bluuebunny/crossref_metadata_2025 huggingface dataset:
Algarve Cervical Cancer Screening Programme
Authors: Correia M , Pacheco A , Morera J , Pereira R , Ferrinho D , Vale L , Cardoso C
Published: November 2019

Issue

Cervical Cancer (CC) is the 7th most frequent and the 2nd most common in women. The standardized mortality rate, in Portugal is 2.3/100000 inhabitants and Algarve is the region with highest rate, 4.9/100000.

Description

Programme started in 2010. Population-based screening programme can reduce incidence, mortality and morbidity with an early diagnosis, preventing aggressive interventions in precancerous phase, improving survival and life quality. Target population, woman age 25-64.are invited to primary test liquid-based cytology (ThinPrep) every 3 years. Health Centres are responsible for select, invite, collect samples and send to Hospital laboratory. For positives, a cervical pathology consultation is required. National Guidelines now indicates DNA testing for human papillomavirus (HPV) as primary screening test, each 5 years, to woman age 25 to 60 and screening program changes will be implemented in 2019 with improved response time and lower cost.

Results

Since 2010 the target population has increased 12% every 2 years and the adhesion rate increased ≈68% and≈108%. Nevertheless the 3rd cycle has showed 10,8% (17.975) adhesion rate. Most women 16.112 (89.6%) had a negative diagnosis, 503 (2,8%) is ASC-US + (HPV test), and 761(4,2%) had a cervical pathology consultation. From those, 117 (15.4%) had a LSIL, 69 (9,1%) HSIL and 2(0,3%) cancer. Cancer detection rate is 0,1 ‰.

Lessons

The small adhesion rate particularly by aged women, the users unfriendly Information System and direct screening health units management are some of the issues that requires improvement. Also population literacy, self-sampling vaginal fluid and clinical meetings are some of the options to improve screening program.

Key messages

Cervical Cancer early diagnosis prevent aggressive interventions in a precancerous phase, improves survival and life quality. Better access and health communication are major points in screening programs.
A framework to help defining relevant preventive actions in multi-professional health care centers
Authors: Pluvinage B , Dugué F , Dépinoy D
Published: November 2019

For more than 10 years in France, multi-professional healthcare centers have been considered as innovative organizations, which offer attractive work conditions for health professionals and help to structure primary care. Their development is strongly supported by public policy (e.g. specific funding methods, a target of 2000 teams by 2022) and is seen as a mean to enhance preventive actions.

From a public health perspective, when professionals define their collective project, preventive actions should be chosen according to their relevance (by considering local population needs), effectiveness (based on evidence) and realism (in terms of implementation). Our goal was to make an inventory of existing tools and recommendations but also to propose a framework that considers the actual practicing conditions of French primary care teams. Three methods were used: a bibliographic study, feedback from a consulting firm with a 10 years’ experience in supporting new teams in defining their multi-professional project, and interviews from experts and health professionals.

Due to professional training and practice, preventive actions are less familiar to professionals when they are not integrated into individual and curative cares. Indeed, most existing recommendations are designed from a macroscopic point of view, dismissing the particularities of multi-professional private practice. Thus, we could identify 9 categories of factors likely to determine the relevance of a preventive action, including a specific context-population-team setting. Although this is an exploratory work, feedback from professionals confirms the potential positive or negative influence of these items on the implementation of an action.

Our framework could be converted into a tool consisting of a list of questions to ask before primary care teams choose a preventive action to implement. Frequent assessments should be carried out and shared in order to develop empirical and reliable knowledge in this field.

Key messages

Despite a strong public policy to develop multi-professional health care centers in France, recommendations about preventive actions insufficiently consider specific conditions of practice. Mixing theoretical and practical perspectives, our framework could help to improve the relevance, effectiveness and realism of preventive actions considering a specific context-population-team setting.
Healthy public policy competences for public health: interactive and practice-oriented curriculum
Authors: Guyon A , Lessard R , Masse-Jolicoeur M , Tessier S
Published: November 2019

Background

Developing and implementing healthy public policy (HPP) is one of the practical competences expected of public health professionals in Europe and beyond (ASPHER 2018, Public Health Agency of Canada 2015, US Public Health Foundation 2014). Yet, organizational practices in building public health capacity to promote HPP are seldom documented. In order to improve its HPP interventions, the Montreal Public Health Unit has been leading and evaluating a HPP multidisciplinary community of practice since 2014. In response to participants’ requests, we recently formalized a HPP curriculum.

