bluuebunny/crossref_metadata_2025 huggingface dataset:
Invasive pneumococcal disease in Latvia seven years after PCV10 introduction
Authors: Savrasova L , Zeltina I , Villerusha A , Balasegaram S
Published: November 2019

Background

In 2009 in Latvia, invasive pneumococcal disease (IPD) became notifiable for physicians and in 2010 vaccination of infants with PCV7 commenced. In 2012 PCV10 vaccination was introduced. The objectives of our study were to evaluate trend of incidence and trend serotype distribution of IPD in Latvia and to investigate factors associated with death from IPD.

Methods

Laboratory confirmed IPD cases are passively notified to the Centre for Disease Prevention and Control of Latvia by laboratories and clinicians. We calculated incidence by age, sex, case fatality and trend in serotypes.

Results

From 2012 to 2018, 466 cases of IPD were reported, mean annual incidence 3.4/100,000. The notified incidence remained stable from 2012-2014 (2.7), peaked in 2015 (4.4) and fell to 3.9 in 2018. The highest mean annual IPD incidence was in infants (4.8) and in elderly (6). The highest mean annual incidence was reported in males (4.5) in comparison to females (2.4) (IR-1.8 95%CI 1.6-2.4). Case fatality was 19% (87/466) and 23% (37/162) in cases aged > =65 years. 90% (421/466) of isolates were serotyped. The proportion of PCV10 vaccine serotypes fell from 50% (20/40) in 2012 to 19% (14/74) in 2018 (chi2 test for trend =0.000). Since year 2017, PPV23nonPCV13 and Non-vaccine serotypes become more common. We detected PCV13 serotype (RR 2.04 95%CI 1.37-3.02), S.pneumoniae serotype 3 (RR 1. 91 95% CI 1.25-2.93) significantly associated with IPD death.

Conclusions

Surveillance data indicate evidence of serotype replacement. Surveillance evaluation should asses the representativeness of notification. Furthermore S. pneumoniae carriage study may be useful to characterise serotype circulation. Serotype 3 and age demonstrate independent and significant association with fatal IPD outcome.

Key messages

IPD surveillance data analysis indicated evidence of serotype replacement with PPV23nonPCV13, NonVaccine serotypes. Serotype 19A becomes more common with significant increasing trend. Serotype 3 and age independently and significantly associated with fatal IPD outcome. S.pneumoniae carriage study would be very useful providing more evidence of characterizing serotypes circulation.
How to build and share an experiential knowledge in public health?
Authors: Laurent A , Ferron C , Lombrail P , Berry P , Frattini M O , Berdougo F , Rusch E
Published: November 2019

Health promotion stakeholders are encouraged to base their intervention strategies on evidence. However, the evidence produced by public health research is outcome-based and provides little information on “how to act?” It is necessary to complete this evidence with experiential data constituting an evidence of a different nature, answering questions about organizations, skills and tools mobilized to achieve the results, and valuing skilled actors’ knowledge and good practice.

For two years, a group of 15 French organizations has been working on capitalization and sharing experiential knowledge. This work is part of the setting up of a national evidence platform. After a benchmarking phase, the group developed and tested a capitalization method which focuses on the collection and analysis of qualitative data and aims to explain the contexts and processes at work in the actions: knowledge and skills, strategies, perceived challenges and facilitating factors, key moments. The group also worked on the structure, content and use of a shareable document.

The test has shown the pedagogical interest of the method for the actors who were invited to develop a reflective thinking about their action, as well as the relevance of this method to build experiential knowledge. The ongoing group’s work concerns the dissemination of collected data. A practical guide for stakeholders is being finalised. The group is defining the selection process of the initiatives to be valued, in particular with regard to results that make sense for all stakeholders.

The main difficulty of the approach - its low level of recognition and entrenchment in public health - will be discussed during the presentation, as well as the necessity to ensure the legitimacy of this approach in a context where the notion of evidence is centered on quantitative data produced with an objective defined “a priori” and in a controlled context.

Key messages

This work opens the way for an original reflection in public health to build a shareable experiential knowledge, and to valorize and strengthen field actors’ practical expertise. This work has pedagogical, political, scientific and informational impacts. It contributes to knowledge transfer and provides self-training, a practical vision of policies, and questions for research.
Commuter e-bike use is associated with increased total physical activity over time
Authors: Chabanas B , Praznoczy C , Duclos M
Published: November 2019

Background

Active commuting such as cycling has been recommended as a practical way to increase population physical activity levels and improve health. Beside positive health effects observed in experimental studies, less is known about how e-bikes can improve public health outcomes in real-life settings.

Objectives

To describe the patterns over time in physical activity, sedentary behavior, cardiorespiratory fitness and psychophysiological well-being in a population of new commuter e-bike users.

