bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacts of transboundary coal air pollution from Balkan region to European public health
Authors: Matkovic Puljic V , Jones D , Myllyvirta L , Gierens R
Published: November 2019

Background

Western Balkan region holds coal power plants that are old, inefficient and substandard. In 2016, the region’s 16 plants emitted more SO2 than the entire 250 European coal power plants. In this study we modelled the transboundary nature of air pollution affecting this region and EU.

Methods

We calculated health impacts and costs from Western Balkan coal plants by the following steps: (1) Identify coal power plants in the Western Balkans in 2016; (2) Source 2016 coal power plant emissions data; (3) Model the pollutant exposure resulting from the emissions from Western Balkan coal power plants; (4) Calculate health impacts associated with modelled pollutant exposures; (5) Attribute the health impacts to individual coal power plants; (6) Calculate the cost of the health impacts.

Results

The modeling shows that every year Western Balkans’ plants cause 3,000 premature deaths, 8,000 cases of bronchitis in children, and other chronic illnesses costing both health systems and economies a total of € 6.1-11.5 billion. The EU bears the majority of health cost, more than half of these health costs relate to the EU (€ 3.1 to 5.8 billion), a third (32%) to Western Balkan countries (€ 1.9 to 3.6 billion) and around 17% in other countries. Moreover, Bulgaria and Croatia’s health budgets are the most heavily impacted. Costs needed to cover the health impacts of Western Balkan coal pollution amount to € 0.3-0.7 billion. For Bulgaria this is the same as 10%-18% of the country’s total health expenditure in 2016. For Croatia (costs of € 0.2-0.4 billion), it amounts to 8%-14% of total health expenditure in 2016.

Discussion

These results imply an coal phase out to protect public health. Strong enforcement of the existing pollution control measures are needed. Political processes such as EU accession of Balkan countries may be a door to prioritise pollution control and air quality, in particular by excluding companies planning new coal power capacity from EU financing.
Rabies vaccination strategies in a western country: a cost evaluation
Authors: Suijkerbuijk A W M , Mangen M J J , Haverkate M R , Bantjes S E , Ruijs W L M , Swaan C M , Visser L G , Over E A B , Luppino F S , de Wit G A
Published: November 2019

Introduction

Rabies is a fatal but preventable infectious disease with a large disease burden in endemic countries. The risk of contracting rabies for travellers from a Western country is low. However, an increasing number of Dutch travellers, potentially exposed to rabies abroad, consult a clinician for post-exposure prophylaxis. In this study, several interventions were examined on how they might influence costs involved in rabies treatment and prevention, including the most recent vaccination guidelines and the use of intradermal vaccination.

Methods

A decision tree based economic model was constructed. Costs of new versus old guidelines, intramuscular versus intradermal vaccination, and post-exposure treatment subsequent to increased vaccination coverage in several risk groups were calculated and compared to each other. Statistical uncertainty with respect to numbers of travellers and vaccination coverage was assessed.

Results

Costs were highest using the old guidelines, estimated at €15.1 million (€405 per vaccinated person). Intradermal vaccinations in combination with the new guidelines led to the lowest costs, estimated at €10.1 million (€270 per vaccinated person). A higher vaccination uptake resulted in higher overall costs. The ratio between the additional vaccinated persons and additional costs in all risk groups was similar, around €104 per person.

Conclusions

The new rabies vaccination guidelines reduced total costs. Strategies with increased vaccination uptake led to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs. Although intradermal administration of rabies vaccination on a large scale can reduce total costs of pre-exposure prophylaxis and can positively influence vaccination uptake, it remains a costly intervention.

Key messages

The new vaccination guidelines reduce total costs of rabies prevention. Intradermal administration of rabies vaccination on a large scale can further reduce total costs of pre-exposure prophylaxis. Strategies with increased vaccination uptake lead to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs.
Nutritional quality of food consumed (graded by the FSAm-NPS / Nutri-Score) and mortality in Europe
Authors: Deschasaux M , Huybrechts I , Murphy N , Julia C , Hercberg S , Srour B , Ferrari P , Riboli E , Gunter M , Touvier M
Published: November 2019

Background

Unhealthy diets are major contributors for non-communicable diseases (NCDs) and related deaths. To help consumers make healthier food choices, political authorities are considering implementing a simple label to reflect the nutritional quality of food products. The Nutri-Score, based on the nutrient profiling system of the Food Standards Agency (FSAm-NPS), was chosen by several countries in Europe (France, Belgium, Spain). Yet, its implementation is only voluntary per EU regulation. Scientific evidence is therefore needed regarding the relevance of the FSAm-NPS at the European level. Hence, our objective is to study how the nutritional quality of foods consumed graded by the FSAm-NPS relates to NCDs-related mortality in European populations.

