bluuebunny/crossref_metadata_2025 huggingface dataset:
Care Manager nurse for chronic patients in primary care: a literature review
Authors: Faggian E , Balduit C , Labelli E , Gregori D , Martinato M
Published: October 2020

Background

The reorganization of home care provides nurses the opportunity to move to a role of “Care Manager”, affording a more effective management of chronic patients. This study aims to investigate whether the introduction of this new nursing role improved care related outcomes in people with one or more chronic conditions in primary care setting.

Methods

Articles considered for this review had to assess the outcomes obtained from outpatient care and home care in which the care manager nurse had been involved. Literature search was performed in PubMed, Cinahl, Scopus, Cochrane, and Google Scholar.

Results

20 studies have been selected. Care manager was introduced mainly into the American healthcare systems (80%) and only partly in the European ones (20%). Nurse provided outpatient care (95%) and home care (75%) dealing with the development of the care plan, therapeutic education and proactive prevention. The interventions were based on three fundamental principles of the Chronic Care Model: care teams, self-care support, computerized information system. The health outcomes achieved include: reduction of health care costs, hospital admissions and mortality rates; improvements of disease-specific clinical parameters and quality of life, and an excellent level of satisfaction on patients' and healthcare professionals' side (perceived quality of care).

Conclusions

The literature shows that nursing interventions carried out by the care manager in collaboration with other primary care professionals provided positive results in many ways.

Key messages

The reorganization of home care provides nurses the opportunity to take the role of “Care Manager”. This figure could afford a more effective management of chronic patients.

Nurse provided outpatient care (95%) and home care (75%) dealing with the development of the care plan, therapeutic education and proactive prevention. These interventions led to positive results.
Regional variation in appropriate care for ST-elevation myocardial infarction in Finland
Authors: Reissell E , Lumme S , Satokangas M , Manderbacka K
Published: October 2020

Background

Timely primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-elevation myocardial infarction (STEMI). Although cardiac units were established in all central hospitals in late 1990s for sparsely populated Finland, studies have shown that regional variation has increased. Additionally, the dense Finnish hospital network includes non-cardiac facilities where patients may be inappropriately admitted and then transferred for PCI. We aim to investigate the current regional differences in receiving timely PCI, determinants of these variations and the effect of hospital transfers.

Methods

Finnish Hospital Discharge Register data on PCIs for STEMI patients in 2015-17 were linked to register data on socio-demographics. In these preliminary analyses we used logistic regression modelling.

Results

Our results suggest that there were significant regional differences both for timely PCI in STEMI patients and in the probability of hospital transfers during an episode of care. The regional odds ratios (OR) for receiving PCI on time varied from 0.41 (95% confidence interval 0.33-0.52) to 2.73 (2.09-3.57) compared with the capital region when controlling for age, gender and hospital transfers. The ORs for being transferred during an episode of care varied from 0.26 (0.15-0.44) to 16.6 (11.6-23.6). Patients not transferred were more likely to receive PCI (OR 1.89 (1.67-2.15)). Men received PCI on time more often (OR 1.31 (1.18-1.46)) and women were more likely to be transferred (OR 1.29 (1.15-1.45)).

Conclusions

The probability for receiving PCI on time was related to the size of the hospital's population base and academic affiliation and inversely to transfers between hospitals. Hospital transfers during care episode and atypical symptoms often seen in women may cause critical delays for PCI. Other determinants for variation of timely PCI and its effects on equity will be analysed using multilevel modelling.

Key messages

Appropriate care for STEMI varies across regions and reflects inept practices in provider network. These findings are more pronounced in women showing persisting gender-related inequity.
A social law lens on maternal mortality in the U.S.: Lessons from Germany and the Netherlands
Authors: Tonti L
Published: October 2020

The United States has one of the worst maternal mortality rates among developed nations. American mothers are three times more likely than Canadian mothers and six times more likely than Scandinavian mothers to die from pregnancy-related deaths. Currently, for every 100,000 live births, 26.4 mothers are dying in the U.S, with significant disparities between White mothers and mothers of color. Projections indicate that by 2030, the maternal mortality rate will rise to 45 maternal deaths out of 100,000 live births. In direct contrast, most other similarly situated high-income nations have decreased their maternal mortality rates in recent years, evidencing only single-digit mortality per 100,000 mothers.

This research examines how social protection measures afforded by the law can facilitate differences in these rates. Specifically, this presentation compares legal interventions enshrined in social law that impact maternal health in the United States, Germany, and the Netherlands, including mandated access to prenatal care, midwifery reimbursement, and obligatory duration of postnatal care. Compared to the United States, both Germany and the Netherlands enshrine more comprehensively midwifery compensation and access to postnatal care in their social legal codes and insurance benefit schemes.