Methods

This was a population-based prospective longitudinal study in France. 33 new users of e-bike were recruited and measured at 4-time points (T0, T1, T2, T3), from before the effective beginning of the e-bike use (T0) until a mean of 4.6 months of use (T3) (min: 3.2, max: 7). Repeated measures multilevel modeling was used on 4 waves of measurements to assess variations over time of e-bike use, total moderate and vigorous physical activity (MVPA) and total sedentary time (SED-time). Pre-post comparisons between T0 and T3 were performed to detect change in cardiorespiratory fitness, markers of adiposity, self-esteem, quality of life (SF12-v2), and physical activity motivations (EMAPS).

Results

Adherence to e-bike commuting was high and stable, with a mean of 82% (3%) of weekly use. Multilevel modeling indicated that MVPA followed a significant increasing curvilinear trajectory over time, plateauing after 90 days (+ 21 MET-h/week compared to mean T0 at 33 MET-h/week). No significant change was found in SED-time, averaging a mean of 8.6 hours/day. Greater adherence to using an e-bike was associated with greater increases in MVPA. Several markers of physical and mental health improved.

Conclusions

New commuter e-bike users undergo a significant increase in MVPA while being already at a high level before e-bike use onset. This increase in MVPA could be meaningful to attenuate detrimental effects of a persistent high sedentary behavior.

Key messages

MVPA significantly increases among new commuter e-bike users, along with improvements in physical and mental health. High SED-time is persistent, making increase in MVPA in a population with a moderately high initial level still crucial.
Global trends in incidence and mortality of neonatal encephalopathy due to birth asphyxia and trauma
Authors: Lau K
Published: November 2019

Background

Neonatal encephalopathy due to birth asphyxia and trauma is a leading cause of premature death and long-term disability as estimated by the Global Burden of Disease (GBD) 2017 study. To evaluate comparative improvements in prevention and survival, this analysis evaluated GBD 2017 mortality to incidence (MI) ratios as a proxy for case fatality over time, location, and socio-demographic status.

Methods

We derived estimates of cause-specific mortality and incidence at birth from GBD 2017, calculating MI ratios of neonatal encephalopathy in children <1 year. We analyzed temporal, geographic, and socio-demographic trends in incidence, mortality, and MI ratio.

Results

Neonatal encephalopathy incidence shows little change over time, with global incidence in children under one essentially the same in 2017 (1,996 cases per 100,000 (1,334-2,912)) and 1990 (1,996 cases per 100,000 (1,331-2,926)). Regions show the same trend, though a large difference exists between the highest and lowest regional incidence, with incidence in Central Sub-Saharan Africa over 20 times higher than in Australasia. Over the same period, MI ratios for neonatal encephalopathy have decreased across all regions. Model input data represented 52 countries for prevalence and 145 countries for mortality, with notable data sparsity in Africa and Eastern Europe.

Conclusions

Case fatality of neonatal encephalopathy, as approximated by MI ratio, has declined worldwide over the past three decades, but incidence has shown little change. This suggests treatment of neonatal encephalopathy has improved, but more research is needed on risk factors in order to increase prevention. Continued work is also needed to reduce disparities in incidence and mortality between countries with different levels of SDI. Improving data coverage in lower SDI regions will be critical to accurately monitor progress toward reducing inequity.

Key messages

Neonatal encephalopathy is a leading cause of premature death and disability. Incidence of neonatal encephalopathy has changed little since 1990, indicating more work is needed on prevention. Case fatality of neonatal encephalopathy can be approximated by the mortality to incidence ratio, and has declined worldwide over the past three decades, suggesting improvements in treatment.
Postpartum women’s experience of abuse in childhood, postnatal depression, and thoughts of self-harm
Authors: Cho S H , Khang Y H , June K J , Lee J Y , Cho H J , Kim Y M
Published: November 2019

Background

Postnatal depression threatens the health of both mothers and babies. To improve maternal and child health in Seoul, South Korea, a nurse home visitation program for pregnant women and new mothers and babies has been implemented since 2013.

Methods

Cross-sectional data collected from 9,124 mothers while they were visiting a public health center for prenatal services or a nurse was visiting their home within 6 weeks after birth between 2014 and 2018 were analyzed. Mothers were asked whether they had experienced physical, emotional, or sexual abuse in their childhood. Postnatal depression and thoughts of self-harm were measured using the Edinburgh Postnatal Depression Scale (EPDS). Postnatal depression was defined as a total EPDS score of 13 or higher; thoughts of self-harm were defined as a response of “yes, quite often,” “sometimes,” or “hardly ever” to the corresponding item, excluding the response of “never".

Results

Overall, 3.2% of mothers had experienced child abuse; 8.1% experienced postnatal depression and 5.4% reported thoughts of self-harm. Postnatal depression was more common in mothers who had experienced child abuse than among those who had not (24.2% vs. 7.6%). A similar pattern was found for thoughts of self-harm (21.1% vs. 4.9%, respectively). When controlling for mothers’ age, economic status, history of receiving treatment for mental health problems, and other factors, having experienced child abuse was associated with a 2.73-fold increase in the odds of postnatal depression (odds ratio, 2.02-3.70) and a 3.58-fold increase in the odds of thoughts of self-harm (odds ratio, 2.58-4.96).

