bluuebunny/crossref_metadata_2025 huggingface dataset:
Reality of trans-identity in Benin and social reactions: Analysis based on a national survey in 2017
Authors: Hessou S , Glele Ahanhanzo Y , Kpozehouen A , Yadouleton T , Sodoloufo O , Capo-Chichi V , Dossoh B , Gnanhoui-David B , Nelson M
Published: November 2019

Background

Transgender individuals are a key population recognized transmission of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), with higher risks of infection. Adoption of risky behaviours would be strategies of coping to face psychological disorders related to the social consequences of gender transition. To address their specific health needs in Benin, this study describes transgenderism and social reactions.

Methods

Through a cross sectional design, subjects were recruited by respondent-driven sampling from networks selected in the whole of the country in 2017. Subjects included were above 15 years old who identify themselves as transgender. Data was collected via questionnaires with variables related to the individual management of gender affirmation, social reactions, and risky behaviours.

Results

A total of 326 transgender individuals were identified with a majority of subjects being originally of the male gender (89.57%). The average age was 24.13±4.88 with a strong representation of schoolchildren and students (36.50%). In 64.72% of the cases, the family was informed of the trans-identity. The overall attitude of the family was of acceptance/support in 7 cases out of 10. Stigmatization and discrimination are reported by 50% of the subjects and 59.02% have been subjected to at least one assault. Among these, half had no appeal initiative and the main reason would be the absence/non-knowledge of legal remedy. Sexual multi-partnership which is the most common risky behaviour occurred in 81.54% of the cases.

Conclusions

Transgender people exist and constitute a population with specific needs in Benin. The services dedicated to this target must integrate the prevention of STIs/HIV but also legal, social and psychological support.

Key messages

Transgenderism in Benin mainly concerns young male subjects. Prevention programs should also be focused on social and psychological aspects to manage the identity transition that constitute a key step of shifting into risky behaviours.
Are Roma people exposed to NCD? Modifiable risk factors in a rural Roma community from Romania
Authors: Mangaloiu D , Bratu E , Furtunescu F , Minca D
Published: November 2019

Background

Knowing the prevalence of modifiable risk factors for noncommunicable diseases is the first step to plan effective public health interventions. The study aims to identify the prevalence and distribution of risk factors of non-communicable diseases (NCD) among adult Roma population in a rural community.

Methods

Using a tool based on the WHO stepwise approach, a cross-sectional study was carried out among a sample 116 adults aged 18-85 years (52 male and 64 female), from a rural community with 800 Roma members. The study instrument included questions to record behavioral risk factors (smoking behavior, alcohol drinking, diet and physical activity and also data on anthropometry and value of blood pressure). Descriptive statistics methods were used to analyze the data.

Results

The smoking prevalence was 35,3% (95%CI, 27.0 to 44.3,) higher for men (49,9%, 95%CI, 36,6-63,4%) than for women (23,4%, 95%CI, 14.2-34,9), higher than the smoking prevalence recorded for Romanian population in 2017 Eurobarometer study. Prevalence of obesity (body mass index ≥30 kg/m[2]) was observed to be high among Roma respondents 34,48% (95% CI, 26,26 to 43,47) compared with self-reported obesity rates among adults in Romania (9%, Eurostat, EHIS 2014). The observed proportion of obesity is similar for both genders, but central obesity was lower for men compared to women (57,4% to 79.6%). There was observed a higher proportion of people declaring they eat fruits less than once on a week (25%, 95% CI, 17,7 to 37,4) and adding salt before tasting the dishes (58,6%). Most of interviewed people have a sedentary lifestyle with less than 30 minutes of physical activity per day.

Conclusions

The high prevalence of risk factors for NCD in this rural Roma community indicates the likelihood of a high future burden of illness.

Key messages

There is a need for both further research into the health of Roma people regarding NCD and prevention interventions to address behavioral risk factors for NCD. Knowing the prevalence of modifiable risk factors for noncommunicable diseases is the first step to plan effective public health interventions.
Effects of Private Health Insurance on Unmet Medical Experience in Chronic disease Patients
Authors: lee J H
Published: November 2019

Background

Chronic patients are called ’long-term disorders,’ as they last for more than a year. They need continuous care, so health care through easily accessible medical institutions such as primary care is needed for them. In South Korea, however, they are mostly managed through secondary medical service systems, such as hospitals that are difficult to access. This causes them to increase their own burden rate, limiting their ongoing management of the chronic disease. However, it is known that Korea’s private health insurance policy affects the use of medical services, their own burden rate and reduces the unmet medical experience. Therefore this study aims to analyze the impact of the Korean chronic disease on private insurance subscription and unmet medical experience.