Evidence accumulated by comparing these interventions with maternal mortality statistics suggests that legal interventions that spur extra attention to mothers during and after birth may help prevent pregnancy-related deaths. It also opens a discussion about how policymakers can use legal interventions to help eliminate racial disparities in maternity practice.

Key messages

Codified legal interventions that mandate extra attention to mothers during and after birth may help prevent pregnancy-related deaths. Compared to the U.S., both Germany and the Netherlands better enshrine midwifery compensation and access to postnatal care in their social legal codes and insurance benefit schemes.
Socioeconomic inequalities, migration and poly tobacco use among male adults in developing countries
Authors: Millett C , Filippidis F T
Published: October 2020

Background

Concurrently using two (dual users) or more than two (poly tobacco users) tobacco products is common in developing (low-and middle-income) countries, especially among men, and has been linked to increased health risks and nicotine addiction compared to single tobacco product use. Very little is known about the impact of migration on tobacco use patterns among these populations. This study aims to explore socioeconomic and migration related risk factors in association with poly tobacco use among men in 15 developing countries.

Methods

Data from 15 countries around the world were obtained from the most recent wave of the Demographic and Health Survey (DHS), collected between 2015 and 2018. A total of 155,425 men aged 15-49 were surveyed. Outcomes included single, dual and poly use, examined by education, wealth, and migration status. Migration status was defined as whether the respondent slept or reside away from home in the last 12 months. Multilevel regression models were used to estimate the between those covariates and tobacco use.

Results

In all studied countries, prevalence of dual and poly-tobacco use was highest in respondents with low socioeconomic status (SES). SES gradients in dual and poly tobacco use by education (Risk Ratio [RR]=0.64; 95%CI: 0.55-0.67 for higher education vs illiterates) and wealth index (RR = 0.15; 95%CI: 0.11-0.20 for richest vs poorest) were observed. Furthermore, results showed higher risks of being a poly user among migrant men (RR = 1.70; 95%CI: 1.65-1.71).

Conclusions

We found higher risk of dual and poly tobacco use among male respondents with lower SES and migration backgrounds. This underlines the need to develop strategies to reduce smoking inequality, especially focusing on individuals with a migration background who may have more complex smoking histories and habits.

Key messages

The first study to examine the relationship between poly-tobacco use in men and their migration status in developing countries, highlighting SES gradients in use and risks among the population. Findings imply that policy makers should consider targeting populations with migration background to tackle smoking inequality.
Somali-Swedish Research Cooperation for Health (SSRCH) - a joint initiative by Somali and Swedish Universities to guide the Somali health system recovery process
Authors: Ivarsson A
Published: October 2020

In the fragile Somali state, there is a research imperative to effectively guide health systems recovery, which is crucial in the national rebuilding process for societal stability and peace. Our collaboration has its roots in the early 1980's, was cut short by the civil war and revived in 2014 to meet the need for health research capacity in Somalia today. Somali universities, representing different regions (East Africa University, University of Hargeisa, Galkayo University, Benadir University, Puntland Health Science University, Amoud University, and recently Somali National University) formed a consortium with Swedish universities (Umeå, Lund, Uppsala, Karolinska Institutet and Dalarna) and Somali diaspora professionals. Most recently we joined forces with the Public Health Agency of Sweden, linking us to the National Institute of Health Somalia (NIHS). A joint action programme for capacity building in health research has been developed, as outlined in the article “Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative” (Glob Health Action, 2017;10:1;1348693). We have a model for working collaboratively across regions and cultural barriers, creating hope for real change. As a first step, priority was given to research capacity development of faculty staff at the Somali universities' health faculties and Ministries of Health. A 'training of trainers' course in health research methodology was carried out during 2016-2018, supported by WHO-based Alliance for Health Policy and Systems Research. This has fostered health research as an integral component of these universities' academic development process. Institutional and research capacity in public health has a key role in rebuilding national health services for better health and wellbeing and to reach the SDGs (goals 3, 5, 10, 16).
HBSC Ireland and the public health community: partnerships and processes
Authors: NicGagbhainn S , Kelly C , Gavin A , Molcho M , Kolto A
Published: October 2020

