bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic disparities in diabetes prevalence and quality of care among Israeli children
Authors: Weisband Y Loewenberg , Calderon-Margalit R , Wolff-Sagy Y , Krieger M , Abu-Ahmed W , Ben-Yehuda A , Horwitz E , Manor O
Published: November 2019

Background

Despite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess trends in these over time.

Methods

Repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare that receives data based on electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2-19 years in 2011-2017 (for 2017: N = 2,364,374, including 2,914 with diabetes). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). Using logistic regression, we assessed the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1C> 9%), and assessed whether these changed over time. Models were adjusted for age, and sex.

Results

Diabetes prevalence increased with age and SEP. SEP was positively associated with visiting a specialized diabetes clinic (OR SEP 4 vs. 1 2.53, 95% CI 1.72 - 3.70). Odds of HbA1C testing and odds of poor glycemic control were negatively associated with SEP (OR SEP 4 vs. 1: 0.54, 95% CI 0.40 - 0.72 and OR SEP 4 vs. 1: 0.25, 95% CI 0.18 - 0.34 respectively). Disparities were especially apparent among children aged 2-9 (4.6% poor glycemic control in SEP 4 vs. 40.8% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.8% in 2017.

Conclusions

While poor glycemic control rates among children have improved, significant socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.

Key messages

Major socioeconomic inequalities in the control of diabetes among children in Israel remain despite universal health care coverage. The rate of uncontrolled diabetes among Israeli children has improved over time.
Mood disorders with onset in early adulthood and socio-economic outcomes over the long run
Authors: Hakulinen C , Musliner K L , Agerbo E
Published: November 2019

Background

Mood disorders have been associated with poor socioeconomic outcomes, but there is a lack of large-scale population-based studies on the topic. We examined associations between bipolar disorder and depression with an onset between ages 15 and 25, and subsequent socio-economic outcomes (employment, income and educational attainment) using Danish registry data.

Methods

All individuals (n = 2 390 127; 49% women) born in Denmark between 1955 and 1990, who were alive at their 25th birthday were included. Employment status, wage or self-employment earnings, and educational attainment were assessed annually from the age of 25 to 58 (years 1980 to 2015). Mood disorder diagnosis was obtained from the Danish Psychiatric Central Register. The associations were examined using logistic regression analyses.

Results

At the age of 30, 46% of individuals with bipolar disorder and 35% of individuals with depression were not employed, and 52% of individuals diagnosed with bipolar disorder and 42% of individuals with depression did not have any secondary or post-secondary education. Bipolar disorder and depression were associated with increased and increasing risk (at age 30: bipolar disorder, OR 7.21, 95% CI 6.54 to 7.96; depression, OR 4.07, 95% CI 3.93 to 4.22) of not being employed over the follow-up. Similarly, both bipolar disorder and depression were associated with increased risk of not completing secondary or post-secondary education (at the age of 30, bipolar disorder: OR 3.21, 95% CI 2.92 to 3.54; depression: OR 2.81, 95% CI 2.71 to 2.91), but this difference become smaller over the follow-up. An individual with bipolar disorder or depression earned around 36% and 51%, respectively, of the earnings earned by an individual without mood disorders.

Conclusions

Mood disorders diagnosed in early adulthood are associated with lasting poor socioeconomic outcomes over the long run.

Key messages

Early onset mood disorders are associated with consistently, and in some cases increasingly, poorer socioeconomic outcomes over time. An individual with early onset bipolar disorder or depression earned around third and half, respectively, of the earnings earned by an individual without early onset mood disorders.
’The Pyramid of Success” the health promotion program for school- children with visual impairment
Authors: Wrzesinska M , Binder K , Rakoczy J , Tabała K , Lipert A
Published: November 2019

Issue/problem

Young people with visual impairment (VI) are more likely to have low literacy comparing to the rest of population. Additionally, they are at the high risk of obesity what has been attributed to poor food choices or lack of physical activity. Hence, interventions to support their nutrition status are needed.

Description of the problem

One hundred eighty six students aged 10-18 years (M = 13.9; SD = 2.44) selected from 6 schools for pupils with VI. An intervention describing healthy lifestyle guidelines was performed. Two innovative tools concerning nutrition guidelines tailored to the needs of people with VI were used during intervention: The Healthy Lifestyle Pyramid (HLP) and the Puzzle Game (PG). Participants were devoted to the Control Group (CG; N = 94) where only HLP was used and the Study Group (SG, N = 92) who participated in the classes with both tools: HLP and PG. Before and just after intervention a single-choice questionnaire regarding health literacy comprising 15 questions was used to verify the level of required knowledge regarding nutrition.

