bluuebunny/crossref_metadata_2025 huggingface dataset:
Do we practice what we preach? Assessing the food environment in Malta’s only state hospital
Authors: Cuschieri S , Cauchi D
Published: November 2019

Introduction

Food environments are likely to be key contributors to the development of diabetes and obesity. Hospitals should strive to create a model food environment that facilitates and promotes a healthy eating behaviour among visitors, patients and staff. The study objective was to evaluate foods and beverages available for purchase in vending machines at Malta’s only state hospital.

Methods

An observational study gathered data regarding location, type of food and beverage items available in the vending machines found within the public areas within the only state hospital in Malta. All items on sale were categorized into ’healthy’ and ’unhealthy’ food and beverage according to pre-defined criteria.

Results

There were 33 vending machines: sixteen offered beverage options, and the remainder contained food items, which displayed exclusively confectionary items. The beverage machines were identically stocked so that bottled water contributed 17%, diet soft drinks 33% and regular soft drinks 50% of overall beverage choices. Fresh vegetables or fruit were not available for sale (except for 1 beverage machine offering fresh squeezed orange juice) with most items on display classified as ‘unhealthy’.

Conclusions

Hospital food environments should complement health professionals’ efforts in promoting healthier lifestyles, however, the majority of foods and beverages available for purchase at Malta’s only state hospital through vending machines is unhealthy. Urgent action is required to rectify the current situation.

Key messages

Vending machines offered ’unhealthy’ choices to patients, relatives and staff. Hospital food environment should promote healthier food and beverage options.
Situations in which mothers experience difficulty stimulating healthy EBRB in school-aged children
Authors: Ruiter E L M , Fransen G A J , Molleman G R M , Hoeijmakers M J H M , van der Velden K , Engels R C M E
Published: November 2019

Background

Parental support is an important element in overweight prevention programs for children. The purpose of this study was to examine everyday life situations in which mothers encounter difficulties encouraging healthy energy balance-related behavior in their school-age children.

Methods

We formed four focus groups containing 6-9 participants each. The participants were mothers of Dutch, Turkish, or Moroccan descent with a child 8-13 years of age. All focus group sessions were recorded, transcribed, and coded. Content was analyzed conventionally using ATLAS.ti 6.

Results

Twenty-seven difficult everyday life situations were identified in 14 settings. The five most frequently reported situations were a daily struggle regarding eating vegetables, eating breakfast on time before going to school, eating candy and snacks between meals, and spending excessive time watching television and using the computer. A perceived loss of parental control, the inability to establish rules and the failure to consistently enforce those rules were the most commonly cited reasons for why the mothers experience these situations as being difficult.

Conclusions

We identified five difficult everyday life situations related to healthy energy balance-related behavior. These five difficult situations were used as the input for developing a web-based parenting program designed to prevent children from becoming overweight. We reasoned that if we use these situations and the underlying reasons, many parents would recognize these situations and are willing to learn how to deal with them and complete the e-learning.

Key messages

The identified everyday-life-situations in which mothers experience difficulty stimulating healthy EBRBs in their children age 8-13 were used as input for our e-learning program to prevent overweight. Mothers who live in low-SES neighborhoods were easily willing to participate in focus groups and discuss EBRB-related topics.
Visual information on labels in commercial baby foods on Bulgarian market
Authors: Rangelova L , Partzova A
Published: November 2019

Background

Production and sale of commercial baby foods in Bulgaria has grown in the last years. The evidence suggests that inappropriate promotion and advertising of commercial complementary foods can affect unfavourably child nutrition. The World Health Assembly has urged all Member States to “end inappropriate promotion of foods for infants and young children”.

Methods

The survey is part of WHO Regional Office for Europe project: Commercial foods for infants and young children in the WHO European Region. The data was collected in November 2017 in two districts in Sofia, Bulgaria using the mobile questionnaire, developed by WHO. The presence on various types of visual information on the package was recorded for 771 products on the market.

Results

The results reviled that 94.4% of the labels of baby foods on the market in the capital of Bulgaria - Sofia, use the pictures of ingredients and 52.9% - the cartoon images. The use of images of infants and young children presented in 8.7 % of the products and 6.9% of them marketed as suitable for babies under six months old, in violation of the International Code of Marketing of Breastmilk Substitutes. 0.4 % of baby foods use images of mothers in the labels. The “other” visual information related to various claims including “quality”, “bio” (i.e. organic) and various other nutrition and health claims.

Conclusions

There is inappropriate promotion of commercial complementary foods on Bulgarian market.

