bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing the patient information material for cancer patients using the participatory health research approach
Authors: Salm S
Published: October 2020

By applying the PHR, a literature-based assessment catalogue was designed and piloted (PIM-check list) with the PIM optimization team (experts, network supporters and experienced end-users). It contains altogether 31 criteria that are clustered into: (1) correctness & validity, (2) 'content-related readability', (3) 'structural readability' and (4) 'graphic-/formatting-related readability'. The PIM is assessable through a traffic light rating system. This simple rating system enables not only experts, but also the end-users (cancer patients) to easily evaluate the PIM without initial and complex training. Moreover, for each criterion, an open text field is provided to write in suggestions for improvement.

The available isPO PIM were assessed with this instrument by three groups: (1) experts (network supporters & external evaluators), (2) self-help representatives, and (3) isPO programme service providers. Several feedback loops encouraged all participants to provide critical feedback.

In addition to the improvement suggestions from the completed PIM-check lists, a hierarchical overview of the PIM was developed by the PIM-optimization team. It highlights the moment of being in contact with the PIM, the specification of the target group and the depth of information in the specific PIM. These aspects were also considered when creating two new PIM (poster & one-pager document concerning the study consent form). In addition, a uniform design for the 'door-opener' PIM (poster & flyer) was aimed to be a “recognition factor”. Both the optimized and newly designed PIM were presented to and assessed by experienced cancer patients that do not participate in isPO. Suggestions for further improvements were integrated by the PIM-team. The PIM were presented to the isPO service providers for further optimization proposals. A final test for its comprehensibility was conducted using experienced patients in a focus group discussion, and the new PIM were implemented in the field.
Carcinogenicity assessment: technical and political challenges
Authors: Madia F , Worth A , Whelan M , Corvi R
Published: October 2020

The rising rates of cancer incidence and prevalence identified by the WHO are of serious concern. The scientific advances of the past twenty years have helped to describe major properties of the cancer disease, enabling therapies that are more sophisticated. It has become clear that the management of relevant risk factors can also significantly reduce cancer occurrence worldwide. Public health policy actions cannot be decoupled from environmental policy actions, since exposure to chemicals through air, soil, water and food can contribute to cancer as well as other chronic diseases. Furthermore, due to the increasing global trend of chemical production including novel compounds, chemical exposure patterns are foreseen to change, posing high demands on chemical safety assessment, and creating potential protection gaps. The safety assessment of carcinogenicity needs to evolve to keep pace with changes in the chemical environment and cancer epidemiology. The presentation focusses on EC-JRC recommendations and future strategies for carcinogenicity safety assessment. This also includes discussion on how the traditional data streams of regulatory toxicology, together with new available assessment methods can inform, along with indicators of public health status based on biomonitoring and clinical data, a more holistic human-relevant and impactful approach to carcinogenicity assessment and overall prevention of cancer disease.
Expert Recommendations for Health Literacy Policies addressing Children and Adolescents
Authors: Okan O , Corsmeier M , Sørensen K , Bauer U
Published: October 2020

Background

There is an on-going and a well observable uptake of health literacy in the national and international agenda-setting pertaining to the development of new policy strategies to address the issue of promoting health literacy in whole societies. Therefore, the aim of this research is to analyse those policies on how they address children and develop recommendations for future policies.

Methods

Policy documents on national levels, published by February 2019 were retrieved using a two-pronged strategy: (1) systematic review methods (database and online search) and (2) expert consultation. Based on a SWOT analysis of these policies, an interview guide was developed and policy experts (N = 63) from 46 countries across the world were interviewed. Based on the qualitative analysis, a Delphi Study was developed to gather expert comments and validation.

Results

The search has identified 26 policies in 19 countries including case-laws and enacted statues, governmental strategies, polices driven by national key experts, and educational policies. The content of these informed the interview guide. The initial analysis of the interviews led to several recommendations pertaining to schools and the education sector, including principals, teachers and whole-school approaches, characteristics of different settings, such as policy, education and administration, economic perspectives, and the need for research and evidence in order to inform future strategies.

Conclusions

The results will be compiled into a recommendation report and a policy brief. In addition, those will be translated into other languages to share with the countries of the experts who participated in this project. While almost all policies address children somehow, several limitations make it difficult to evaluate the quality of the different policies. To secure and sustain more effective, child-focused policies, current knowledge gaps regarding research on children`s health literacy should be addressed.
Turning constraints into resources: the experience of TRAIN4M&H training program on migrants’ health
Authors: Declich S , DePonte G , Russo M L , Marchetti G , Dente M G , Punzo O , Marceca M
Published: October 2020

Background

The tender TRAIN4M&H (Provision of training for first-line health professionals and law enforcement officers working at local level with migrants and refugees, and training of trainers- contract 20167204), funded by the EC-DG SANTE under the 3rd EU HP, intended to conduct training programme in all EU/EEA countries for health professionals, law enforcement officers an social workers in front-line countries and coach trainers in the others.