Results

There was a significant main effect of using HLP in the CG F(1. 132)=14.524, p < 0.001. The main effect of using HLP and PG in the SG was also significant, F(1. 132)=6.188, p = 0.014. The actual difference in mean scores between SG and CG was medium. The effect size, calculated using partial eta squared, was .045.

Lessons

The interventions with tools tailored to the needs of people with VI had positive significant impact on nutrition knowledge. Health promotion activities focusing on the health literacy improvement are more effective when various approaches are used to present information. Future health promotion activities should be adjusted to the needs of different populations to provide an equal access to healthy behaviours and to enhance health literacy.

Key messages

Using tools tailored to the needs of people with VI provide an equal access to health promotion. Health promotion activities are more effective when range approaches are used to present information.
Machine learning application to the reduction of ambulatory care sensitive admissions (ACSA)
Authors: Ngo T , Georgescu V , Gervet C , Laurent A , Libourel T , Mercier G
Published: November 2019

Background

Reducing Ambulatory Care Sensitive Admissions (ACSA) not only enhances patients’ quality of life but could also save substantial costs. ACSA are avoidable admissions for chronic conditions that are associated with socio-economic status, health status, utilization and readiness of primary care service as well as environmental factors. Undoubtedly, health authorities are highly interested in enhancing the health care services in order to reduce the number of ACSA. The objective is to identify the geographic areas where the primary care workforce should be increased in order to maximize the decrease in ACSA.

Methods

Using ambulatory care and inpatient claims data as well as contextual variables, we apply support vector machine regression (SVR) to select the geographic areas (fr. Bassins de vie - BVs) and the number of to-be-added primary care nurses that maximize the ACSA reduction. We also take into account the constraints related to budget and the equality of health care access. Particularly, there are three possible constraints: (1) the total number of nurses can be added in the whole region; (2) the maximum number of the nurses can be added at each area; (3) the maximum density of nurses (numbers of the nurses per 10,000 habitants) can be reached at each area. The results are visualized using spatial maps.

Preliminary results

In 2014, 27,000 ACSA occurred in the Occitanie, France region. For a specific set of constraints values, the model identified 16 BVs (out of 201) where the addition of 30 nurses could lead to the maximum ACSA reduction in number which is 17.

Conclusions

In the French Occitanie region, our SVR model was able to target a small number of geographic areas to maximize the impact of increased primary care workforce on ACSA. Our approach is applied to a single region, and it can be applied to other regions or extended at the national level as well as to other countries.

Key messages

A decision support tool to help health authorities in locating primary health care resources for the maximum reduction of ambulatory care sensitive admissions. An application of machine learning in primary care services.
Patients’ participation in the colorectal cancer screening program and their health beliefs
Authors: Kaseliene S , Mesceriakova-Veliuliene O
Published: November 2019

Background

Both morbidity and mortality rates from colorectal cancer (CRC) have been increasing in Lithuania. However, only about 50% of the target Lithuanian population was involved in CRC screening in 2018. The aim of this study was to evaluate associations between the involvement of 50- to 74-year-old primary care patients in CRC screening and their health beliefs as well as awareness about this screening.

Methods

A cross-sectional study was conducted in September-November 2016. A total of 390 patients aged 50-74 years were anonymously surveyed at 10 primary health care institutions of Šakiai region, Lithuania. The response rate was 86.7%. Chi-square and z tests were used to determine a relationship between two nominal (categorical) variables (α = 0.05).

Results

43.1% of the respondents noted about their participation in the CRC screening program. Those who had participated in the program more often (p < 0.05) than nonparticipants reported to be worried about getting CRC (60.6% vs 43%) and thought that this could happen already in the next year (16.8% vs 6.5%), more frequently believed that the possibility of getting CRC for them was very high (74.8% vs 60.9%), that they had predisposition to CRC (44.9% vs 27.6%) and that CRC screening will prevent them from problems in the future (97.4% vs 90.9%). The participants of the CRC screening program also more frequently (p < 0.05) than nonparticipants noted that they had heard about this program before their involvement in it (98.8% vs 70.9%) and got this information from their family doctor 2.1 times more frequently (88.1% vs 41.4%). Nearly half (47.3%) of the program participants and 30.6% of the nonparticipants mentioned that the responsibility for participation in the CRC screening program should be taken by patients themselves (p < 0.05).

Conclusions

Participation of patients in the CRC screening program is related to their health beliefs, awareness and active engagement of family doctors in CRC screening programs.