When HBSC Ireland data was first collected in 1998, very few data on children's health was available. HBSC was seen as an opportunity for Public Health Practitioners and policy-makers to move towards evidence-informed practice. Public health practitioners are invited to liaise with the research team on questionnaire content. HBSC Ireland collaborates to ensure scientifically appropriate measures that can also assist in meeting policy goals. In 2014 the researchers worked with the policy lead for Tobacco to assess children's exposure to tobacco smoke & their views of cigarette packaging. Findings were used to provide a rationale for new legislation on plain packaging for tobacco products and provide a baseline for policy evaluation. In 2018 we worked with the Health Research Board Evidence Centre to develop items on alcohol procurement and location of consumption. A partnership with the Institute of Public Health lead to the inclusion of new items on exposures to UV light and sun protection. This work is being used to develop public health messaging for children and parents by the national cancer control programme. A strategic partnership between HBSC Ireland and the Department of Children and Youth Affairs has enabled the extensive use of HBSC data in the monitoring of the Better Outcomes, Brighter Futures policy framework for children & young people. This has included adopting existing international survey items as indicators and developing new items to fill gaps in the available evidence base. The core principles of these initiatives include transparency; background conceptual & methodological materials are prepared & pilot studies are published. A key element of Knowledge Translation work is our helpdesk, providing analyses to public & community bodies for the purposes of practice, research or policy. More than 50 short reports have been provided as part of this service to the public health community in Ireland.
Building a comprehensive list of health-related SDG targets for the WHO European Region
Authors: Nogales Crespo K A , Abrantes A , Dias S
Published: October 2020

Background

Within a sustainable development framework, health is envisioned to integrate across all Sustainable Development Goals (SDGs) as both a precondition and an outcome. Yet, to this day, there is no consensus over which SDG targets are relevant for health and wellbeing. While WHO identified health-related targets across all SDGs, inputs from the academic community are more conservative. Using policy documents (PDs), this study aims to build a comprehensive list of health-related SDG targets for the WHO European Region.

Methods

PDs endorsed during the 2015-2018 Sessions of the Regional Committee for Europe were selected. A supplementary list of PDs was built reviewing the content of progress reports. 32 PDs were selected following the inclusion criteria of validity and scope. With the collaboration of the Sustainable and Development Programme of WHO EURO, a working list of health-related targets was built. A content analysis of PDs was used to test this list and discover additional targets.

Results

Outside SDG 3, we identified 55 health-related targets distributed across all SDGs (22 additional to the working list). Emerging fields circumscribed to SDG 2, 4, 5, 10, 11, 12, 13, 16, and 17 - in subjects related to food safety and sustainable production, health and sustainable literacy, social welfare policies, adequate housing, sustainable and inclusive communities, climate change resilience, accountable and effective institutions, participatory decision making, knowledge sharing, operational sciences, and partnerships for sustainable development.

Conclusions

By performing an analysis beyond the semantics of the SDGs, we constructed a more comprehensive and accurate representation of how health and wellbeing are embodied in the 2030 Agenda. Previous studies have used the explicit content of the SDGs, hindering the possibility to find additional connections. PDs constitute a valuable resource to advance public health within a sustainable development framework.

Key messages

PDs cross-sectoral approach contribute to understand and acknowledge the connection between health and a variety of non-health topics. Health in the 2030 Agenda relates to targets across all SDGs.
Fostering R&D of novel antibiotics and other technologies to prevent and treat infection
Authors: Renwick M , Mossialos E
Published: October 2020

Generating innovative antibiotics is an essential part of addressing antimicrobial resistance. New policies and incentives are necessary to overcoming the multiplicity of scientific, regulatory, and economic hurdles that obstruct antibiotic discovery and development. This presentation assesses the changing landscape of the antibiotics market, barriers to drug discovery and development, incentive mechanisms and strategies to overcome these barriers, and the current product pipeline for antibiotics and alternative therapies. Over recent years, many incentive programmes have been implemented to foster the antibiotic value chain. This chapter proceeds to review the key multilateral, European Union, United States, United Kingdom and regulatory initiatives incentivizing antibiotic research and development. While these initiatives have helped lift the antibiotic pipeline out of dormancy, the recent progresses in development are not sufficient to counter the unrelenting advancement of antimicrobial resistance. We argue that the current global incentive package could be strengthened by ensuring that a continuum of incentives is offered to developers, reflecting the economic need, cost distribution, and barriers of the antibiotic value chain. A global governing body that provides overarching guidance to international and national-level incentive programmes will be critical to achieving such a continuum.
Quantitative and qualitative content analysis methods for document review for monitoring purposes
Authors: Pinsker E
Published: October 2020

Following the introduction of the workshop, the first presentation will give a brief overview of quantitative and qualitative methods for content analysis that can be used for the systematic review of documents for the purposes of monitoring and evaluation of public health initiatives and programs. The types of existing documents useful for monitoring and evaluation will be identified. Furthermore, tips will be given on designing reporting forms for later review, if there is an opportunity to do so. Data management tools useful for both quantitative and qualitative content analysis will be described.
Digital health literacy in general populations – An international comparison
Authors: Van Den Broucke S , Levin-Zamir D , Schaeffer D , Pettersen K , Guttersrud Ø , Finbråten H , Telo de Arriaga M , Vrdelja M , Link T , Pelikan J
Published: October 2020

Background

Due to the digital transformation in late modern society, digital (or e-) health literacy (DHL) is becoming increasingly relevant for people to take health related decisions. Yet despite its importance for evidence-based policy, very few tools have been developed to measure DHL, and even fewer studies have measured DHL in general populations. The Action Network on Measuring Population and Organizational Health Literacy (M-POHL) is one of the first to include a measure of DHL and its relevant correlates in the Health Literacy Survey 2019 (HLS19).