Methods

Our prospective analyses included 501,594 adults from the EPIC cohort (1992-2015, median follow-up: 17.2y). Usual food intakes were assessed with standardized country-specific methods. The FSAm-NPS was calculated using the 100g content of each food in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox proportional hazards models were computed.

Results

The consumption of foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of mortality overall (n = 50,743 events: HRQ5vs.Q1=1.06 [95%CI: 1.02-1.09], P-trend<0.001) and by cancer (n = 21,971 events: HRQ5vs.Q1=1.06 [1.01-1.11], P-trend=0.003), respiratory diseases (n = 2,796 events: HRQ5vs.Q1=1.33 [1.16-1.52], P-trend<0.001) and cardiovascular diseases, although more weakly (n = 12,407 events: HRQ5vs.Q1=1.05 [0.98,1.11], P-trend=0.04).

Conclusions

In this large multinational European cohort, consuming foods with a higher FSAm-NPS score was associated with higher mortality, supporting the relevance of the FSAm-NPS to grade the nutritional quality of food products for public health applications (e.g, Nutri-Score) to guide the consumers towards healthier food choices.

Key messages

The consumption of food products with a lower nutritional quality as graded by the FSAm-NPS score was associated with higher mortality in the large multinational European EPIC cohort. This adds support to the relevance of the FSAm-NPS to grade the nutritional quality of foodstuffs for public health applications (e.g. Nutri-Score label) to help consumers make healthier food choices.
Consumption of ultra-processed foods and the risk of overweight, obesity, and weight trajectories
Authors: Srour B , Beslay M , Allès B , Chazelas E , Deschasaux M , Hercberg S , Monteiro C A , Kesse-Guyot E , Touvier M , Julia C
Published: November 2019

Previous epidemiological studies found associations between the consumption of ultra-processed foods (UPF) and the risk of obesity-related outcomes. The aim of this study is to investigate the associations between UPF consumption and the risk of overweight and obesity, and weight trajectories, in in the French large scale NutriNet-Santé cohort.

Methods

Overall, 110260 participants aged at least 18 years from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected using repeated 24h dietary records, merged with a food composition database of 3300 different products, categorized according to their degree of processing by the NOVA classification. Associations between UPF intake and risks of overweight and obesity were assessed using Cox proportional hazard models. Associations between UPF intake and weight trajectories were assessed using linear mixed models for repeated measures with random slope and intercept.

Results

UPF intake was associated with a higher risk of overweight (n = 7063 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.11 (1.08-1.14); P < 0.0001) and obesity (n = 3066 incident cases; HR = 1.09 (1.05-1.13); P < 0.0001). Higher consumers of UPF (4th quartile) were more likely to present an increase in body mass index over time (β = 0.04, P < 0.0001). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (fruits and vegetables and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns) and after a large range of sensitivity analyses.

Conclusions

In this large observational prospective study, higher consumption of UPF was associated with a higher risk of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.

Key messages

The consumption of ultra-processed food is associated with an increased risk of overweight and obesity. As the French Public Helath agency recommends, their consumption should be limited. Nutritional composition, food additives, contact materials, or neoformed contaminants might play a role in these associations and further studies are needed to understand their relative contribution.
Explaining healthcare among unaccompanied minor refugees: a realist review
Authors: Ulrich H , Mlinarić M , Kohler E
Published: November 2019

Introduction

Existing research on psychosocial care of unaccompanied minor refugees (UMRs) mainly focusses on socio-epidemiological accounts and qualitative evidence from the perspective of experts in the field of psychosocial care. In contrast, knowledge concerning differing context factors as well as underlying mechanisms of current healthcare barriers, which could inform policy recommendations, are rather scant.

Methods

To synthesize scientific evidence and gray literature dealing with the field of psychosocial healthcare of UMRs, a realist review (RR) was conducted following six methodological steps of RAMESES publication standards for realist synthesis. Based on a iterative search of keywords “UMR”, “UMF”, “UMA” and “mental health care” in electronic databases PubMed, GBV and Web of Science we gained access to 974 texts from 2005 to 2019. Screend studies and reports were systematically reviewed according rigor and relevance, which included n = 53 documents for realist synthesis with theory-informed context-mechanism-outcome configurations (CMOs).

Results

UMRs have a high prevalence risk for posttraumatic stress disorders and they face manifold institutional, cultural, ethical, juridical, and language-based barriers of care. A dominant and multiple CMO highlight residence status (C1), which limits access of UMRs to healthcare (M1) and produces psychosocially related mental health outcomes (O1). Residence status (C1) may also trigger mechanisms of structural or at least perceived discrimination (M2), which mediates undersupply of UMRs (O2).

