bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the ehealth card facilitate access to healthcare from the point of view of refugees in Germany?
Authors: Rolke K , Wenner J , Razum O
Published: November 2019

Background

The municipalities in the federal state of North Rhine-Westphalia (NRW) decide autonomously how to organize access to health care for refugees: either with electronic health card (eHC model) or with health care voucher (HcV model). The eHC model is often expected to facilitate access to health care and to reduce bureaucratic barriers. However, there are only few analyses of how refugees perceive the two models and their corresponding access to health care.

Methods

A total of 28 problem-centered interviews with refugees were conducted in three municipalities in NRW (two with HcV and one with eHC model). Sampling was purposive, aiming to achieve a maximum variation of interview partners with regard to age, gender, chronic illnesses, pregnancy and parenthood. The interviews were conducted with the support of translators in the language of the respondents’ choice. Interviews transcripts were evaluated by content analysis using the software atlas.ti.

Results

Refugees using both the eHC and HcV models report mostly positive experiences when seeking care - both in terms of treatment and interaction with physicians or non-medical staff. The first contact with the health care system was rarely organized by refugees themselves in both models, but mostly with the support of social workers, friends, or family members. The main perceived difference between the models was that in the HcV model, urgent treatment required additional waiting time.

Conclusions

Access to care is assessed similarly well by refugees in all municipalities. The additional approval process for treatment by the social welfare office in HcV municipalities may lead to a delayed treatment. Formal and informal support is particularly important for newly arriving refugees to help them navigate the complex German health system.

Key messages

The implementation of one access model alone does not facilitate access to health care for refugees. Formal and informal support is necessary for refugees to gain access to the health system.
Factors associated with self- and other-directed aggression in Slovak adolescents
Authors: Janovska A , Gajdosova B , Kalina O
Published: November 2019

Background

We investigated differences in intrapersonal and interpersonal characteristics of adolescents with and without reported aggressive behaviours (AB). We distinguished two types of intrapersonal factors (self-esteem (SE), self-control (SC)) and three types of interpersonal factors (prosocial peers (PP), supportive relationships at home (SRH), supportive relationships at school (SRS)). We separately examined self-directed aggressive behaviours (self-destructive thoughts, self-destructive behaviour) and other-directed aggressive behaviours (using vulgar words, fighting, physical harm, intimidation, mockery of classmates).

Methods

A representative sample of 1101 adolescents (50.1% female, mean age of 13.5 years) was collected from primary schools in Slovakia. The respondents completed the SE Scale, the SC Scale, the Resilience and Youth Development scale and they were also asked about the frequency of AB. In each form of AB (self- and other-directed) two groups were created: those who reported some AB and those who did not report any AB. Descriptive statistics and nonparametric tests were used for the data analysis.

Results

Almost 75% of the adolescents reported some AB towards others and 41% reported self-harming thoughts or behaviours. Statistically significant differences were observed for both self-directed AB (SE: p<.001, SC: p<.001, PP: p<.001, SRH: p=.013, SRS: p<.001) and other-directed AB (SE: p=.034, SC: p<.001, PP: p<.001, SRH: p=.039, SRS: p=.016). In all cases adolescents who reported AB typically had a lower level of intrapersonal and interpersonal variables compared to those who did not report AB.

Conclusions

The study contributed to the understanding of factors linked to aggressive behaviour of adolescents and confirmed the associations with self-esteem, self-control, supportive relationships at home and at school and having prosocial peers.

Key messages

Aggressive behaviour of adolescents can be linked to interpersonal and intrapersonal relationships. The above holds for both self- and other-directed aggression.
What should parents do to emphasise their disapproval of adolescents’ substance use?
Authors: Bacikova-Sleskova M , Hricová L , Kalina O , Benka J
Published: November 2019

Background

Previous research has shown that one of the strongest predictor of smoking and alcohol consumption in early adolescence is perceived parental approval of such behaviour. The aim of the present study is to explore which parenting practices predict the probability of perceiving parental disapproval of smoking and alcohol consumption in adolescence.

Methods

A representative sample of 1133 early adolescents (mean age = 12.9, SD 0.77) filled in questionnaires including sociodemographic characteristics (3 items), perceived parental risk behaviour (alcohol consumption at least once a week, drunkenness once a month and daily smoking); substance specific conversations with parents (1 item); both emotional and controlling aspects of parenting (6 items), and perceived parental disapproval of adolescents’ smoking and alcohol consumption as dependent variables. Logistic regression was used to analyse the data.

