implement thresholds into standard care, policy makers need to collaborate with public sickness funds and hospitals to refine thresholds based on nation-wide data.

Key messages

An adequate definition of PROM score thresholds is necessary to be able to evaluate intervention recommendations and treatment success after surgery. So far, existing research is limited. Recovery paths and therefore PROM score thresholds differ between indications and are dependent on patients’ pre-surgery condition, best described by pre-surgery PROM scores.