Conclusions

The inclusion of lay perspectives and an intersectional approach could inform health services research and practitioners. The reflection of UMR’s social positions between categorical constructs of resilience and vulnerability, discriminatory discourses of othering, and restrictive health policies may guide policy recommendations to potentially reduce persistent disadvantages.

Key messages

The inclusion of lay perspectives and an intersectional approach could inform UMR related health services research and practitioners. The reflection of UMR’s social positions (between categories, discourses, and health policies) may guide policy recommendations to potentially reduce persistent disadvantages.
Contraceptive use among undocumented migrant women seen by Médecins du Monde in the Humanitarian Hub
Authors: Déom V , Ben Abdelhafidh L , Rojas Lopez F , Vanden Bussche I , Glorie C , De Bethune X
Published: November 2019

In order to address the growing needs of the undocumented migrant population living in the Maximilian Park in Brussels, Médecins du Monde and 8 other organisations created The Humanitarian Hub in January 2018 where migrants can access medical care among other services. From January to February 2018, only 5 women out of 1483 patients visited The Humanitarian Hub regarding sexual & reproductive health and none asked about contraception. In response, a voluntary demedicalized midwifery clinic was implemented to build trust with the women and offer them contraception.

At our field teams’ request, operational research was conducted. We used a mixed methodology, including retrospective quantitative analysis of patient files and field observations made during participant observation sessions. These observations helped us better understand the barriers women face in accessing contraception and how migration complicates its usage.

By implementing gender-sensitive consultations, the number of women patients rose from 5,4% to 10,6% in 2018. Between March 2018 and March 2019, 144 women consulted midwives regarding their sexual & reproductive health. Quantitative analysis on pre-exposure contraception on 52 files showed that 4 used a contraception, 25 women requested one, 4 refused it, 19 discussed it with the midwife, and among them, 8 agreed to try it. The most common reasons for the 80 consultations analysed were requesting contraception (62,5%), including morning-after pills (12,5%) and fear of pregnancy (32,5%). The most common contraceptive method was the pill (63,6%) followed by injections (30,3%).

Our medical team saw 29 women with unwanted pregnancies, which confirms the importance of focusing on contraception options for migrant women, although addressing this may be difficult in medical consultations. It also supports the need to implement demedicalized midwifery consultations to facilitate sensitive discussions with migrant women.

Key messages

Our research shows that contraceptive use is a particularly sensitive challenge in the irregular migrant women population due to the particularities of their lives. The development of demedicalized midwifery consultations helps professionals give irregular migrant women feasible advice on contraception in regard to their unique situations.
Chronic pain and migration-related factors among Syrian refugees: a cross-sectional study
Authors: Strømme E M , Haj-Younes J , Hasha W , Fadnes L T , Kumar B , Diaz E
Published: November 2019

Background

Refugees display high rates of chronic pain. However, the relationship between refugee-related exposures introduced along their migration trajectories and the development of chronic pain remains unclear. The aim of this study was to assess the impact of stressors induced at various migration stages on chronic pain in Syrian refugees.

Methods

This is a cross-sectional survey among adult Syrian refugees in Lebanon and in Norway. We conducted logistic regression to study the associations between chronic pain and migration-related factors experienced prior to or during flight (trauma exposure, migrating alone and detainment) and after arrival in a new country (legal status, social relationships, living conditions and access to health care).

Results

Altogether 827 Syrians participated (response rate 85%). The mean age was 33 years and 41% were women. The overall prevalence of chronic pain was 30%. The mean WHO Quality of Life (WHOQOL) domain scores for both social relationships (13.4) and environment (10.2) were significantly lower among those reporting chronic pain, with low scores indicating less satisfaction. Regression analyses revealed an association between chronic pain and exposure to trauma (adjusted odds ratio (AOR) 2.5 (1.8; 3.4)), but no clear association between chronic pain and migrating alone or history of detention. Poor social relationships (AOR 1.9 (1.2; 3.1)), poor support from friends (AOR 1.5 (1.0; 2.1)) and poor living place (AOR 1.4 (1.0; 2.0)) were associated with reporting chronic pain, although associations reduced when adjusting for traumatic experiences. The associations between chronic pain and poor economy (AOR 1.6 (1.1; 2.5)) and poor access to health care (AOR 1.5 (1.0; 2.1)) persisted after trauma exposure adjustment.

Conclusions

We found a strong relationship between trauma exposure and chronic pain. Further, perceived poor economy and poor access to health care were associated with chronic pain regardless of trauma history.