Results

The most important predictor of perceived parental disapproval of alcohol use was behavioural control (setting rules) (OR 2.34), followed by parental non-drinking (OR 1.81) and alcohol specific communication (OR 1.28). Regarding smoking disapproval, the significant predictors were parental non-smoking (OR 1.92); behavioural control (OR 1.79); time spent with a child (OR 1.44) and lower psychological control (guild induction, pressuring, manipulation) (OR 0.69).

Conclusions

Decreasing adolescents’ substance use via increasing their perceived parental disapproval of such behaviour seems to be substance specific. The most salient strategy both for smoking and drinking seems to be the use of behavioural control characterized by clear rules setting and lack of parental own substance use.

Key messages

Decreasing adolescents’ substance use via increasing their perceived parental disapproval of such behaviour seems to be substance specific. The most salient strategy to increase perceived parental disapproval of smoking and alcohol consumption seems to be the use of behavioural control characterized by clear rules setting.
Adolescent tooth brushing frequency evolution (2006-2014), risk factors and causality hypothesis
Authors: de Grado G Fernandez , Offner D , Godeau E , Nabet C , Musset A M
Published: November 2019

Objectives

To analyze the evolution of tooth brushing frequency (TBF) as well as the impact of socio-economic status and health behaviors between 2006, 2010 and 2014 among adolescents from the French Health Behavior in School-aged Children (HBSC) cross-sectional studies.

Methods

We included 18727 adolescents aged 11, 13 or 15 years old (y/o). The relationship between TBF and variables such as eating habits, health and socio-economic status markers as well as their evolution over the 3 studies were analyzed using logistic regression. We used directed acyclic graphs (DAGs) to represent the potential chain of causality between TBF, its associated factors, as well as latent variables such as the risk for oral diseases.

Results

Proportion of adolescents brushing twice a day increased from 68.8% in 2006 to 70.8% in 2010 and 78.8% in 2014 (p < 0.0001). Notable predictors (p < 0.0001) were being a girl (adjusted Odd Ratio = 1.5) and even more an older girl (aOR 1.5 for 15y/o vs 11 y/o girls), having breakfast and fruits daily (aOR 1.4 and aOR 1.6), excellent perceived health (aOR 1.2), obesity or overweight (aOR 0.6), being bullied at school (aOR 0.8) and perceived family wealth (aOR 1.4 for High vs Low). Impacts of these predictors were stable over the 3 studies. DAGs highlighted the fact that a low TBF and its associated risk factors described a high-risk population for poor oral and global health. Variables at the origin of those risks seemed to be age, sex, familial environment, socio-economic environment and education.

Conclusions

TBF among French adolescents improved from 2006 to 2014. This may be linked with global prevention programs developed during this time period. These programs should be associated with more specific ones targeted towards and adapted to disadvantaged populations to diminish inequalities. The use of DAGs is a powerful tool to identify the origin of those inequalities as well as the right factors to target in order to achieve efficient prevention.

Key messages

Global and specific prevention programs should be associated to allow a global improvement in tooth brushing as well as a diminution of inequalities. Use of specific statistical tools can help identify specific trends in health behaviors and alterable risk factors.
Association between positive mental health and family background among young people in Finland
Authors: Appelqvist-Schmidlechner K , Tamminen N , Solin P
Published: November 2019

Background

Positive mental health (PMH) is an important construct for understanding the full continuum of mental health. The aim of this study was to examine the association of family background with the level of PMH among adolescents and young adults in Finland.

Methods

Data from population-based Finnish School Health Promotion Study targeted at year 8. and 9. students of comprehensive school and year 1. and 2. students of upper secondary school and vocational schools was used (n = 134684) for the study. PMH was measured with short Warwick-Edinburgh-Mental-Wellbeing-Scale (SWEMWBS) and examined on a continuum from languishing (low level of positive mental health) to moderate to flourishing mental health (high level of positive mental health). Associations between flourishing/languishing mental health and family background variables were analysed with logistic regression analysis, school level and gender were adjusted.

Results

Flourishing mental health was associated with intact family background, higher education of parents and better financial situation of family. In contrast, languishing was associated with non-intact family conditions (single parent family, parents divorced, stepfamily) and parents’ unemployment, lower level of education and financial problems.

Conclusions

Family structure and socioeconomic status of parents have an impact on PMH of young people. Young people with non-intact family structure and/or poorer socioeconomic status may lack positive sense of well-being, in other words they have challenges to enjoy their life, to believe in their own abilities, to cope with normal stresses of life, to study productively and to enjoy interacting with others. Targeted interventions and promotive actions should be directed for young people with challenging family conditions in particular.

Key messages

Investigating positive mental health (PMH) is essential for understanding the full continuum of mental health. Family structure and parents’ socioeconomic status have an impact on PMH of young people.
Effectiveness of a drug use prevention program on alcohol use and drunkenness among schoolchildren
Authors: Štefaňáková M , Kulanová-Dobrowolska M , Orosová O , Abrinková L
Published: November 2019

Introduction

Unplugged is a universal drug prevention program consisting of 12 lessons and intended for primary schools. In the school year 2017/2018, Unplugged was implemented in the Slovak Republic in the 7th grade.

