bluuebunny/crossref_metadata_2025 huggingface dataset:
Is school furniture design a contributing factor to low back pain in adolescents?
Authors: Ben Ayed H , Jedidi J , Cheikhrouhou F , Ayadi A , Yaich S , Damak J
Published: November 2019

Background

Recent evidence showed that low back pain (LBP) is frequent among youth. Individual etiologic factors are most often associated with musculoskeletal overuse and altered postural control. This study aimed to evaluate the association between school furniture design and LBP in school-adolescents.

Methods

A cross-sectional study was conducted using a self-reported questionnaire distributed to school-adolescents aged 12-18 years, in Southern Tunisia, 2018. We performed a stratified three-step sample to obtain a representative sample of 1400 subjects.

Results

The response rate was 87.2% (1221 students). The mean schoolbag weight was 3±1.3 kg. The schoolbag to body weight ratio was 0.05±0.03. The main method of carrying a schoolbag was on both shoulders (57.2%). During the last 3 months, LBP was reported in 391 cases (32%). Multivariate analysis using logistic regression showed that high-school grade was independently associated with LBP (Adjusted Odds Ratio (AOR)=2.7;95% CI = [1.9-3.7];p<0.001). Classroom furniture and layout design independently associated with LBP included too low seat backrest (AOR=1.4;95% CI = [1.12-1.87];p=0.005), too far seat to black(board) distance (AOR=1.5;95% CI = [1.1-2.2];p=0.041), schoolbag to body weight ratio ≥10% (AOR=1.7;95% CI = [1.2-2.4]; p = 0.002) and carrying schoolbag for 30-60 minutes (AOR=1.48;95% CI = [1.1-2.1]; p = 0.029). Otherwise, carrying school bag by hand (AOR=0.25; 95% CI = [0.07-0.89]; p = 0.033) was found to be independently associated with lower prevalence of LBP complaints.

Conclusions

Current design of school furniture is not compatible with the adequate purposed dimensions in students. It increased substantially the risk of LBP, which emphasizes the need for multi-disciplinary approach involving teachers, policy makers and health care professionals.

Key messages

School related LBP may threaten the physical performance and the social life of adolescents. Revising school environments and radical ergonomic interventions are mandatory.
Features of establishment of early lactation in women who gave birth after in vitro fertilization
Authors: Samchuk P , Rozalieva Y , Gil A
Published: November 2019

Background

Breastfeeding gives babies the best possible start in life and breastmilk works like a baby’s first vaccine. Pregnancy resulting from IVF is often associated with placental insufficiency in which the hormone-producing function of placenta can be compromised that may result in reduced lactogenesis. The aim was to study the emergence of early lactation after IVF in women with a history of infertility.

Methods

The study involved 34 women after IVF with a singleton full-term pregnancy with a history of tubal-peritoneal infertility. Control group comprised of 47 women with naturally occurred pregnancy. Delivery occurred naturally. All women were assessed for hormonal function of placenta for a period of 16-18, 28-32, and 37-38 weeks of pregnancy. The average daily amount of milk on a 5th day after delivery was measured.

Results

In the IVF group vs. control group there was a decrease in the production of hormones by the placenta (progesterone, estriol, placental lactogen) preparing the mammary glands for lactation (p < 0.05). At gestational age of 16-18 weeks progesterone level in IVF group was 172.2±10.72 nmol/l; 28-32: 274.2±8.45 nmol/l; 37-38 weeks: 343.2±9,1 nmol/l. The level of estriol at 16-18 weeks was 2.87±1.42 ng/ml; 28-32: 10.94±0.6 ng/ml; 37-38 weeks: 25.21±0.22 ng/ml. Placental lactogen at16-18 weeks: 1.15±0.2 nmol/l; 28-32: 6.39±0.69 nmol/l; 37-38 weeks: 7.23±0.59 nmol/l. On day 5 normal lactation was observed in 21(62%) and 43(91.5%) women in IVF and control group, respectively (p < 0.05).

Conclusions

Increased number of cases of hypolactation was observed in women after IVF, which was associated with decrease in the hormonal function of placenta. Women who have given birth to children after IVF require special attention from the side of medical personnel and from loved ones in the early stages of establishment of breastfeeding.

Key messages

IVF is a risk factor for hypolactation, which is associated with placental hormone-producing insufficiency. Women who have given birth after IVF require support aimed at promotion of early lactation and breastfeeding.
Screening for celiac disease in school aged children in Croatia
Authors: Petricevic-Vidovic T P V , Musil V M , Sičaja E S , Mišak Z M
Published: November 2019

Background

Celiac disease primarily affects small intestine and occurs as an immune-based reaction to dietary gluten in wheat, barley and rye. There has been a significant increase in prevalence and an increase in diagnosis rate due to diagnostic tests improvements. Celiac disease can present with gastrointestinal and non-gastrointestinal abnormalities, but also many individuals may have no symptoms at all. Early diagnosis of celiac disease is essential, because untreated disorder may result in serious complications. The aim of this study was to detect celiac disease in asymptomatic school-aged children and to determine prevalence rate.