Key messages

Trauma exposure, perceived poor economy and poor access to health care are associated with chronic pain among Syrian refugees. Public health care interventions should consider the combined impact of risk factors throughout the migration trajectory.
Health and web for women: preliminary results of “SEI Donna” survey
Authors: Covolo L , Guana M , Bonaccorsi G , Brunelli L , Castaldi S , De Donno A , Mereu A , Verani M , Zaniboni D , Gelatti U
Published: November 2019

Background

In 2018, 52% of the European population use the Web to seek health information and 77% consider it a useful tool to improve their knowledge about health. The Italian survey “SEI Donna” aims to investigate knowledge, perceptions and use of the web tools in women regarding health issues.

Methods

We used an online questionnaire to collect data including the type of online research and the degree of trust towards different sources. We also assessed health literacy (HL) and eHealth literacy scale (eHEALS) using validated tests.

Results

Of 7291 women who completed the questionnaire, 96% (n = 7022) seeks health information online. The 33% of women follows social media groups on health. One third of sample (31%) purchased a health product online, particularly cosmetics (75%) and supplements (41%). More than one third of sample thinks that information retrieved by web improve their health (35%) and influence their habits (34%). Half of sample (52%) searched online for a second opinion after medical examination. The reason was the need of a deepening in the 67% of cases. Overall, the HL is functional in 34% of cases, marginal in 56% and low in the rest (10%). Women with low HL trust less health information reported by institutional websites than women with functional HL, respectively 73% vs 86% (p < 0.001) and the eHEALS score of women less trusting is lower than those trusting, 23±7 vs 28±7 (p < 0.001).

One third of women declares not to be able to evaluate the reliability of a website particularly women with low HL (36%) compared to those with functional HL (20%), p < 0.001. Women reporting not to be able to evaluate the reliability of a website have eHEALS score lower than women who indicated an institutional website, respectively 24±7 vs 28±7 (p < 0.001).

Conclusions

The results confirm the large use of the web as a tool to seek health information, have a second opinion and buy health products. A good level of HL and eHEALS seem to make women more skilled in surfing the web.

Key messages

The results confirm the importance to put effort on strategies aiming to improve health literacy and eHealth literacy in the population. In the public health communication perspective, the fact that one third of women thinks that information retrieved by web improve their health and influence their habits, must be considered.
Effects of maternity waiting homes on perinatal deaths in an Ethiopian hospital. A case-control study
Authors: Dalla Zuanna T , Fonzo M , Sperotto M , Resti C , Tsegaye A , Azzimonti G , Manenti F , Putoto G , Bertoncello C , Zanovello S
Published: November 2019

Background

A Maternity Waiting Home (MWH) is a residential facility located near a medical facility, where women with high risk pregnancies can await and be transferred to the medical facility shortly before delivery or earlier if a complication arise. MWH are widespread in the developing countries, to reduce the long distances to reach health facilities. The aim of this study was to investigate whether MWH was an effective strategy in reducing perinatal deaths at Wolisso Hospital in Ethiopia, from 2014 to 2017. This hospital is supported by the Italian NGO Doctors With Africa CUAMM, with a strong commitment to reduce maternal and child mortality.

Methods

Through a case-control study, we compared perinatal mortality among women admitted via MWH and women admitted directly to the hospital. Cases were mothers who experienced at least a perinatal death before discharge. For each case, two mothers who gave birth to one or more babies alive until discharge were selected as controls. 3 groups of confounding variables were considered: maternal conditions or related to the current pregnancy, variables related to the delivery and neonatal characteristics. A regression model was built adjusting for each group. Statistically significant variables were combined in a final model.

Results

1175 cases and 2350 controls were included. Women admitted through MWH showed a OR 0.49 (95%CI:0.33-0.71; p < 0.000) for perinatal mortality when adjusted for the maternal/current pregnancy conditions, and a OR 0.60 (95%CI:0.40-0.90, p = 0.013) when adjusted for the delivery variables. In the final model the risk of perinatal mortality for women admitted to MWH was 54% less than those admitted directly to the hospital (OR = 0.46, 95%CI:0.30-0.70; p < 0.000).

Conclusions

Our results show a more than halved risk of perinatal death cases for women admitted to the hospital through a MWH in rural Ethiopia, and support the policy implemented by the government in building such structures nearby each hospital.

Key messages

Maternity Waiting Home is a structure near a health facility, where pregnant women at risk wait for their delivery. MWH is an easy and effective tool to reduce perinatal deaths in rural Ethiopia.
Tobacco smoking in pregnant women: fifty years of evolution in France
Authors: Demiguel V , Blondel B , Bonnet C , Andler R , Saurel-Cubizolles M J , Regnault N
Published: November 2019

Background

Smoking during pregnancy is a major modifiable risk factor for maternal and foetal morbidity. We aimed to describe 1/smoking trends in France between 1972 and 2016, 2/ the factors associated with smoking cessation and reduction during pregnancy in 2016.