Key messages

The patients who had participated in the CRC screening program had more negative health beliefs regarding CRC and were better informed on the program by their family doctor than nonparticipants. Family doctors should pay more attention to informing patients about CRC and its prevention.
Assessement of the influenza burden in nursing homes during two influenza seasons
Authors: Qalla-Widmer L , Petignat C
Published: November 2019

Influenza is a significant cause of morbidity and mortality in elderly. They are at high risk of complications after influenza virus infection. Data on the epidemiology of influenza within nursing homes (NH) are limited. The purpose of this prospective study was to better describe the burden of influenza among residents of NH of canton of Vaud, Switzerland, with influenza-like illness during 2016-2017 and 2017-2018 influenza seasons. First, we determined the proportion of influenza-like illness due to influenza in NH residents. We specifically assessed the impact of a positive influenza PCR on clinical features, morbidity and mortality, 30 and 90 days after diagnosis, as compared to a negative influenza PCR. Moreover, influenza vaccination rates of the residents and the healthcare workers within each nursing home were assessed at the end of each influenza season. A PCR test was performed on 509 residents from 61 NH. 227 influenza virus infections were diagnosed; 181 influenza A and 46 influenza B. Compared to residents without influenza virus infection (IVI), residents with IVI were more often feverish with a high fever (69.1% and 88.5% respectively, p < 0.0001) are significantly more frequently hospitalized within 30 days after diagnosis (17.6% vs 7.1%, p = 0.0003). Any cause mortality at 30 days was similar in both groups (12.8% vs 10.6%, p = 0.48). Only 18.1% of IVI residents were treated with an antiviral and 60.4% of them received antibiotics. Influenza vaccination rates of the healthcare workers and residents were respectively 50% and 82%. During influenza season, the feverish residents should be suspected to have influenza virus infection. Residents should be diagnosed (PCR) and treated with an antiviral where appropriate to limit the risk of hospitalization. Healthcare workers should be encouraged to be vaccinated against influenza in order to acquire a better herd immunity within the NH which will limit the spread of influenza.

Key messages

Influenza virus in nursing homes is not treated enough. Influenza virus infection in nursing homes causes a high number of hospitalizations.
Monitoring inequalities in self-rated health over 36 years among Finnish women and men
Authors: Lahelma E , Pietiläinen O , Pentala-Nikulainen O , Helakorpi S , Rahkonen O
Published: November 2019

Background

Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations.

Methods

Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII).

Results

Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities.

Conclusions

Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated.

Key messages

Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.
Using e-health to shorten treatment delay in patients with severe aortic stenosis
Authors: Michel M , Hammami J , Vinet M A , Picot-Ngo C ,   NA STOP-AS Investigators, Debroucker F , Gilard M , Chevreul K
Published: November 2019

Background

Transcatheter aortic valve replacement (TAVR) is a relatively new alternative to open surgery in patients with a severe aortic stenosis at high risk of surgery but there are important variations in treatment delay which can lead to increased morbidity and mortality. Those delays have many causes, including patients’ unawareness of the urgency, delays in obtaining the necessary preoperative tests and organizational factors at the hospital level. The aim of our study was to co-construct an e-health tool for patients and their families to empower them and improve knowledge on the disease and TAVR to ultimately decrease the delay between the medical decision for TAVR and the actual procedure.

Methods

A prospective study was first carried out to identify organizational factors associated with variations in treatment delay (both at the patient and hospital level). A preliminary survey was sent to all TAVR centers in France to understand and describe their organization. Descriptive analyses were then carried out on the answers. In a second step, two focus groups were carried with, the first with patients and carers and the second with healthcare professionals in order to elaborate the e-health tool.

Results

A website has been developed for patients and their families. It includes information in video form on aortic stenosis and its different treatments, on TAVR, the necessary tests required prior to TAVR (with a geolocalisation of available facilities nearby so that patients may know where to go), and what they can expect during the hospital admission and after their release. Patients undergoing TAVR will be informed of the website’s existence by their cardiologist. Web pages intended for healthcare professionals who are not TAVR specialists (general practitioners…) will also be available on the website.

Conclusions

A cluster randomized controlled trial will now test the efficacy and efficiency of the e-health tool in reducing TAVR treatment delay.

Key messages

We built a e-health tool in collaboration with patients, carers and healthcare professionals to increase patients’ knowledge on aortic stenosis and TAVR. The website will provide information through videos to empower patients and ultimately decrease treatment delay and its associated morbi-mortality.
E-health and governance models - a scoping review
Authors: Linstad L , Ekeland A G
Published: November 2019

Background

Research has shown that national large-scale e-health projects are rarely defined as successful.

Methods

We have conducted a search in the PubMed database on governance models.