Objective

To examine the effectiveness of Unplugged on lifetime prevalence of drunkenness and alcohol use during the last 30 days as well as the moderation effect of gender in these relationships. Furthermore, the role of smoking in relation to alcohol use and drunkenness was monitored.

Methods

The study has been designed as a cluster randomized controlled trial with data collection before the program implementation and immediately after the implementation. In total, 486 schoolchildren participated in the trial (M = 13.05; 49.6% boys) and were randomly assigned to either an experimental (N = 277) or control group (N = 209). Binary logistic regression was applied and adjusted for gender and baseline risk behaviour.

Results

There was no significant effect of Unplugged and no moderation effect of gender with regard to lifetime prevalence of drunkenness. However, smoking was also reported by those schoolchildren who reported drunkenness (OR 6.735; 95%CI 3.210-14.132). A significant program effect was found regarding the prevalence of alcohol use during the last 30 days. The schoolchildren in the experimental group had lower alcohol use in comparison to the control group (OR 0.501; 95%CI 0.253-0.993). The moderation effect of gender showed that the program had an effect on alcohol consumption in boys. After completing Unplugged, alcohol consumption in boys decreased significantly (OR 3.222; 95%CI 1.158-8.962). The results also confirmed that smoking is related to the prevalence of alcohol use during the last 30 days (OR 3.109; 95% CI 1.226-7.885).

Conclusions

The findings confirmed that Unplugged reduced alcohol use among boys. It has been also shown that smoking is a significant predictor of alcohol use and drunkenness.

Key messages

The findings point to the role of gender differences in the effectiveness of a prevention program. The effectiveness of the preventive program is more pronounced for those schoolchildren who are more likely to use alcohol before the program, especially boys.
Effects of educational policy on unhappiness of middle and high school students in Korea, 2006-2016
Authors: Eun S J , Kim H-S
Published: November 2019

Background

Educational policies may have a substantial impact on health and well-being of students, who spend most of their daily lives at school. Policies on secondary education in Korea has changed in the late 2000s, which diversified college entrance exams (CEEs) and made the National Curriculum (NC) more autonomous to mitigate students’ burden of preparing for CEEs. This study aimed to estimate effects of educational policy changes on unhappiness, which is known to be associated with health status such as mortality, morbidity, and prognosis, of students in secondary education.

Methods

Using repeated cross-sectional self-reported data of 773,362 students in the Korea Youth Risk Behavior Web-based Survey during 2006-2016, cross-classified random effects models were fitted to estimate the fixed cohort effects of educational policy changes on unhappiness while considering individual factors and random effects of periods and grade cohorts.

Results

Students’ unhappiness increased when the NC began to become autonomous (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.03-1.42), but it increased less after the autonomous NC was fully applied (OR 1.14, 95% CI 0.92-1.42). Two times of diversification of CEEs increased unhappiness (OR 1.21, 95% CI 1.06-1.38 for the first diversification and OR 1.33, 95% CI 1.07-1.67 for the second diversification). Unhappiness was high in students with high stress level (OR 7.59, 95% CI 7.43-7.75), low academic performance (OR 1.48, 95% CI 1.44-1.52), and low household economic status (OR 2.32, 95% CI 2.26-2.39).

Conclusions

Enhancement of autonomy of the NC and diversification of CEEs increased students’ unhappiness. Educational policy changes that diversified competencies required for college admission might result in an increase in academic burden in the context of Korea, where entrance into prestigious universities is crucial for success in life. Improvement of educational policy is needed to increase students’ happiness.

Key messages

Educational policies may have a substantial impact on health and well-being of students, who spend most of their daily lives at school. Education policy changes in Korea increased students’ unhappiness, which might be due to an increase in academic burden resulted from diversification of competencies required for college admission.
Risks and success conditions for the French sanitary service of health students
Authors: Gerbaud L , Pizon F , Odoul J , Clavelou P
Published: November 2019

Background

French sanitary service of health students was a pledge of the French Presidency. It is mainly presented as a massive information campaign on good practices in health made by “thousands of health students going into the enterprises and schools”. We tried to skip this orientation and to go to actions in favor of people’s empowerment and ability in health choices.