Methods

French National Perinatal Surveys are routine surveys based on a representative sample of births (N = 11,733 in 2016). Data were collected in face-to-face interviews in postnatal wards and from the mother’s medical record. Smoking rates before pregnancy and during 3rd trimester were estimated for each study year and characteristics associated with smoking reduction (relative percent change in number of cigarettes smoked before and during pregnancy <50% or ≥ 50%) compared with smoking cessation were analysed using multinomial logistic regression.

Results

After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester (30.1% and 16.2%, respectively in 2016). In 2016, 45.8% ceased smoking during pregnancy, 37.2% reduced by ≥ 50% their consumption and 16.9% reduced by < 50% or did not reduce at all. The more cigarettes women smoked before pregnancy, the greater this reduction was (p < 0,001). Moderate reduction (<50%) vs stopping was more frequent in multiparae compared to nulliparae (aOR=2,47 [IC95%:1,93-3,15]) and in women with low education (aOR(<High school vs university graduates)=7,20 [4,78-10,82]) and low income (aOR(<1500€per month/>3000€)=2,30 [1,51-3,50]).

Conclusions

Smoking rates were high before and during pregnancy in France in 2016. Socio-demographic factors should be considered when targeting women most at risk of continuing smoking during pregnancy.

Key messages

After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester in France. Supporting female smokers of childbearing age in their attempts to quit and remain non-smokers even after pregnancy is crucial, especially in multiparae and women in poor social condition.
Regulation of health care professionals as a quality strategy
Authors: Panteli D , Kreutzberg A , Reichebner C , Maier C , Destrebecq F
Published: November 2019

Health professionals are both a health system input and an active component of the functions that the health system performs. As such, the performance of the health workforce is directly linked to the quality of health services. Regulation is essential to define a clear framework within which health professionals acquire and maintain the competence needed to provide health services that are of high quality, i.e. that are safe, effective and patient-centered. This presentation discusses the evidence on a sequence of strategies that regulate health professionals, looking at how they are currently deployed in Europe, how (cost-)effective they are, and what can be done to optimize their implementation.

Adopting a comprehensive perspective ranging from the entry into training to life-long maintenance and demonstration of competence, the presentation brings together a) strategies to develop professional competence (including training structure and contents, curriculum development and the accreditation of institutions for health education); b) strategies that regulate the entry of physicians and nurses into their professions (e.g. licensing and registration); c) mechanisms to maintain competence (e.g. continuing professional development); and d) levers to address instances when fitness to practice comes into question.
“Pay for Quality” (P4Q) as a quality strategy
Authors: Quentin W , Eckhardt H , Smith P
Published: November 2019

P4Q can be implemented in various health care settings, targeting a range of health care providers or professionals. P4Q schemes can reward high quality measured in terms of structures, processes, and/or outcomes, and/or penalise low quality and are implementable in line with other quality improvement interventions. This presentation aims to clarify the concept of P4Q, highlight the use of P4Q schemes in different settings in European countries, and systematize the evidence on the effectiveness, cost-effectiveness and implementation of P4Q as a quality strategy.

We could identify fourteen primary care P4Q programmes and thirteen hospital P4Q programmes in a total of 16 European countries. P4Q schemes in primary care incentivise mostly process and structural quality with respect to prevention and chronic care. P4Q schemes in hospital care prioritize improvements in health outcomes and patient safety. Studies suggest small positive effects on process-of-care (POC) indicators in primary care but not in hospital care. Evidence on health outcomes and patient safety indicators is inconclusive. Cost-effectiveness is unlikely because of lacking effectiveness. P4Q schemes are more effective when the focus of a scheme is on areas of quality where change is needed and if the scheme embraces a more comprehensive approach, covering many different areas of care; however, such programmes are generally technically and politically difficult to implement. In this light, this presentation will conclude with a number of recommendations, both technical and policy-oriented.
Awareness of HPV and drivers of HPV vaccine uptake among university students in Italy
Authors: Baldovin T , Cocchio S , Fonzo M , Bennici S E , Buja A , Bertoncello C , Baldo V
Published: November 2019

HPV vaccination is a milestone in primary prevention. However in Italy, vaccine coverage is still nowhere near the target of 95%. We investigated drivers of vaccine uptake among university students, as they are likely to have just assumed a central role in their healthcare decision-making and potential barriers may differ from parents.

University students aged 18-25 were asked to fill in a questionnaire. The effect of socio-demographic and behavioural characteristics on HPV awareness was assessed with a logistic regression adjusting for age, gender, nationality, degree course, relationship, age at first intercourse, number of sexual partners, smoking, sexual orientation, past diagnosis of STDs and knowledge of people who had received HPV vaccine. A second regression adjusting also for information sources, awareness and knowledge investigated drivers of vaccine uptake.