Objectives

Over a period of 12 months in 2018-2019, our objectives were to: (1) develop and pre-test a competency-based professional development curriculum in HPP for public health staff and interns (2) provide a repository of relevant references (3) identify dynamic pedagogical strategies applicable to a community of practice.

Results

As community of practice members and facilitators, we developed a HPP curriculum with the support of pedagogical and HPP experts. It was pre-tested and iteratively adjusted with members of the community of practice. We drew content from various disciplines including political sciences, public health, communication studies and public relations. We identified relevant: (1) competences; (2) core concepts; (3) practical skills; (4) key references; (5) practical case studies, (6) interactive pedagogical strategies such as an open-source online learning system.

Conclusions

We developed an innovative healthy public policy (HPP) curriculum in order to support an existing community of practice among public health staff. Dynamic pedagogical strategies and a more formal HPP curriculum can support competence development among public health staff, and this can be achieved while relying mostly on in-house expertise. This constitutes a stimulating capacity-building initiative for the enhancement of public health core competences.

Key messages

Developing healthy public policy is a core practical competence expected of public health professionals. Yet, organizational practices in building healthy public policy capacity are seldom documented. Developing dynamic pedagogical strategies and a more formal healthy public policy curriculum can support competence development among public health staff, while relying mostly on in-house expertise.
Spatial characterization of the targeting’s worst-off au Burkina Faso
Authors: Bonnet E , Nikiéma A , Roy F A , Ridde V
Published: November 2019

Introduction

In 2014, the Government of Burkina Faso received technical and financial support from the World Bank to test the PBF project with various equity measures. Health equity measures included community based selection of worst-off and user fee exemption for them at the point of service. This selection was carried out in 8 health districts. More than 110,000 worst-off have been selected. Several analyses show that their use of care remains low. Our study aims to characterize the selection of the indigent by considering geographical determinants in order to better understand the weakness of access to care.

Methods

We have mapped the selection of the indigent based on the geolocation data collected with a GIS. We carried out spatial analyses to measure access to localities, health center and the main access roads. We have also integrated population data and geo-environmental characteristics. All these data were aggregated in 500 m cells to provide all variables on a single scale. A total of 9 variables were generated to characterize the spatial targeting’s worst-of. We combined two cluster analyses, i.e., k-means, and hierarchical clustering.

Results

We obtain a characterization of the selection into four classes. These classes highlight that the community-based selection of the worst-off is unequal in terms of distances to localities, health centres, and isolation. The results refine our knowledge of geographical accessibility to health centres by illustrating that distances to the health care centre are not the only geographical determinants to be considered.

Conclusions

This study is a contribution to the analysis of the characterization of the targeting of the worst-off. The results suggest that it is important to strengthen support for the most isolated worst-off for an access care. More broadly, this study shows that it is necessary to integrate the geographical dimension into the definition of targeting the worst-off.

Key messages

It is necessary to integrate the geographical dimension into the definition of targeting the worst-off. It is important to strengthen support for the most isolated worst-off for an access care.
What if we combine Quit and win and individual approach to help smokers quit at the community level?
Authors: Kovacevic J , Zombori D
Published: November 2019

Issue

Tobacco eventually kills up to a half of its users. Helping smokers who wish to quit is one of the six cost effective interventions listed by World Bank to decrease smoking harm. Tobacco Control Scale in 2016, shows diversity in approaches and coverage to help smokers quit across Europe. Comprehensive interventions are most effective. Combining contest, financial incentives, individual approach and triggers (start of Lent or other) could be implemented in other settings.

Description of the problem

Contest to motivate smokers for a quit attempt and individual help provided, has been conducted yearly since 2015 in a local community in Pozega-Slavonia County in Croatia. Data on all participants from 2015 through 2018 contests were collected by questionnaires and long term smoking status (6 months) evaluated by phone interviewing. Statistical analysis was conducted in SPSS. The objective was to determine how effective in helping smokers quit is a novel combination of evidence-based approaches “Quit and win” and individual support in local setting and to establish certain smokers characteristics as possible predictors of outcome.