Conclusions

Mothers should be screened for having experienced child abuse when providing public health perinatal care to improve mothers’ mental health and parenting practices and to promote their children’s growth and development.

Key messages

Child abuse may have a lifelong negative effect on victims, and the effect extends to the next generation’s health and development. Public health policy and interventions to prevent child abuse are needed to tackle health inequality beginning in early childhood.
Comprehensive unhealthy lifestyle is associated with alcohol consumption as J-shaped curve
Authors: Shimoshikiryo I , Ibusuki R , Shimatani K , Nishimoto D , Takezaki T , Wakai K ,   J-MICC Study Group
Published: November 2019

Background

Alcohol consumption is a confirmed risk factor for cancer as well as cardiovascular and other diseases. Decreased and increased risks with light and heavy consumption, respectively (J-shaped associations), were reported for total mortality. However, whether alcohol itself or its related-factors are involved in this association, is unclear. This study examined the background characteristics of comprehensive lifestyles and clinical factors according to alcohol consumption, using data from a baseline survey of large-scaled cohort study conducted among the general Japanese using Breslow’s healthy lifestyle index.

Methods

The study subjects were 23,885 males and 28,165 females aged 35 to 69 years, who were enrolled in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. To determine unhealthy lifestyle scores, smoking, exercise, sleeping duration, breakfast consumption, eating between meals, and obesity were combined. The odds ratios (ORs) of unhealthy lifestyles and clinical factors according to alcohol consumption were estimated using a logistic regression model.

Results

The ORs of combined unhealthy lifestyles decreased among light drinkers in males (0.73, 0.67-0.80) and females (0.88, 0.82-0.95), and increased among heavy drinkers (1.52, 1.27-1.83; 2.15, 1.44-3.20, respectively). These associations were not found for each unhealthy lifestyle and atherosclerosis-related factors, except for less breakfast intake in males and less frequent habitual exercise in females.

Conclusions

The present study suggests that the J-shaped association between comprehensive unhealthy lifestyle and alcohol consumption may be an important background factor of the association between alcohol consumption and risk of total mortality. Further study for total mortality with them is warranted.

Key messages

This study showed comprehensive unhealthy lifestyles were observed not only among heavy drinkers, but also among non-drinkers. Light drinkers have more healthy lifestyles, which contribute to their better health.
Evaluation of polypharmacy in Japan using the national health insurance claims database in 2015-2017
Authors: Park J S , Okui T , Furuhashi H , Tokunaga S , Nakashima N
Published: November 2019

Background

There is growing awareness of polypharmacy as a global issue. Several countries have introduced policies to optimize multidrug prescriptions. In Japan, hospital prescription fee “F100” and outpatient prescription fee “F400” have been instituted to promote the correct use of drugs, the medical treatment fee is restricted when seven or more types of drugs are prescribed. However, non-polypharmacy patients who need multiple drugs are also comprehensively evaluated within the purview of the same drug insurance claim criteria. Thus, the current state of such policies is still unclear. This study identified the age group in which drug claims have changed based on drug insurance claim criteria and elucidated the relationship between policy interventions and multidrug prescriptions.

Methods

We analyzed F100 and F400 cases using open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan from April 2015 to March 2017. These sources include a population of about 69 million patients. Moreover, the growth rate of the number of patients who were prescribed seven or more types of drugs was evaluated.

Results

F100 prescription claims decreased by − 12.7% (n = 3,239,070) in 2016 as compared to 2015 (n = 3,700,396), and the number of F400 prescription claims decreased by − 7.7% (n = 28,745,468) in 2016 as compared to 2015 (n = 31,142,484), for seven or more types of drugs. The drug insurance claim rate among people over the age of 65 was 74.2% to F100 and 77.9% to F400, and this age group represented the highest proportion among all age groups.

Conclusions

The rate of health insurance claims for multidrug prescriptions clearly decreased after the institution of policy interventions to optimize the use of seven or more types of drugs. The present study suggests that the prescription fee restriction could reduce the rate of multidrug prescriptions and consequent decreases the risk of adverse drug-related events in polypharmacy patients.

Key messages

Policy interventions related to the optimization of drug prescriptions encourage behavioral factors of healthcare providers. Polypharmacy treatment must be established through prescriptions information linkage between clinical practices and community.
Unmet dental health care needs among adults in Serbia, Survey on Income and Living Conditions 2017
Authors: Terzic-Supic Z , Todorovic J , Vojvodic K , Piperac P , Santric-Milicevic M
Published: November 2019

Background

Changes in the health insurance law in 2005 led to the changes in the organization of the provision of dental health care in Serbia. Prior to this law, dental health care was available for every resident covered by mandatory health insurance without additional out-of-pocket payments. Now the dental health care is available only for children under the age of 18, students under the age of 26, pregnant women and for emergency dental care. The aim of this study was to assess the prevalence of unmet dental health care needs among adults and to assess the factors associated with unmet dental health care needs.