Key messages

Special measures, including legislative to limit inappropriate practices for the advertising of foods for infants and young children, are needed. Raising the parents’ awareness of the criteria for selecting commercial complementary foods is necessary.
Food “from the Outside” and Correct Nutrition for Outpatients
Authors: Tur-Sinai A , Bisharat B , Zelber-Gagi S
Published: November 2019

Background

It is a common custom to visit patients in hospital. Visitors often bring along outside food products, including some that may not be recommended for the patient. Even so, neither the Ministry of Health nor the hospitals have explicit guidelines in place as to what people can and cannot bring their inpatient friends or kin. The study deals with three main questions: What are the patterns of spending on outside food products for inpatients? What are the types of food products brought for inpatients? How medical professionals view the matter?

Methods

This quantitative study uses three closed-structured-questionnaire surveys-among visitors, inpatients, and medical staff. Thematic analysis of the findings yields patterns of spending on outside food products for inpatients, the types of food products brought, awareness of the health implications of consuming these products, patterns of consumption among inpatients, and how medical professionals view the matter.

Results

There are five major findings: (a) Most expenditure on outside food for inpatients occurs in the first few days of hospitalization. (b) Most food brought to inpatients is not defined as healthy. (c) There is a gap between visitors’ awareness of the health implications of bringing food to inpatients and their actual conduct. (d) Most patients realize that the food brought to them is bad for their health but tend to eat it anyway. (e) Medical staff disapproves of bringing food to inpatients.

Conclusions

Information on the extent of bringing food to inpatients, and the types and nature of what is brought, sheds light on the question of food security among inpatients, with emphasis on the motive behind the (in)correct nutrition. Information about the attitudes of patients, visitors, and medical staff toward the need to continue bringing food sheds light on questions of equality and social justice in inpatient care.

Key messages

Healthcare services should be more aware of assuring inpatients’ right to correct nutrition in the senses of reducing inpatients’ exposure to externalities that may impede their convalescence. Healthcare services should be more mindful of the advantages of using the egalitarian nutrition system that hospitals operate for all patients.
Effect of lifestyle on blood pressure in Portuguese population under antihypertensive drugs
Authors: Salvador M R , Gonçalves S C , Romana G Q , Nunes B , Kislaya I , Dias C M , Rodrigues A P
Published: November 2019

Background

Hypertension is one of the main risk factors for disability and death from cardiovascular diseases. Current guidelines include initiatives to control blood pressure values in hypertensive patients that focus on lifestyle changes. The main objective of this study was to estimate the association between lifestyle and blood pressure in patients under antihypertensive drugs.

Methods

An analysis of the data of Portuguese Health Examination Survey (INSEF) was performed. Individuals who met INSEF inclusion criteria and who referred to be under antihypertensive drugs in the two weeks prior to the questionnaire were studied. Lifestyle variables (alcohol consumption, smoking, additional salt intake, fruit and vegetables consumption, practice of physical activity) were measured by questionnaire, and blood pressure values were obtained by physical examination. Associations between lifestyle factors and blood pressure, stratified by sex and adjusted to sociodemographic variables and to obesity, were estimated through a multiple linear regression model.

Results

Alcohol consumption (ß=6.31, p = 0.007) and smoking (ß=4.72, p = 0.018) were associated with systolic blood pressure in men. Additional salt intake, fruit and vegetable consumption, and practice of physical activity were not associated with blood pressure in men. In women, no association was observed for any behavioural variable.

Conclusions

These conclusions reinforce the need, also in the population under antihypertensive drugs, particularly in the male sex, to focus the fight against high systolic blood pressure in these two modifiable and preventable behaviours: smoking and alcoholic consumption.

Key messages

Alcohol consumption and smoking are the behavioral determinants associated with high systolic blood pressure values in men under antihypertensive drugs. These conclusions reinforce the need to focus the fight against high systolic blood pressure in the preventable and modifiable behavioural determinants.
Drinking water quality: results from the data analysis in Lombardy region
Authors: Rivolta S , Diurno G , Ammoni E , Castaldi S , Gramegna M
Published: November 2019

Background

Ensuring access to safe and quality drinking water is an essential aspect of public health, as well as a fundamental human right as an extension of the right to life affirmed by the Universal Declaration of Human Rights. Previously in Lombardy, the reporting of water sampling control activities was prepared only by the local health authorities (LHAs). Recently, however, the activation of a data centralization information system allows the monitoring of the whole regional territory and the elaboration of a periodic report.

Methods

The data relating to the analytical checks on drinking water in the Lombardy Region were extracted from the regional database for 2014, 2015 and 2016 and grouped by ’Chemical’, ’Microbiological’ and ’Indicators’ parameters.

The analysis focused on the number and analytical compliance of all the samples performed. All the results considered both the overall regional data and each LHA.

Results

From a quantitative point of view, the activity of entering the sampling data seems to progressively improve, remaining rather heterogeneous among the various LHAs.