Results

Data for 153 participants were collected. There were more (54%) male participants. Participants mean age was 35.8 years (range 18-67). Short term (30 day) abstinence rate was 73.9% (113/153) and out of those 34.1% (31/91) abstained long term (6 months). Long term follow-up was 80.5% (91/113). Overall, long term quit rate was 23.7% (31/131). There were no statistically significant differences in short and long term quit rates depending on age, sex, education, employment or socio-economic status, pack-year measure or personal success estimates.

Lessons

Comprehensive contest approach was found to be effective in helping smokers quit. Interest for implementation was shown by several counties and cities in Croatia. Effectiveness regardless of personal and social characteristics of contestants shows potential in different settings.

Key messages

Comprehensive interventions that include contest, financial incentives, individual approach and triggers in smoking cessation helped one in four involved smokers to quit. This approach has potential for implementation in diverse local communities as no difference in quit rates in different sex, age or socioeconomic groups were detected.
Digital health literacy among adults living in the community in Singapore
Authors: Soh J S , Wong A W
Published: November 2019

Background

this study aimed to determine the level of digital literacy in adult Singaporeans in the community and its association with demographic characteristics, physical activity, self-rated health and bodily pain, and to identify the health needs of frequent internet users.

Methods

a cross-sectional survey was carried out among individuals living in Punggol, Singapore on 2 June 2018. Survey data were using a 20-minute self-completion questionnaire. The questionnaire included the validated 8-item eHealth Literary Scale (eHEALS), the validated 4-item Exercise Stage of Change Questionnaire, a single item on self-reported health status and Likert scale items to assess level of bodily pain in the last 4 weeks and how much that pain interfered with normal work. The questionnaires and interviews were administered by registered nurses. Quota sampling was used to obtain sufficient numbers from different ethnic groups for analysis of the survey: the initial target was 120 Chinese, 60 Malay and 60 Indian individuals, one per household.

Results

survey data were collected from 279 individuals (49.6% female), including 197 (71.1%) Chinese, 47 (17.0%) Malay, 18 (6.5%) Indian and 15 (5.4%) others. The mean age was 35.6 (SD 11.3). The eHEALS score had a mean of 29.4 (SD 6.2) out of a maximum of 40. Self-reported health status was positively associated with pain in the last 4 weeks (Kendall’s τ = 0.141, p = 0.007), how much that pain interfered with normal work (Kendall’s τ = 0.160, p = 0.003) and the Exercise Stages of Change score (Kendall’s τ=-0.271, p < 0.001). The correlation between the two pain variables was strong (Kendall’s τ = 0.582, p < 0.001). The only one of these measures significantly related to the eHEALS score was the Exercise Stages of Change score (Kendall’s τ = 0.104, p = 0.030). From linear regression models, the only independent variables consistently associated with the eHEALS score were age (B=-0.090, p = 0.006) and having a mobile phone plan (B = 8.171, p < 0.001).

Key messages

Digital health literacy was negatively related to age and positively related to having a mobile phone plan. The study finding suggest the need to identify individual Singaporeans with poor e-health literacy and provide them with remedial education.
Information and communication technology-based interventions to support healthcare in migrants
Authors: Vaccaro F G , Alecreu A Oradini , Scardoni A , Frascella B , Vigezzi G P , Odone A , Signorelli C
Published: November 2019

Background

Advances in the field of Information and Communication Technology (ICT) are revolutionizing healthcare, while massive migration flows and cross-border populations’ transit impose the planning, implementation, and evaluation of new integrated healthcare services and programmes. Nevertheless, no conclusive evidence exists on the vast potential offered by ICT to promote healthcare in migrant populations.

Methods

We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool and critically appraise all the available evidence on the effectiveness of ICT-based interventions to support the healthcare provision to migrant and in-transit populations in Europe. We searched the electronic databases Medline and Embase, relevant grey literature and consulted with experts in the field. We restricted the area of interest to EU/EEA countries and included studies providing original quantitative data.

Results

Out of 127 retrieved records, 53 (42%) met the inclusion criteria. Included studies were classified in the following four interventions: implementation of healthcare services (47%), patients’ education (26%), healthcare services’ monitoring (17%), and interventions on providers (10%). The most relevant data refer to telemedicine, prevention interventions, and healthcare data sharing and the most represented specific health-topic is that of mental health (26%). We present available data qualitatively and quantitatively pooled by country, type of ICT, target population and health topic.