Objectives

Training was aimed at reinforcing skills, improving understanding and positive attitudes, and promoting a holistic approach in the work with migrants. The boundaries set by the tender included a short training duration; exclusive use of pre-existing and validated training materials; different professional targets. Italian National Health Institute and Sapienza University of Rome designed the training programme. Criteria for content selection and methodological choices were submitted for consultation to an inter-professional Expert Group in two steps.

Results

Given the limited training timeframe, the delivery of specialised content could not be the focus of this training. It was decided therefore to transform the target requirement into added value, by mixing the target groups into multi-professional classes. This bring a diversity of understandings into the classroom and enhance communication between sectors. The training included also topics such as “context of migration” and “intercultural competences” to create common ground for multi-professional exchange. Similarly, the need to adapt to different EU/EEA contexts argued for a modular structure where Units are selected by the Local Trainer based on a training needs assessment questionnaire sent to trainees beforehand. All materials are on EU Health Policy Platform's Agora (webgate.ec.europa.eu/hpf/).

Conclusions

Training on migrants' health is a complex process, requiring the engagement of learners from their previous experiences and an interdisciplinary approach.

Key messages

Inter-professional training programme can be used for the adult trainings especially in case of a cross-sectoral topic as migrants’ health is. Inter-professional training is a strategy that can guide coherently content design, outcome identification and the choice of evaluations tools.
Do leaders in departments with low nurse turnover use unique strategies? A positive deviance study
Authors: Hølge-Hazelton B , Berthelsen C B
Published: October 2020

Background

High nurse turnover in hospitals is a global problem and factors such as nurses' relationships with their managers have been associated with retention and turnover. Previous studies have utilized a deficit-based approach. This study aims to investigate nurse leaderś experiences and descriptions of practices in hospital departments with low nurse turnover in a region facing the highest nurse turnover rates in Denmark. The research questions were: What considerations and strategies regarding turnover do the nurse leaders have? How do the nurse leaders describe the culture and work environment in their departments?

Methods

A constructivist design with a focused ethnography methodology was used to construct data, primarily through interviews. Positive deviance inspired the theoretical perspective. Head nurses and ward managers from medical, surgical, acute and psychiatric departments with the lowest nurse turnover participated in the study (total 9 leaders). The female leaders, had an age range from 43 to 65; their management experience ranged from 1 to 27 years.

Results

Despite the fact that leaders came from very different contexts, they all had clear visions for the culture and values of their departments, including ideas about how to proceed with the current and future challenge of nurse turnover. The results are presented as two categories related to the research questions: The culture is unique, and Maintaining, protecting or re-establishing the unique culture.

Conclusions

Nurse leaders from departments with low nurse turnover compared to similar departments in the same region all described their cultures as unique, but held in common values of diversity and balance in the group of staff, and the leaders' roles were focused on maintaining, protecting or re-establishing that culture.

Key messages

Nurse leaders with clear cultural awareness and visions for the context in which they operate may be positively associated with lower nurse turnover. The head mainly nurses lead indirectly by securing the best possible conditions at a strategic level, so the nurses could thrive.
Implementation of the European health interview survey into the National FinSote survey in Finland
Authors: Parikka S , Koskela T , Ikonen J , Kilpeläinen H , Tolonen H
Published: October 2020

Background

This methodological paper describes the integration of the European Health Interview Survey wave 3 (EHIS 3) into the National FinSote Survey (FinSote2019/EHIS). Finnish Institute for Health and Welfare (THL) conducted the survey in Finland.

Methods

FinSote 2019/EHIS was conducted as a cross-sectional health, welfare and services survey. A simple random sampling was used to recruit 15 000 individuals aged 15 years and older. Data collection was carried out by self-administered questionnaire that was available in web and paper form. To minimize the respondent burden socio-demographic background variables were obtained from administrative registers. In Finland, EHIS wave 3 was conducted as a part of the National FinSote survey. The questionnaire included both EHIS 3 modules on health status, health care, health determinants (excluding derogation variables), social background variables and additional national questions. In data processing, two datasets were formed: national dataset for sustaining time series as well as monitoring nationally relevant topics and EHIS dataset including the quality and validation rules specified by Eurostat.

Results

In total, 6,251 questionnaires were completed. The response rate was 44 % in EHIS data (aged 15+) and 45 % in national FinSote data (aged 20+). The representativeness of the results was increased by applying weighting procedures. The sample size was just large enough to achieve the precision requirements determined by Eurostat. Access to micro data of the EHIS 3 will be provided by Eurostat and to the FinSote 2019/EHIS by THL.