Methods

Using the 2014 survey data of the Korea Welfare Panel, the final analysis of the study was 4,243 households with chronic diseases among 6,581 households. The independent variable of this study is whether private health insurance is subscribed or not, and the dependent variable is unmet medical experience due to economic factors. The analysis method used frequency analysis and logistic regression. [Use SPss 22 for analysis]

Results

1,417(33.4%) of households subscribed to private insurance. The figure is significantly lower than the country’s reported private health insurance subscription rate (72.6%). Based on the median income of 60 percent of household income, high-income households have lower unmet medical experience than low-income households. In the case of unsubscribed private health insurance among the people with chronic diseases, the unmet medical experience was 1.921 times higher than that of those who signed up.

Conclusions: In order to reduce the burden on chronic patients, the government needs to strengthen the primary medical care system.Reinforce connectivity with private insurance through public financial support of national health insurance.

Key messages

Chronic disease. Private health insurance.
Legal policy challenges in withdrawal of dialysis treatment in Japan
Authors: Tanaka M , Kodama S
Published: November 2019

Issue/problem

In 2017, Japanese dialysis patients and kidney transplant cases numbered roughly 330,000 and 1,700, respectively. In March 2019, a patient died after a physician terminated her kidney dialysis at a hospital in Tokyo. The Tokyo Metropolitan Government and the Japanese Society for Dialysis Therapy (JSDT) investigated the case, questioning the patient’s terminal status and desire to withdraw her request to terminate dialysis.

Description of the problem

No Japanese law addresses treatment withdrawal, but several court decisions and the Ministry of Health, Labor and Welfare’s process guidelines and JSDT guidelines address treatment withdrawal from terminal patients. We examined relevant court decisions and guidelines, identifying three legal policy issues that may impact legal policy discussions on treatment withdrawal in other countries, regardless of the enactment status of such laws.

Results

First, the patient was not “terminally ill” as defined by the court rulings and guidelines. Second, a clear decision based on appropriate informed consent from the patient seemed absent, violating the court rulings and guidelines. Third, the physician’s judgment of patient competency for decision-making may have been missing.

Lessons

We considered problems beyond the court rulings and guidelines by focusing on the patient’s right to self-determination and treatment refusal in other countries. The Patient Self-Determination Act and the Patient’s Bill of Rights (US) as well as court rulings and the NHS Charter (UK) guarantee such rights, and collectively enable competent patients in the US, UK, and elsewhere to refuse dialysis even if they are not terminal. Japanese legislation does not guarantee such patient rights or the explicit allowance/prohibition of treatment withdrawal, regardless of the patient’s terminal status; enactment of such laws should be considered.

Key messages

We identified legal ambiguity due to a lack of the patient’s right to both self-determination and treatment refusal. This could impact the international discussion on dialysis treatment withdrawal.
A discourse network analysis of the public media debate on the UK Soft Drinks Industry Levy
Authors: Buckton C H , Fergie G , Leifeld P , Hilton S
Published: November 2019

Background

On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a policy designed to reduce population level sugar consumption and related illnesses. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative.

Methods

Media content analysis was employed to build a data set of relevant articles from UK national newspapers. Articles were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the stakeholder network and coalitions evident in the debate, leading up to and following the announcement of the SDIL.

Results

We identified 3,883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Visualisations revealed a complex network of stakeholders with two discourse coalitions. Polarisation arose from 3 factors: (i) differences in political ideology; (ii) position on the specific policy option; (iii) interpretation of the evidence. Industry stakeholders appeared less united before the SDIL announcement. Some industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver was a dominant supportive stakeholder, suggestive of his role as a policy entrepreneur.

Conclusions

This study illustrates the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Public health advocates seeking to gain support for future upstream regulation to promote population health would benefit from tailoring their communication to take advantage of sources of polarisation. Vocal celebrity policy entrepreneurs may be instrumental to facilitate alignment of stakeholders around a clear ideology.

Key messages

This study provides a novel insight into the network of stakeholders involved in public debates on food policies. Public health advocates may benefit by identifying and aligning with a clear ideology.
Actions to improve chronic heart failure management in Paris and its suburbs, preliminary results
Authors: Marty M , Nicolle P , Bataille S , Roudier-Daval C
Published: November 2019

Background

Chronic Heart Failure treatment requires close collaboration between multiple health professionals (hospitals, general practitionners, cardiologists, nurses, pharmacists,...). Guidelines for management of chronic heart failure patients after hospitalization for heart failure were published in France in 2014.

In Paris and its suburbs (Ile de France) several indicators show that improvement of processes is required especially regarding linkage between hospital and ambulatory care (for example admission rate in emergency unit was 59,7% in 2014).

Actions

Since 2015 Regional Health Agency and Social Insurance have conducted several actions to improve patients care pathway: feed back to providers on their own results, support patients after hospital discharge, commitment of several hospitals to organize meetings with field professionals, setting up semi-urgent consultations in hospitals, bundled payment experience...