From a qualitative point of view drinking water in Lombardy is to be considered good overall: both the chemical and microbiological non-compliant samples in Lombardy are lower than 10% for the years 2014 and 2015 and lower than 5% in 2016 thus indicating an apparently improving trend.

Conclusions

For a better evaluation of the numerical appropriateness of the controls carried out, an update of the registry system of the supply areas and a more uniform LHA programming is necessary.

For a better assessment of the quality of water destined for human consumption oriented to the conformity of parameters, it is necessary to adopt an analytical judgment system on individual parameters instead of on the entire sample. A further improvement will be the inclusion in the database of the data of the aqueduct managers included in the Water Safety Plans (WSPs).

Key messages

Water quality assessment and its control activity reporting is an essential aspect in public health prevention. It is essential to strive for continuous improvement in the data collection method to better monitor potential risks and to evaluate the best future safe water supply strategies.
Knowledge and Attitude towards the Gradual Reduction of Salt in Bread – an Online Survey
Authors: Costa A , Costa L , Santos J , Braz P , Santos M , Brazão R , Lopes I , Guerreiro A , Alves J , Caldas de Almeida T
Published: November 2019

Background

Bread is one of the main sources of salt intake in Portugal. Based on this evidence, a protocol signed between national Health Sector and the Associations of Industrial Bakeries, in 2017, established gradually decrease salt in bread until 2021. This measure also targets schools’ available bread, this should not exceed 1g salt, to end of 2018. A pilot Health Impact Assessment (HIA) aims to assess the potential impact on salt reduction in bread on the eating habits of children (6-18 years) and their families.

Methods

A questionnaire is being performed to assess the effect of this measure. The first version was designed by a panel of 11 experts (content validity), following the plain text principles. A external specialist revised it for facial validity. A pilot was tested. Thereafter, a REDCap online survey of “Knowledge and Attitude towards the Gradual Reduction of Salt in Bread” questionnaire was finalized. The target group is the parents or guardians of children and young persons, of School Clusters in the south of Portugal.

Results

Final online survey totalizes 33 items, divided into four blocks: 1.Knowledge and General literacy data, 2.Domestic Consumption, 3.Scholar consumption and 4.Sociodemographic. An adult responsible for the child/young person should answer the survey. Access is possible through a REDCap link, using computers available in the School Cluster, or other manner suitable for the purpose.

Conclusions

This survey will contribute to the identification of modifiable behaviors related with salt intake. Such evidence may eventually provide the opportunity for new strategies in this area.

Key messages

Health Impact Assessment as a procedure to assess the effects of measures and policies on human health. Questionnaires are a rapid tool to access perceptions, attitudes and knowledge.
The psychometric properties of a short version of the General Self-Efficacy Scale: A Rasch analysis
Authors: Steigen A M S , Finbråten H S F , Kleppang A L K
Published: November 2019

Background

Self-efficacy is important in adolescence and is found to affect adolescents’ physical activity, risk-taking behaviour and health decisions. Self-efficacy describes a person’s belief in own coping abilities. Having good measures of self-efficacy may contribute to more valid knowledge about the potential role of self-efficacy as a health promoting factor in adolescents lives. Several scales measuring self-efficacy exists. One of these is the General Self-Efficacy Scale comprising 10-items. However, there exists several short versions of the scale. In a large cross-sectional study among adolescents in secondary schools in Norway, five of the items from the General Self-Efficacy Scale are used. The aim of this study is to examine the psychometric properties of this short version of the General Self-Efficacy Scale applying Rasch measurement theory.

Methods

This study is based on cross-sectional data from the Youth Data Survey. The data collection was carried out in lower and upper secondary schools in Norway during 2018. In total, 6646 adolescents responded to a web-based questionnaire. The data were analysed using the partial credit parameterization of the unidimensional Rasch model.

Results

Preliminary results indicated that the short version had acceptable reliability (person separation index: 0.78). However, the targeting could have been better (mean person location: 1.441). All items had ordered thresholds. One under-discriminating item and three over-discriminating items were identified. Three items displayed differential item functioning with regard to gender and one item displayed differential item functioning for school level.

Conclusions

Based on our preliminary findings this short version of the General Self-Efficacy Scale has the potential to measure self-efficacy among adolescents, but there are room for improvements. The scale has some shortcomings related to targeting and differential item functioning that needs to be further explored.

Key messages

The short version of the General Self-Efficacy Scale has the potential to measure self-efficacy in adolescents. The scale has some shortcomings that needs to be further judged.
Unexpected effect of smoking/drinking cessation among computed tomography lung screening consumers
Authors: Chen C-C , Wu W-C , Chan D-C
Published: November 2019

Background

Low-dose computed tomography (LDCT) screening is an innovated tool for lung cancer prevention. The findings of LDCT trials indicated that the screening could increase the motivation of smoking cessation for high-risk groups. However, none studies have investigated the associations between commercial LDCT lung screening and unhealthy behaviours among those customers.