Methods

Cross sectional study was conducted on a sample of 2000 children in school year 2018/2019 in school health service. The sample comprised 15.8% of elementary school first grade population in City of Zagreb, aged 6-7 years. SimtomaX in-vitro rapid screening test was used to detect IgA and IgG deamidated gliadin peptide and/or IgA deficiency. Children with positive tests were referred to clinical diagnostic. Data were analysed by descriptive statistic.

Results

The study comprised 1404 children (51% girls, response rate 70%). Positive result was found in 5.6% children (42 girls and 37 boys). Up to now, celiac disease was confirmed with duodenal biopsy in 0.5% asymptomatic children (3 girls, 4 boys).

Conclusions

The results of the study showed prevalence of celiac disease of 0.5% in asymptomatic first grade school children. Children diagnosed with celiac disease require gluten-free diet and follow-up of gastroenterologist, nutritionist and school doctor. The results of the study will be used to raise the awareness and encourage more active search for celiac disease among asymptomatic school children.

Key messages

Recognition of celiac disease in asymptomatic children reduces risk of complications. Adequate diet for individuals with celiac disease should be ensured from kindergarten through school time.
Social deprivation and adverse perinatal outcomes in France: national study of preterm and SGA birth
Authors: Barry Y , Gallay A , Regnault N
Published: November 2019

Introduction

A slow but steady increase in preterm birth (PTB) rate has been reported in France in the last decades while decreasing in some European countries. Studies suggest PTB and small for gestational age (SGA) show a social gradient. Our objective was to determine whether this social gradient is changing in France over the study period.

Methods

We selected all births records after 22 weeks of gestation in France between 2010 to 2017 (N = 6, 439, 355) in the French National Health Data System (SNDS). PTB was defined as birth before 37 completed weeks and SGA as birth weight below the 10th percentile according to the French intrauterine growth references curves. The SNDS includes an ecological social disadvantage index in quintiles (Q1:least deprived, Q5:most deprived). PTB and SGA rates were estimated in each deprivation quintile. Trends were quantified using a Poisson regression model.

Results

The prevalence of PTB was 7.4% and SGA 11.9 % in 2017. French overseas regions (FOR) had the highest rates (7.2 vs. 10.9% and 11.5 vs. 18.0%, mainland France vs FOR respectively for PTB and SGA in 2017). Although we identified annual fluctuations, there was a significant average annual percentage change in prevalence of PTB and SGA respectively, +0.65% [IC95%:+0.1%; +1.2%; p = 0.03]; 0.66% [IC95%:+0.26%; +1.06%; p = 0, 01]. There was a marked but relatively stable social gradient over the study period. When combining all study years, PTB was more frequent among deprived women (Q5: 7.6% vs Q1: 6.8%) as well as SGA (Q5: 10.6% vs Q1: 12.1%).

Conclusions

PTB and SGA prevalence trends are still increasing in France with regional disparities. Social deprivation remains a predictor of PTB and SGA.

Key messages

A persisting social gradient is observed in PTB and SGA in France. A better understanding of its mechanism will help designing interventions that will reduce social inequalities in health.
Cost-effectiveness of mental health promotion and prevention for young people: a systematic review
Authors: Schmidt M , Werbrouck A , Verhaeghe N , Putman K , Simoens S , Annemans L
Published: November 2019

Background

Effective mental health promotion and mental disorder prevention interventions may reduce the impact that mental health problems have on young people’s wellbeing. The objectives of this research were to summarize and assess health economic evaluations of mental health promotion and prevention for children and adolescents aged 6-18 years.

Methods

Four electronic databases were searched for full health economic evaluations published between January 1, 2013 and October 31, 2018 that evaluated the cost-effectiveness of universal mental health promotion and primary mental disorder prevention interventions. Each study was subject to a systematic quality-appraisal.

Results

Nine studies were included. Eight were carried out in the European Union, and eight evaluated school-based interventions. All evaluated interventions led to incremental costs compared to their comparators and most were associated with small increases in quality-adjusted life years. Four studies evaluated the cost-effectiveness of cognitive behavioural therapy-based interventions for the prevention of depression or anxiety, with mixed results. Cost-effectiveness estimates for mental health promotion and anti-bullying interventions were promising. Drivers of cost-effectiveness were implementation costs, intervention effectiveness, delivery mode and duration, baseline prevalence, and the perspective of the evaluation. The overall study quality was reasonable, though most studies only assessed short-term costs and effects.

Conclusions

Few studies were found. This limits the possibility of drawing strong conclusions about cost-effectiveness. There is some evidence based on decision-analytic modelling that anti-bullying interventions represent value for money. There is a lack of studies that take into account long-term costs and effects.