Methods

The study was the secondary analysis of the data from the Survey on income and Living conditions in Serbia, conducted during 2017. Multivariate logistic regression analysis was used to assess the association of unmet dental health care needs and socio-demographic and socio-economic factors.

Results

Total of 1718/12437 (12.1%) adults reported unmet dental health care needs. The main reason reported was not being able to afford it (1014/1718, 59.0%), along with the fear of doctors or hospitals (260/1718, 15.5%). Multivariate logistic regression analysis showed the association of unmet dental health care needs and being employed (OR: 1.50, 95% CI: 1.24-1.80), unemployed (OR: 1.96, 95% CI: 1.65-2.33), having primary (OR: 1.47, 95% CI: 1.16-1.86), or secondary education (OR: 1.43, 95% CI: 1.21-1.69), being divorced (OR: 1.47, 95% CI: 1.17-1.85), having good (OR:1.44, 95% CI: 1.20- 1.74), average (OR: 2.36, 95% CI: 1.91-2.92), poor (OR: 2.29, 95%CI: 1.77-2.97), or very poor general health (OR: 2.42, 95% CI: 1.68-3.48), having limitation in daily activities (OR: 0.66, 95% CI: 0.60-0.77) and being materially deprived (OR: 1.67, 95% CI: 1.46-1.90).

Conclusions

The prevalence of unmet dental health care needs in high among adults in Serbia. There is an association between social characteristics and health status with unmet dental health care needs in Serbia.

Key messages

There is a high prevalence of unmet dental health care needs in Serbia. Unmet dental health care needs are associated with social characteristics and health status.
Pay for performance scheme for general practitioners in France: results in 2018
Authors: Atramont A A , Coffy S C , Sebo S S , Debeugny G D
Published: November 2019

Methods

A pay-for-performance scheme, known as Remuneration on public health objectives (ROSP) and based on meeting targets on quality and efficiency indicators, was introduced for general practitioners in France in 2012. Since 2017, following the 2016 medical agreement between Health Insurance and doctors’ unions, ROSP has consisted of 29 indicators: 8 about chronic disease management, 12 about prevention and 9 about appropriate and efficient prescriptions. The aim of this work was to describe the 2018 results and the overall evolution of the indicators for office-based practitioners. Data are from the French national health system database.

Results

Follow-up of diabetic patients is steady: diabetic retinopathy screening and regular HbA1c measurement have been performed in 63% and 79% of them since 2016, respectively. Screening for chronic kidney disease improved for diabetic patients (29% in 2015 to 39% in 2018) and hypertensive patients (6% to 11%) but remain low. Influenza vaccination among people over 65 years increased in 2018 (55%) while a downward trend has been observed since 2011 (58% in 2011, 53% in 2016). The number of antibiotic treatments has decreased since 2011, from 46 out of 100 adults without long-term disease to 36 in 2018. In contrast, breast cancer and cervical cancer screening indicators have stagnated for several years around 66% and 56%, respectively. In terms of efficiency, all the indicators improved, most of them consisting in biosimilar and generic drugs prescription. By 2018, ROSP represents 3% of doctors’ revenue (including fee-for-service and lump sum payments).

Conclusions

By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations.

Key messages

By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations.
Cost-effectiveness analysis of the Un Chez Soi d’Abord randomized controlled trial: a Markov model
Authors: Lemoine C , Loubiere S , Tinland A , Boucekine M , Auquier P
Published: November 2019

Objectives

Providing permanent supported housing (rent subsidies), integrating clinical and social services to homeless people may represent a financial barrier for building a healthier European public policy. Our objective was to conduct a cost-effectiveness analysis of the French Housing First program.

Design and methods

Between 2011 and 2014, homeless people with severe mental illness from 4 French major cities were randomized to Housing First (HF, n = 353) or Treatment as Usual (TAU, n = 350) and followed over 24 months. Housing stability and survival were assessed. Costs incurred by health (ED visits, hospital admissions, physician consultations), social (shelters, supported accommodations, other residential structures), justice services (court appearances, detention and penitentiary centres), and welfare benefits were collected over 24 months. Markov models of 6-month transition probabilities were compared among HF group (offering an independent house and support from outpatient mental health and social team) and TAU group (receiving pre-existing dedicated homeless-targeted programs and services). Three Markov states were defined: stable housing (at least 90 nights in an independent housing), unstable housing (i.e. inverse) and death. A societal perspective and a life-time horizon were chosen. Robust sensitivity analyses were performed, including Tornado diagram and Monte-Carlo simulations.