Methods

Based on an existing instrument (Van der Vaart & Drossaert, 2017), adapted to the format of the HLS-EU questionnaire for measuring comprehensive health literacy, 10 items with four Likert categories were developed to measure self-reported DHL, as well as 6 questions measuring the use of digital resources to obtain health related information and communicate with their health care system, as an optional package of the HLS19 study. Ten of the 15 countries participating in HLS19 included this optional package into their national survey. Data were collected from probability samples of at least 1.000 respondents per country, taken from the general population 18+ by personal interviews, telephone interviews or internet.

Results

For comparisons between countries, distributions of the answers to single items as well as psychometric validation and descriptive data for an index of DHL will be presented. Associations of DHL with general comprehensive health literacy, with the use of digital resources, and with other selected correlates based on correlational and regression analysis will also be presented comparatively for countries.

Conclusions

This study is the first to present standardized comparative data for the distributions of DHL and its correlates in the general population of WHO-Europe region Member States. The relevance of these results for national and European health policy will be discussed.

Panelists:

Doris Schaeffer

Interdisciplinary Centre for Health Literacy Research, Bielefeld University, Bielefeld, Germany

Contact: doris.schaeffer@uni-bielefeld.de

Maria Lopatina

Department of Public Health, National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia

Contact: ms.lopatina@gmail.com

Miguel Arriaga

Division of Literacy, Health and Well-being, Directorate-General on Health, Lisbon, Portugal

Contact: miguelarriaga@dgs.min-saude.pt
Appropriate management and long-term outcomes of older women with breast carcinoma in Umbria (Italy)
Authors: Naldini G , Caricato M , Gili A , Lupi C , Bianconi F , Stracci F
Published: October 2020

Background

Age is an important risk factor for breast cancer, which represents the most common malignancy and the leading cause of cancer death among women aged ≥50 years. International recommendations suggest that fit older women could gain similar benefit from adjuvant treatments as younger patients. The aim of our study is to estimate the average predicted probability (APP) of receiving non-adherent-to-guidelines adjuvant treatments, 5-years relative survival (5y-RS) and relative excess risk of death (RER) in older women with primitive invasive non-metastatic breast carcinoma in Umbria in 2001-2014.

Methods

We analyzed high-quality data from the Umbrian Cancer Registry. Women aged 50-89 years were grouped according to eligibility criteria for each adjuvant treatment: hormone therapy, radiotherapy, and chemotherapy. We estimated the APP and, for women aged 50-79 years, the 5y-RS (Pohar-Perme method) and RER.

Results

Age affected the APP of receiving non-adherent-to-guidelines treatments. In the age group 70-79, the 5y-RS was higher in women receiving adherent-to-guidelines treatments: hormone therapy (96.81, 95% CI 93.46-98.46 vs 77.70, 95% CI 67.64-84.97), radiotherapy (96.60, 95% CI 92.75-98.42 vs 77.46, 95% CI 69.73-83.44) and chemotherapy (83.81, 95% CI 75.99-89.27 vs 70.26, 95% CI 60.15-78.26). The RER was significantly higher in women receiving non-adherent-to-guidelines hormone therapy in any age group and radiotherapy in women aged 60-69 (4.55, p < 0.001) and 70-79 years (6.14, p < 0.001).

Conclusions

The oldest age group showed the highest APP of non-adherence-to-guidelines. Non-adherence-to-guidelines was associated with worse long-term outcomes at any age. Our findings suggest a further awareness on the importance of therapeutic strategy adhering to evidence-based recommendations.

Key messages

Older women with invasive breast carcinoma tend to receive non-adherent-to-guidelines treatments. Non-adherent-to-guidelines therapeutic strategy correlates with worse health outcomes.
Elder abuse and depressive symptoms: Which is cause and effect? Bidirectional longitudinal studies
Authors: Koga C , Tsuji T , Hanazato M , Suzuki N , Kondo K
Published: October 2020

Background

Elder abuse is a serious public health concern that increases the risks of negative health outcomes globally. It is well known that abuse in older adults is associated with depression; however, longitudinal studies investigating the causal relationship between these events are scarce. Because the cause precedes the result over time, the temporal relationships between abuse and depression should be verified from each direction. This longitudinal study therefore investigated and clarified whether depression causes or results from elder abuse among older Japanese adults.