Preliminary Results

Indicators evolution from 2014 to 2017 is favorable for rate of admission in emergency unit (57,8% versus 59,7%), 6 months mortality (20,7% versus 23,1%), hospital readmission 6 months after index admission (24,4% versus 25,2%), but unfavorable for ambulatory clinical follow up rates (general practitionner consultation within fourteen days after hospital discharge (46,1% versus 52,5%), cardiologist consultation within sixty days after hospital discharge (47,1% versus 52,8%).

Conclusions

It is too early to assess the impact of each action and it will be difficult to conclude, because of interaction between actions. The evolution of outcome care indicators is satisfactory, which suggests the interest of acting on a whole care process. The worsening clinical follow up indicators leads to wonder about access to health care and requires an analysis by territory to adapt the actions.

Key messages

Actions to improve chronic heart failure management in Paris and its suburbs firsts outcomes are satisfactory. Acction adaptations are necessary and should be assessed in 2019/2020.
Colorectal Cancer Screening Programme: Algarve Preliminary data
Authors: Correia M , Cancela M , Caldeira P , Morera J , Cardoso C , Pereira R , Ferrinho D , Vale L
Published: November 2019

Problem

The burden of disease for oncological problems is significant in Portugal. Population-based screenings, such as colorectal cancer screening (CCS) with faecal occult blood tests (FIT) is a priority program to reduce the burden of disease and a cost-effectiveness measure.

Description problem

Algarve CCS started in 2017,to early detect colorectal cancer reducing morbidity and mortality. Screening strategy to detect and remove cancer precursors (adenomas) and early cancer detection with less invasive treatment using a non-invasive stool test was selected. A quantitative faecal immunochemical test for haemoglobin (FIT) with higher sensitivity for adenoma and cancer, specific for human globin with no dietary restriction, with a single sample screening is considered a test with higher participation. Target population all gender from 50 to 75 are invited to participate in the CCS by letter. Screening interval is 2 years and FIT cut-off- 117 (ng Hb/mL). Software was used to manage all CCS. Health units distribute the test and a flyer. All FIT-positive were invited to do a full colonoscopy at University Hospital.

Results

A preliminary descriptive analysis (2017/2019) was made. After exclusions 25017 of target population participate 34,4%(n = 8594),27.5%(n = 6883) submitted it for analysis, 3.9% (n = 266) had positive FIT and were invited for a full colonoscopy with 57.5% (n = 153)participation rate. Cancer detection was 0.9‰ and adenomas detection rate was 9.9%. FIT positive with colonoscopy 3.9% (n = 6) had carcinoma and 44.4% (n = 68) had adenoma.

Lessons

Some operational changes were made to improve participants and professionals adherence to CCS. Pathology observed in the positive cases, reinforce the need to implement strategies to increase literacy, raise public awareness, keep the screening test and improve accessibility of health facilities.

Key messages

The importance of a colorectal cancer early diagnosis prevent aggressive interventions in a precancerous phase. The importance of a colorectal cancer early diagnosis improves survival and population quality of life.
Predictors of a high work participation in the flexi-job scheme: a regional Danish cohort study
Authors: Munkedal D , Weye N , Fonager K
Published: November 2019

Background

In Denmark, people with permanent and significant reduced work capacity can be assigned to a flexi-job (FJ) scheme. In 2013, the social security policy for FJ was reformed in order to improve the chances for employment for people with reduced work capacity. In a Danish cohort study from the North Denmark Region we aimed to describe work participation in the flexi-job scheme before and after the reform. Furthermore, we described the associations between employment in the flexi-job scheme and predictors such as sociodemographic factors, healthcare use, and work participation before assignment.

Methods

The study population included individuals assigned to the FJ scheme between 2010 and 2015 in the North Denmark Region. The study population was followed until leaving the FJ scheme or end of follow up (September 2017). Baseline information included data on sex, age, place of residence, number of contacts to specialized healthcare, and number of working weeks five years before. Work participation score (WPS) was defined as number of working weeks divided with the total number of weeks in the FJ scheme. High WPS was defined as above the median. We used a logistic regression model to study associations between baseline characteristics and high WPS.

Results

A total of 4,668 people were included in the study. The overall median WPS were 73% (interquartile range (IQR) 42% - 90%). Policy changes (OR 1.40, 95% confidence interval (CI ): 1.24 - 1.59), male sex (OR 1.16, CI:1.03 - 1.31), young age (OR 1.45, CI: 1.17 - 1.80), urban living (OR 1.22, CI:1.03 - 1.46), no contact to specialized healthcare (OR 1.54, CI: 1.21 - 1.99), and a strong association to the labor market before awarded FJ (OR 4.25, CI: 3.34 - 5.41) were all predictors of a high WPS during FJ-scheme.