Results

Our search resulted in 220 hits, 11 papers included. We sorted these in four health systems Governance takes three different paths. 1) governance of e-health - how governments govern e-health programs through national and regional strategies, standards, incentives, legislation 2) governance through e-health - e-health as a strategic tool to obtain national health policy goals 3) governance in e-health - governance in medical networks initiated bottom-up and run by clinicians.

In the Single-Payer we find two papers. Both these describe governance of e-health. When the processes had been running for a period of time it shifted to governance through e-health. Two papers from New Zealand describe top-down governance model of e-health. Under the Multi-Payer health system we find a paper that describes the experiences of realizing a national telehealth network in Australia through a governance model in e-health. Under Unknown health system and national governance models, we include a paper that describes a governance model of e-health in Haiti. Two other papers describe the tension between non-profit and for-profit organizations on access to health data and domain names. The authors questions how governments shall realize governance models which captures these new aspects in healthcare. The second paper describes the challenges faced by the authorities’ governance of the purchase and sale of health domains when public health institutions do not have an overview of this. The papers in this category may question if there is a need for a fourth governance model in e-health on the global level.

Conclusions

The development of governance models are not static but part of processes and context dependent. Need for a fourth governance model on the global level.

Key messages

Research has shown that national large-scale e-health projects are rarely defined as successful. Currently scattered knowledge on how large-scale e-health projects that bring economic, clinical and societal benefits are governed.
Media Freedom is the Primary Culprit for Depressive Disorders: A Cross-National Analysis
Authors: Lin Y C , Yan H T
Published: November 2019

Background

There has been much speculation about social environments causing an epidemic of depression. The objectives of this study are to examine how media freedom influences prevalence of depressive disorders. A direct effect of free media is great levels of information complexity causing poor mental health. Two indirect effects are that media freedom facilitates modernization, which is associated with competition-related stress, and government investment in social protection, which impedes the person’s ability to manage stress.

Methods

The study used a cross-sectional analysis on determinants of prevalence of depressive disorders in 2015 covering 98 democratic countries. Media freedom was measured as the degree to which a country allows the freedom of news and information of print media, television, and radio broadcasting (0-100: least to most free). Control variables were then added, including GDP per capita growth, population density, country latitude, and religious affiliations. Further, a mediation analysis was applied to test if there is a causal pathway that links the degrees of media freedom and the levels of economic development or/and social protection to prevalence of depression.

Results

We found that an increase in the score of media freedom by 10 resulted in a 0.20 percentage point increase in prevalence of depressive disorders (%) (0.20, CI = 0.10-0.30). Our theoretical expectations were still confirmed when this study examined the relationship for each year between 2011 and 2014 (e.g. in 2014, 0.19, CI = 0.09-0.29), used an alternative index of media freedom from a practitioners’ view (0.17, CI = 0.02-0.32), or measured each country’s level of internet and digital media freedom (0.30, CI = 0.10-0.49). Further, a mediation test showed that 39.88% and 21.38% of the total effect was mediated through the economic and social pathway respectively.

Conclusions

The findings suggest that great levels of media freedom matter in increasing prevalence of depression.

Key messages

Great levels of media freedom matter in increasing prevalence of depression. There are direct and two indirect effects of media freedom on prevalence of depression.
Effects of a work-stress intervention in Swedish primary care versus treatment as usual: RCT-study
Authors: Sandheimer C , Hedenrud T , Hensing G , Holmgren K
Published: November 2019

Background

Work stress is an increasing burden in society. To identify early symptoms of work stress in primary health care (PHC) could result in earlier and better adjusted care. A work stress questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate if the use of WSQ, in combination with physician’s feedback, results in differences in health care visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU.

Methods

A two-armed RCT was conducted at seven primary health care centres (PHCC) in Region Västra Götaland, Sweden. One group received the WSQ-intervention and the controls received TAU. Employed not sick-listed persons aged 18-64 that sought care for mental and physical health complaints at the PHCCs participated. Register data on health care visits and treatments 12 months prior inclusion and 12 months after was obtained and analysed with Fisher’s exact test together with questionnaire data (WSQ and background features).

Results

A total of 271 participants were included in the study, 132 intervention and 139 controls. The proportion that visited psychologists/psychotherapists was higher among the intervention group with high stress (19.5%, n = 87) during follow-up compared to corresponding controls (7.2%, n = 97) (p = 0.048). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11.3%) (p = 0.048).

Conclusions

Significant differences were found between the WSQ intervention group and the controls reporting high stress in visits to psychologists and in amount of received collaborative care. This confirms our hypothesis that the WSQ can help physicians to identify work stress and give suitable rehabilitative measures at an earlier stage in the care process compared to TAU.