Methods

We established a prospective observational study at a community hospital in Taiwan. In total, 1326 customers of the commercial LDCT lung screening without lung cancer history were recruited. At the day of screening, interviewers collected their baseline demographic information and smoking/drinking habits. Only 605 participants completed two follow-up surveys at the 3rd and 12th month. Screening findings were defined as ’normal’ if there were no nodules or only definitely benign nodules and as ’abnormal’ if any lung nodule or ground-glass opacity were found. We applied the generalised linear mixed model to estimate the effects of time and screening findings on daily smoking and weekly drinking.

Results

The rates of daily smoking (weekly drinking) decreased from 13.1% (15.5%), to 10.9% (12.9%) in the 3rd month, and 7.9% (12.4%) in the 12th month. The associations between abnormal screening findings and smoking (-0.25, 95% CI: -0.77,0.28) or drinking (0.13, 95% CI: -0.29, 0.56) cessation are not significant. The time effect on smoking cessation was persistent (-0.23 and -0.62 at the two periods, 95% CI: -0.39, -0.07 and -0.85. -.038), and the effect on stopping drinking was relatively small (-0.23 and -0.28 at the two periods, 95% CI: -0.43, -0.04 and -0.52, -0.04).

Conclusions Commercial LDCT screening would decrease the rates of smoking more than drinking among these consumers, and the abnormal finding was not further associated with cessations. It implies that commercial screenings may be beneficial for decreasing unhealthy behaviours as a teachable occasion.

Key messages

Commercial LDCT lung screening program may have benefits for decreasing smoking and even drinking behaviours among the non-specific high-risk population. It might be a good moment for health providers and practitioners to conduct cancer-related health education during commercial screening programs.
Quantitative Health Impact Assessment Methodology for Societal Initiatives: A Scoping Review
Authors: Reumers L M , Bekker M P M , Jansen M W J , Hilderink H B M , Ruwaard D
Published: November 2019

Background

Promoting health rather than treating disease is gaining popularity and promotion initiatives are increasingly situated in the societal domain. In this scoping review, the literature on quantitative health impact assessment (HIA) practice and methodology is explored in order to provide an overview of methods that have been used or proposed for estimating societal initiatives’ health outcomes.

Methods

Systematic searches were done in PubMed and Web of Science in order to identify relevant literature. A set of selection criteria ensured that studies held useful quantitative HIA methodology and a societal approach. Reference lists of all selected studies were then examined for other studies. After literature selection, quantifiable features of interest were recorded and general observations on the composition of the current literature were made.

Results

The literature selection process yielded 54 included studies, most of which focus on lifestyle-related determinants. Of different health outcome measurements, deaths (averted) was most frequently used, followed by life years and quality- and disability-adjusted life years. Equity is frequently mentioned, but not often estimated. Most studies made estimates based on simulation models, notably with Monte Carlo, Markov and system dynamics models (simulation period mean 46 years; median 50 years). Inputs for the models such as relative risks, transition probabilities and price elasticities were taken from census and register data, survey data, evidence from previous (scientific) studies and outcomes from stakeholder sessions.

Conclusions

HIA holds a wide range of practices with some overlap. Different methods’ strengths and weaknesses partly depend on the phenomenon of interest. Some policy types have standard approaches, but there is no one universal optimal method and therefore having a grasp of multiple methods is useful. Furthermore, estimating health effect distributions could make an important addition to HIA.

Key messages

Quantitative HIA can be conducted using various methodological bases and most studies use some form of simulation modelling. Different simulation methods are distinct, but do show some overlap. Quantitative HIA topics often relate to individual behaviour (micro-level proximal determinants). There is room for HIA method development for determinants with indirect connections to the individual.
Hospital contextual factors affecting the use of health technologies: a systematic review
Authors: Grossi A , Hoxhaj I , Gabutti I , Carini E , Pezzullo A M , Cacciatore P , Specchia M L , Cicchetti A , Boccia S , de Waure C
Published: November 2019

Background

Healthcare systems are facing great challenges due to increased share of aging population, growing health needs and economic restraints. To keep a high quality of assistance it is important to invest in health technologies (HTs) that have the potential of improving health outcomes. Even though a lot of guidance does exist on how HTs should be introduced, used and dismissed, there is a surprising gap in literature concerning the awareness of hospitals in the actual utilization of HTs, namely utilization in daily practice after formal adoption.

Methods

We performed a systematic literature review of qualitative and quantitative studies aimed at investigating hospital contextual factors that influence the actual utilization of HTs at hospital level. PubMed, Scopus, Web of Science, Econlit and Ovid were searched to retrieve studies published in English from 1st January 2010 to 31st May 2018.