Conclusions

Policy changes increased work participation in the FJ-scheme. However, the strongest predictor of a high WPS for people awarded FJ was the degree of work participation before the scheme.

Key messages

Several factors had impact on work participation in a flexi-job scheme. The flexi-job scheme might be insufficient to secure employment for people with prior weak affiliation to the labor market.
Regional variations of amenable mortality rate in Latvia
Authors: Skrule J , Lepiksone J
Published: November 2019

Background

Death can be considered as amenable if all or most deaths from that cause (at certain age group if appropriate) could be avoided through optimal quality of health care. Amenable mortality is one of indicators to use for assessing health system performance and outcome.

Methods

For amenable death causes using list of diseases and conditions from Office for National Statistics of United Kingdom (used by Eurostat). Calculation of amenable death rate (per 100000 population) for ages 0 to 74 years at regional level (six statistical regions) for time period 2015-2017, direct age-standardization to the overall national population. Results accompanied by confidence intervals (95%).

Results

There is a slight decline in amenable mortality of Latvia at national level over the period 2015-2017. Amenable death rate of Latvia in 2017 was 309 per 100 000 (95% CI, 308.95 - 309.05). Death rates at regional level varies from 274.34 (274.23 - 274.44) in Pieriga region to 375.49 (375.37 - 375.62) per 100 000 in Latgale region. There are no significant changes in ranking of regions for three years period.

Conclusions

Results shows that there are differences of amenable mortality rates between regions of Latvia. There are health inequalities between regions: Pieriga region show the best health care services performance, while Latgale displays the worst performance. There is field for deeper analysis and find better interventions for improvements at national level and reducing variability between regions.

Key messages

There are regional variations of amenable mortality in Latvia. Regional variations show places to reduce health inequality.
Government-based financing strategies for public health in Ukraine: way of transforming
Authors: Kovalenko N , Duda M , Liashko V
Published: November 2019

Since 2016 Ukraine is going through health financing reform. National public health (PH) system functioned with focus only on control of epidemics and sanitary situations. Following EU recommendations, the Government established Center for Public Health (CPH) and adopted the Concept of PH System Development. As new Budget Code comes into force in 2020, PH system must be transformed on institutional and financing level.

We conducted policy analyses and developed PH financing options and found that existing budget programs (epidemiological surveillance and purchases of medicines) make up over 70% of the total government PH spending. Public spending was ineffective based on line budget approach without attention to quality and not linked to epidemiological situation. New PH mechanisms will be piloted in 2019 in several regions to calibrate approach and ensure evidence-based policy. Transformed financing model focuses on purchasing PH services rather than maintenance.

We selected a phased approach to launch new PH financing mechanism. Procurement system ProZorro allows to follow transparency and good governance principles while purchasing PH services. Using experience with GF’s procurements, the CPH will purchase services: HIV and hepatitis prevention among key population, supporting PLWHIV, epidemiological surveillance. Legal framework developed and agreed with stakeholders. This approach allows to shift focus from dealing with consequences to prevention and early revealing of potential PH risks. Provider’s staff and network will be optimized. Budget economy is up to 15% in 2019, and additional 5% in 2020.

The rebuilding PH system showed that 2019 is an opportunity to develop and pilot new financing approaches. Key step is to ensure that national policy equipped with legislation and recommendations to implement new PH approaches. Pilot results will become a strong base for further PH system development as well as evidence-based policy for effective response to PH needs.

Key messages

Public health system in Ukraine is going through reforming process to address existing challenges and introducing new financing approaches with a focus on regional level. Using transparent procurement system to transform the public health financing mechanisms due to existing limitations and overall health financing reform in Ukraine.
Perceptions of barriers and levers to health-enhancing physical activity policies in French cities
Authors: Noël Racine A , Garbarino J M , Corrion K , d’Arripe-Longueville F , Massiera B , Vuillemin A
Published: November 2019

Background

Policy is one of the levers to initiate structural change to foster the promotion of Health-Enhancing Physical Activity (HEPA). To this end, policymakers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been published on this topic at the local level. The purpose of this study was to identify the barriers and levers to develop HEPA policies from the point of view of municipals managers and elected officials in mid-size French cities.

Methods

This study was conducted following the concept mapping approach: a list of statements was submitted to 17 French mid-size cities. These statements completed the beginning of this sentence: “In a mid-size municipality context, to develop HEPA policies, it is necessary to...”. First, key informants in each city rated the importance of each statement without considering their local context according to a Likert scale, ranging from 1 (not at all important) to 6 (extremely important). Then, they had to rate the feasibility of each statement considering their local context according to a Likert scale ranging from 1 (not at all feasible) to 6 (extremely feasible).