Results

There is evidence of changes (P<.001) in housing stability (246% more days housed) for the HF group compared with TAU group. From the societal perspective, HF was €10,163 (3%) more costly than usual care. ICER was €5.32 per additional night spent in independent housing. In sensitivity analyses, HF was less costly and more effective in 28% of iterations.

Conclusions

HF proves to be cost-effective in homeless people with mental disorders and may assist decision-makers in defining conditions for further implementation of these innovations in Europe.

Key messages

Housing First model proves to be cost-effective in homeless people with mental disorders. Housing First model was less costly and more effective in 28% of ieration compared to treatment as usual.
The recent Italian vaccination law and the role of Local Health Authorities: the case of LHA Roma 1
Authors: Frisicale E M , Miceli M T , Romagnuolo M R , Agostinacchio R , Angelis F De , Gangere F , Giudiceandrea B , Rombolà A M , Spadea A , Goletti M
Published: November 2019

Issue/problem

The increase of vaccine hesitancy is leading to decrease vaccination coverage. In Italy, a new vaccination law was approved in July 2017 to contrast the spread of preventable infections. 10 vaccines became mandatory for children and unaccompanied foreign minors aged 0-16 and provided for free according to the national immunization schedule for each birth cohort. Being vaccinated is now required to attend schools and kindergartens even if a ban for students aged 0-6 or a fine for the other are previewed.

Description of the problem

According to the law, in Lazio Region, a web platform was realized in May 2018 in order to permit schools to update the list of their pupils. Medical doctors from LHAs had to evaluate continuously the updated lists, verifying the vaccination status of each student in order to approve their enrolment at schools or to recall parents providing counseling about vaccination.

Results

From August 2018 to March 2019 schools settled in the area of LHA Roma 1 registered 121.687 pupils (among those 105.720 pupils were also resident in the area of LHA Roma 1). After a preliminary check within data already present in the regional vaccination registry, around 30 healthcare operators, from the 6 healthcare districts of LHA Roma 1, were widely involved in order to evaluate pupils’ vaccination status. The number of evaluations decreases in the same period from 19.634 to 4921, but 4908 out of these 4921 were pupils not found in the regional vaccination registry, probably for errors in the registration of personal data such as the fiscal code. Some students’ families received vaccination counseling.

Lessons

The web platform realization was an innovative way to monitor vaccination status: it facilitates a further collaboration among schools and LHAs in order to guarantee health in community and to increase awareness about vaccinations and their benefits. A great involvement of schools and healthcare operators was observed.

Key messages

Although some problems such as pupils not found in the regional vaccination registry persist, the way of working in a collaborative way addressing community troubles is clearly traced. Technology and information systems help community services in monitoring and improving health outcomes. Their use has to be improved and promoted.
Advancement of hepatic fibrosis among general women with/without NAFLD
Authors: Ibusuki R , Shimoshikiryo I , Shimatani K , Nishimoto D , Maenohara S , Takezaki T
Published: November 2019

Background

Nonalcoholic fatty liver disease (NAFLD) is increasing, being prevalent at 30% of the general population worldwide. A part of NAFLD develops nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Hepatic fibrosis plays an important role in their pathogenesis. However, it is unclear how hepatic fibrosis is observed and advanced in NAFLD among general population. To investigate the hepatic fibrosis among general population, we prospectively observed hepatic fibrosis using serum markers.

Methods

The subjects were 228 women who participated as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in Kagoshima, Japan, and were followed from 2005 to 2014. NAFLD was defined as fatty liver by abdominal ultrasonography; consuming ethanol < 20 g/day; and being none hepatitis B and C carriers. NAFLD were confirmed after two-time consecutive examination, because its disappearance is ambiguous in some cases. Hepatic fibrosis was evaluated using serum M2BPGi and Type IV collagen 7s. The comparison of their changed values between groups was done using the ANOVA adjusted for age. The association between their change and related factors was done using general linear regression model.

Results

The prevalence of NAFLD was 31.6% at baseline. In the 5-year observation, the NAFLD + => NAFLD + ( ++) group was 23.7%; − +, 2.6%; + −, 7.9%; and - - (control), 65.8%. The values of M2BPGi and Type IV collagen 7s were higher in ++, -+, +- groups than controls at baseline. The change of M2BPGi values was observed in all groups, including controls, and the changed values were higher in ++ and -+ groups. Higher creatinine levels were positively associated with change of M2BPGi values. In contrast, the change of Type IV collagen 7s was not apparent.

Conclusions

This study suggested hepatic fibrosis was advanced with age among general women without NAFLD, and the presence of NAFLD enhanced hepatic fibrosis more.

Key messages

Hepatic fibrosis may be slightly developing with age among general population, and will be enhanced with fatty liver. It is important to prevent fatty liver development to control risk factors, such as obesity and metabolic syndrome, to reduce the risk of NASH, liver cirrhosis and hepatocellular carcinoma.
Risk factors for hazardous drinking in university students from South Africa and Belgium
Authors: Hal G Van , Larivière Y , Inaç Y , Hoque M
Published: November 2019

Background

Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultural and geographical differences exist regarding alcohol use. In this study, we compare the alcohol use and hazardous drinking in Belgian (BE) and South African (SA) university students.