Results

A total of 33 studies were included mostly addressing information and communication technologies (ICTs). Findings suggest that contextual factors that impact on actual utilization of HTs at hospital level are ascribable to four main families: financial factors, leadership styles, human resource management and hospital infrastructure. It emerges also that involving professionals at all levels and planning people’s work and competencies are major determinants of HTs actual utilization.

Conclusions

The evidence suggests that several contextual factors play a major role in HTs actual utilization at hospital level even though data are mostly referred to ICTs being the other HTs unexplored. Indeed, findings from this study suggest that numerous items should be evaluated when considering to use a new HTs at hospital level. Nevertheless, evidence regarding actual utilization of medical and surgical HTs is still lacking and future research is needed.

Key messages

Financial factors, leadership styles, human resource management, hospital infrastructure are relevant determinants of actual utilization of new HTs at hospital level. The evidence on contextual factors that influence actual utilization of HTs is mostly referred to ICTs and further research is indeed deserved.
Usefulness of the results of a surveillance program for uncompensated work-related diseases in France
Authors: Robert M , Fouquet A , Rivière S , Delezire P , Homère J , Garras L , Chatelot J
Published: November 2019

Background

French employees receive compensations for diseases officially recognized as professionnal disease. Reimbursment data are thus used to produce statistics. Such data do not integrate uncompensated work-related diseases (UUWRD) defined as likely to be of occupational origin but not recognized as well. In 2003, the National Public Health Agency implemented a surveillance program on UWRD. This program is a complement to the compensation system for occupational diseases.

This communication presents results UWRD program can provide.

Methods

Twice a year, a network of volunteer occupational physicians (OP) reports ill health and associated work exposures of employees. Employee sociodemographics are notified. In 2018, half of French regions are integrated in the program.

Prevalence rates are calculated for UWRD. Chi-squared tests are used to compare prevalence rates between groups. Multivariate logistic regressions are conducted to evaluate:1- risks to report UWRD between groups, 2- prevalence rates trends. Underreporting rates of UWRD are approximated using an indicator capturing differences between figures produced by UWRD program and the compensation system.

Results

Over the 2009-2014 period, women working in mass food retail were observed at higher risk to present musuculoskeletical disorders than women of other sectors (ORa = 2.0). Same results were noted for men (ORa = 1.3). In mass food retail, decreases in musculoskeletal disorder prevalence rates were reported. Estimated average annual change rates were of 7.0 % for women and 11.0% for men. In 2011, UWRD data highlighted that between half and three-quarter of work-related musculoskeletal disorders were unreported by the compensation system.

Conclusions

UWRD data are used to identify vulnerable groups, analyse temporal trends and evaluate underreporting of professionnal disease.

Key messages

URWD program is a complement to the compensation system and let to better monitor health status of communities. Such informations are of interest to guide prevention policies.
Longitudinal analysis of work-family conflict and self-rated health among working parents in Germany
Authors: Borgmann L S , Rattay P , Lampert T
Published: November 2019

In the wake of a rising labor market participation of women and changing and family arrangements, parents are increasingly faced with the challenge of reconciling work and family life, which can lead to work-family conflicts (WFC). The present study examined the longitudinal effect of WFC on self-rated health among working parents in Germany.

The data was drawn from wave 6 (2013) and wave 8 (2015) of the pairfam family and relationship panel. It included working persons living together with at least one child (662 mothers and 529 fathers). Pairfam is a random sample of about 12,000 persons drawn from German habitants in private households. Data was collected via computer-assisted personal interviews with yearly follow-ups. The drop-out rate of the panel from wave 1 to wave 8 is 62%. Self-rated health was measured as a single item with five response options. Using logistic regressions, we estimated the longitudinal effects of the effect of WFC in wave 8 on self-rated health. Moderating effects of education and household income were considered. The analyses were adjusted for self-rated health in wave 6.

The odds ratio for poor self-rated health for mothers who developed WFC in wave 8 compared to mothers who did not report a conflict in both waves was 2.6 (95% CI: 1.47-2.41). For fathers with newly emerged WFC in wave 8, the odds ratio was 2.1 (95% CI: 1.08-3.80). Interaction of WFC with education and household income showed a weak non-significant effect on the self-rated health of mothers and fathers. The health of parents who reported a conflict in wave 6 but not in wave 8 was on a similar level as the health of parents with no conflict in both waves.

The results point out that WFC can lead to a decline of self-rated health. Further investigations should be carried out to determine groups who are particularly affected by health-related outcomes of WFC. It also remains to be discussed how self-rated health can be improved e.g. through reconciliation policies.