Key messages

Based on the evidence, schools should be supported in the implementation of long-term anti-bullying programmes to improve young people’s wellbeing. More research is needed on the long-term costs and effects of mental health promotion and prevention for children and adolescents.
Parental Education, Health Literacy and Children’s Height in Adult Life
Authors: Jarosz E , Gugushvili A
Published: November 2019

Background

Adult’s body height has been positively associated with various health and social benefits. Studies have demonstrated that parental education is one of the key covariates of individual’s health and height in both childhood and adulthood. However, another important covariate of child’s health, parental functional literacy, has been largely overlooked in studies on height. The objective of this study was to analyse the associations between parents’ education, their health literacy and children’s adult body height.

Methods

We used data for 17,331 men and 21,909 women from the 2016 wave of the nationally representative Life in Transition Survey (LITS) conducted in 34 countries in Southern and Eastern Europe, the Middle East, and Central Asia. Using ordinary least squares and Poisson regression models, we analysed the links between both mothers’ and fathers’ educational attainment, parental functional literacy - measured by the number of books in childhood homes - and individuals’ height, while also taking into account other available individual and contextual explanations of height which occurred either before respondents’ birth or during their childhood.

Results

Our results demonstrate that mothers’ educational attainment and parental functional literacy have strong independent associations with children’s adult height. Sufficient literacy skills of the parent may have positive effect on children’s growth even if parental education is low. These associations hold for both men and women and remain significant across time.

Conclusions

This study offers a unique contribution by tracking the long-term trends in height and its socio-demographic and socioeconomic explanations. Reported differences in individuals’ adult height were linked with early childhood living conditions, specifically, with mothers’ education and parental functional literacy.

Key messages

We track the long-term trends in height and its socio-demographic and socioe-conomic explanations. Regardless of the level of maternal education, parental functional literacy is a strong and consistent predictor of individuals’ height.
Parents’ evaluation of early home visit by midwife
Authors: Sollesnes R , Nilsen A B V , Langeland E
Published: November 2019

Background

The Norwegian guidelines for postnatal care strongly recommend that families are offered home visit by a midwife within the first week after early discharge from maternity clinic, in addition to home visit by health visitor 7-10 days after delivery. Due to lack of midwifery resources out of hospital, Bergen municipality has started a project where selected groups such as first time mothers, minority families and women who during pregnancy are defined as being in need of extra follow up, receive a home visit by their antenatal midwives. The main purpose of the study is to explore user satisfaction with the home visit by the midwife, and the parents’ experience of security and coping the first week after the delivery.

Methods

The design is a mixed method design including a clinical controlled trial. In addition to questions about the home visit, Parents’ Postnatal Sense of Security is used to measure safety, and by The Orientation to Life Questionnaire, coping as a Sense of Coherence is measured. The trial includes an intervention group who receive home visit by midwife, and a control group who met the inclusion criteria, but of different reasons do not receive home visit by midwife. The data collection started in November 2018 and is in progress.

Results

Preliminary results shows that the families consider home visit by midwife as useful, and as a good support the first week after delivery. Results from comparing the two groups regarding Sense of Security and Sense of Coherence will be presented.

Conclusions

Implications for better postpartum care will be presented.

Key messages

Investigate parents’ satisfaction with postpartum care at home, and ‘sense of security’ and ‘coping as a sense of coherence’. Contribute with suggestions for how to improve the postnatal care in a health promoting perspective.
Positive health as a new concept for physiotherapy in the Netherlands?
Authors: De Bot C M A , Boemaars C , Dierx J A J
Published: November 2019

Background

The current WHO definition of health seems to no longer meet the changes in the current Dutch health system. An alternative approach which puts emphasis on health, not disease, is Positive Health. This focus shifts the emphasis on improving resilience and well-being rather than the perspective on what is lacking in health. In 2014, this new definition of Positive health was included in the professional profile ’physiotherapist’ of the Royal Dutch Association for Physiotherapy. This study examines the attitude of physiotherapists to Positive Health and to what extent they experience this concept in their current working practice.

Methods

A mixed method study was used, with a quantitative and qualitative method. A survey was completed by 276 physiotherapists and 7 semi-structured interviews were conducted among physiotherapists.

Results

Positive health was considered positive by 68% of the physiotherapists that health is seen as a dynamic concept rather than static, and 60.5% consider it important that the emphasis is on self-regulation. However, physiotherapists wonder if all patients have the ability to self-manage skills. The qualitative analysis shows that all therapists find the new definition positive and that it covers all aspects of health.

Conclusions

In general, physiotherapists are positive about the definition of positive health. Positive health can help physiotherapists in their work with clients and other professionals because of the multidisciplinary approach.

Key messages

Positive health can help physiotherapists to promote health in their clients. Positive health can stimulate cooperation between physiotherapists and client to increase self-management.
Dynamics of the occupational respiratory diseases in Bulgaria in the period 2009-2016
Authors: Tzacheva N , Tabanska-Petkova M , Lyubomirova K
Published: November 2019

Background

The number of occupational respiratory diseases has declined in recent years in Bulgaria. This is the result of technological advance, mechanization and automation of the processes generating high levels of dust in the work environment; adequate ventilation; personal protective equipment and, last but not least, the training of workers on preventive approaches.