Conclusions

Integrating EHIS wave 3 into an existing national monitoring system was challenging in Finland. The harmonization might lead to interruptions of existing national time trends. Inclusion of some national well-being and social care variables might be irrelevant to respondent aged 15-19 years.

Key messages

Conducting EHIS as a part of National FinSote survey in Finland was cost-effective but challenging. Cultural differences in regards to living conditions in younger respondents and health care system made it challenging to integrate EHIS into national survey.
Health system responsiveness to refugees: a population-based, cross-sectional study in Germany
Authors: Biddle L , Wenner J , Bozorgmehr K
Published: October 2020

Background

Responsiveness, a critical component of health system performance, has received little attention in the context of international migration. Yet the concept provides a unique lens to study the system's ability to meet the legitimate expectations of its users. This study aims to identify predictors of responsiveness for asylum seekers and refugees (ASR) in Germany.

Methods

A population-based, cross-sectional health monitoring survey was conducted in Germany's third-largest federal state using random sampling at the level of all 1938 accommodation centers. Established instruments were used to measure responsiveness, health status, and socio-demographic factors. Data were weighted for sampling design and calibrated using asylum statistics. Adjusted logistic regression models were applied to identify predictors of responsiveness related to health status, structural, and socio-demographic variables.

Results

Of 560 respondents (response rate: 42%), 344 provided data on responsiveness. Combined weighted scores for responsiveness were 75% (CI: 69%-82%), with large variations between domains ranging from 86% (CI: 80%-90%) for cleanliness and 83% (CI: 76%-89%) for respect domains, to 56% (CI: 48%-63%) for choice and 52% (CI: 46%-59%) for timeliness domains. Overall responsiveness was worse for ASR with poor general health (OR 0.35; CI: 0.14-0.84), chronic illnesses (OR: 0.37; CI: 0.17-0.81), symptoms of depression (OR: 0.37; CI: 0.15-0.90) and anxiety (OR: 0.26; 0.10-0.68), and poor quality of life (OR: 0.18; 0.06-0.60). Socio-demographic and structural factors were not significantly associated with responsiveness.

Conclusions

There is room for improvement, especially regarding choice of provider and timeliness of care for ASR in Germany. Poor health status is a predictor of responsiveness, indicating that ASR most in need of a supportive care environment are being sold short. There is therefore an inequitable distribution of health system responsiveness among ASR.

Key messages

There is a large variation in scores across responsiveness domains, with choice of provider and timeliness of the health system being rated as particularly poor by ASR. Responsiveness is worse for individuals with poor health status, indicating that those most in need of a supportive care environment are being sold short.
Can a community empowerment intervention improve health and wellbeing in a post-industrial UK town?
Authors: Coan S , Woodward J , South J , Bagnall A , Southby K , Button D , Trigwell J
Published: October 2020

Background

'Local People' programme operates in 29 UK communities experiencing disadvantage and economic stressors that impact on population wellbeing. The programme uses a community empowerment approach to increase social connections, and collective control, improve health, and reduce inequalities. This links to SDGs 3 and 11. Mechanisms include a decision-making group led by residents, a project lead, funding, and support from a national charity.

Methods

A mixed method evaluation was conducted (2017-19) to identify processes and assess outcomes and impacts. This presentation outlines the findings from five in-depth qualitative case studies (c140 interviews) with emphasis on one post-industrial UK town suffering from the effects of industrial decline. A within case and cross case qualitative analysis was undertaken using a thematic framework.

Results

Priorities set by local areas focused on increasing community involvement and connections between people. A wide range of activities took place including regular classes and community events. The five case studies found strong qualitative evidence of increased social connectedness, community spirit and a sense of purpose, along with the area becoming a better place to live. People involved in project delivery gained confidence and skills, improved their wellbeing and gained a sense of control. There is, as yet, limited evidence that increased involvement has influenced the wider determinants of health. In the post-industrial town, people's social networks expanded, enriching their lives and providing missed companionship. Participants in the programme reported improved mental and physical health, as well as increased confidence and skills. Involvement gave a voice to marginalised older people in the area.

Conclusions

Empowering communities and putting residents in control can lead to improvements in connectedness and some aspects of health and wellbeing, even in post-industrial towns facing considerable and complex challenges.

Key messages

The community empowerment programme increased social connectedness. The programme led to improved mental and physical health in participants.
Environmental and individual characteristics associated with car use across Europe
Authors: den Braver N R , Kok J G , Mackenbach J D , Rutter H , Oppert J M , Compernolle S , Twisk J W R , Brug J , Beulens J W J , Lakerveld J
Published: October 2020

Background

This study aimed to determine which neighbourhood- and individual-level characteristics were associated with car driving in adults of five urban areas across Europe, and to determine the percentage of variance in car driving explained by characteristics at both levels.