Key messages

The use of WSQ with physicians’ feedback generated more visits to psychologists and more received collaborative care compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary care and accommodate rehabilitative measures compared to treatment as usual.
Childhood adversities and chronic pain among midlife employees
Authors: Salonsalmi A , Lallukka T , Lahelma E , Pietiläinen O , Rahkonen O
Published: November 2019

Introduction

Chronic pain is common among employees. Childhood adversities are known determinants of adult health but their association with chronic pain in adulthood is largely unknown. We aimed to examine the associations between childhood adversities and chronic pain among midlife employees.

Methods

Data on seven childhood adversities and chronic pain (pain having lasted at least 3 months) were derived from the baseline survey of the Helsinki Health Study collected in 2000 to 2002 among 40 to 60-year-old employees of the City of Helsinki in Finland. The study included 8140 employees of whom 80% were women. The analyses were made by logistic regression and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, gender, father’s education, own education, marital status, working conditions, sleep problems and common mental disorders were included as covariates.

Results

Economic difficulties in the childhood family (OR 1.60, 95% CI 1.41-1.81), childhood illness (1.74, 1.45-2.08), parental divorce (1.26, 1.07-1.48), parental alcohol problems (1.34, 1.18-1.52) and bullying in school or among peers (1.59, 1.37-1.89) were associated with an increased odds of chronic pain in midlife. Adjusting for father’s education, own education and marital status did not contribute to the associations. Working conditions, sleep problems and common mental disorders slightly attenuated the associations between childhood adversities and chronic pain.

Conclusions

Childhood adversities associate to chronic pain in midlife. The results suggest that promoting well-being among children might lead to less pain decades after childhood.

Key messages

Childhood adversities are associated with chronic pain in adulthood. Considering well-being among children might lead to less pain decades after childhood.
Job demands & control among employees in Sweden aged 55-64 and labour market status 11 years later
Authors: Farrants K , Alexanderson K
Published: November 2019

Background

As discussions about extending working lives are ongoing, more knowledge is warranted on how psychosocial working conditions are associated with labour market status in older age.

Aim

Among employees aged 55-64 years, explore associations between job demands/control with their labour market status 11 years later, using a job exposure matrix (JEM).

Methods

A population-based prospective cohort study using nationwide register data. All 616,818 individuals in Sweden who in 2001 were in paid work and aged 55-64, were categorized using JEM into 9 groups, based on tertiles. They were followed up in 2012 regarding their labour market status (main income from: paid work, old-age pension, marginalised (no income/social assistance), sickness absence >183 net days, emigrated, dead) using multinomial logistic regression for odds ratios (OR) and 95% confidence intervals (CI), controlling for labour market status and sociodemographics in 2001. Analyses were stratified by sex.

Results

The majority (women: 84.9%, men: 80.3%) had main income from old-age pension at the 11-year follow-up; 4.7% from paid work (women: 3.9%, men: 5.6%). Those initially in jobs with high demands were less likely to be marginalised at follow-up (OR women high demands/medium control 0.51, CI 0.38-0.68, high demands/high control 0.68, CI 0.50-0.92; OR men high demands/medium control 0.55, CI 0.31-0.96, high demands/high control 0.47, CI 0.30-0.73). Those in occupations with low demands were less likely to be in paid work (OR women low demands/low control 0.56, CI 0.51-0.62, low demands/medium control 0.63, CI 0.58-0.69; OR men low demands/low control 0.56, CI 0.51-0.63, low demands/medium control 0.63, CI 0.58-0.69).

Conclusions

High job demands with high job control among people aged 55-64 in 2001 were associated with higher rate and OR of having main income from paid work in 2012, and high job demands regardless of level of job control were associated with less marginalisation.

Key messages

Levels of job demands when aged 55-64 were associated with labour market status 11 years later for women and men, while levels of job control were less so. High job demands were associated with a higher likelihood of being in paid work and lower likelihood of being marginalised at the end of follow-up.
Health inequality and self-employment in South Korea
Authors: Kim HyeJin , Min Jin-Young , Min Kyoung-Bok
Published: November 2019

Background

Self-employed persons work for themselves as owners of a business rather than for an employer. Although self-employed persons have autonomy and flexibility, they are vulnerable to workplace health and safety hazards. However, there has been little interest in the health of self-employed persons, especially in small business owners. This study investigated the health status of small self-employed business owners compared to standard workers.