Methods

The aim of the study is to find out the trends of registered occupational respiratory diseases in Bulgaria in 2009-2016, according to official statistics. Analytical and statistical methods were used.

Results

In 2016, the number of occupational diseases (n = 33), registered in Bulgaria decreased by 71.55% compared to 2009 (n = 116). In 2009, the relative share of silicosis from respiratory occupational diseases was 47.54% (n = 29), while in 2016 it grew to 64.29% (n = 9). Its share is also increasing as part of all occupational diseases in Bulgaria from 25% in 2009 to 27,27% in 2016. The registered cases of chronic rhinitis, nasopharyngitis and pharyngitis for the whole period are only 2, of professional asthma - 3; of chronic bronchitis - 5, less than cases of asbestosis - 9. In 2009, there were five reported cases of talcosis and the total number of cases of siderosis was 23 for the period of eight years. There are 4 cases of other pneumoconiosis and 2 of pneumoconiosis associated with tuberculosis, as well as 10 cases of toxic pulmonary fibrosis during the whole period.

Conclusions

It is worth noting the small number of occupational respiratory diseases that could be caused by other factors not necessarily related to the work environment, such as chronic bronchitis and asthma, although they are significantly more frequent than those mandatory caused by occupational hazards such as silicosis, asbestosis and toxic pulmonary fibrosis. This means that a significant proportion of these cases are counted as common chronic non-communicable diseases with significant negative social consequences.

Key messages

The registered occupational respiratory diseases decrease, but the relative share of those with strictly professional etiology, such as silicosis, is growing. A significant proportion of occupational respiratory diseases are reported as chronic non-communicable diseases.
Prevention of chronic diseases in family medicine in Croatia
Authors: Maric-Bajs M , Puljak A , Polić Vižintin M
Published: November 2019

Background

Inappropriate habits and behaviour patterns are risk factors for most chronic non-communicable diseases. Prevention and education are one of the continuous tasks of public health professionals. Primary preventive care requires an active approach from the health professionals.

Methods

This program includes preventive examination and certain laboratory tests persons older than 55 who did not visit their family doctor at least two years. 721 persons were examined and interviewed from 2014 to 2018. The paper shows analytic results expressed in percentages of the prevalence and 95% confidence interval (CI).

Results

A total of 721 patients were included. Sex ratio male:female was 0.47. The age (mean) was 61.4 years [standard deviation (SD) = 9.1]. Up to three alcoholic drinks per week consumed 22.1% respondents (37.1% male and 11.9% female). There were 24.1% smokers and 14.6% former smokers. Overweight (BMI 25-30) were 44.4% male and 36.3% female. Obese (BMI>30) were 27.6% male and 30.3% female. Digitorectal examination was performed in 582 persons and detected pathological phenomena in 10.3% female and 19.4% male. Hypertension was found in 14.9% male and 18.2% female. Isolated systolic hypertension was found in 19.8% male and 16.7% female, and isolated diastolic hypertension in 3.9% male and 3.5% female. Suspicion on one or more newly diagnosed disease was placed in 55.9% (95% CI 52.3-59.5) respondents. In total, there was a suspicion of 696 newly diagnosed diseases. Newly diagnosed diseases were disorders of lipoprotein metabolism (n = 156, 21.6%), followed by hypertension (n = 69, 9.6%), obesity (n = 52, 7.2%) and independent of insulin diabetes (n = 51, 7,1%). 53 persons [7,4% (95% CI 5,4-9,3)] had suspected neoplasm and they were immediately referred for further diagnostic evaluation.

Conclusions

The public health significance of such programs with active approach and detecting malignant state as early as possible is extremely important.

Key messages

Primary preventive care requires an active approach from the health professionals. Detecting chronic non-communicable diseases in earlier phase is important and confirms the public health significance of prevention programs.
From the experience of planning a life with diabetes to the mechanisms of the management of illness
Authors: Mathilde M M , André W A , Paul K N P
Published: November 2019

Background

In the context of chronic diseases, it is now recognized that experiences of planning a new life with diabetes are very informative, and are a source of knowledge that can be used to improve patient care and quality of life. However, the professionals in health and the patients’ therapeutic education are still struggling to translate this knowledge into their practices or to make use of it, as long as its forms remain largely unknown and it is not known how to identify these. Objective: The study aims to identify these knowledges and to report on how it is produced, based on an analysis of the experiences of diabetic patients in Yaoundé, Cameroon.

Methods

The study combines a phenomenographic approach aiming at ethnographing the form and contents of lessons learned from life experiences with diabetes; and an operation of reflexive ethnography centered on the patient, apprehending the process of elaboration or production of these teachings. It includes six diabetics selected from the typical sampling method. The data collected were analysed using paradoxical analysis and interpreted in a pragmatic perspective.