Methods

Neighbourhood environment characteristics potentially related to car use were identified from the literature. These characteristics were subsequently assessed using a Google Street View audit and available GIS databases, in 59 administrative residential neighbourhoods in five European urban areas. Car driving (min/week) and individual level characteristics were self-reported by study participants (analytic sample n = 4,258). We used linear multilevel regression analyses to assess cross-sectional associations of individual and neighbourhood-level characteristics with weekly minutes of car driving, and assessed explained variance at each level and for the total model.

Results

Higher residential density (β:-2.61, 95%CI: -4.99;-0.22) and higher land-use mix (β:-3.73, 95%CI: -5.61;-1.86) were significantly associated with fewer weekly minutes of car driving. At the individual level, higher age (β: 1.47, 95%CI: 0.60;2.33), male sex (β: 43.2, 95%CI:24.7; 61.7), being employed (β:80.1, 95%CI: 53.6; 106.5) and ≥3 person household composition (β: 47.4, 95%CI: 20.6;74.2) were associated with higher weekly minutes of car driving. Individual and neighbourhood characteristics contributed about equally to explained variance in minutes of weekly car driving, with 2% and 3% respectively.

Conclusions

Residential density and land-use mix were consistently associated with minutes of weekly car driving, besides age, sex, employment and household composition. Although total explained variance was low, both individual- and neighbourhood-level characteristics were similarly important in their associations with car use in five European urban areas.

Key messages

Both individual and neighbourhood level characteristics contributed equally to explained variation in car driving, across Europe. Higher residential density and land-use mix are consistently associated with lower care use.
Health Management Information for Decision Making
Authors: Iqbal Anwar A
Published: October 2020

With support of the European Union, icddr, b partnered with Directorate General of Health Services in the Ministry of Health and Family Welfare in Bangladesh, to improve the health management information system in the country. The project first performed analysis of strengths and weaknesses. New data analytic systems were developed, new dashboards and other tools for visualisation were put in place. Health managers in different areas were trained in using data analysis for decision-making. By making data available for communities more transparency was created in health management.

The SHARE project organised two international conferences on Data for Decision-making, publish reports, policy briefs, organised think tank meetings and community interventions to enhance data use in evidence-based policies.

Most important lesson learned: with appropriate tools, information can be understood by service providers as well as service users and lead to better healthcare. Researchers can mediate between statisticians and end users of data.
Developing local knowledge centre for health policy
Authors: Chenge F
Published: October 2020

With the support of the European Union, the Health Knowledge Centre in DR Congo was initiated. The Centre is a small independent organisation, that has strategic liaisons with three Schools of Public Health in DR Congo and with the National Biomedical Laboratory. The Centre produces policy advice, often based on knowledge generated in the universities.

Through its direct relationship with the Ministry of Health it is able to develop new policy directions in the health sector, e.g. through analysing and advising on healthcare financing.

The Centre produces policy briefs, organises round tables, and has a website to inform stakeholders on policies in health.

Most important lesson learned: an organisation that mediates between universities on the one hand and policy makers on the other hand is able to formulate evidence-based policies.
Conducting a national burden of disease study in South Korea: from past to present
Authors: Yoon S J , Kim Y E , Park H , Oh I H , Jo M W , Ock M , Go D S , Kim K A , Kim K
Published: October 2020

South Korea has been measuring its own burden of disease since the early 2000s and has developed a methodology for its calculation. Since 2012, South Korea has been carrying out disease burden research through the Research and Development Project, supported by the Ministry of Health and Welfare. Because the Korean health insurance system covers the entire population of the country, the Korean National Burden of Disease (KNBD) study is based on individual claims data. Disease prevalence, incidence, and mortality rates, which are the epidemiologic indicators used to calculate burden of disease, are based on actual data, and the incidence-based approach is used for Years Lived with disability (YLD), Years of Life Lost (YLL), and Disability Adjusted Life Year (DALY). The KNBD study is conducted for 260 diseases and injuries and subdivided into sub-national levels. Disability weights (DW) are calculated to reflect the sociocultural characteristics of a disease. For cause-specific DWs, we conducted a self-administered web-based survey for medical doctors and students. Using a ranking method, we calculated cause-specific DWs. For this reason, KNBD study results cannot be directly compared with GBD results.

The major findings of the KNBD study are as follows. In Korea, the DALY rate (per 100,000 people) steadily increased for all income levels. The higher the income, the lower the burden of disease; low-income people had a higher burden of disease than high-income people. However, thyroid cancer, refraction and accommodation disorders had a high burden of disease in the high-income group. Growth in the YLD rate was faster than in the YLL rate. In 2016 the leading causes of disease burden were diabetes mellitus, low back pain, and chronic obstructive pulmonary disease.