Methods

Two longitudinal analyses were conducted using data derived from the Japan Gerontological Evaluation Study. The data were collected in 2010 and 2013 through a mail survey of 1737 people (983 females, 754 males) across Japan.

Results

Of those who did not experience abuse in 2010, 38 (5.0%) males and 53 (5.4%) females newly experienced abuse in 2013. Among respondents who did not have depressive symptoms in 2010, 60 (8.0%) males and 61 (6.2%) females newly reported depressive symptoms in 2013. After adjusting for demographic factors in analysis 1, people who experienced abuse were 2.28-fold (95% confidence interval [CI] = 1.68-3.09) more likely to have depressive symptoms 3 years later than those who were not abused. In analysis 2, respondents who had mild or severe depression in 2010 were 2.23-fold (95% CI = 1.61-3.10) more likely to have experienced abuse after 3 years than those who did not have depression.

Conclusions

After adjusting for several demographic factors, the results showed that abuse can lead to depression and that depression can be a cause of abuse. Therefore, preventing abuse should be considered from both directions.

Key messages

Elder abuse could be a cause for depressive symptoms. Depressive symptoms could be a cause of elder abuse.
Metabolically healthy obesity in a young population assisted by the Family Health Strategy in Brazil
Authors: Klen M , Botelho E , Botelho B , Ferreira L , Mello T , Borges R , Machado M , Fernandes A , Pecly I , Muxfeldt E
Published: October 2020

Background

Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective

To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil.

Methods

A cross-sectional population study for CV risk assessment in adults aged 20-50 years old from a FHC unit in Rio de Janeiro. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥ 30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥ 200 mg/dL, HDL<40 mg/dL (men) and 50 mg/dL (women), triglycerides>150 mg/dL and increased waist circumference.

Results

A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p = 0.03), hypertension (44% vs 19%, p < 0.001), dyslipidemia (50% vs 36%, p = 0.002) and diabetes (7% vs 2%, p = 0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p = 0.02) and abdominal circumference (102 vs 110 cm, p = 0.03), with lower diastolic BP.

Conclusions

MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.

Key messages

In this young population, MHO was more prevalent and presented a lower CV risk. The follow-up of MHO will show if they are really healthy or if they are at an early stage of the disease.
Health inequality monitoring - measuring what and how, exactly?
Authors: Henriksson G , Olsson G
Published: October 2020

The output from health inequality monitoring systems at the national level should be comparable across countries to enable judgements about how health inequalities evolves in the EU. Such comparability presumes a common approach to what kind of data should be compiled, what indicators to focus and what measures to use. Hence, there are many decisions to be made and to agree upon. Only in terms of possible indicators, there is an overwhelming number of possibilities. This is confusing and could easily lead to diverging conclusions on how health inequalities develop within and across countries over time. As part of the Joint Action Health Equity Europe and the work conducted in work package five on monitoring, a core health inequality indicator set is being developed. The set should include a small number of indicators and contain information on health, on social determinants of health and on some measure of social position, preferably education. The indicator set should be based on data already reported to EU and liaised with other indicator initiatives. The final set will be proposed to be included on available EC platforms and specific websites as indicators of health inequalities. Such an indicator set will facilitate valid judgements on how health inequalities evolves in countries and in the EU.

In this presentation, we will learn more about the proposed JAHEE indicator set, and about the work process. We will also get a chance to reflect on and discuss the proposed indicators and measures.

The auditorium will be invited to reflect on conclusions.
Assessment tools for screening the mental health of refugee minors: from preschool to adolescence
Authors: Fängström K , Salari R , Durbeej N , Dahlberg A , Hasselblad T , Warner G , Sarkadi A
Published: October 2020