Methods

The third Korean Working Conditions Survey for a total of 32,630 workers aged 20-59 were analyzed. A small business was defined as self-employment with 0-4 workers. Standard employment included full-time employment with a permanent or one-year contract. Health outcomes included the presence of depressive symptom and 8 types of physical health; hearing problems, skin problems, backache, muscular pains (upper limbs), muscular pains (lower limbs), headaches/eye strain, injuries, and overall fatigue.

Results

Among 32,630 workers, 10,652 (32.64%) were small business self-employed. Compared with standard employed workers, small business self-employed had a 1.2-fold [adjusted OR (Odds Ratio) =1.20, 95%CI (Confidence Interval) 1.09-1.32] increased likelihood for depression after adjustment for potential covariates. Small business self-employed was at higher risk of work-related physical health problems: backache (OR = 1.16, 95%CI 1.06-1.26), muscular pains in upper limbs (OR = 1.19, 95%CI 1.12-1.27), and muscular pains in lower limbs (OR = 1.14, 95%CI 1.07-1.22).

Conclusions

Our study found health inequality of small business self-employed, showing higher odds for mental and physical health problems in small business self-employed than in standardly employed workers.

Key messages

The current study showed vulnerability of self-employed in small business to health problems. Our study would be helpful to build up better working environment for small business owners and improve occupational health inequalities in South Korea.
Prenatal care: missed opportunity for HBV prevention in women of childbearing age in rural Senegal
Authors: Djaogol T , Coste M , Marcellin F , Diallo A , Carrieri P , Boyer S ,   and the ANRS 12356 AmBASS Study Group
Published: November 2019

Background

Perinatal transmission of hepatitis B virus (HBV) constitutes an important risk in highly endemic countries including Senegal. Although the prevalence of chronic HBV infection is estimated at 11% in this country, specific data on women of childbearing age are sorely lacking. We described in this study the prevalence of the HBV antigen (HbsAg) in women of childbearing age in rural Senegal, as well as general knowledge on HBV and hepatitis B status awareness.

Methods

A cross-sectional study including HBV screening was conducted at home in the rural Niakhar area. Chronic HBV infection was determined through HBsAg detection using dried blood spots. Socio-demographic and behavioral data were collected through standardized face-to-face questionnaires. The analyzes included 368 women aged 15-49 (67% married; 65% with at least 1 child) enrolled from October 2018 to March 2019.

Results

Preliminary results show that 49 women (13%) had positive HBsAg. Only 68 women (18%) have already heard about HBV. Among them, 53% knew that there exists an HBV vaccine and 78%, 75% and 67% correctly answered that HBV can be transmitted through blood contact, childbirth and sexual intercourse, respectively.

Among the 233 (63%) women who had already given birth, 76% had attended at least 4 antenatal care sessions and 74% had given birth in a healthcare facility for their last pregnancy. However, only 1% reported to have already been screened for HBV. Main reasons reported for not having been screened were having never heard about this test (80%) and not having been offered screening during antenatal care sessions (10%).

Conclusions

General knowledge and awareness of HBV status are particularly low in women of childbearing age living in rural Senegal, despite high antenatal care sessions attendance. Given the high prevalence of chronic HBV infection found in this population, it is urgent to ensure systematic HVB screening and to provide adequate information to women during pregnancy.

Key messages

The prevalence of chronic HBV is high in women of childbearing age in Senegal. National recommendations for women attending antenatal care sessions should include HBV screening and counselling.
Does the over-medicalisation of pregnancy help to improve neonatal outcomes?
Authors: Kundisova L , Nante N , Cuccaro C , Mariottini E , Alaimo L
Published: November 2019

Introduction

The over-medicalization of pregnancy is frequent, especially in high-income countries and comports unnecessary costs for health systems. In Italy the national health service guarantees access to health care services, but still a lot of pregnant women search for private health care. This study aimed to analyse if the over-medicalization of pregnancy had an impact on neonatal outcomes.

Methods

The cross-sectional study was conducted in Siena (Italy), data were extracted from medical records. All women that gave birth between January 2016-May 2018 and were classified as “low/moderate risk” pregnancy were included. Examined variables were: age, number of obstetrics and ultrasound (US) visits (≤9/≥10), timing of the first visit (<12weeks/>12weeks of pregnancy), health facility (public/private), previous spontaneous abortions (SA) or voluntary interruptions of pregnancy (VIP). The outcome variables were preterm birth (PB) and admission in neonatal intensive therapy unit (NITU). Analysis was performed with Stata 12.