We will present South Korea's disease burden calculation methodology and its results and share the efforts to calculate disease burden in other countries.
Use of non-health EU databases for health surveillance. En-risk application
Authors: Fernández-Navarro P , Pérez-Gómez B , Gómez-García T , Sarmiento-Suárez R , Padrón-Monedero A , Ortiz-Pinto M , Galán I , Noguer I
Published: October 2020

Background

To combine health information and environmental health determinants is key, for epidemiological monitoring and health risk studies but its integration represents a challenge that requires specific expertise. An example of a potentially useful source of significant environmental data relevant for health is the European Pollutant Release and Transfer Register (E-PRTR), which allows estimating exposure to industrial pollution. Our aim was to develop an easy-to-use tool that allows to perform a screening suggesting the presence/absence of excess risk of a disease linked to residential proximity to industrial pollution.

Methods

En-risk: java interactive tool was developed to merge E-PRTR information and municipal mortality/morbidity data, to perform an exploratory spatial analysis of association between them by type of industrial facility using distance as proxy of exposure. The application needs cartography of the country and a database of the annual observed deaths (mortality) or cases (morbidity) and population broken down by age groups and sex per municipality. With this it calculates the expected number of deaths, the distance from the municipal centroids to the industrial location (classifying municipalities as exposed or not exposed), and perform the statistical analyses. Municipal lung cancer deaths (2005-2009) in Spain provided by the National Institute of Statistics were analyzed with this application as an example.

Results

En-risk gives a table of Relative Risk of mortality/morbidity due to exposure to industrial pollution by industrial sector and sex. The analysis in lung cancer deaths showed an excess of mortality associated to proximity to several industrial sectors.

Conclusions

En-risk facilitates the study of the relationship between industrial pollution and health around Europe. It can be used by public health services to identify health problems.
The psychosocial health needs of bisexual men in Senegal: A research translation experience
Authors: Martínez-Pérez G , Nabil F , Mbaye E , Nkoum N
Published: October 2020

Background

Criminalization of same-sex relations is a driver of the HIV epidemic. Whilst LGBT activists advocate for social change in sub-Saharan Africa, men who engage in same-sex relations -many of which have sex with women (MSM/W)- face obstacles in all steps of the HIV cascade of care. In Senegal, research on MSM/W has been authorized given their assigned status as a key population in the fight against HIV. In 2018-19, a grounded theory research was done with the aim to understand the health experiences of MSM/W in Dakar.

Methods

Individual interviews were conducted with 19 MSM/W. Respondents were recruited with the aid of local grassroots. A non-structured life story guide was used to help them recall in chronological order their experiences with healthcare.

Results

No major constraints in using HIV services were expressed. There were narratives of self-hatred, internalized homophobia, emotional stress, sleep disorders, and low self-esteem. A few mentioned suicidal thoughts. Histories of sexual abuse, and feelings of sexual orientation being passed on by the perpetrators were common. Fear of hatred and violence caused some respondents to pursue heterosexual relationships, and, in a few cases, to resort to spiritual healers to change their sexual identity. In spite of religion being identified as a fueler of stigmatization, many found relief in practicing Islam.

Conclusions

Findings informed a Training Program on MSM/W Psychosocial Health, which will target 100 healthcare workers in 2020. This study shows that psychosocial health for MSM/W needs to be promoted not just as a component in the Zero HIV Transmission for 2030 efforts. It is time to move from an HIV Care for All MSM to a Wellbeing for All MSM paradigm. Further research on same-sex identities as determinants of diseases other than HIV is needed. Human rights should be at the fore of efforts to build capacities to tackle the psychosocial needs of all MSM/W in Senegal.
Green Deal as a Climate Changes Dam on the Road to Health
Authors: Jevtic M , Bouland C
Published: October 2020

Public health professionals (PHP) have a dual task in climate change. They should persuade their colleagues in clinical medicine of the importance of all the issues covered by the GD. The fact that the health sector contributes to the overall emissions of 4.4% speaks to the lack of awareness within the health sector itself. The issue of providing adequate infrastructure for the health sector is essential. Strengthening the opportunities and development of the circular economy within healthcare is more than just a current issue. The second task of PHP is targeting the broader population. The public health mission is being implemented, inter alia, through numerous activities related to environmental monitoring and assessment of the impact on health. GD should be a roadmap for priorities and actions in public health, bearing in mind: an ambitious goal of climate neutrality, an insistence on clean, affordable and safe energy, a strategy for a clean and circular economy. GD provides a framework for the development of sustainable and smart transport, the development of green agriculture and policies from field to table. It also insists on biodiversity conservation and protection actions. The pursuit of zero pollution and an environment free of toxic chemicals, as well as incorporating sustainability into all policies, is also an indispensable part of GD. GD represents a leadership step in the global framework towards a healthier future and comprises all the non-EU members as well. The public health sector should consider the GD as an argument for achieving goals at national levels, and align national public health policies with the goals of this document. There is a need for stronger advocacy of health and public-health interests along with incorporating sustainability into all policies. Achieving goals requires the education process for healthcare professionals covering all of topics of climate change, energy and air pollution to a much greater extent than before.
Innovative ways in providing energy – towards improving health
Authors: Van Den Hazel P
Published: October 2020

The Energy issues in the world demand new innovative ways of providing us with energy. Innovations sometimes go faster than that the health sector can study the disadvantages for health. The burden of disease might change due to new forms of energy.