Objectives

Our program was designed to change students’ ideas on prevention, by focusing on reflexivity, motivational approaches, education and ethic in health promotion, of peer-to-peer effects and concrete use of educational tools for teen-agers groups. We developed students’ autonomy and ability to negotiate their project with the prevention structures. Training was 11 workshops (2 hours each), of 15 to 20 students (mixing medical, pharmaceutical, dental and midwives), and e-learning. Then they had 5 months to negotiate with their place of intervention (secondary schools and apprenticeship centers) and create their own new project. Intervention lasted for one week, full time, in various teen-agers settings, so that to reduce social and territorial inequities in health.

Results

After a first test (28 students in 6 settings), 250 students acted in 72 teen-agers’ facilities. Problem occurs in 1 case (lack of negotiation and preparation before the intervention) and satisfaction of both students and facilities are high. At the same times, we had to face constraints due to double bind policies of the state authorities (i.e. as asking for more training time and reducing training financing, asking to send students in deprived or isolated areas and reimbursing scarcely the costs).

Conclusions

An educational program on training and students’ autonomy works if we take care on five points: learning of educational process in health, control of peer-to-peer effects, reduction of health inequities, and reinforcement of local health promotion policies. This also needs state policies that are ready to play the game.

Key messages

Training of health students to develop their autonomy and ability in health education works. Inconsistency in State policies is the major problem.
The trends in health behaviour of the first-year students from Kaunas universities, 2000 - 2017
Authors: Petkeviciene J , Kriaucioniene V
Published: November 2019

Background

First-year university students are exposed to different factors affecting their lifestyle. The aim of the study was to evaluate the trends in health behaviour of first-year students from four Kaunas universities over 17 years.

Methods

The study was carried out in 2000, 2010 and 2017. In total, 689, 739 and 1062 randomly selected first-year students participated (response rates >90%). During the lectures, participants filled in the anonymous questionnaire that included information on nutrition, physical activity, harmful habits, height, and weight.

Results

The reduction in daily smoking was observed: from 30.2% in 2000 to 18.4% in 2017 among males and from 21.1% to 15.9% among females, respectively. The proportion of male students drinking alcohol at least once a week declined from 62.7% in 2000 to 31.6% in 2017 and the proportion of females - from 41.5% to 27.3%, respectively. There was an increase in the proportion of students who have tried or are taking drugs: from 15.9% in 2000 to 27.8% in 2017 among males and from 4.8% to 18.8% among females, respectively. The changes in the nutrition habits of the students were observed: the proportion of students who consumed red meat every day decreased (up to 35.6% in 2017). In 2017, more students consumed cereals, fresh fruits and vegetables every day and fewer sweets, confectionery and soft drinks at least once a week than in 2000. There was a decline in meantime students spent sitting as well as in the average duration of the sleep. The proportion of students who take part in sports activities has increased by 17.1%. However, the prevalence of overweight and obesity increased from 11.7% in 2000 to 23.7% in 2017 among males, and from 4.2% to 9.0% among females, respectively.

Conclusions

Over 17 years, most health behaviours of the first-year students have changed in a positive direction; however, some unhealthy habits are still common and the prevalence of overweight has increased.

Key messages

This study highlights the importance of implementing preventive programmes among students after starting university. Monitoring of changes in health behaviour of students helps timely respond to the challenges.
Presence of intimate family and cancer screening behavior: a cross-sectional study of 4237 workers
Authors: Miyamatsu N , Shima A , Morino A , Azuma S , Ichikawa M , Godai K , Kawatsu Y , Nishikawa T , Tanaka H , Okamura T
Published: November 2019

Background

Presence of intimate family is considered as one of the related factors of health behaviors. The study aim was to clarify the relationship between the presence of significant others and having a colorectal cancer screening.

Methods

This study used data of baseline survey of intervention study regarding breast cancer screening at worksites. A total of 6827 workers, aged 40 and over of the retail company, were required to fill out a self-administrated questionnaire related to cancer screening. the intimate family was defined as a person’s spouse or partner and children. Logistic regression analyses were performed to estimate odds ratios [ORs] and 95% confidence intervals [CIs] of undergoing an annual screening for colorectal cancer by the presence of spouse or partner adjusting for age. The same analysis was performed regarding the presence of children.

Results

Response rates were 70% in men and 71% in women. After excluding participants with a past history of cancer and lack of information about colorectal cancer screening or the presence of significant others, 4203 remained for the analyses. A total of 1777 participants reported that they had undergone screening for colorectal cancer within a year (42% in men and 42% in women). Screening rates of participants with/without a spouse were 45% and 30% in men, 44% and 38% in women. Screening rates of participants with/without children were 45% and 33% in men, 43% and 38% in women. ORs of undergoing annual colorectal cancer screening by the presence of spouse were 1.8 (1.3-2.5) in men and 1.3 (1.1-1.5) in women. ORs by the presence of children were 1.6 (1.2-2.1) in men and 1.1 (0.9-1.3) in women.