Key messages

Work-family conflict leads to a poorer self-rated health of working parents in Germany. The health of working parents with lower education and income is affected more severely by work-family conflict compared to parents with higher education and income.
Individual- and company level determinants of vocational rehabilitation: a multilevel study
Authors: Laaksonen M , Rantala J , Liukko J , Polvinen A , Varis J , Kesälä M , Kuivalainen S
Published: November 2019

Backround

Vocational rehabilitation (VR) is considered an important means to combat work ability problems and enable people to continue working despite health problems. We examined the magnitude of company level variation in VR and determined which individual- and company level characteristics are associated with access to VR due to mental disorders, musculoskeletal diseases, and other somatic diseases.

Methods

A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62 years at the end of 2010 (5.567 companies with 300.601 employees) was followed up for incident VR for six years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company level, were used as explanatory variables in multilevel logit models.

Results

After controlling for the individual level covariates, companies accounted for 12% of the variance in VR. The proportion was largest in VR due to musculoskeletal diseases. VR was more common among women, older employees (except the very oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. VR was more common in larger companies, and in construction and in health and social work, and less common in professional activities. VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates.

Conclusions

Company level variation in VR was substantial after controlling for individual level characteristics of the employees. The employer may have an important role in the prevention of work disability through vocational rehabilitation.

Key messages

Company level variation in vocational rehabilitation was substantial after controlling for individual level characteristics of the employees. The employer may have an important in the prevention of work disability through vocational rehabilitation.
Physicians’ use of information from sickness certification guidelines: A nationwide Swedish survey
Authors: Svärd V , Alexanderson K
Published: November 2019

Background

Sickness certification guidelines, introduced in Sweden 2007, are to support physician’s work with sickness certification of patients. Our aim was to explore the clinical importance of the guidelines, by studying what kind of information from guidelines the physicians use, and if this differ between type of clinics.

Methods

Data from a questionnaire sent to all 34 718 physicians in Sweden in 2017 were used (54% response rate). The study is based on answers from the 13 750 physicians who had sick-leave consultations.

Results

Half of the respondents used the guidelines at least once a month, and this was most common in primary healthcare (72%), occupational health services (64%) and psychiatry (61%). The type of information used differed; 53% used recommendations about suggested sick-leave duration and 29% about degree (full- or part-time) of sickness absence. Using information about function respectively work capacity was more common within psychiatry (42 and 42%), primary healthcare (37 and 38%) and occupational health services (35 and 41%) and less common among physicians in surgery and orthopaedic clinics (12 and 12%) who more often used information about duration (48 and 53%). In total, 74% reported that the guidelines to some extent were problematic to apply while 29% reported that they improved the quality of how they handled sickness certification tasks. Half (47%) experienced that the guidelines facilitated their contacts with patients.

Conclusions

The use of sickness certification guidelines varied between type of clinic and a majority experienced to some extent that the guidelines were problematic to apply. Further studies are needed to assess what information physicians in different settings need and what developments of the guidelines that are warranted.

Key messages

Half of the physicians used the sickness certification guidelines every month, but the type of information used varied with type of clinical setting. As many as half of the physicians stated that the sickness certification guidelines facilitated their contacts with patients, but a majority found them somewhat problematic to apply.
Determinants of managerial preventive actions in relation to common mental disorders at work
Authors: van de Voort I W H , De Rijk A , Hensing G , Bertilsson M
Published: November 2019

Background

Managers may prevent Common Mental Disorders (CMDs) among their subordinates due to their authority to influence the work environment. Yet, their perspective has received only limited attention in research. This study aims to increase managers’ capacity to contribute to the prevention of CMDs by exploring the determinants of two managerial preventive actions: ’reviewing assignments and the work situation’ (MPA-review) and ’taking initiative to talk about depression and anxiety at work’ (MPA-talk).

Methods

An online survey was sent to 4,737 Swedish managers, aged 20-65 years (71% participated, n = 3,358) in 2017, of which 2,921 were included as they answered the MPA-items. Ten possible determinants of MPAs, comprising person-, work-, and competence-related characteristics of managers were related to performing MPAs (yes or no). Bivariate and multivariate binary logistic regression was performed to test associations (OR with 95% CI) between each determinant and MPAs. We have adjusted for experience-related characteristics of managers and company size.

Results

50% of managers initiated MPA-review and 57% MPA-talk. Managers had a higher odds to initiate respectively MPA-review and MPA-talk when being female (OR 1.42, 95% CI 1.17-1.73; OR 1.33, 95% CI 1.08-1.64), working in organizations offering lectures on CMDs (OR 1.36, 95% CI 1.01-1.83; OR 1.84, 95% CI 1.30-2.60) or stress counselling (OR 1.79, 95% 1.46-2.20; OR 1.53, 95% CI 1.22-1.91), having responsibility for the work environment (OR 1.42, 95% CI 1.15-1.74; OR 1.44, 95% CI 1.16-1.79), or having had received training on CMDs (OR 1.56, 95% CI 1.27-1.93; OR 1.61, 95% CI 1.28-2.03).