Heat pumps is one example of a new form of energy that has also health disadvantages in use. Noise is one major issue in the use of heat pumps. There is a limited amount of studies on the use of heat pumps in densely populated areas in cities. Other forms of energy transition such as wind turbines are another source of concern.

Methods

Literature review

Results

The use of heat pumps has problems in the application by its users. The installation is not always adequate causing more noise problems.

Wind turbines show problems with low frequency noise, shadow and general wellbeing of persons living in the neighbourhood.

Conclusions

Good practices could save a lot of hindrance and health effects.
Strengthening health promotion policy
Authors: De Leeuw E
Published: October 2020

Policy development and implementation are too often considered the 'autonomous' result of a mix of good evidence production and social support for change. But both these policy drivers need to be created, supported, and - to be honest - manipulated toward the best possible configuration of different intervention modalities (or 'policy instruments') involving ranges of audiences (from the traditional 'risk group' to a much more fuzzy caste of politicians at many different levels of governments and governance). Whereas there is an acknowledgement that intervention development and evaluation must take into account multi-level complexity thinking, the realisation that this must translate into a similarly complex world of policy development has not yet sunk in.

This presentation will review the interface between (a) the available evidence and knowledge bases for health promotion policy effectiveness; (b) the role and deceptive nature of social, political and determinants of health and political action; and (c) the nature of deliberative democracy and its various forms (e.g., 'participatory budgeting') and the prerogative of community action. I will claim - and demonstrate - that the discipline of health political science has made available functional toolkits for shaping and investigating systematically the policy process for health. Particularly, we need to progress our thinking from traditional mono-paradigmatic empirical research only, to a dynamic world of hybridisation of theories and practices. I will demonstrate the feasibility of this approach by showing the new policy opportunities that can be created by combining policy network research with language frame network mapping.
Hybrid team based learning-personalised education for teaching epidemiology in public health degrees
Authors: Ha T , Kemp B , Wallace M
Published: October 2020

Background

University education in Australia and internationally involves teaching diverse students: in terms of age, life experience, previous degrees completed, and level of English competency. In Australia the Bachelors of Public Health (BPH) at The University of Wollongong, epidemiology is a core subject. It aims to equip students with the knowledge and skills needed to design, critique and interpret studies that investigate why different populations experience different health outcomes. A student-centred learning strategy; Hybrid Team Based Learning and Personalised Education teaching strategy (HTBL-PE) was created to maximise academic success. Each phase has a distinct purpose based on learning theories (e.g. TBL, Bloom's taxonomy and Vygotsky). HTBL-PE aims to systematically build students abilities; strengthen self-confidence and belief, by teaching the way students learn and harnessing the capabilities of the team to strengthen the individual.

Objectives

HTBL-PE was evaluated in spring 2019 in the BPH, where their experiences at the beginning and end of semester were measured.

Results

In total 73 out of 84 enrolled students provided data at both time-points (87%). At the end of the semester, the vast majority of students indicated their interest in epidemiology had increased (93%), critical thinking had improved (92%), and confidence as independent learners had increased (86%). Outcomes did not differ significantly by gender or across learning styles. More than two thirds of students had already applied learnings from this subject in other settings (67%). Students' final mark for this subject was significantly higher than their Weighted Average Mark (WAM) prior to the semester (+17.4, p < 0.001). Average scores for the subject were > 84/100 with a < 0.5% failure rate.

Conclusions

HTBL-PE has positive learning outcomes; low failure rates, increased confidence in learning and themselves, increased interest in epidemiology and high overall scores in the subject.

Key messages

An effective new innovative teaching strategy resulted in a subject average score > 84/100 and <0.5% failure rate. The vast majority of students reported increased confidence as independent lifelong learners, critical thinking, confidence in epidemiology (knowledge, skills, and attitudes) and themselves.
Risk of infection in antimicrobial-resistant Gram-negative bacteria carriers: A systematic review
Authors: Arzilli G , Scardina G , Casigliani V , Moi M , Lucenteforte E , Petri D , Rello J , Manissero D , Lopalco P L , Tavoschi L
Published: October 2020

Background

Antimicrobial-resistant Gram-negative bacteria (AMR-GNB) have emerged as important health care-associated pathogens. Infections with AMR-GNB are associated with high patient morbidity and attributable mortality. Colonization is a prerequisite for infection, however the extent to which colonized patients develop infection is unclear. This systematic review explored the risk of developing infection during hospitalisation among AMR-GNB faecal carriers. Also, we investigated the acquisition rate for AMR-GNB colonization among patients not colonized at admission.