Conclusions

This study indicated that health behavior in cancer screening could be affected by having a spouse in both men and women. The presence of children positively related in men. Male workers with children might be under some pressure to keep their health, from a sense of responsibility of main income earner.

Key messages

Health behavior in cancer screening could be affected by having a spouse. Health behavior in cancer screening could be affected by having a child only in men.
Monitoring measles outbreaks using emergency department data in France
Authors: Noel G , Franke F , Forgeot C , Piarroux J , Viudes G , Caserio-Schönemann C
Published: November 2019

Background

Measles’ outbreaks still occur in industrialised countries and reactive monitoring of the disease is needed. In France, measles’ monitoring is based on a mandatory notification (MN).

Methods

In France, for each emergency department (ED) visit, an Electronic ED Abstract (EEDA) is transmitted to the OSCOUR® network included in national Syndromic Surveillance System. EEDA include the diagnosis at discharge using International Classification of Disease (ICD-10). This study aims to evaluate the correlation between the number of measles MN and the number of ED visits related to measles and to calculate the positive predictive value (PPV) of diagnosis at discharge of measles in ED. The study period covered the third wave of the 2008-2011 French outbreak. From 2010 to 2011, we analyzed EEDA transmitted from 32/53 ED of the PACA region and regional measles MN. Using weekly aggregated data, the correlation between the number of measles cases given by both MN and ED sources was assessed (Pearson coefficient). In the 4 ED (2 pediatric) of the teaching hospital of Marseille, electronic medical files coded as measles were reviewed to evaluate the PPV of the diagnosis coded according to the national MN case definition (gold standard).

Results

2,949 MN were transmitted and 1,306/1.3 million visits in ED were coded as measles. The peak of the outbreak was reported the same week by EEDA and MN. The correlation between EEDA and MN was strong (0.91; p < 0.001). Hospitalization rate was 20.7% and 21.0% according to EEDA and MN (p = 0.81). Among 363 medical files coded as measles in the 4 ED, 14 cases (3.9%) did not fulfilled the national case definition (PPV: 96.1 [IC95%: 94.2-98.1]), 86 (23.7%) fulfilled criteria for “clinical case” and 263 (72.5%) for “confirmed case".

Conclusions

Most of the time, ED visits coded as measles fulfilled diagnosis criteria. Our results suggested that EEDA (better reactivity) could be complementary to MN (better completeness) to monitor measles.

Key messages

Most of the time, ED visits coded as measles fulfilled diagnosis criteria: PPV of coded medical diagnosis in ED for measles is high. Reactivity of ED data monitoring could usefully complete mandatory notification for measles surveillance.
Prevalence and risk factors of hepatitis B in Tunisia
Authors: Lahchaichi A , Hadj M Ben , Bouguerra H , Talmoudi K , Bahrini A , Bahri O , Letaief H , Hazgui O , Hannachi N , Bouafif N Ben Alaya
Published: November 2019

Background

Hepatitis B virus (HBV) infection is a major public health problem. Data related to epidemiology, distributions and outcomes of VHB infections in Tunisia remains scarce. This work aimed to study the prevalence of HBV infections and their distribution as well as the main risk factors associated to HBV infection.

Methods

Our study was a cross-sectional household- based study carried out among a representative sample of 22 275 from January 2014 to December 2015. Sampling was based on the National Census of 2014. For data collection, questionnaires were administrated by trained investigator and blood samples were sent to the Reference laboratory for analysis of HBV markers.

Results

Among 21720 surveyed subjects, 19663 subjects had a laboratory tests and the serological results reached to 19155. Overall prevalence of HBs Ag was 1.7% [1.6-1.9]. Prevalence of HBsAg was significantly higher in men (2.1% against 1.4%; p < 10-3), in age group more than 20 years (2.1% against 0.1% p ≪10-3) and in the Central region (2.3%; p < 10-3). Among the associated risk factors in univariate analysis were chronic dialysis, dental care, surgical intervention, hospitalization, traditional circumcision, scarification and multiple sexual partners. Multivariate analysis showed that male gender, age over 20 years, center and south regions, hospital follow-up of a chronic pathology and having a family member chronic carrier of HBs Ag were the associated risk factors of HBV infection and vaccination was the only protective factor.

Conclusions

Our study allowed to have a clear estimate of the national prevalence of HBsAg and to classify Tunisia as a country of low endemicity of Hepatitis B. This decline is mainly due to the introduction of vaccination since 1995 and the improvement of the health system. However, more efforts should be paid to reduce nosocomial transmission and traditional high-risk behaviors.