Conclusions

Managers report taking more actions to prevent CMDs in their workforce when they are female, have received training on CMDs or work in organisations where CMD preventive measures have been implemented.

Key messages

Organizations could invest in company-wide preventive measures and training to enable MPAs. Managerial education should include information on CMDs in order to improve managers’ preventive capacity.
Occupational diseases in self-employed workers in France
Authors: Latil F , Neme B
Published: November 2019

Background

In France, self- employed workers receive disability benefits, but are outside of the specific legislation protecting employees from occupational accident and diseases. Physicians are generally not aware of this shortcoming and ask for occupational diseases benefits, as they do for salaried employees. The health fund of independent workers (HFIW ), dismiss the application, which is uphold by law, but can be a threat to the patient, if it shutters hope for other available benefits. Our aim was to see if the request for occupational diseases was related to significant disability in self-employed workers, and if such a disability could be handled by available benefits from HFIW. This survey could be instructive for countries without occupational diseases frame for self-employed workers.

Methods

A prospective study was conducted on self-employed claimants applying for occupational disease, from June 2015 to September 2017, with an 18 month period follow-up, in the Ile- de- France region. A questionnaire was sent to the claimant and the data were completed through a phone call or appointment. The main outcome was the number of claimants qualifying for disability benefit available at the HFIW.

Results

148 claimants were identified and 141 (95%) matched with the occupational diseases legal setting. The causative agents were close to those observed in employed workers: musculoskeletal, asbestosis. Disability allowance, complete or partial, could be provided by the HFIW because his criteria were met in 38 claimants(27%);benefits for asbestosis exposure were possible through a specialized body in 16 claimants(11%).

Conclusions

The occupational disease request from self-employed workers matched with medical conditions granted by the HFIW, or external social bodies. This screening should be routinely implemented by nurses or any insurance officer.

Key messages

Self-employed workers are outside of the specific legislation protecting employees from occupational accident and diseases but 27% of them may apply for other disability benefits. The occupational disease request from self-employed workers dismiss an application but match with available disability benefits from the Independent health fund and should be routinely screened.
Predicting occupational exposure to trace metals from welding by non-air monitoring based models
Authors: Omrane F , Gargouri I , Khadhraoui M , Elleuch B , Zmirou-Navier D
Published: November 2019

Mathematical models for estimating occupational exposure to chemicals were developed as a promising alternative to air monitoring that is pricey and sometimes unavailable. Still, models parameters are derived from former air monitoring. Contrarily, our study aims to calculate all parameters independently of monitoring data. We implemented this approach to assess exposure in welding plants. Then, prediction abilities are evaluated by comparison with air measurements.

The Near Field-Far Field (NF-FF) model seeks to give accurate exposure estimation near an emission source. One workplace includes Shielded Metal Arc Welding (SMAW) worker T1 who is in the NF. The other contains induction welding (IW) T2 and packaging workers T3 who are in NF and FF, respectively. The emitted metals are identified from materials compositions. Ventilation rates are calculated by the anemometer technique. Emission rates are calculated using the emission factor method for SMAW and mass balance method for IW, solely based on literature, materials quantities and their compositions. To evaluate the match between measured (6 replicates) and predicted levels, we checked their correlations and tested the mean differences of paired values.

T1 is exposed to Al, Cu, Ni, Cr and Pb, while T2 and T3 are exposed to Al, Cu, Ni, Cr and Zn. A strong correlation was found (r = 0.78, p = 0.008) for NF predictions and air measurements. The T-test was significant, confirming that NF predictions and measured levels are quite close.

In contrast, our approach did not succeed to predict the FF exposure (insignificant correlation), which is probably due to the mobility of T3.

Non-air monitoring based models showed good effectiveness to predict the exposure levels close to emission sources for SMAW and IW processes. Thus, to assess health risks or to evaluate compliance with workplace air standards, our modeling approach that is time and cost saving, can be adopted as a support tool or even an alternative to air monitoring.

Key messages

With a view to assess occupational exposure, non-air monitoring based models, that are time and cost saving tools, showed good prediction abilities for trace metal levels near welding emission sources. The use of non-air monitoring based models would help to control the working environment of occupationally exposed populations to welding fumes, which is useful to comply with air quality standards.
Direct access physiotherapy for patients with musculoskeletal disorders: a systematic review
Authors: Demont A , Bourmaud A , Kechichian A , Desmeules F
Published: November 2019

Background

Although the benefits of physiotherapy is well supported in the literature, the impact of having direct access to physiotherapy is not well established. Update of the current available evidence is warranted. The aim of this systematic review was to update the current evidence regarding the impact of direct access physiotherapy compared to usual care for patients with musculoskeletal disorders.