Methods

We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on hospitalised patients ≥18 years old in high-income countries (excluding long-term care facilities).

Results

Out of 9496 articles, 55 studies fulfilled our inclusion criteria. Forty-two studies reported data from EU/EEA, 6 from USA and 7 from other regions. Almost all studies (n = 45) were conducted in university hospitals. Most studies (n = 41;74.5%) were performed in high-risk wards (ICU, haematology, burn units and transplant units). Out of 55 studies, 8 examined AMR-GNB, 27 Enterobacteriaceae, while the others investigated specific pathogens: Klebsiella spp. (n = 11), E. Coli (n = 2), A. Baumannii (n = 3) and P. Aeruginosa (n = 4). The rate of AMR-GNB carriage acquisition was 10.5% (n = 40 studies; 95% CI:8.2-13.1). The risk of progression to infection among patients colonized at hospital admission was 13.9% (n = 15; 5.4-24.9), while the infection rate in patients who acquired carriage during hospitalization was 23.0% (n = 7; 5.9-45.2). Patients with an undefined time of colonization presented an infection rate of 16.9% (n = 13; 11.2-23.4). Considering these three populations as a whole, the risk of developing infection was 16.0% (11.0-21.0).

Conclusions

Our results suggest that risk of progression to infection in AMR-GNB colonized patients in hospital setting is high.

Key messages

The aim of our study was to estimate the risk of progression to infection, during hospital stay, in patients colonized by AMR-GNB at hospital admission in high-income countries. Our results suggest that faecal colonization with AMR-GNB poses a 16.0% risk of subsequent AMR-GNB infection. This risk in higher (23.0%) in patients who acquired colonization during hospitalisation.
AI detection of M. Tuberculosis pathogens using Generative Adversarial Network (GAN) analyses
Authors: Dedicatoria M , Klaus S , Case R , Na S , Ludwick E , Wu D , Quattrochi L
Published: October 2020

Background

Rapid identification of pathogens is critical to outbreak detection and sentinel surveillance; however most diagnoses are made in laboratory settings. Advancements in artificial intelligence (AI) and computer vision offer unprecedented opportunities to facilitate detection and reduce response time in field settings. An initial step is the creation of analysis algorithms for offline mobile computing applications.

Methods

AI models to identify objects using computer vision are typically “trained” on previously labeled images. The scarcity of labeled image-libraries creates a bottleneck, requiring thousands of labor hours to annotate images by hand to create “training data.” We describe the applicability of Generative Adversarial Network (GAN) methods to amass sufficient training data with minimal manual input.

Results

Our AI models are built with a performance score of 0.84-0.93 for M. Tuberculosis, a measure of the AI model's accuracy using precision and recall. Our results demonstrate that our GAN pipeline boosts model robustness and learnability of sparse open source data.

Conclusions

The use of labeled training data to identify M. Tuberculosis developed using our GAN pipeline techniques demonstrates the potential for rapid identification of known pathogens in field settings. Our work paves the way for the development of offline mobile computing applications to identify pathogens outside of a laboratory setting. Advancements in artificial intelligence (AI) and computer vision offer unprecedented opportunities to decrease detection time in field settings by combining these technologies. Further development of these capabilities can improve time-to-detection and outbreak response significantly.

Key messages

Rapidly deploy AI detectors to aid in disease outbreak and surveillance. Our concept aligns with deploying responsive alerting capabilities to address dynamic threats in low resource, offline computing environs.
Positive association between depression and educational outcomes among young adults
Authors: Smirnov I , Dementeva J
Published: October 2020

It has been previously shown that depression is negatively associated with the academic performance of university students. These results, however, rely on university grades and, thus, do not allow comparison of students from different educational organizations. As a result, the relationship between academic performance and depression on a population level is not well known.

We use data from the Russian panel study 'TrEC' that tracks 4,893 participants since 2011. This panel is nationally representative for one age cohorts (13-14 years old in 2011). The data set includes educational outcomes of students measured using standardized tests (PISA scores and scores at Unified State Examination). In 2018, participants filled PHQ-9. At that point, many of them were in the first year of their Master's programs.

The prevalence of depression (PHQ-9 > = 10) was 20% for women and 11% for men. We find no association between PHQ-9 scores for women and their PISA scores, Pearson's r = 0.01 (CI95% = [-0.03, 0.06]), however we find positive association for men, r = 0.16 (CI95% = [0.11, 0.20]). This corresponds to a relative risk of being depressed for the highest performing men (PISA levels 5 and 6) of 1.6.