Key messages

Tunisia has become a country of low endemicity for hepatitis B. This was a result to the introduction of vaccination since 1995.
Human papillomavirus infections and cervical cancer screening in Tunisian women
Authors: Bouguerra H , Hechaichi A , Letaief H , Ardhaoui M , Ennaiefer E , Bougatef S , Chahed K , Mechala M , Boubaker S , Alaya N Ben
Published: November 2019

Background

Human papillomavirus (HPV) infections are a significant public health problem with global estimations over 520 000 new cases and 274 000 deaths due to cervical cancer. In Tunisia, cervical cancer is the third cause of cancer in women but only a few prevalence studies conducted in specific populations are available. The present study aims to estimate the national prevalence of HPV infection and cervical cancer testing among Tunisian women.

Methods

We conducted a population-based cross-sectional study in 2014. We included all sexually active women aged 18 years and older, present in primary health care centers the day of the study. Data collection was based on a standardized questionnaire including socio-demographic data, high-risk behaviors and previous cervical screening. HPV detection and typing was only done for betaglobin positive PCR-test. Ethical considerations were respected.

Results

The total number of surveyed women was 1494 and the overall prevalence of HPV infection was 7.5% IC95% [5.9%-9.0%]. The most common genotypes were HPV6 (21.9%) and HPV16 (11.5%). Prevalence of high-risk HPV was higher than low-risk HPV; 4.8% IC95% [3.7%-6.2%] and 3.8% IC95% [2.8%-4.8%] respectively. The prevalence of previous cervical screening was 36.6% (95% CI [34.3%-39.2%]). This rate was significantly associated with age (p < 10-3); from 13.9% among those <30 years to 49.3% among those ≥ 50 years.

Conclusions

Our survey provides an important overview of the current situation of HPV infection among Tunisian women. National prevalence of HPV infection was 7.5% but only 36.6% of women had a previous cervical cancer screening. This coverage remains poor, thus the need of targeted education and encouraging strategies to reduce cervical cancer burden in Tunisia.

Key messages

National prevalence of HPV infection is not negligeable in Tunisia, especially high risk HPV infections. Cervical screening is still low among Tunisian women, hence the need for education targeted to this population.
Welfare state impact on mental wellbeing of the oldest old in Europe: A multilevel survey data study
Authors: Kalseth J
Published: November 2019

Background

Improving the health and wellbeing of the oldest old population is a key public health policy concern considering the rapid aging of the world’s population. The purpose of this study was to investigate the impact of the welfare state on different aspects of mental wellbeing of the oldest old population in Europe. Several approaches to measure welfare state types were compared.

Methods

The study used individual level data from Round 6 of the European Social Survey to measure six dimensions of mental wellbeing among the 80+ population including countries belonging to the European Union or European Economic Area. Welfare state types were measured using one welfare state- and three elderly care regime typologies, as well as three welfare state dimensions based on factor analyses of several welfare state characteristics. Welfare state impact on mental wellbeing was analysed by multilevel regression analyses, controlling for age and gender.

Results

The preliminary results show that universalistic and service-based regimes, as e.g. Nordic countries, are associated with higher level of subjective wellbeing and social trust, but not psychological wellbeing, compared to family-based regimes with low formal support. East Europe have lower scores on all dimensions compared to Nordic countries. The welfare state dimension capturing prioritisation of health and social services and gender equality is positively associated with all wellbeing aspects, whereas the factors capturing labour market participation of seniors and income equality respectively, are only significantly associated with subjective wellbeing and social trust.

Conclusions

The result point to caring approaches with high level of formal support and gender equalisation as key to enhance all aspects of mental wellbeing for the oldest old. Stimulating long duration of working life and reducing income inequalities have the potential to increase life satisfaction and happiness and social trust.

Key messages

Welfare state matter for the mental wellbeing in the oldest old population. General measures, supporting formal care, labour market participation and income and gender equality will also benefit the oldest old.
Development of a barometer to display and monitor health and wellbeing on the neighborhood level
Authors: Hilger-Kolb J , Röhrbein H , Kairies H , Heinrich K , Hoffmann K
Published: November 2019

Background

Neighborhoods and their characteristics play a key role for establishing and maintaining health and wellbeing of their residents. However, before programs promoting health and wellbeing in the neighborhood can be planned and implemented, it is necessary to identify local needs for action. This is especially important for the stakeholders that work in the neighborhood (e.g., employees of the local community, headmasters of schools). We thus developed exemplary for Herzogenried -a neighborhood in the German city of Mannheim- a barometer that aims to assess and monitor health and wellbeing in the neighborhood and indicates potential needs for action.

Methods

We conducted a detailed literature search to identify indicators that were associated with health and wellbeing in neighborhoods. Based on the search we created a primary list of indicators, which we presented and discussed during 15 meetings with a total of 26 different stakeholders. Available data on the indicators agreed on were checked for accuracy, statistically processed, and visualized for incorporation into the barometer.