9,988 questionnaires were included; awareness of HPV and vaccine was 83.3% and 69.9%, respectively. Awareness (adjOR: 3.3 95%CI 2.3-4.6) and a good knowledge positively affected acceptability, as well as a previous diagnosis of STDs and knowledge of vaccinated people. Healthcare workers (adjOR 1.6 95%CI 1.4-1.9) and family members (adjOR 1.7 95%CI 1.4-2.1) were the most influencing information sources, even if knowledge of vaccinated people was by far more persuasive (adjOR 2.7 95%CI 2.2-3.3). Only 12% of participants were acquainted with skin to skin HPV transmission, while 75% believed in a full effectiveness of condom; less than 22% associated HPV with cancer (other than cervical cancer).

Efforts to increase awareness are likely to be worth considering that: awareness is the main determinant of vaccine uptake; only 50% of individuals not interested in receiving vaccine were aware of it; males are much less aware (adjOR 0.09 95%CI 0.07-0.11). Moreover, this study spotlights some misconceptions and may provide suitable evidence in tailoring more efficacious communication strategies.

Key messages

There is room for improving the awareness of HPV. Efforts are likely to be worth since it remains the main determinant of vaccine uptake. Awareness has been growing but a gender gap still persists. Communication should focus more on HPV involvement in neoplasia other than cervical cancer; transmission via skin to skin contact; multiple sex partnership; partial protection of condom.
Measles outbreak at the Val Thorens ski station, France, 2019
Authors: Brottet E , Ronnaux-Baron A S , Grangeret N , Deher M , Andrivot B , Fougere E
Published: November 2019

During the 2019 winter season, a measles outbreak occurred at the Val Thorens ski station in France, in an area frequented by over 300,000 holiday-makers (70% foreigners) and 2,500 seasonal workers.

Between 24/01/2019 and 15/04/2019, 55 cases were reported (18 confirmed and 37 clinical). Apart from 5 infected children under 2 years old attending the same nursery, cases were mainly seasonal workers between 19 and 41 years old. Five cases were hospitalised, one with severe pneumonia. Of the 36 cases with known vaccination status, 25 (69%) had not completed 2-dose vaccination. Other confirmed cases in visitors to Val Thorens were reported in neighbouring valleys (n = 3), and in other French regions. One case was reported the French overseas territory Guadeloupe (WHO ‘Americas’ region where measles has been eradicated). British, Belgian, Danish, Dutch and Irish authorities reported 7 cases in people who had stayed in the area. The list of exported cases is non-exhaustive.

The regional health agency (ARS) provided increased information on epidemic risk and vaccination recommendations, particularly to health professionals and the town council. Identifying all contacts was difficult because many had occurred with seasonal workers. In addition to the approximately 150 vaccinations carried out by the Val Thorens medical centre from the start of the outbreak, only 41 other people were vaccinated in 5 free vaccination sessions organized in situ by the ARS, and the local medical and immunization centres.

The large attendance at the station favoured the outbreak and its extension in France and abroad. Due to low measles vaccine coverage in France (80.3% for 2-dose cover in 2 years in 2017), outbreaks in non-vaccinated and not fully vaccinated populations are increasing, as seen in Val Thorens.

Key messages

A major measles epidemic occurring in an undervaccinated population in frequent contact with tourists, led to the extension of cases in France and Europe. Despite 5 free in situ vaccination sessions, with the mobilisation of local health professionals, few seasonal workers came to be vaccinated.
The role of country-level structural stigma on sexual orientation disclosure and discrimination in health care settings among lesbian, gay, and bisexuals across Europe
Authors: Bränström R , Pachankis J E
Published: November 2019

Background

The national climate surrounding sexual minorities (i.e., those self-identifying as lesbian, gay, or bisexual [LGB]) varies greatly worldwide. Recent Cross-European studies have shown that country-level structural stigma is a strong determinant of sexual minority individuals health risk behaviors and mental health. The consequences of the significant country-level variation in structural stigma on sexual minorities’ experiences of health care discrimination and disclosure of sexual orientation to health care providers have not been previously investigated.

Methods

In 2012, 86 000 sexual minority individuals (aged 18 years and older) from all 28 European Union countries responded to questions concerning discrimination in health care settings and sexual orientation disclosure to health care providers (EU LGBT survey). Structural stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of sexual minority acceptance among citizens of each country.

Results

Disclosure of sexual orientation to health care providers were much more common in low stigma coutries (e.g., the Netherlands, Sweden, UK) compared to high stigma coutries (e.g., Lithuania, Latvia, Slovakia). Experiences of discrimination in health care settings were more common among LGB indiviudals who were open about their sexual orientaiton and increased by degree of country-level structural stigma.