This result holds after controlling for the socioeconomic status of participants and the fact of studying at university. For those participants who study at a university, it is possible to additionally control for the selectivity of their university as the average academic performance of enrollees is publicly available information for Russian universities. We find that the personal educational outcomes rather than the selectivity of the university explain the results.

It is generally believed that educational outcomes are negatively associated with depression. We find no such association for women and a positive association for men. This result might be particular to Russia or to a certain age cohort. In any case, they highlight the need for more research in this area.

Key message

We use data from a nationally representative panel and find that educational outcomes measured by a standardized test are positively associated with depression for young men but not for young women.
Is the Strengths and Difficulties Questionnaire applicable to lower educated adolescents?
Authors: Theunissen M , de Wolff M
Published: October 2020

Background

The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a widely used instrument to identify emotional and behavioral problems by Preventive Child Healthcare (PCH). It is a valid instrument in more highly educated adolescents, however evidence regarding lower educated adolescents (vocational school) is lacking. The aim of this study was to compare the psychometric properties of the SDQ-SR when used with less well and more highly educated ('higher') adolescents, and to explore opinions of adolescents and PCH professionals regarding its suitability.

Methods

We included 426 adolescents (130 lower and 296 higher educated), who completed the SDQ-SR. We compared how the psychometric properties (i.e. internal consistency) applied to lower and higher educated adolescents. We assessed whether the five-factor structure of the SDQ is invariant across different educational levels. Moreover, we interviewed 24 adolescents from pre-vocational secondary education schools, and performed online focus group interviews with 17 PCH professionals.

Results

The internal consistencies (Cronbach's alphas) per SDQ scale were comparable for lower and higher educated adolescents. On most subscales the lower educated adolescents had higher mean scores than the higher educated adolescents. Findings on differences by educational level for the other psychometric properties, i.e. multi-group invariance and single group (CFA) analyses, were inconsistent, with some measures showing unequal factor loadings but others not. Although professionals and lower educated adolescents reported that the SDQ includes many outdated and difficult words, professionals nevertheless perceived the SDQ-SR as a valid instrument.

Conclusions

The psychometric properties of the SDQ-SR are sufficient for use among lower educated adolescents. However, for optimal implementation in PCH there is a need for improvement in the wording of the SDQ, as expressed by both professionals and adolescents.

Key messages

The psychometric properties of the SDQ are sufficient for use among lower educated adolescents. For optimal implementation the SDQ needs to be updated in more understandable language.
Mental health, health and healthcare utilization of asylum seeking and refugee children in Germany
Authors: Costa D , Biddle L , Bozorgmehr K
Published: October 2020

Background

The mental health condition and healthcare needs of asylum seeking and refugee (ASR) children are essential aspects of health services organization. We describe the relation between psychosocial functioning, health status and healthcare use of ASR children in Germany using a cross-sectional population-based survey.

Methods

560 ASR adults in 58 collective accommodations in Germany's 3rd largest federal state were randomly sampled and assessed in 2018 (response rate: 42%). 126 participants answered the Strengths and Difficulties Questionnaire (SDQ) to assess children' psychosocial functioning with higher scores suggesting poorer functioning. SDQ dimensions (Emotional; Conduct; Peer; Hyperactivity; ProSocial; Total) were compared by demographics, health (long-lasting illness, physical limitation, pain) and healthcare use (unmet need for a pediatrician/specialist, hospital/emergency department visits). Age and sex-adjusted odds ratios (AOR, 95%CI, Confidence Intervals) for presenting borderline/abnormal scores for each SDQ dimension were computed using logistic regression models depending on children' health and healthcare use.

Results

Valid data of 90 ASR children was analyzed: 57% girls; 40% 10-17 years; 58% from East/West Asia; 56% in Germany for more than a year. A borderline/abnormal SDQ Total score was associated with pain (compared to no pain, AOR, 95%CI=3.14, 1.21-8.10) and with an unmet need for a specialist (4.57, 1.09-19.16). High scores (borderline/abnormal) in the SDQ Emotional dimension were positively associated with a long-lasting illness (5.25, 1.57-17.55), physical limitation (4.28, 2.48-12.27) and pain (3.00, 1.10-8.22), and negatively associated with visiting a pediatrician (0.23, 0.07-0.78), a specialist (0.16, 0.04-0.69) and the emergency department (0.27, 0.08-0.96).

Conclusions

Somatic clinical encounters with ASR children should include the assessment of mental health symptomatology, especially in those with worst physical health conditions.

Key messages

Among asylum seeking and refugee children, a poor physical condition and unmet medical needs are linked with poorer mental health. Provision of care to this vulnerable group must include mental health.