Results

The results reveal various mechanisms of self-management of the disease and stigma, developed by patients, such as: identity recomposition; valorization of treatment by promoting its benefits to others; control of information about one’s illness oscillating between concealment and disclosure; therapeutic adjustments according to the life situations or interactions; rearrangement of individual and family habits; listening and decoding of the language of illness, body and the effects of food on the body; learning of conceptualized knowledge about diabetes and nutrition through various sources of information.

Conclusions

the study suggests that these mechanisms should be considered as relevant forms of knowledge; and the should be used to improve both preventive, therapeutic and educational practices and the quality of life of the diabetics.

Key messages

The mechanisms of self-management of diabetes and stigma develop by diabetics trough their experience of planning a new life with diabetes should be considered as relevant forms of knowledge. These mechanisms should be used by health professionnals and patients’ education professionals to improve their practices and the quality of life of diabetics.
Prevalence of multiple sclerosis in the South of Italy based on healthcare administrative data
Authors: Palladino R , Brescia Morra V , Lanzillo R , Giordana R , Fumo M G , Montuori P , Sormani M P , Triassi M , Moccia M
Published: November 2019

Background

Multiple sclerosis (MS) is an heterogenous disease whose prevalence varies in Europe. Hereby, we aimed to estimate prevalence of MS in the Campania Region of Italy.

Methods

To identify individuals with MS living in the Campania Region of Italy, we extracted data from the following healthcare administrative databases: hospital discharge records, regional drug registry, and specialist outpatient visits from Jan-2015 to 3Dec-2017. Individuals alive on the 1-Jan-2018 were included to capture prevalence on this date. Age-sex standardised prevalence rates were calculated using the direct standardisation method; the European population in 2018 was considered as reference population. To assess differences in the prevalence ratios across the five provinces of the region, standardised morbility ratios (SMR) were calculated. To calculate 95% confidence intervals (95%CI) for the standardised rates, the Byar’s approximation method based on the Poisson distribution was used.

Results

We identified 5,361 individuals with MS (females 64.5%, age 45.6±12.7 years). Standardised prevalence rate per 100,000 people was 90.0 cases (95%CI=87.60, 92.40) (112.07 for females [95%CI=108.36, 115.88] and 66.20 for males [95%CI=63.26, 69.25]). The SMR in the province of Naples, the most densely populated, was 0.90 (95%CI=0.86, 0.96), whereas the highest SMR was found in the province of Salerno (SMR=1.30; 95%CI=1.23, 1.38), and the lowest in the province of Caserta (SMR=0.89; 95%CI=0.82-0.96).

Conclusions

Prevalence of MS in the Campania Region is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses). In the future, healthcare administrative databases could be used to monitor MS prevalence/incidence and to plan healthcare resource utilization.

Key messages

Prevalence of MS in the Campania Region is 90 cases per 100,000 people. It is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses).
Improving chronic diseases management using Learning from Excellence (LfE) model
Authors: Borghini A , Vola F , Pennucci F , Seghieri C , Nuti S
Published: November 2019

Background

Learning from excellence (LfE) model demonstrated to be an effective method in the promotion of quality improvement in healthcare and in the reduction of patient’s harm. We applied LfE to identify the best models that could represent the excellence in the management of chronic heart failure (CHF) patients among the models adopted among 98 healthcare providers across 10 Italian Regions.

Methods

The research consisted of 2 phases: 1) the creation of a 9 indicators set to map CHF pathways and the analysis of these indicators through a quantitative approach using a modified positive deviance model which identified the best performers among our sample of hospitals and local health authorities (H/LHA) grouped in geographical Areas. We transformed 3 indicators (“tracking” indicators) into a 0-5 scale to assure direct comparison. 2) The H/LHA best performers were asked to share their organizational and clinical model during a workshop where every stakeholder involved could take part.

Results

Among the 10 investigated Italian Regions, 42 Areas were ranked and ranged 1,83-3,91. The three best performing areas that ranked above the 3rd quartile and were interested in taking part in this new approach were selected. The results arising from the qualitative analysis of these areas showed that communication, trust and shared goals among healthcare professionals resulted to play a key role among the best performing H/LHA. Indeed, the same role is played by all the policies and practices that enabled Interactions among healthcare workforce and patients, thus representing the ‘integration of care’.

Conclusions

The identification-celebration of best performers LfE implementation model holds the potential to promote quality improvement of processes among healthcare providers. This potential also unlocks in the chronic disease management field, making the sharing of best performers’ experience possible at a Regional and National level.

Key messages

Learning from excellence model demonstrated to be an effective method in the promotion of best models in the management of chronic diseases. Communication, trust and shared goals among healthcare professionals resulted to play a key role among the best performing hospital and local health authority.
Participatory approach in developing the long-term care strategy in Slovakia
Authors: Katreniakova Z , Levyova M , Giertl M , Nagyova I
Published: November 2019

Issue/problem

In Slovak Republic (SR) old-age dependency will rise rapidly in the near future and will more than double in the next 15 years. This profound demographic changes will require restructuring of health and social care systems with more people working in the long-term care (LTC) sector and most likely a higher level of public spending to cover the growing LTC needs.