Results

A total of 23 municipal managers and 10 elected officials from sport (n = 14), health (n = 10), and social (n = 9) sectors from 11 French mid-size cities participated in this study. Statements related to political commitment, shared governance and partnership appeared as potential levers to develop HEPA policies. Statements related to the economic model of the local HEPA promotion, mandate of the mayor, and land use planning appeared as potential barriers to develop HEPA policies. The results varied according to the position and the sector of the respondent.

Conclusions

The results suggest that some local contextual factors could affect the development of HEPA policies in mid-size French cities. This study contributes to a better understanding of the development of local HEPA policies in the French context.

Key messages

Local contextual factors should be considered when developing health-enhancing physical activity policies. The perceptions of these local contextual factors varied according to the position and the sector of the respondent.
Do modern dental care systems adequately meet the health needs of citizens? Poland comparing to EU
Authors: Kobza J K
Published: November 2019

Background

residents of highly developed countries do not have universal access to dental care at a level corresponding to the current needs, that results from the ongoing socio-economic, health and demographic changes. Dental care is fragmentary, covers only selected population groups, by far the largest negligence is in the field of prevention. Poland is an example of bad oral health status, where dental caries index for adolescents in all ages groups has been the highest in Europe.

Objective

The aim of this study was to carry out an analysis of some organizational, financial and social aspects of a dental care in Poland, comparing to EU countries, and to identify the main causes of a bad oral health outcomes.

Material and methods

This research presents findings from the 610 dental providers interviews, carried out in 2018. The survey consisted of 32 questions, concerning all relevant aspects of dental clinics activity. Statistical analyzes were performed in a SAS package - 9.4 version.

Results

Poland has the highest number of dentists in EU (9.9 per 100 thou. of population) while the average for EU is 6.6. Dental rooms are modernly equipped. Dentists apply the newest technologies, they are constantly improving their knowledge and implement the TQM tools. Less than 30 % of patients are treated in public system, the average waiting time for the appointment in public sector is three times longer than in private one. Dentists perform the care of young people mainly in the area of conservative dentistry.

Conclusions

Improving children’s oral health should be a public health priority in Poland. Public authorities in a very limited extent participate in the organization, financing, supplying and supervising of dental care. Health promotion programs are ineffective, health needs assessment aren’t being done, we observe the lack of cooperation between the key health institutions and lack of tools to identify socio-economic inequalities.

Key messages

Research financed by Medical University of Silesia in Katowice. The aim of the study was to carry out an analysis of some organizational, financial, social aspects of a dental care in Poland comparing to EU, and to identify the causes of a bad health outcomes.
Implementation of a new model of management to increase the effectiveness of nursing specialists
Authors: Koikov V , Baigozhina Z , Umbetzhanova A , Bekbergenova Z h , Derbissalina G
Published: November 2019

Issue/problem

Nurses play a key role in the system of public health. The total number of nurses in Kazakhstan is 105,441 people (January 1, 2019), which is over 40% of all health workers in the health system of Kazakhstan. The continuing problem of insufficiently effective nursing service (NS) in the country prompted us to develop policy options to increase the NS effectiveness.

Description of the problem

Key problems of the NS in Kazakhstan include the ineffective management of NS in health organizations, which is associated with an underestimation of the role of nurses in the therapeutic and diagnostic process. There is also a discrepancy in the functioning of the system of nursing education, research and practice with European directives. There are inadequate regulatory acts governing the activities of nurses (including the lack of national guidelines, nursing standards, etc.).

Results

As a result of analyzing the current situation in the country and summarizing the data from systematic reviews, we were developed the Policy Brief on the issues of implementation of a new model of the NS management. As the key policy options, we proposed: 1. Improving the NS management in health organizations based on a revision of the role of nursing staff in the treatment and diagnostic process; 2. Improving the sectoral qualifications system of nursing specialists in accordance with European directives; 3. Ensuring the development of evidence-based nursing practices with the implementation of generally accepted international standards and models, the development of national guidelines and standards for NS.

Lessons

The proposed measures found support from the Ministry of Health and were included in the action plans. Each of these policy options contributes to increasing the effectiveness of NS in the health system of Kazakhstan, but these options provide more substantial achievement of the goal of enhancing the role and status of a nurse with their combined implementation.

Key messages

Implementation of a new model of the NS management in which nurses and physicions work on an equal footing and independently can significantly improve the efficiency of NS. Implementation of evidence-based approaches to the formation of a policy in the field of the NS development gives possibility to increase the effectiveness of the reforms in this field.
Tamoxifen and antidepressant’s co-prescription: general practitioners and pharmacist’s alert
Authors: Chaslerie A C , Vigneau Victorri C , Grude F , Thomasset A , Even A , Gourdet J , Prieur J P
Published: November 2019

Issue

Well known drug-drug interaction with some antidepressants, especially selective serotonin reuptake inhibitors which reduce tamoxifen’s effectiveness and associated with an increased risk of death from breast cancer.