The high number of asylum seekers in Sweden highlighted the need to develop and evaluate structured assessment tools for children and adolescents. In a series of studies, we aimed to explore the utility of (i) the Strengths and Difficulties Questionnaire with a trauma supplement of six items (SDQ-T) for preschool children; (ii) the Children's Revised Impact of Events Scale (CRIES-8) with unaccompanied refugee adolescents; and (iii) the Refugee Health Screener (RHS-13) with refugee adolescents. Parents of two- to six-year-olds (N = 61) were asked to complete the SDQ-T, and refugee adolescents were asked to complete the CRIES-8 (N = 208) and, in a separate study, the RHS-13 (N = 29) during the routine health checks. Focus-group interviews were conducted with the nurses who used the SDQ-T. The nurses felt the SDQ-T contributed to a more structured and informative conversation about the child's mental health. The SDQ total difficulties showed good internal consistency (α=.82). A significant proportion of children scored above the clinical cut-off and SDQ scores correlated with the number of post-traumatic stress symptoms measured using the trauma supplement (rho=.29). The findings suggest the SDQ-T is a useful tool in this clinical setting. The CRIES-8 was feasible to use, showed good internal consistency and its factor structure was confirmed. However, an independent assessment of test-retest reliability (N = 48) and longitudinal invariance (N = 284) indicated potential instability. It could be the CRIES-8 does not perform well when used with the unaccompanied refugee adolescent population over time, or that PTSD symptoms are less stable within this group given the multiple stressors in everyday life related to acculturation stress, family separation and living arrangements. The RHS showed excellent internal consistency (α=.96) and correlated with symptoms of post-traumatic stress disorder (r=.41).
Injuries and violence in migrants and refugees as a major health challenge
Authors: Bartovic J
Published: October 2020

Injuries and violence are a major health challenge among migrants and refugees, causing often both physical and mental disorders especially on vulnerable or traumatized individuals (e.g. victims of torture and trauma, unaccompanied minors and victims of trafficking and gender-based violence).

Incidences are significant at all stages of the migratory process, incl.: injuries associated with different migratory modes of transportviolence and intentional injuries en routesexual and gender-based violencehuman trafficking and smugglingoccupational injuries and violenceracially incited violence, hate crimes, and religious discrimination.

Knowledge is limited, e.g. due to the invisibility of victims within health and social systems, the lack of regulated and effective mechanisms to report incidences and lack of recording fatalities and missing refugees and migrants. Cross-country collaboration and commitment to cover lack of records and information are needed to address aforementioned issues.
Strategies and interventions to effectively prevent and deal with incidences among refugees and migrants, using practical case studies from country level
Authors: Costanzo G
Published: October 2020

Member States of the WHO European Region are currently facing high migratory pressure, and violence and injury among refugees and migrants travelling to and living in the Region is a major health risk. The development and implementation of interventions to prevent and effectively deal with such incidences are necessary.

The main findings of the WHO technical guidance Strategies and interventions on preventing and responding to violence and injuries among refugees and migrants will be presented as well as best practice examples from countries. Existing regulations and laws for the prevention of violence and protection of refuges and migrants across the WHO European Region will be discussed as well as recommended strategies and interventions: ensuring safe passage for migrationaddressing causes of violence and injuries in transit and destination countriesidentifying victims and providing care and protectioninvestigating and prosecuting perpetratorsstrengthening the knowledge base
Erickson Solution-Focused Health Coaching: an Innovative Approach for Sustainable Nutrition
Authors: Tkacova R
Published: October 2020

Background

Overweight and obesity have become an epidemic and a significant public health challenge. Apart from genetics, every obesogenic factor is modifiable and therefore, it is personal behaviors that play a dominant role in obesity prevention and management. Also, in a current climate emergency, each individual's behavior including food preferences and nutrition needs to be viewed from the global perspective. Previously, we examined Erickson solution-focused health coaching as a behavioral intervention supporting the adherence to healthy nutrition and exercise. Currently, we incorporated the 'ecology' aspect to our model. By applying Erickson ecology health coaching worldwide, we aim to support sustainable nutrition resulting in obesity prevention and management. To that effect, we established the Erickson Coaching for Health World Game (ECOHEALTH WG) project.

Methods

The ECOHEALTH WG involves research activities, health coach training, health education including ecological nutrition, and individual or group health coaching.

Results

Our research investigation assessed the impact of Erickson health coaching on the adherence to sustainable nutrition, anthropometry and body composition in overweight and obese persons with sleep apnea. The mean weight loss was 5.2±1.0% and 77% of participants achieved a target reduction of > 3%, in association with the sustained shift to plant-based food preferences. Moreover, health coach training was conducted in Austria, China, Slovakia, and Turkey. In the coming months, we project conducting health coach training in multiple countries around the Globe.

Conclusions

The ECOHEALTH WG project represents a unique opportunity to assist people to adhere to sustainable nutrition worldwide, with beneficial effects on the environment. A partnership between health coaches and healthcare providers has major potential to support healthy food choices and sustainable nutrition worldwide.
Barriers to home bowel screening test in South Asians in the UK
Authors: Smith L , Howcutt S , Saini P , Brett J , Henshall C , Watson E
Published: October 2020

Background

Bowel cancer is common and accounts for 10% of all cancer mortality. Early detection significantly reduces mortality. In the UK, the NHS Bowel Cancer Screening Programme invites adults aged 60-74 years to carry out a home screening test biennially. The national target for test completion is 60%; completion is substantially lower (∼30%) amongst South Asian populations. Our aim was to develop a community-based intervention to increase completion of the home bowel screening test in South Asians.