Methods

An online survey assessing alcohol use among university students in South Africa (University of KwaZulu-Natal) and Belgium (University of Antwerp) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). For male students a cut-off point of 5 was used for hazardous drinking and for female students a score of 4. In total, 499 students were included in the study (250 BE and 249 SA students). A comparative analysis between both universities was performed for men and women separately with a Pearson chi-square test or Mann-Whitney U test. Furthermore, the association between hazardous drinking and several exposure variables was explored using multivariable logistic regression analysis.

Results

A significant higher amount of male (94.8%) as well as female (92.4%) BE students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) SA students (p < 0.001). Additionally, a significant higher amount of BE students were hazardous drinkers, compared to the SA students (p < 0.001). Multivariate analysis showed that male BE students were approximately five times more likely to be hazardous drinkers than male SA students (OR = 5.057, 95% CI 1.378-18.556; p = 0.015). Female BE students were over twice more likely to be hazardous drinkers than female SA students (OR = 2.371, 95% CI 0.846-6.644; p = 0.099).

Conclusions

BE students drink significantly more alcohol and a significant higher proportion of BE students were hazardous drinkers compared to SA students. Qualitative research in both groups has been conducted to get more insight into the reasons of these differences and will also be presented at the Conference.

Key messages

When studying alcohol use (disorders) in university students, it is of utmost importance to take into account the socio-cultural context. After finding quantitatively assessed differences in alcohol use (disorder) across different socio-cultural settings, it is evenly important to find out about the reasons why.
Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys
Authors: Rosta J , Aasland O G , Rø K Isaksson
Published: November 2019

Background

Changes in the organization of health care can influence the doctors` working conditions, which may in turn impact on doctors` perception of work stress. Since high levels of work stress can affect both the doctors’ own health and the quality of patient care, it is of importance for public health. We studied changes in work stress among Norwegian doctors from 2010 to 2018-19, and the associations of high work stress with job positions, self-rated health and sickness absence in 2018-19.

Methods

The study populations consisted of representative samples of 1,500 to 2,200 doctors working as hospital doctors, general practitioners (GPs), private practice specialists and doctors in academia. Data were drawn from nationwide repeated postal surveys in 2010, 2016 and 2018-19 in Norway. Response rates were between 67%-73%. The main outcome measure was perception of work stress as measured by the validated short form of the Effort-Reward Imbalance Questionnaire (ERI). Linear mixed models, proportions with 95% confidence intervals and logistic regression model were used in the analyses.

Results

From 2010 to 2018-19, the scores on the effort items (time pressure, responsibility, demands) increased significantly and the scores on the reward items (recognition, job stability, promotion prospects, prestige) decreased significantly for GPs, but remained stable for doctors in other positions. The proportion of doctors with high levels of work stress increased significantly for GPs. In 2018-19, high levels of work stress were associated with being a GP as compared with other job positions, younger age groups, average or poor health vs. very good or good health, but not with sickness absence or gender.

Conclusions

During a nine-year-period, work stress increased significantly for GPs, but remained stable for other job positions. This may be partly due to several health care reforms. Less work stress may improve both the doctors` own health and the quality of health care.

Key messages

From 2010 to 2018-19 in Norway, the proportion of GPs with high levels of work stress increased, while it remained stable for doctors in other job positions. This study supports previous findings on the association between high levels of work stress and health.
Teaching medical students multi-disciplinary team work through integrated course
Authors: Khozhamkul R , Kosherbaeva L , Kumar A , Bayildinova K , Sydykova S
Published: November 2019

Healthcare reform in Kazakhstan has created a basis for shift from disease centered approach to person and prevention centered healthcare. In order to embrace that agenda, Kazakh National Medical University has developed and implemented project-based course in General practitioners (GP) training program at the internship level. The objective of the program is to acquire skills on work in multidisciplinary teams for health promotion and research. We used project-based learning pedagogical framework for the course. 6 ECTS course was integrated into curriculum of internship in the track of GP training, at the 7th year, for 1 semester. During the course participants were introduced to the theoretical concepts of health promotion and disease prevention program planning, created and implemented their own project. At the end of the course students were required to do a poster presentation. Main outcomes of educational program were that students will (1) gain understanding of health promotion and disease prevention concepts, (2) would be able to implement research skills, (3) and work in integrated multidisciplinary team. To measure results, we disseminated self-administered online based questionnaire for students after the last class (n = 122). Questionnaire consisted of 4 domains: self-development and team work, teaching, context and clinical practice. There were 17 domains that students assessed with 5-point Likert scale, where 1- strongly disagree, 2- disagree, 3- agree to some extent, 4 - agree, 5 - strongly agree. Questionnaire also included 1 open - ended question for overall comments on the course and demographic questions. The response rate was 68,8% (n = 84), overall satisfaction rate was 77.6% (3.88 out of 5), rate on team work and practical work was 86% (4.3) and 83.6% (4.18). Comments of students showed that there is still not enough understanding on integrated person-centered primary healthcare approach and lack of integrated team work at clinical sites.