Description of the problem

To identify and characterize the exposure to antidepressants in women with breast cancer treated with tamofixen in a west french area. Retrospective population based cohort study; claims from the French Health insurance database. Women living in Pays de la Loire area, aged 20 years or older treated with tamoxifen for breast cancer in 2018 who had concomitant treatment with antidepressants. Call phone to general practitioner’s and meeting with pharmacist when a high or moderate level drug-drug interaction’s was identified.

Results

Of 4138 women treated with tamoxifen, 497 (12%) received an antidepressant treatment in 2018, corresponding to 571 co-prescriptions. Of them, 74 (13%) was moderate level drug-drug interaction, 66 (11.6%) high level and 307 (53.8%) weak level.70% of high level drug-drug interaction were due to paroxetine and 43% of moderate level due to duloxetine. For these co-prescriptions, concomitant patient’s exposure was for more than four months in 22% cases. 127 different general practitioners and 152 pharmacists (339 different dispensation’s date) were concerned by these drug-drug interactions.

Lessons

French health insurance medical department has contacted general practitioners or pharmacists concerned by these drug-drug interactions. We informed general practitioners to be aware about women treated with tamoxifen when co-prescription with an antidepressant is necessary, preference should be given to one of them that show little or no inhibition of cytochrome P450 2D6.

Key messages

Mediation medication and detection of drug-drug interaction by pharmacist. Preferential choice of antidepressant by general practitioner or women treat with co-prescription (tamoxifen and antidepressant).
The relationship between causes of procrastination and sociodemographic factors
Authors: Vlachopanou P , Tsiampalis T , Karagiannopoulou E
Published: November 2019

Background

In recent decades there has been keen research interest in the concept of procrastination and its impact on the student population with few studies being conducted in the Greek student population. The present study aimed to contribute to our knowledge regarding the causes that bring about academic procrastination and to further explore participants’ characteristics regarding these causes.

Methods

A cross-sectional study conducted in Greece with 628 college students at the University of Ioannina. Specially designed instruments were used to record students’ sociodemographic characteristics and causes of procrastination (CP). Factor Analysis (FA) with principal components (PCA) was used to derive the main students’ causes of procrastination, though Analysis of Covariance was used to examine the effect of their characteristics on these causes.

Results

5 main causes of procrastination were identified explaining 48% of the total variation. Students’ lack of duty/ low tolerance for frustration was significantly associated with their gender (p = 0.005), year of study (p = 0.048) and grades (p = 0.008), while their dependency/difficulty of claim was significantly affected by students’ gender (p = 0.042), way of living (p = 0.034), place of residence (p = 0.001) and their age (p = 0.006). Moreover, their place of residence was significantly associated with their

fear of failure (p = 0.001) and their difficulties in time management and decision making (p = 0.049), with those not living in the place of origin presenting greater values in relation to the aforementioned factors.

Conclusions

Procrastination is a widespread phenomenon in academic settings that affects differently each gender and is also affected by the sociodemographic factors. This study demonstrates the importance of investigating the causes of procrastination as a concept that helps us understand students’ behaviour and patterns associated with it.

Key messages

There is a great need for further studies on the causes of procrastination in order to help Universities to design learning environments that will be helpful for their students. The college instructors should train students not to procrastinate via preventing interventions.
Ageing and its challenges: Communitary Intervention Group findings and experience in 2017, Porto(PT)
Authors: Sottomayor A , Perez-Duque M , Santiago M M
Published: November 2019

West Porto Public Health(PH) Unit manages a multidisciplinary intervention group - Communitary Intervention Group(GIC) - that responds to critical life situations. It mainly covers mental and public health problems, often associated with ageing. We aimed to characterise the population of referred cases to GIC in 2017, know their geographical distribution and compare case ratio between parish. Data was provided by GIC and all cases from 2017 were included. We used GPS coordinates and QGIS to map the distribution of cases. Case number was compared between parish through the calculation of ratios (considering population size). 95% Confidence intervals (CI) were calculated by Byar’s method to assess differences between parish.

A total of 88 cases were referred to GIC in 2017, mostly by the Police (37,1%). Mean age was 62,3 years(16-94) and 62,9% had > =60 years. Majority (53,3%) were women. The main problem identified was unsanitary housing(23,6%) and elderly at risk(23,6%), followed by psychiatric alterations(15,7%). Considering elderly at risk, 38,1% was associated with unsanitary housing and 14,3% with psychiatric alterations. Parish “Cedofeita, Santo Ildefonso, Sé, Miragaia, São Nicolau e Vitória”(CSSMS) had the highest number of cases (33,7%) and “Lordelo do Ouro e Massarelos” the highest case ratio (21,96; 95%CI:13,92-32,95). Visually most cases live in parish CSSMS or near social neighborhoods. Case ratios was not statistically different between parish.