Methods

Multi-methods comprising two stages: 1) group and individual interviews with South Asians aged 50-74 years purposively sampled from community groups for maximum variation. Semi-structured interviews based on the Theoretical Domains Framework (TDF) investigated determinants of bowel screening completion. Interviews were recorded, transcribed, and analysed using framework analysis and findings mapped onto the COM-B Behaviour Change Wheel; 2) Co-production of intervention during two workshops with key stakeholders and target population.

Results

To-date 25 adults recruited of Indian, Pakistani and Bangladeshi ethnicity with variation in age, gender, first language, faith, and compliance with bowel screening. Key barriers and TDF domains that they mapped to were: - lack of knowledge about bowel cancer and screening; lack of language, literacy and physical ability (skills) to carry out the home test; confidence to carry it out correctly (belief about capabilities); appropriate space and time to carry out the test (environmental context and resources); putting off undertaking the test (memory attention and decision processes); risk perception and fear of cancer (emotions). Enablers were: social influences from peers; goals and motivations.

Conclusions

Early results suggest an intervention comprising education, persuasion, modelling and enablement functions could increase completion of the home test.

Key messages

Community engagement and working with community leaders enhanced the success of recruitment. The TDF was a useful framework for identifying barriers to home bowel screening test by South Asians in the South East of England.
Onset of smoking amongst middle school students in Switzerland
Authors: Kee K , Schulz P
Published: October 2020

Smoking is a major concern amongst youth in Switzerland. This study aims to understand the longitudinal drivers of smoking initiation among middle school students in Switzerland.

Data was collected as part of an ongoing longitudinal survey study. Participants were students from middle schools in Switzerland. 1076 adolescents were surveyed in four waves from 2015 to 2019. All participants were non-smokers at the start of the study, when they were aged 10 respectively 11. Furthermore, data from adolescents' parents were collected, including their smoking behavior, perceived quality of relation with their child, as well as parental monitoring behavior. A survival analysis was carried out, describing if and when the event of smoking initiation occurs among adolescents.

Our life table showed that 31% (n = 330) of participants started smoking between the first and fourth years of their schooling. The proportion of non-smoking participants decreased yearly. The proportions of non-smokers were 0.98, 0.93, 0.86, and 0.83 in 2016, 2017, 2018 and 2019 respectively. A life table was used to describe and summarize the sample distribution of smoking initiation and the percentage of risk. Second, a Discrete-Time Hazard Model was tested with parental smoking behavior, perceived quality of relation with their child and parental monitoring behavior as drivers to predict adolescents' smoking initiation.

The findings show that the number of smokers and new smokers increases over time among adolescents. Parental smoking behavior and the perceived quality of relationship with their offspring are factors that influence an adolescent's smoking initiation. This suggests that there may be sharing and normative influences amongst the cohorts as students move up the school grades. Future studies should investigate personal and environmental factors that contribute to smoking initiation amongst adolescents.

Key messages

Findings show that the number of smokers and new smokers increases over time among adolescents. Sharing and normative influences among adolescents as they move up the school grades may influence smoking initiation.
30.I. Round table: Human rights and the right to health – implications for day to day public health practice
Authors:   Organised by: UK Faculty of Public Health, EUPHA Public health and law initiative, Temple University (USA),   Chair persons: Farhang Tahzib - UK
Published: October 2020

Public health laws have significant impact to improve public's health and essential to achieving the sustainable development goals. Human Rights legislation and advancing the Right to Health approaches are seen as key to tackling social determinants of health and widening health inequalities. Health law is not just the work of lawyers, legislators and enforcers. There is growing expectations and need for public health practitioners and leaders to understand local and international legal systems and obligations and their critical role in improving and protecting the public's health, and to work in strategic partnership to improve population health through law and policy. Yet such issues are often neglected in educational and training programmes in public health and their practical implications poorly understood and appreciated by practitioners.

The purpose of this workshop is to highlight the nature and key role of law in improving public's health in practice, and to share the work by NHS Scotland and Wales in considering human rights and right to health approaches in their day to day to day activities and projects in public health.

It will highlight practical issues and ideas in advancing the political goal of public health law reform and getting the right to health approaches into day to day practice and activities. This will include options to include educational and training activities for the public health workforce, including its practical inclusion in public health curriculum. It will share case study of the innovative and powerful “Wellbeing of Future Generations Act” in Wales and its implications for public's health and practice.

The panel for the workshop will be senior expert experienced public health legal scholars, practitioners and policy makers who will briefly share their expert perspectives on the issue and the projects. One of the elements of the roundtable workshop will be to reflect and consult with the participants around their experience and insights in considering public law and right to health approaches in their practice and the needs, opportunities and barriers to engage more systematically in strategic partnerships and activities around better understanding and use of public health law to protect and improve public's health and the training and educational needs to advance the agenda.