Description of the problem

Providing LTC in Slovakia has many problem areas. It is governed by several acts and regulations, which are not always linked and sometimes do not cover the situation entirely. There is not coordinated and integrated LTC model implemented and the distribution of the roles between the health and social care systems is lacking.

Results

Since 2017 a policy dialog between the key stakeholders - the Ministry of Health of the SR; the Ministry of Labour, Social Affairs and Family of the SR; and civic societies led by the Association for the Patients’ Rights Protection has been in place with aim to improve the current LTC Strategy Proposal. Online survey was carried out in May - June 2018, which brought deeper insights into the needs regarding demand and supply, and uncovered the main limitations of the current LTC system, e.g. insufficient capacity of LTC beds or a malfunctioning information system. This was followed by six workshops for professional and lay public, organised between February and March 2019 with aim to collect further evidence on regional level.

Lessons

The LTC Strategy Proposal development is one of 12 pilot projects within the national project - Promoting partnership and dialogue on participatory public policy making in SR. The initiative takes into account the needs and demands of LTC target groups and will serve as a starting point for further action in this area. [Grant Support: APVV-15-0719].

Key messages

In Slovakia, a complex solution of long-term care issues is essential. Developing the LTC Strategy Proposal through participatory approach is an important starting point for future action.
Organizing the institutional Public Health response to heat under climate change: A scoping review
Authors: Boeckmann M , Sanchez Martinez G , Kendrovski V
Published: November 2019

Background

Extreme heat events are a major health risk, and their intensity and frequency are expected to increase under climate change. Heat health action plans (HHAP) aim to prevent adverse health effects through measures such as warning systems or communication campaigns. This scoping review asked whether the peer-reviewed Public Health literature suggests evidence for good practice governance of HHAP.

Methods

Databases PubMed and Web of Science were searched using search string combinations of heat, policy, warning system, and related terms. Data was extracted into a pre-defined extraction table based on theory-driven variables related to responsibilities, processes of stakeholder involvement, evaluation and whether good practice advice was provided. Findings were narratively synthesized and gaps in the current knowledge evaluated from a normative standpoint.

Results

Searches resulted in 6681 hits. After title, abstract and full text screening, 20 articles were assessed, 11 from Europe and 9 from other regions. Findings on structure of governance revealed that the Ministry of Health or Ministry for the Environment leads the development of an adaptation plan or HHAP guidance, while locally Departments of Health most often lead coordination of actions. Interagency cooperation was reported as essential, while in the majority of included studies the public are perceived as recipients of advice and warnings rather than as active stakeholders. Tailoring national guidance to local contexts as well as raising awareness of the plan not only among the public but also among all levels of management was one suggested good practice.

Conclusions

Few articles explicitly examine the organization of HHAP and no conclusions about whether a specific approach is superior can be drawn from these studies. To adequately protect human health from extreme heat events, an assessment of whether current governance structures are able to provide effective heat health action could be useful.

Key messages

The peer-reviewed literature does not provide information on which type of HHAP governance is superior. In the absence of a gold standard, it should be assessed what stakeholders and discourses are absent from HHAP governance to ensure vulnerable groups are adequately addressed by HHAP.
“Is anyone walking in our neighborhoods?”: Citizens’ experience of the neighbourhood environment
Authors: Middleton N , Kleopa D , Panayiotou A , Kouta C
Published: November 2019

Background

Several generic or feature-specific neighbourhood audit tools have been developed in recent years. In the context of developing the Cyprus Neighbourhood Observation Tool for auditing urban environments (CyNOTes), a virtual ethnographic study of citizens’ perceptions of their neighbourhood environment was performed.

Methods

The municipality and mayor’s Facebook were reviewed for posts related to neighbourhood environment over a 12-month period (e.g. regeneration projects). Comments were content analysed using a deductive as well as an inductive approach to gain an in-depth understanding of citizens’ perceptions of neighbourhood environment.

Results

348 comments to 27 relevant posts were identified. The unit of analysis was sentences or short phrases and 289 CMU were identified. The central theme was “Citizens’ voice”. Six themes and several sub-themes emerged. “Comparisons” to contrast the differing conditions between high-profile locations versus “left out” residential neighbourhoods (“Yes, the city centre, the waterfront is a jewel, what about the neighborhoods?”) or to compare their experience to “another place-another time”. They express “Mixed feelings” ranging from “hope” to “disbelief” about proposed actions. Citizens are referring to “Consequences” of neighbourhood adverse environment on “Quality of Life” or “Local ecomomy and housing” and identify “Causes” in “Money and Power” or “Lack of vision and planning”. They are placing “Responsibility” in both “Authorities’ inaction” as well as “Everyone’s role”. “Suggestions” included measures related to “Law and Order” as well as “Citizens’ participation”.