Results

The barometer consists of the following eight dimensions which in total include 80 indicators: population structure, population development, household structure, material wellbeing, education, family and upbringing, health, and personal security. The barometer also includes a map that displays structural characteristics of the neighborhood such as physicians, schools, supermarkets. An important challenge we faced was the availability of indicators as some of them were only accessible at the community level or for specific age groups.

Conclusions

The barometer offers a comprehensive overview on the neighborhood, provides first hints for the local stakeholders on needs for action, and helps to prioritize the issues that should be addressed to promote health and wellbeing in Herzogenried. It will also serve as a prototype for other neighborhoods in the future.

Key messages

The barometer was planned to serve as a transferable tool to identify and prioritize action steps for neighborhood development and to help promoting health and wellbeing of their residents. As the barometer displays indicators relevant for various community stakeholders it can serve to identify joint goals and thus foster stronger trans-sectoral collaboration at the neighborhood level.
The use of digital devices in the field of healthcare in Bulgaria
Authors: Kilova K , Milkov D , Mateva N
Published: November 2019

Background

The opportunities that information and communication technologies provide in the field of healthcare are many and constantly growing. Thanks to them, consumers have access to health information, consultations and remote treatment and connection with medical centers. They help to improve health promotion activities, whose mission is to promote health as a core value. The aim of the present study is to explore the attitudes regarding the use of digital devices in the field of healthcare of Bulgarian population.

Methods

A direct anonymous survey was conducted among 356 respondents, randomly selected and with an average age of 38.26 ± 0.15 (110 men and 246 women). The study was conducted from October 2018 to April 2019. The data analysis was performed using the statistical software SPSS v.23.0.

Results

The results showed that 78.9% of respondents have used or are willing to use digital devices to search for and record health information. A statistical gender difference was found in the answer to the question of using a digital device for self-registration of information (χ2 = 28.6, P < 0.05), as women are more likely to do so. More than 75% of respondents are willing to share health information with a medical professional in real-time via the internet. Older people are more reserved and hesitant about providing health information to a state agency (66.7%). The smartphone and computer/laptop are among the most preferred digital modalities in the healthcare field, with men and younger respondents more likely to use digital devices in relation to their health (χ2=39.9, P < 0.05). Women are more critical about the use of information and communication technologies in healthcare (χ2=48.2, P < 0.05).

Conclusions

The present study found a positive attitude among all respondents towards the introduction of modern technologies in the healthcare field and the opportunity of remote contact with medical professionals, using personal digital devices.

Key messages

The opportunities that information and communication technologies provide in the field of healthcare are many and constantly growing. The aim of the present study is to explore the attitudes regarding the use of digital devices in the field of healthcare of Bulgarian population.
Parents and health professionals’ opinions on information tools on mandatory childhood vaccines
Authors: Hennequin C H , Vergelys C V , Chauvet L C , Cortaredona S C , Dube E D , Verger P V
Published: November 2019

Background

South-eastern France is marked by insufficient vaccination coverage for several vaccines and some mistrust of its population towards vaccination. In this context and given the application of new vaccination obligations for early childhood, we carried out a qualitative survey to study opinions of parents and health professionals (HPs) on information tools on vaccination (ITV).

Methods

An inventory of French existing ITV was conducted to select a diverse set of 17 ITV for our qualitative evaluation. In 2018, we carried out 26 individual interviews with parents of young children (recruited in nurseries and kindergartens) and 5 focus groups with HPs (nurses, general practitioners, midwives and pediatricians; n = 33).

Results

Most parents appreciated videos for their convenience: they used them to discover new/complex subjects in an entertaining way. Paper ITV remained essential mostly among parents with high socio-economic status (SES) or marked vaccine hesitancy, who also requested detailed information and scientific sources. Some parents of low SES considered ITV difficult to understand because of their length, quantity of information and scientific language. For HPs, giving their patients a paper ITV is a way to show the importance they attach to their patient’s questions. HPs reported reluctance using videos during consultations. Some HPs stated their need for guidance on two aspects: 1) key discussion points to use when giving an ITV to parents and 2) most appropriate timing to give ITVs: prescription, injection…

Conclusions

In the pool of tested ITV, articulation and formatting of arguments are not always optimal for HP and parents use. Tailored ITV should be available for the different needs of HP and parents, especially, for the latter, according to their SES and hesitancy profiles. ITV adapted to use during consultation are necessary.