The type of referred cases suggests a lack of support to elderly. Immediate attention from health services is needed since this situation leads to a misuse of healthcare services, without a sustained benefit, peaking with health deterioration. More investigation is needed, especially to clearly identify social and health determinants. This is particularly important considering the population ageing and the socioeconomic pressure it perpetuates in future generations, compromising their health.

Key messages

Health services must rethink elderly care. Promoting quality of life through aging is key to sustainability.
Health Literacy of Hearing-Impaired High School Students, Some of the Problem, and their Expectations
Authors: Gür K , Dolaner G , Turan R
Published: November 2019

Purpose

This study aims to determine hearing-impaired students’ levels of health literacy, problems when they receive healthcare service and their expectations.

Methods

This descriptive study was conducted on 88 hearing-impaired high school students over 15 years of age. The data collection tools used in the study are “Form of Problems Experienced When Receiving Healthcare Service”, “Form of Expectations from Healthcare Service”, and Turkey Health Literacy Scale (THLS-32). The researchers know sign language. The Health Sciences Faculty granted approval for the study (04.12.2017-255). The families were informed of the program through the school administration, and their consent was obtained.

Results

70.5% of the students had inadequate, 19.3% had limited, 2.3% had adequate and 8% had excellent health literacy levels. Those who had communication problems with the doctor (25%), those who misused the prescribed medication (13.6%) and those who could not use the medication without help (43.2%) had low THLS scores (<0.05). Those who stated that they did not understand what the nurses said (43.2%) and the health education materials (56.8%) and those who reported that they were confused when they had more than one appointment (20.5%) had significantly low THLS scores (<0.05). 55.7% of them expected that their prescriptions or care procedures were to be given in writing, and 87.5% expected them to be told in sign language.

Conclusions

Most of of the participants have significantly weaker general health literacy. Students with low THLS scores have less understanding of the given information and have problems with health workers.

Main messages: This can create disparities and inequalities in the use of healthcare services and in the health outcomes.

Key messages

This can create disparities and inequalities in the use of healthcare services. This can create disparities and in the health outcomes.
Racial discrimination and biological dysregulation among Indigenous adults: The role of culture
Authors: Copeland J
Published: November 2019

Background

Racial discrimination is an ongoing social concern that requires public health solidarity to address. Indigenous peoples in many countries report high levels of discrimination across a variety of life domains, particularly when they migrate into urban centres for school or work. Discrimination has wide-ranging impacts that go beyond mental distress to include alterations in stress biomarkers across multiple systems. This study examined the impacts of discrimination on multisystem biological dysregulation among urban Indigenous adults in Canada, operationalized through allostatic load; and the role that Indigenous cultural continuity might play in resilience.

Methods

This cross-sectional study collected data from 150 Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (M age: 28 years). Allostatic load (AL) was measured as a composite of 7 biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models examined associations adjusted for confounders.

Results

Past-year discrimination was significantly and linearly associated with increased AL adjusting for age and income (B = 0.17, p = 0.02). Among adults with low cultural continuity, past-year discrimination was associated with AL in models adjusted for age and child discrimination (B = 0.17, p = 0.01), with past-year discrimination and the full model explaining 24% and 41% of the variance in AL; respectively. Among adults with high cultural continuity, past-year discrimination was not associated with AL, and the full model explained 1% of the variance in AL.

Conclusions

Past-year racial discrimination was an adverse event capable of influencing multisystem biological dysregulation among Indigenous adults, independent of age and income. Indigenous cultural continuity may promote biological resilience against racism within this population.

Key messages

Racial discrimination was associated with multisystem biological dysregulation among urban Indigenous adults, controlling for age and income. Indigenous cultural continuity buffered the impact of discrimination on biological health.
Evaluation of the use of standardized methods to identify mental health problems among refugees
Authors: Delilovic S , Lonnroth K , Hagstrom A
Published: November 2019

Background

The number of refugees arriving and residing in Sweden remains high. They represent one of the most vulnerable sub-populations in the country, who carry a disproportional part of the disease burden. Information on health status, health determinants and the extent to which refugees get access to needed services is limited. In Sweden refugees are offered a free-of -charge health examination (HE). Yet, standardized mental health screening is often neglected as a part of the HE. A pilot project aimed to initiate early mental health screening was implemented.