Key messages

Education of future general practitioners should include training on teamwork in integrated teams and health promotion. Project based learning helps training multi-disciplinary team work skills not only within students but also in teams at involved sites.
Older Patients in Emergency Departments. Challenges from the health care providers’ perspective
Authors: Deutschbein J , Möckel M , Schenk L
Published: November 2019

Background

Patients aged 65 and above are the fastest growing patient population in Europe. This is one of greatest challenges for almost all health services providers, including acute hospitals and their Emergency Departments (ED). As of today, older patients represent up to 30% of all ED patients, it is estimated. However, it is largely unclear to what degree EDs are currently prepared for older patients and how they need to adjust. This study analyses the present situation from the perspective of health care professionals caring for older ED patients.

Methods

The study was embedded in a mixed methods design using qualitative expert interviews. N = 25 semi-structured, guided interviews were conducted with professional health care providers from 7 Berlin EDs (physicians, nurses), and adjacent health care sectors such as nursing homes, rehabilitation clinics, and medical practices. Interviewees were asked about their daily experiences with older ED patients and their ideas of health care deficits and potentials. Data was analyzed using content analysis and hermeneutics.

Results

Health care providers assess the ED care situation for older patients and the necessity of adjustments in different ways but mostly as deficient. EDs are described as not elderly-friendly and partly as hazardous: older patients are at risk of adverse events such as developing a delirium. Risk factors are prolonged length of stay, the busy and noisy ED setting, and falls hazards. In general, ED staffing is not adequate to care for older patients with complex needs.

Conclusions

Considering demographic change, German Eds need to concentrate on the growing number of oder patients and their specific needs. Further research and development of specific care concepts for older ED patients is strongly needed. Potential adjustments of ED structures and care concepts also need to involve patients’ experiences and subjective needs. However, data on the patient perspective is still missing.

Key messages

Older patients and demographic change represent great challenges for EDs. Care concepts need to be developed to meet older patients needs and to avoid risks of adverse events.
Parents’ socioeconomic position, psychological problems, and emotional neglect in childhood
Authors: Löve J , Mehlig K , Källström Å , Hensing G , Gunnarsdottir H
Published: November 2019

Background

Despite high prevalence and severe consequences for health and wellbeing, emotional neglect (EN) in childhood is a neglected topic in epidemiological research. To enable prevention of neglect knowledge is important about conditions related to EN such as parental individual characteristics and social/economic situation. Aim to investigate the relationship between parental socioeconomic position (SEP), psychological problems, and EN in childhood.

Methods

The sample comprised Swedish women, N = 976, mean age 22. EN was assessed by five indicators: maternal/paternal rejection, maternal/paternal lack of time, and occurrence of domestic violence. The associations between parental SEP/psychological problems and EN were examined by logistic regressions.

Results

The odds of experiencing domestic violence in childhood was higher among women with parents with low (OR 3.1 95% CI 1.1-8.5) or medium SEP (OR 3.4 95% CI 1.7-6.9). Women who reported maternal psychological problems had higher odds of maternal rejection (OR 6.8 95% CI 3.5-13.0), maternal lack of time (OR 2.4 95% CI 1.2-5.0) and paternal rejection (OR 1.9 95% CI 1.1-3.5). Women who reported paternal psychological problems had higher odds of perceiving their father as rejecting (OR 4.0 95% CI 2.1-7.7), not having enough time for them (OR 4.9 95% CI 2.3-10.6), and experiencing domestic violence (OR 4.9 95% CI 2.1-11.6).

Conclusions

Lower SES was not related to EN in form of parental rejection or lack of time but to the occurrence of domestic violence. Parental psychological problems were related to all indicators of EN but differently among mothers and fathers. Public health initiatives aiming at supporting parents should also embrace parental psychological wellbeing.

Key messages

Emotional neglect was clearly related to parental psychological problems but not parental socioeconomic status. Gendered structures need to be considered in studies of emotional neglect.
Gender differences in self-reported health - the significance of inequality in domestic work
Authors: Nyman C Staland , Hensing G
Published: November 2019

Background

Gender difference in health is an important public health issue. Although biological factors contribute, social processes and living conditions create, maintain and exacerbate health differences between women and men. The aim of this study was to examine if lack of equality in domestic work contributes to the explanation of gender differences in self-reported mental well-being, common symptoms and persistent illness.