Key messages

Information tools on vaccination (ITV) are not always optimal for HP and parents use. ITV should be tested and better adapted to the patient profile and consultation context.
How often do partial disability pensioners end up on a full disability pension?
Authors: Polvinen A , Laaksonen M
Published: November 2019

Background

Extending working lives and deferring retirement have been important topics of discussion in recent years. Full disability pensioners seldom work, but most partial disability pensioners continuing working while receiving a pension. However, very little is known about how often partial disability pensioners end up on a full disability pension. The aims of this study were to investigate to what degree partial disability pensions become full disability pensions, and how age, gender, marital status, education, unemployment or a disability diagnosis are associated with that.

Methods

The register data included 2,969 Finns who were aged 18-59 years and whose partial disability retirement started in 2010. The follow-up period ranged from 2010 to the end of 2015. Cox models were used to estimate hazard ratios for full disability retirement.

Results

Approximately 40 per cent of the partial disability pensioners ended up on a full disability pension during the follow-up period. Partial disability pensioners who were older, had a lower educational level or a history of unemployment, or who suffered from mental disorders ended up on a full disability pension more often than others. The risk of full disability retirement was 1.5-fold among those with mental disorders compared to those with musculoskeletal diseases.

Conclusions

Partial disability pensioners with a low education, a history of unemployment or who suffer from mental disorders experience a higher risk of ending up on a full disability pension. More focus should be paid to improving education, preventing mental health problems and unemployment in order to help the disabled work longer.

Key messages

Preventing partial disability pensioners from ending up on a full disability pension can extend their working lives. Partial disability pensioners with a low education, a history of unemployment or poor mental health more often stop working altogether. More focus should be paid to improving these issues.
Effect of smoking behaviour before and during pregnancy on Low head circumference at birth
Authors: Kharkova O , Odland J
Published: November 2019

Background

Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on low birth weight, the influence of maternal smoking on low head circumference at birth is not well documented. The aim of the study was to assess an effect of smoking behavior before and during pregnancy on low head circumference at birth.

Methods

The study is based on the Murmansk County Birth registry. Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. Low head circumference was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain.

Results

A dose-response relationship was evident between the number of cigarettes smoked per day during pregnancy and the odds of low head circumference at birth (adjusted OR1-5 cig/day = 1.69 with 95% CI: 1.31-2.19; OR6-10 cig/day = 2.08 with 95% CI: 1.63-2.65; and OR ≥ 11 cig/day = 5.19 with 95% CI: 3.89-6.92). Compared to non-smokers, quitting smoking during the first trimester of pregnancy had no significant effect on low head circumference at birth (adjusted ORquitters = 1.04 with 95% CI: 0.80-1.34).

Conclusions

Despite dose-response relationship was observed between maternal smoking and low head circumference at birth, women who stopped smoking during the first trimester were at no higher risk of having a baby with the low head circumference as compared to non-smokers. Our findings underline a continued need for actions against maternal smoking.

Key messages

women who stopped smoking during the first trimester were at no higher risk of having a baby with the low head circumference as compared to non-smokers. A dose-response relationship was evident between the number of cigarettes smoked per day during pregnancy and the odds of low head circumference at birth.
Neighborhood disparities in stroke and socioeconomic, urban-rural factors using stroke registry
Authors: Padilla C , Grimaud O , Nowak E , Timsit S
Published: November 2019

Introduction

Despite major improvements in management over recent decades, stroke remains a devastating disease in Europe and geographic disparities persist. Determining the spatial distribution of stroke may be useful for both epidemiological research and health services planning. The aim of this study was to estimate stroke incidence rates in Pays de Brest (Western France) and to explore the presence of geographic clusters associated with socioeconomic and urban-rural characteristics.

Methods

The study included incidence stroke cases aged 60 years and more from the Stroke Brest registry for the period 2008 to 2013 aggregated at the census block level. Poisson and negative binomial regression models were used to explore determinants of disease risk. Geographically weighted regression (GWR) was used to allow estimation of local regression coefficients.

Results

Between 2008 and 2013, 3088 cases aged 60 years were identified in Pays de Brest. The incidence of stroke was 6.67 per 1 000 inhabitants. Living in a rural neighborhood with a higher level of blue collar and of farmer was associated with higher age adjusted stroke incidence rate ratio (IRR) 1.23, [95%CI 1.09-1.39]. Higher risk was also found in a city center neighborhood with a higher level of blue [IRR 1.22, 95%CI 1.04-1.49]. Local Poisson GWR models achieved the best fit and suggested evidence of spatially varying regression coefficients and clusters of higher incidence.

Conclusions

Our study contributes to a better understanding of the relationship between stroke risks and contextual characteristics such as socioeconomic circumstances and urban rural setting. This will help targeting areas for specific public health prevention.

Key messages

Variations of stroke were marked according to socioeconomic and urban-rural setting of the living area. This study will help targeting areas for specific public health prevention.