Key messages

Strengthening public health laws and advancing right to health approaches are vital to improving public’s health and tackling health inequalities. There is need to build capacity and competency of public health leaders and practitioners around public health law and strategic partnerships to improve population health.
Participatory action research: why sharing power is needed to improve public health research
Authors: Dorant E
Published: October 2020

Action research is a qualitative research method well-known for its purpose: to bring transformative change through the simultaneous process of taking action and doing research. It typically employs a cyclical approach of observation, reflection and action. Participatory Action Research (PAR) builds on active collaboration with professionals, practitioners and end–users (stakeholders) working in the system or setting, for instance within a health care setting like a hospital, or within an broader organizational system addressing a public health issue. It seeks to democratize knowledge production and foster opportunities for empowerment by those involved.

Especially in public health research, where different organizational systems or levels are interconnected, stakeholder involvement needs to be considered early in the research process. Stakeholders possess expert and insider -experiential- knowledge, and therefore power. PAR advocates for power to be shared between academic researchers and stakeholders, already in the ideation phase of a new research project, but also in the later phases in its life cycle.

However, dilemmas have to be solved, like: when in the project's life cycle is the optimal phase to involve stakeholders?how much, at what level or grade, should or could stakeholders be involved, and how much power can be shared between academic researchers and these external stakeholders?Is it worthwhile to involve stakeholders in terms of resources, and who pays the bill?can an academic researcher take the risk of not involving them?
What possibilities and barriers for community engagement does graphical facilitation establish?
Authors: Sandholdt C , Hviid Malling G M , Jeppesen M , Villadsen S F , Lund R
Published: October 2020

Participatory approaches are appropriate to apply in interventions aiming at improving health and wellbeing in the everyday life of people living in deprived areas. However, more research is needed on how participation is staged, what negotiations of power are possible and to what extent the applied methods for engagement are accessible to a less affluent spectrum of residents. We apply an interdisciplinary approach to allow theoretical reflections on the applied strategy of participation. The intervention employs the use of physical materials through the performance of drawing to make participation less dependent of language and writing skills and hereby more equal. With this participatory intervention study, we aim to empower residents to increase their ability to act on their own health, i.e. social relations and life quality. We apply graphical facilitation by using physical drawing materials to explore how this method can give voice to the residents by providing them the opportunity to tell their story - from where they came to where they hope to go. The main component in the study is four participatory workshops in spring 2020: a) two focusing on teaching of basic drawing skills; b) one where the residents individually draw their own life story; c) one where the residents draw their shared vision of their community. This intervention study aims to contribute to health promotion by exploring generic methods to engage residents in deprived areas. The intended outcome is to empower residents by giving them a means of communication transferable to other settings in everyday life.
Association between history of cancer and dementia types: a case-control study in the United Kingdom
Authors: Gagatsis L G , Ford E F , Bremner S B , Paudyal P P
Published: October 2020

Background

Cancer and dementia are important diseases of ageing. Cancer affects 1 in 3 people in their lifetime, and dementia will affect 1 in 3 people who reach 90 years of age. Evidence suggests that people who have survived cancer may have a lower risk of subsequently developing Alzheimer's Disease (AD); however, there is no evidence on the association between cancer and incident Vascular Dementia (VD), which is the second most common form of dementia. We evaluated the prevalence of cancer history in cases and dementia-free controls using electronic health records for primary care in the United Kingdom.

Methods

The association between dementia (AD or VD) and history of cancer was investigated using a retrospective case-control study. N = 45,000 cases of dementia over the age of 65 were matched (age, sex, practice) 1:1 to dementia-free cases within the Clinical Research Practice Datalink. Odds Ratios (OR) for history of cancer among dementia cases and controls were computed using logistic regression models adjusting for potential confounding variables (socio-demographic and lifestyle factors, diabetes, depression, hypertension).

Results

Preliminary results indicate that history of cancer was less prevalent among dementia cases than among controls. Cases reporting a history of cancer had significantly lower odds of AD than controls; this association remained significant after adjustment. No significant association was found between cancer history and VD.

Conclusions

This study supports prior research suggesting that cancer survivors may be less likely to experience AD in their lifetime; however, this inverse association requires further research that accounts for potential survivorship bias. Moreover, the absence of an association between cancer and VD suggests a link between neurodegeneration and oncogenesis.

Key messages

History of cancer may have differential associations with different types of dementia, which may inform research on the aetiology of Alzheimer’s disease. Given the limitations of case-control studies, cohort studies are needed to further assess the relationship between cancer and different forms of dementia.