Conclusions

Disclosure of sexual orientation and experiences of discrimination in health care settings varies greatly among LGB individuals in Europe largely due to structural stigma surrounding sexual minorities.

Main messages

These findings highlight the importance of eliminating legislation, policies, and national attitudes that promote the unequal treatment of sexual minorities in currently unsupportive European countries.
Smoking among immigrants in Norway, results from the Living Condition Survey among immigrants 2016
Authors: Kjøllesdal M , Øien-Ødegaard C , Grewal N K , Indseth T
Published: November 2019

Introduction

Smoking is one of the major risk factors for health and disease. Knowledge on smoking prevalence in groups of immigrants is needed to tailor interventions for smoking cessation.

Methods

Statistics Norway carried out a Living Condition Survey among immigrants in 2016. Participants were immigrants from twelve countries of origin with ≥2 years residency in Norway. They were interviewed in the main language of their country of origin, English or Norwegian as preferred. In this report 4339 immigrants aged 15-66 years were included. Participants were asked “Does it happen that you smoke?” and all participants answering yes to this question were classified as smokers.

Results

A smaller proportion immigrant women (14%) than other women (21%) smoked, whereas a larger proportion immigrant men (32%) smoked compared to other men (22%). Among immigrant women, the proportion of smokers varied greatly, from almost no smokers from Eritrea and Afghanistan (<1%) to a high proportion among those from Turkey (32%) and Kosovo (29%). Among men, a low proportion of Eritreans (15%) and Sri Lankans (16%) smoked, but >40% of men from Vietnam, Turkey, Poland and Kosovo smoked. Having moved to Norway in young age and long duration of residence increased the odds of smoking among women. Men without a close friend were more likely than other men to smoke.

Conclusions

Variation in smoking by country of origin and gender should taken into account in future smoking cessation initiatives and prevention among immigrants.

Key messages

Smoking prevalence among immigrant vary substantially by country of origin and gender. Smoking is related to acculturation and social environment.
Towards quantifying CO2 emissions from EPH conference travel
Authors: Fehr R , Zeegers Paget D , Mekel O C L , Bos N
Published: November 2019

Background

Aviation is accountable for significant emissions of carbon dioxide (CO2). Factors determining emissions include, e.g., trip distance, aircraft fuel efficiency, cabin class, atmospheric conditions, and stopovers. Approaches to estimate the carbon footprint are available, e.g., as carbon emissions calculators, offered by carbon offset providers.

Goal: To estimate the amount of CO2 emissions associated with EPH conference air travel, for fostering awareness among EPH conference attendees.

Methods

Based on EPH attendees’ empirical distribution of countries of origin for the 2017 Stockholm and 2018 Ljubljana conference, rough estimates of travel distances, CO2 emissions, and potential carbon offset costs were produced. In the absence of attendees’ detailed travel information, simplifying assumptions had to be made, e.g. on air vs. ground travel, place of departure, and stopovers. In approach A, using two different offset calculators, we look at a given “sample” country which provided a large fraction of foreign participants in both 2017 and 2018, then try to extrapolate to participants at large. In approach B, we use a rough approximation of total distance travelled by all participants, and an average emission value per distance unit.

Results

In approach A, expectedly, the emission estimates provided by the two different calculators and the associated price tags for offsetting were rather similar, whereas the overall approach B created lower estimates of CO2 emissions. In summary, the conference air travel was estimated to emit 650-930 tons CO2, with the cost for setoff being roughly € 20.000. In a typical case, the conference air travel CO2 emission of a person (foreign to the conference country) was estimated as being 580 kg. For comparison: to bring climate change to a halt, the total annual CO2 emission per person needs to be below 600 kg.

Discussion

While estimates should be improved, a major task lies in promoting CO2 emission reduction and mitigation.
Capacity building process – medical curricula implications on the long term
Authors: Ben Rejeb M , Said-Latiri H , Zedini C h , Nabli-Ajmi T h , Dhidah L , Mtiraoui A
Published: November 2019

Introduction

Currently, the Tunisian medical schools are going through a transition period marked by the reform of medical studies. Their curricula must be adapted to globally recognized medical education guidelines. Aware of the importance of teaching scientific research and public health, they are making efforts to integrate this new approach of education within several levels (undergraduate, postgraduate and continuous professional development). In this perspective, the public health research centres (C4EHPs) created under the CONFIDE project provide an opportunity to support such integration.