Methods

Population based questionnaire data on co-habiting women and men in Sweden, aged 19-64 years (n = 2666), was used. Division of planning and performing domestic work, satisfaction with division of domestic work and equality in partner relationship, were analysed in relation to health outcomes using binary logistic regression analysis with adjustments for age, income, country of birth, occupational class, weekly hours in paid work and number of children.

Results

Women, compared to men, showed higher odds (OR) for having low mental well-being, OR 1.35 (1.07-1.70), > 7 common symptoms, OR 1.98 (CI 1.59-2.46) and ≥ 1 persistent illness, OR 1.25 (CI 1.06-1.47). When equal partner relationship and planning and performing domestic work were included in the regression, the ORs for mental well-being and persistent illness slightly weakened and decreased to non-significance when satisfaction with division of domestic work were analysed, OR 1.14 (0.99-1.44) and OR 1.18 (0.99-1.39) respectively. Corresponding ORs for common symptoms were almost unchanged throughout the analysis.

Conclusions

Satisfaction with division of domestic work contributed to explanation of gender differences in persistent illness and notably to differences in mental well-being.

Key messages

Inequality in domestic work could contribute to explanation of gender difference in health. Satisfaction in division of domestic work is of specific relevance in gender difference in mental health.
Promoting health literacy in seniors through self-reliant groups. Results of the GeWinn intervention
Authors: Hassel H , Foitzik E , Klünder C , Langner S , Killenberg A , Neher K , Schimmelpfennig M , Zeiler T , Ladebeck N , Baumgarten K
Published: November 2019

Background

Health literacy (HL) has been demonstrated to be limited among adults aged 65 and over. However, evidence-based HL interventions are lacking. The objective of this study was to develop and test a community-based HL-intervention in the fields of health promotion and self-management of chronic diseases among elderly people.

Methods

A participatory approach was used to develop and implement a 53-weeks program of self-reliant, peer-moderated groups of people aged 60 and over in 14 municipalities in Germany. HL was intended to be improved by promoting of self-management skills, community participation and media literacy. The intervention’s effect on HL was measured by using the HLS-EU-16 questionnaire three times.

Results

Of 183 older adults who completed the HL questionnaire (mean age 69.8, SD 6.74; 20.1% male), 42.3% had intermediate or low levels of HL. A repeated-measures analysis of variance showed statistically significant effects of time on HL scores (F1.91 = 16.948, p ≤ 0.01, eta squared = 0.085) over the one-year period. HL sub-dimensions showed similar results. 87% of the participants would recommend the intervention to other people.

Conclusions

The results indicate that the structure of the intervention is appropriate to involve older adults in self-reliant working groups to improve HL. This is supported by the high acceptance of the intervention the participants showed. As part of the sustained implementation of GeWinn, special attention shall be paid to reaching out to and engaging vulnerable groups (e. g. elderly people with low socio-economic status, older men, migrants).

Key messages

Self-reliant groups in peer-moderation are effective to engage older adults to improve their HL. The intervention improved all HL rates and even doubled the amount of participants with excellent HL.
Evaluation of “Sophia Diabetes”, a diabetic patient support programme, 8 years after its initiation
Authors: Cash R , Cavillon M , Leboucher C , Jouaneton B , Vainchtock A , Aguadé A , Gomez E
Published: November 2019

Background

“Sophia Diabetes” is a personalized diabetic patient support program piloted by French National Health Insurance, launched experimentally in 10 primary health insurance funds in March 2008, extended in 2010 and then generalized to all of France in 2012-2013. A new evaluation was performed in 2018 to determine long-term (2008-2016) improvement of medical follow-up indicators, impact on morbidity, mortality and healthcare expenditure.

Methods

A sample of patients (n = 49,016) eligible for the programme in 2008, but also a sub-group of participating patients (n = 17,007), was matched, using propensity score, with controls randomly selected from the SNDS. Difference in difference method was applied for comparisons at each year of follow-up (Ti) while controlling for differences between populations.

Results

Sophia had a significant positive impact on recommended follow-up indicators, right from the first year. This improvement was maintained for most indicators even if compliance rates remained lower than targets. Sophia Diabetes does not appear to have a major impact on hospitalization rates in either eligible patients or participating patients. However, comparison between participants and controls revealed a less marked increase of hospitalizations for major cardiovascular events at T6 and T7. Compared to their controls, a better use of hospital emergency departments was observed for participants. Ambulatory care expenditure of participants increased more markedly between T4 and T7 (+€105 to €233), related to a better follow-up but in contrast, hospital expenditure increased less markedly during the first year of follow-up (-€139) and the last 2 years (-€360 to -€380).

Conclusions

For the first time in France, a disease management program has been evaluated over a long period. Globally, Sophia programresults in improved patient follow-up, decreased emergency visits, and a less marked increase of hospitalizations for major cardiovascular events at the end of period.

Key messages

First long term evaluation (8 years) of a disease management program in France. Sophia diabetes management program shows a positive impact on some follow-up and morbidity indicators.