Methods

Systematic searches were conducted in 5 bibliographic databases up until May 2018. Two independent raters reviewed studies and used the Quality Assessment Tool for Quantitative Studies to conduct the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction and health care costs.

Results

Sixteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual family physician led care and direct access physiotherapy. However, three studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. Five studies did not observe any adverse events with direct access physiotherapy. Three studies showed shorter waiting time and four studies reported fewer number of physiotherapy visits with direct access. Three studies showed that patients with direct access were less likely to have medication and imaging tests prescribed compared to usual care. Five studies reported higher levels of satisfaction for direct access. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care.

Conclusions

Emerging evidence, although of weak to moderate quality, suggest that direct access physiotherapy provides equal or better outcomes than family physician led care models for musculoskeletal disorders patients. More methodologically strong studies are needed.

Key messages

This review supports the efficacy, safety and cost-effectiveness of direct access PT, while increasing access to care with a more efficient use of resources. There is a need for more methodologically strong studies to evaluate the efficiency of direct access models of care of physiotherapy for patients with MSKD.
Infrequent patient-physician conversations about sexual health at an Austrian university hospital
Authors: Komlenac N , Hochleitner M
Published: November 2019

Background

Many physical diseases are associated with sexual health problems. Studies concerning physicians’ barriers to patient-physician conversations concerning sexual health often fail to go beyond descriptive analyses of such barriers. The current study focused on finding those barriers that best predict the frequency of patient-physician conversations concerning sexual health.

Methods

An online-questionnaire assessed physicians’ sociodemographic information, frequency of holding a discussion on sexual health issues with their patients, and self-perceived barriers to asking patients about sexual health issues. The study was conducted at an Austrian university hospital. 102 physicians (53.9% women/46.1% men) participated. Logistic regression models were calculated to analyze associations between physicians’ barriers and the frequency of patient-physician conversations concerning sexual health in everyday practice.

Results

Of the physicians, 61.8% reported having a discussion on sexual health with their patients at least rarely in their everyday clinical practice. Physicians’ barriers that predicted low frequency of patient-physician conversations concerning sexual health were: expecting the patient to initiate such a conversation, not feeling responsible for this health issue, fear of offending the patient, and one’s own shame and discomfort.

Conclusions

In contrast to other studies about physicians’ barriers to patient-physician conversations concerning sexual health, in the current study time constrains were not a prominent barrier to such conversations. Future training should help physicians recognize the relevance of sexual health in one’s medical discipline and they should be taught how to overcome their feelings of shame or how to cope with patients’ negative reactions during patient-physician conversations concerning sexual health.

Key messages

University hospital physicians rarely address sexual health issues in patient-physician conversations. Physicians most often handed the responsibility to initiate such conversations to the patient.
Used and foregone of primary care in French university students
Authors: Tavolacci M , Habihirwe P , Déchelotte P , Ladner J
Published: November 2019

Background

University students tend to find it difficult to ask for help especially when it comes to health issues. The objective of the study was to determine the health issues of general practitioner and the reasons of primary care foregone in university students.

Methods

A cross sectional study was conducted in 2018 in Normandy university students (France). The socio demographic characteristics of the university students were collected. The primary care seeking during the previous 12 months were assessed by the consultation to the general practitioner and categorized: acute physical issues (stomach aches, cough ...), chronic physical issues (asthma, diabetes...), mental health issues (stress, anxiety...) and preventive medicine (vaccine, certificate...). The foregone of primary care during the previous 12 months and the barriers to accessing primary health-care-seeking were also collected.

Results

1179 university students (58.0% of women, age mean 20.4 years) were included. Frequency of health issues in the last 12 months were preventive issues (57.2%), acute physical issues (52.2%), chronic physical issues (16.7%) and psychological issues (18.4%). The foregone of primary care of the university students was reported by 20.5% of university students. The three main barriers reported by these students to accessing primary health-care-seeking behaviour were self-treatment (60.6%), lake of time (64.7%) and financial barriers (25.4%). Logistic regression showed that the foregone of primary care was positively associated with being female students AOR=1.69 CI95% (1.21-2.36), grant holder AOR=1.52 CI95% (1.10-2.02), and living in rented accommodation AOR=1.47 CI95% (1.03-2.02).

Conclusions

Half of university students consult the general practitioner for physical concerns and one fifth for psychological disorders. However with 20% of primary care foregone by university students, the access of primary care in the targeted population could be improved.

Key messages

One fifth of university students foregoes to primary care. Female students, grant holder and living in accommodation are the risk factors of foregone of primary care.