Results

A total of 2392 women were included; 22% with≥10 obstetrics visits; 19% with≥10 US visits; 87% had the first visit before 12 weeks of pregnancy and 57% were followed by a private healthcare facility. Six percent of babies were born preterm and 11% were admitted in NITU. The PB condition appeared associated with SA (OR:2.4, 95%CI 1.6-3.6 p < 0.001) and VIP (OR:1.8, 95%CI 1.2-2.8 p < 0.005).

Admission in NITU was associated with previous VIP (OR:1.4, 95%CI 1.01-2.03 p < 0.05) and PB (OR:2.16 95%CI 1.37-3.41 p = 0.001). Multiple logistic regression identified only PB as associated with this outcome.

Conclusions

Neonatal outcomes do not show association with number of obstetric/US visits and the type of health facility. It seems that controlled pregnancy does not help to reduce the risk of adverse events as premature birth or admission in intensive therapy.

Key messages

The over-medicalization of pregnancy is frequent, especially in high-income countries and it has an important impact on health-related costs. More controlled pregnancy does not help to reduce the risk of adverse events as preterm birth and necessity of recovery in neonatal intensive therapy unit.
Individual and process factors influencing user’s satisfaction with Housing First services
Authors: Loubiere S , Tinland A , Boucekine M , Girard V , Auquier P
Published: November 2019

Objectives

Housing First models aim to give homeless with severe drugs and mental health problems a permanent home and assertive care team support. Concern persists that user satisfaction and retention rate are key values in the evaluation of such inclusive-care programs, to secure good outcomes. The aims of this study were 1) to explore user’s satisfaction with Housing First services, and 2) to determine individual or contextual factors influencing user’s satisfaction.

Methods

Based on the French Un Chez Soi d’Abord sample, we analysed data from homeless people with severe mental problems assigned to the Housing First and followed during 3 years. Measures included team tracking frequency, service users’ needs, and a Client Satisfaction Questionnaire (CSQ-8). Generalized estimating equations were used with a random effect for site to identify relevant baseline confounders for the CSQ score.

Results

At 36-month follow-up, 131 HF participants completed the services user’s needs and CSQ-8 questionnaires. 94% were still housed. Respondents reported needs from the HF team for managing housing (74%), administrative assistance (63%) and mental illness (43%). The mean total CSQ-8 score was 25.6 (SD = 5.2) out of 32. Four predictors of a higher CSQ score were: higher frequency of visits (regression coefficients 8.2), lower user’s education (-2.2), ever been a tenant (1.4), and suffering of schizophrenia disorder (0.9) (p<.001).

Conclusions

The users’ perception of the quality of HF services appears to be high. Our results underscore the interaction of individual and process factors influencing user satisfaction. These findings suggested that HF intervention in France is a promising strategy for high quality of services to homeless people with mental illness.

Key messages

He users’ perception of the quality of Housing First services appears to be high. Housing First intervention in France is a promising strategy for high quality of services to homeless people with mental illness.
The Public Health Implications of Brexit: A Health Impact Assessment Approach
Authors: Green L
Published: November 2019

On March 29th 2019, the United Kingdom (UK) was due to exit the EU in a process known informally as ’Brexit’. This exit and entry into a 2-year transition is a period of unprecedented political and social upheaval - with many unknowns and much uncertainty attached to the outcomes and future impact.

In preparation for Brexit, Public Health Wales commissioned the Wales HIA Support Unit to carry out a health impact assessment of Brexit in Wales to support and inform its and other public bodies planning and future work.

This paper examines the unique HIA carried out between July and December 2018 on the impact of the UK withdrawal from the EU in Wales. It discusses the robust, participatory process undertaken, the stakeholders involved and the benefits reaped from this. It highlights the evidence gathered and analysed including the collection methods, the complex nature of the work and disseminates the main findings from the HIA including the potential determinants of health and population groups identified.

Finally, it describes the challenges faced, how these were overcome, and the huge benefits, impact and influence it has had to date across a wide range of UK and Welsh organisations and public bodies. This work demonstrates continued leadership in the field of impact assessment and spearheads the requirement for public bodies to carry out HIAs as part of the forthcoming statutory requirements of the Public Health (Wales) Act 2017 an can inform practice at a global level.

Key messages

HIA can inform and influence action in response to important strategic decisions. The Brexit HIA is a unique example which can inform international HIA practice.
Determinants of frequent use of primary care in the German healthcare system
Authors: Rommel A
Published: November 2019

Background

In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system.

Methods

The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany’s national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of physician contacts in the preceding 12 months as frequent attenders. Binary logistic regression models with average marginal effects were used to identify determinants for the frequent use of primary care services.

Results

The sample comprised 7,956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, and factors related to objective need for medical care and subjective health status. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect between subjective health status and number of non-communicable diseases, indicating the association of disease with frequent use was highly moderated by subjective perception of health.