Conclusions

Citizens voice their experiences of the neighbourhood environment lack of influence and control and demand for more involvement in decision-making. They blame authorities for neighbourhood problems but also recognize the lack of individual responsibility, suggesting policing and punitive measures and stronger collective action.

Key messages

A virtual ethnographic study of citizens’ comments on social media offers an in-depth understanding of the neighbourhood experience. Citizens want to have a “voice” to express their concerns about neighbourhood problems as well as to participate in decision-making.
Social cohesion as a mechanism behind neighbourhood effects on mental or physical health
Authors: Kress S , Razum O , Zolitschka K A , Breckenkamp J , Sauzet O
Published: November 2019

Background

The neighbourhood where an individual resides have become a relevant element in the study of health inequalities. While there is substantial evidence that environmental factors affect health, far less evidence of the hypothesised role of social mechanisms in the causal chain between neighbourhood characteristics and health is available.

Methods

Using data from the longitudinal German SOEP panel, we built measures of perceived neighbourhood characteristics and a measure of social cohesion for participant living in urban areas. Participants were included in a longitudinal cohort of 4 year observation time starting in 2004. Using linear regression models, we tested the role of social cohesion as a mediator between the neighbourhood characteristics at baseline and a health outcome (mental and physical component of the SF-12) at the end of follow-up adjusted for socio-economic variables.

Results

For the 4 year follow-up 10 665 participants were included. There was no evidence of a mediation effect of our measure of social cohesion between geographical or institutional characteristics and physical health. The effect of social cohesion on mental health was 2.03 ([1.44, 2.59]) and on physical health 1.78 ([1.27, 2.29]). Social cohesion mediated associations between biological (17%, 11%) or built (11%, 14%) characteristics and both physical and mental health and association between institutional characteristics and mental health (7%).

Discussion

We found evidence for a possible role of social cohesion in the pathway between neighbourhood characteristics and health. Only perceived characteristics have been used in this work and the respective role of objective and subjective measures of neighbourhood characteristics should be further investigated. Moreover, validated measures of social cohesion should be developed.

Key messages

The perception of social cohesion mediates the effect of specific perceived characteristics of neighbourhood on mental and physical health. Interventions seeking to improve social cohesion in neighbourhoods might have positive consequences on the health and wellbeing of inhabitants.
An ego-centred approach for the evaluation of health inequalities in urban areas
Authors: Sauzet O , Zolitschka K A , Spallek J , Breckenkamp J , Razum O
Published: November 2019

Background

Neighbourhood possesses attributes, structural, physical and social, for which pathways to health inequalities could be hypothesized. Hence, neighbourhood is a complex mixture of factors which cannot be simply defined by a delineation on a map, making common definitions of neighbourhood (e.g. administrative borders) problematic. We present a new concept for the evaluation of contextual health inequalities in an urban setting.

Methods

An ego-centred approach to neighbourhood effects on health allows to establish to what degree the health outcomes of a person are on average correlated to the health outcomes of his/her neighbours. This approach does not necessitate the definition of what a neighbourhood is, or of its boundaries. Using data from the BaBi birth cohort following up 958 mother-child pairs in Bielefeld/Germany we illustrate how the method provides information about the spatial structure of a possible association between unmeasured neighbourhood factors and birthweight. Spatially correlated birthweight indicates a neighbourhood effect on maternal health.

Results

A parametric model of the correlation structure gives two indicators: a distance after which health outcomes are no longer correlated (practical range), and the strength of correlation (RSV). We modelled birthweight directly and residuals after controlling for (spatially correlated) covariates. After adjusting for the mother’s demographics and neighbourhood characteristics, birthweights remained spatially correlated with RSV of 11% and a practical range of 128 m.

Conclusions

Modelling the spatial correlation of a health outcome provides a measure of the degree of health correlation, thus offering new evidence on the production of health inequalities while incorporating current modelling approaches. Moreover, it measures heterogeneity in a city. This could be used as an indicator for policy makers or town planners to identify areas in need of socioeconomic investment.

Key messages

Modelling the spatial correlation of health outcomes is an approach which enable to assess unmeasured neighbourhood effects. The health correlation neighbourhood approach helps to investigate the production of health inequalities and to identify urban areas in need of socioeconomic investment.
Arsenic metabolism and urothelial cancer risk: a systematic review and meta-analysis
Authors: Di Martino G , Di Giovanni P , Scampoli P , Meo F , Cedrone F , Lucisano G , Staniscia T
Published: November 2019

Background

Arsenic is a toxic metalloid element frequently found in the environment. Chronic arsenic exposure is a critical public health issue in many countries since the identification of arsenic and its compounds as human carcinogens by the World Health Organization. After absorption, inorganic arsenic (iAs) is mainly methylated into monomethylated and dimethylated compounds (MMA, DMA), which are then excreted through the kidney together with unmethylated iAs. Whether the methylation process is to detoxify or potentiate arsenic toxicity, however, remains an ongoing debate. The purpose of this systematic review was to conduct a comprehensive meta-analysis to estimate the association between arsenic exposure and urothelial cancer.