The progress

The Faculty of Medicine of Sousse was founded in the 70s to open up to its local and regional community. So, the public health topic was one of the top priorities. With the reform started in 2011, the importance of this topic has been further developed by integrating many modules that cover different aspects of public health throughout the curriculum. In this context, the materials, modules and information developed within the CONFIDE project complement the existing modules and bring a fresh perspective on the teaching methods. The faculty of Medicine of Sousse will integrate this information in the curricula to promote scientific production by allowing students to build up their scientific research knowledge, develop higher research competencies such as critical-thinking, problem-solving and data interpretation and analysis and train public health specialists to be health policy makers in the future.

Conclusions

Integrating the new approach based on the achievements of the C4EHP is an essential step for our faculty to develop more training in public health, ensure good quality of its teaching process and participate in the development of health policies that will improve the health of the Tunisian population.
Innovative strategies for the implementation of best practices
Authors: Van Dale D , Leenaars K
Published: November 2019

The Netherlands’ best practice portal for health promotion interventions includes approximately 350 interventions. The aim of the portal is to support policy and practice with evidence based information. There are five different levels to indicate the strength of their evidence base. In 2014, a study on the implementation of the best practices included in the portal showed that health promotion practitioners often do not implement them. One of the arguments given to opt for other interventions than those listed in the portal was the assumption that the ‘standard interventions’ will not fit their particular local context, and that adjusting a best practice is not possible.

We will present the criteria and procedure of the assessment of the quality, effectiveness and the feasibility of health promotion interventions. There after we present two strategies to increase and improve the take up of best practice implementation. The first strategy is to describe and present the core elements of the interventions. This strategy facilitates the possibility for the sound adjustments of a best practice. The second strategy is to identify the common effective elements of a group of interventions, and present that information in an accessible way to policy-makers and practitioners. Effective elements were identified through systematic reviews in combination with focus group interviews with health promotion practitioners. The result is a What works document (What works, What probably works, What doesn’t work and What’s unclear).

An example of the second strategy is a synthesis of the effective elements of fall prevention interventions. These elements were translated into a practical user’s guide, and illustrated with best practice interventions from the portal. Policy-makers and health promotion practitioners appreciated the new way of presenting the best practices.
Challenges to create an evidence-based programme register in France
Authors: Arwidson P , Verry-Jolive C
Published: November 2019

The majority of health promotion and disease prevention interventions implemented in both targeted and general populations have unknown effectiveness. This contrasts with drug treatments which must be proven effective before they can be prescribed. The recent evaluation of four addiction prevention interventions chosen by public health implementers showed that two had positive impacts on addiction prevention and two had deleterious effects.

Despite over 50 years’ worth of scientific literature on the evaluation of health promotion and disease prevention programmes, it is little known and little used by project promoters. These promoters cannot be blamed for not using this literature as it is often difficult to access, to read and to understand. Even if they successfully access and read the articles, interventions are often not described properly, rendering the text useless for implementers. It is therefore necessary to create interfaces that translate this literature into a form useful for funders and project promoters.

As a result, Public Health France has studied existing portals in both the United States and in Europe. An independent double-reviewing process comparable to the review process used by scientific journals for manuscripts as in the Norwegian portal was chosen for this reason.An expert committee has worked during more than one year to design and test a scoring grid that will be published soon.

The 80+ programme evaluations found in the scientific literature will now be reviewed with the approved grid.

Public Health France has also begun visiting each region in France to present the portal to local health authorities and NGOs to enable project promoters to submit their programmes soon and to promote the use of evidence-based or research-based programmes when possible.
School Health Research Network Wales: Development, implementation & contributing to public health policy
Authors: Young H
Published: November 2019

The School Health Research Network (SHRN) was launched in Wales in 2013 as a strategic partnership between Cardiff University, Welsh Government, Public Health Wales (part of the National Health Service) and Cancer Research UK (a research-focused charity). SHRN is led by a multidisciplinary team in the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University.

SHRN aims to: 1) provide health and well-being data from a biennial survey for national, regional and local stakeholders, including schools; 2) co-produce school-based health improvement research for Wales; and 3) build capacity for evidence-informed public health policy and practice.

Building on and integrating with HBSC infrastructure, a transdisciplinary complex adaptive systems (T-CAS) approach has been employed to develop SHRN, for a national culture of prevention for school health improvement. The T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The five key stages involve establishing transdisciplinary strategic partnerships, resource investment and linkage, network development, coproduction activities and reciprocal outputs.

SHRN has successfully established new cross-sector stakeholder partnerships at multiple levels, and embedded network activity within national and local policy. It has established a programme of school engagement activities to secure membership of 212 (100%) secondary schools in Wales and building on HBSC systems and structures has developed a national data infrastructure with the biennial collection of student and school-level health and wellbeing data. SHRN has co-produced scientific evidence and established a new data-led planning system (e.g. 56 research studies co-produced). It has also secured sustainability funding from health and education, while developing research capacity to generate evidence and support professional practice.