Conclusions

We observed strong associations between frequent primary care attendance and objective and subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization behaviour and avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.

Key messages

The number of NCDs diseases and subjective health had the strongest effect on frequent primary care use. The findings suggest that better coordination of care may be the preferred method to manage health services utilization.
Healthcare Workers’ attitudes towards mandatory influenza vaccination: a systematic review
Authors: Corezzi M , Gualano M R , Voglino G , Olivero E , Rossello P , Bert F , Siliquini R
Published: November 2019

Background

Influenza affects approximately between 5 to 10% of general population every year, leading to 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths. Healthcare Workers (HCWs) play a crucial role in spreading the infection to patients. Although the strong recommendations provided, influenza vaccination coverage rates among HCWs are globally well below the coverage target set by WHO. The aim of this study is to assess attitudes towards mandatory influenza vaccination programs among HCWs, in order to make a quantitative synthesis of the phenomenon.

Methods

The present study systematically reviewed published cross-sectional studies investigating attitudes towards compulsory influenza vaccination in Healthcare Workers. PubMed and Scopus scientific databases were searched and 4,198 results were returned. Of these, 23 met the inclusion criteria for the review and 13 were eligible for the meta-analyses. PRISMA statements were followed.

Results

Thirteen studies were conducted in North America, 4 were conducted in Europe, 3 in Asia, 2 were performed in Australia and one study collected data both from Europe and Asia. According to the assessed studies, the percentage of agreement ranged from 44% to 95% for different compulsory vaccination programs. A combined prevalence of 59.8% (95%CI 50.1-68.8) was found in the meta-analysis. Having been vaccinated against influenza in the previous year increases the likelihood (OR 4.1; 95%CI 2.8-6.1) of being in favour of mandatory vaccination policies.

Conclusions

Compulsory influenza vaccination programs are generally accepted by the majority of health professionals, especially by those who have already been vaccinated previously. These results could be important to improve European vaccination strategies, in order to increase influenza vaccination rates among Healthcare Workers.

Key messages

Mandatory influenza vaccination programs are accepted by the majority of Healthcare Workers. Having been previously vaccinated against influenza increases the likelihood of being in favor of a mandatory vaccination policy.
Frailty as predictor for all-cause and cause-specific mortality: 11-year follow-up cohort study
Authors: Dorner T E , Grabovac I , Mogg C , Oberndorfer M , Haider S
Published: November 2019

Background

Frailty is a geriatric syndrome characterised by sarcopenia, malnutrition, and chronic inflammation that leads to adverse health outcomes including dependency, low quality of life, and higher risk for morbidity and mortality. It was the aim of this study to examine the relationship between frailty status and risk of all-cause and cause-specific mortality.

Methods

The study is based on data from the Survey on Health, Aging and Retirement in Europe (SHARE) including 11 European countries with an 11-year follow up. 24,634 participants with a mean age of 64.2 (9.8) 53.6% female, were analysed. Frailty status was calculated using the SHARE- Frailty Instrument, categorizing the participants as robust, pre-frail, and frail. Cox Proportional Hazard models were used to estimate the risk of all-cause and cause-specific (stroke, heart attack, other cardiovascular disease, cancer, respiratory illness, infectious, digestive and other) mortality in frail and pre-frail subjects compared to robust persons.

Results

14.7% and 6.9% were found to be pre-frail or frail at the baseline. During the follow-up, we observed both pre-frailty and frailty being associated with a higher risk of all-cause and cause-specific mortality in the unadjusted model. After adjusting for sex, age, education level, body mass index, smoking, alcohol consumption and a number of comorbidities, frailty was associated with a higher risk of all-cause mortality [HR 1.56 (95% CI 1.37-1.78)], and mortality due to other cardiovascular diseases [HR 1.88 (95% CI 1.27-2.76)], cancer [HR 1.47 (95% CI 1.14-1.90)], and respiratory disease HR [1.82 (95% CI 1.10-3.01)]. Furthermore, pre-frailty was associated with a higher risk of all-cause mortality [HR 1.27 (95% CI 1.14-1.42)] and other cardiovascular disease mortality [HR 1.70 (95% CI 1.22-2.35)].

Conclusions

Our study showed that baseline pre-frailty and frailty are associated with increased all-cause and cause-specific mortality over an 11-year follow up.

Key messages

Frailty but also pre-frailty leads to a higher mortality, even when adjusted for morbidity, lifestyle factors, and socio-demographic factors. More effort is needed to prevent, detect, and treat frailty and pre-frailty, both, on individual and on community level.