Methods

The Refugee Health Screener-13 (RHS-13) was identified as an efficient, valid, and reliable tool for assessing mental health in this population and was integrated into the HE. The RHS-13 was administrated by nurses conducting the HE at two primary health care centers in Stockholm.

Results

During the one-month pilot 80 individuals were screened. The majority originated from Syria, DR Congo and Afghanistan and the distribution by migration background were 58% quota refugees, 35% asylum seekers and 8% others (family reunification and undocumented migrants). Of those screened, 30% screened positive for risk of mental health (cut off ≥11). Out of those who screened positive, 29% screened for mild mental health, 33% for moderate mental health and 38% for severe mental health problems. No statistically significant differences in RHS score were found according to country of origin, sex and age. The results are preliminary. Implementation will continue for 12 months at 4 primary health care centers.

Conclusions

This pilot demonstrated feasibility of RHS-13 in routine care. The findings reinforce the need for standardized guidelines and procedures for mental health screening of refugees. Routine mental health screening should be a part of the overall comprehensive HE, which could improve systematic monitoring of mental health care needs for refugees and ensure access to appropriate mental health care.

Key messages

Standardized procedures for identifying mental health problems among refugees is feasible and can identify health needs while ensuring equitable health examinations. Standardized procedures for identifying mental health problems among refugees is feasible and can identify health needs while ensuring equitable health examinations.
Health assessment of newly arrived refugees to the Municipality of Copenhagen, Denmark
Authors: Andersen M , Frederiksen H Winther , Ahmadi M , Kruse A , Nørredam M
Published: November 2019

Background

Research data on the health status of newly arrived refugees is sparse. Newly arrived refugees and family reunified in The Municipality of Copenhagen has since 2016 been offered a general health assessment. These assessments are conducted by clinicians with expertise in refugee and migrant health from the Section of Immigrant Health. This study describes the sociodemographic characteristics and the burden of disease in this population.

Methods

In this cross-sectional study the population consists of adult patients examined January 2017 to February 2019. Clinicians performed the health assessment including a questionnaire regarding sociodemographics, medical history, symptoms, traumatic events during/before migration, a clinical examination and blood samples.

Results

The population had an equal presentation of males (N = 81) and females (N = 79) primarily from Syria (33%) and Iran (29%). The median age was 31,5 years (SD = 10,9). 67% had ≥8 years of schooling, while 11% had a maximum of 2 years. More than half had experienced war and 50% persecution. 76% suffered from Vitamin D deficiency, 31% of B12 deficiency and 12% of anemia. Few suffered from infectious and somatic diseases, yet many experiences symptoms such as pain (53%) and headaches (54%). 33% presented with symptoms of PTSD.

Conclusions

A high frequency of micronutrition deficiency was prevalent in the refugee group. Furthermore, many suffered from physical symptoms while very few had serious somatic issues. Numerous traumatic experiences were reported and 33% presented with symptoms of PTSD. The data is presumably a reflection of the healthy migrant bias.

Key messages

Despite refugees presumably being tested pre-entry and at holding level, they still suffer several health issues when granted asylum. Many newly arrived refugees suffer from micronutrition deficiency. These conditions are easily treated and could enhance the overall health of the individual.
Your Health, Your Faith: HIV prevention with African faith-based communities in Germany
Authors: Gangarova T , Bakambamba A
Published: November 2019

Migrants are disproportionally affected by HIV/AIDS in Germany, with about every third new HIV diagnosis given to a person who has migrated to Germany. More than half of HIV new diagnoses among migrants are people from sub-Saharan African countries. Because infections are not just brought from the countries of origin but also occur in Germany, HIV prevention services must be better tailored to the needs of migrants.

Your Health, Your Faith (2016-2018) is a community-based participatory health project that aims to improve the involvement of African faith-based communities in HIV prevention services. The project is conducted by the National AIDS Service Organization in collaboration with partners from different African communities, African pastors, AIDS service organizations (ASOs) and researchers from the Ludwig Maximilian University of Munich.

Teams of African activists, African pastors and ASOs have been built in eight German cities. All partners were invited to a series of concept workshops in Berlin in order to define together prevention contents, methods and forms of cooperation. Together, they developed a concept for preaching preventive messages in church settings and scenarios for a mobile educational theatre group.

To date 65 multilingual events have been held at various African churches, reaching approximately 5000 people. The results of the project has been evaluated on a multi-case basis, with quality standards being compiled for prevention events in African churches. In the course of the project, the participants designed a video that illustrates the prevention work in African Church communities. At the request of the pastors involved, a mobile training series on HIV/Aids for African pastors has been developed with the support of medical doctors.

Key messages

HIV prevention in African churches and cooperation between African churches, public health authorities and ASOs is possible and promising. Communication via pastors has proven useful, as have supporting theatre performances that facilitate communication about taboo subjects such as HIV/AIDS.