Methods

10 observational studies met the inclusion criteria and were included in the systematic review. IAs%, MMA% and DMA% were extracted from each paper. Weighted Mean Differences with 95% confidence intervals were defined according to Cases minus Controls. Pooled risk estimates from individual studies were assessed using random effects models. Meta-regression analysis was performed to estimate the extent of urothelial cancer risk as a function of iAs%, MMA% and DMA%.

Results

Results showed as patients with urothelial cancer presented higher level of urinary iAs% (WMD 2.70, 95%CI 0.64-4.76), MMA% (WMD 2.81, 95%CI 1.43-4.20) and DMA% (WMD-3.44, 95%CI-6.57–0.30).

Conclusions

These findings suggest that higher level of iAs% and MMA% and lower level of DMA% were associated with an increased risk of urothelial cancer. Additional population based studies are needed to understand the role of arsenic in cancer development. Understanding the meaning of arsenic metabolism could improve the risk assessment of arsenic toxicity and provide a potential tool for disease prediction and prevention.

Key messages

Higher level of iAs%, MMA% and DMA% were associated with an increased risk of urothelial cancer. Understanding the meaning of arsenic metabolism could improve the risk assessment of arsenic toxicity.
Hillwalking and walk leading motivations, perceived benefits and the role of natural environment
Authors: Morocza N , Frankham J , Boddy L M , Mahon E , Stott T A
Published: November 2019

Background

Promoting the link between human and ecosystem health is crucial for building resilient communities. Hillwalking provides health benefits arising from physical activity and exposure to nature. Furthermore, it is likely to influence environmental knowledge and pro-environmental behaviour through connectedness to nature. This project aimed to explore 1) hillwalking and walk leading motivations and perceived benefits, and 2) the role of the environment and nature connectedness among walk leaders and walking holiday guests.

Methods

The first study was completed with seventeen volunteer walk leaders and used a mixed methods design: hillwalking interviews, physical activity measurements, location data and the Nature-relatedness scale. The second study involved five group interviews with the total of twenty-five guests on three different walking holidays. The qualitative data from both studies were analysed using a combined thematic and grounded theory approach and the results were merged with the quantitative data to explore the impacts of environmental factors.

Results

Primary motivations for hillwalking included pleasure, escape from everyday life pressures, to re-charge, being in nature, social inclusion and health. Emerging overarching themes such as balance and adaptation were reported as essential values for walking and were linked to nutritional, physical activity related and environmental aspects of health awareness. The perceived benefits positively impacted on engagement. Connectedness to nature was linked to environmental knowledge and attitudes which manifested in pro-environmental walking behaviour.

Conclusions

The pleasure arising from several aspects of hillwalking or walk leading was the drive for regular engagement, therefore a primary intrinsic motivation. The results imply that attending group walking holidays has the scope to increase environmental awareness and engagement in outdoor physical activity and could be considered as a promotion tool.

Key messages

The findings have the scope to inform future walking promotion programs and encourage long-term engagement by shifting the focus of promotion messages to intrinsic motivational factors. The results support that hillwalking can be used as a tool for combined health and environmental awareness promotion.
Facing climate change challenges: the Italian Public Health Residents response
Authors: Mammana L , Catalani F , Di Fonzo D , Giannico O V , Miceli R S , Righini M , Rivolta S , Sisti L G , Vaccaro F G
Published: November 2019

Background

Climate change (CC) is one of the most important global issues, and exerts a strong impact on public health (PH). Correlation between CC and PH is a matter of concern in the whole scientific community and requires an interdisciplinary approach. Nevertheless, the need to take action on CC sometimes contrasts with national and local policies, involved professionals’ training and citizens’ education. In order to face these challenges, the Italian network of public health residents “Consulta Specializzandi” of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) decided to create a specific working group.

Objectives

Main objectives are education of PH residents and practitioners on CC, argument disclosure among the SItI and creation of interdisciplinary networks to promote and extend group activities. Secondary objective is development of a study to identify the gap between scientific evidence, recommendations and guidelines, and the European, national and local policies, with the aim of promoting bottom-up researches and good practices in CC management.

Results

The group was created in January 2019; activities started in March. Firstly we defined priorities and work mode. Then we analyzed scientific evidence and promoted self-training on the link between environment and CC and on the impact of CC on individual and public health. Finally, through attendance at workshops and scientific events, we began to train other PH residents and practitioners and started to create networks with other scientific societies, research centers and foreign academies, in order to promote international research, advocacy and disclosure between different institutions regarding the relationship between CC and PH.

Conclusions

The group has already partially achieved its main objectives, especially increasing awareness and training in CC and related issues. Further activities will permit to strength interdisciplinary networks and to move to secondary objectives.

Key messages

CC severely impacts society. Yet there is no widespread feeling of urgency to act towards its causes and consequences. A change in mindset is mandatory, from individual citizens to decision makers. PH residents and practitioners must be the main actors in training and education, advocacy, disclosure and network creation in CC research and management.