Conclusions

Selected ICT-based interventions have been implemented in Europe to promote healthcare in migrant populations; however, in most cases, no monitoring and evaluation exist on their impact, effectiveness, and cost-effectiveness. Strengthened efforts are needed to identify, plan, implement and evaluate effective interventions and share best practices to protect in-transit populations’ health.

Key messages

Information and Communication Technology (ICT) offer great potential to promote health-care in migrant populations. Effective ICT interventions and best practices should be shared across Europe.
Migrants and access to healthcare: the Italian public health residents action plan
Authors: Mammana L , Milani C , Bordin P , Del Riccio M , Sisti L G , Salvia C , Raguzzoni G
Published: November 2019

Background

Fighting health inequalities have been included in the WHO Sustainable Development Goals as a priority. Migrants are between the most vulnerable individuals and healthcare interventions, also during the post-migration period, should be oriented, context-specific and aimed at identifying reasons underlying inequalities, as suggested by the recent WHO report ’No public health without migrant health’. The “Inequality Working Group” of the Italian network of public health (PH) residents of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) aims at identifying an interdisciplinary approach suitable to detect barriers to healthcare access for migrants in different Italian regions. Secondly, we aspire to develop some strategies to overcome unequal healthcare access.

Methods

Focus group methodology was applied to set working group educational needs, priorities of action and working plan. Moreover, we implemented a network between various professionals involved in migrant healthcare, particularly with the Regional Groups of the Italian Society of Migration Medicine (SIMM).

Results

After a period of peer-to-peer education about social determinants of health and migration, we reviewed Italian policies about migrants’ healthcare and considered potential discrepancies from WHO recommendations. Furthermore, we mapped practices regarding access to care for migrant population and we focused on causes underlying unequal healthcare access.

Conclusions

Although with regional differences, migrants have limited access to healthcare services and therefore represent a vulnerable subpopulation.

Key messages

Fighting against the barriers that limit access to care for migrants is a priority for health systems. PH residents have a relevant role in identifying and defining critical issues, designing enforcement measures and implementing advocacy actions.
A first assessment of the electronic health insurance card for asylum seekers in Berlin
Authors: Gottlieb N , Ohm V , Knörnschild M
Published: November 2019

Background

Healthcare provision for asylum seekers differs across Germany. Most states use treatment vouchers as proof of eligibility; i.e., asylum seekers must first obtain a voucher from the welfare office to access healthcare. Since 2016 several states have introduced an electronic health insurance card (EHIC) for asylum seekers that enables access to care akin to statutory insurance. The EHIC has reanimated an old debate about asylum seekers’ health benefits. Opponents claim that medical costs will rise if control over healthcare access is eased. Proponents argue that the EHIC reduces costs through the cutback of administrative workloads and improves access to care. Evidence for either position is scarce.

Goal

The study goal was to assess the 2016 EHIC introduction in Berlin to enable evidence-informed decision-making.

Methods

We analyzed claims data that were retrieved from the Berlin Senate Administration and ten semi-structured in-depth interviews with key informants. Interviews were recorded, transcribed and subjected to thematic analysis using ATLAS.ti software. Ethical clearance was obtained.

Results

Our study found an overall positive evaluation of the EHIC. Although the introduction implied extra efforts and total administrative workloads remained unaltered, the EHIC was said to have the following advantages as compared to treatment vouchers: 1) It simplifies certain work processes and 2) allows for unprecedented financial transparency and control. 3) It eases access to care with 4) no increase in medical costs. Finally 5) the EHIC signifies equality and integration for asylum seekers.

Conclusions

In light of our study results the common economic arguments against greater inclusion of asylum seekers into public healthcare systems appear unfounded. On the contrary, the example of the EHIC shows that inclusion can create win-win-situations by improving healthcare access, whilst keeping medical costs constant and advancing financial transparency.

Key messages

In Germany there is a long-standing debate whether easing access to care for asylum seekers will increase health costs. Our case study shows that, on the contrary, the introduction of an electronic health insurance card for asylum seekers can both improve access and have organizational and economic benefits.
Subjective status comparisons and depressive symptoms among migrants and refugees to Germany
Authors: Polizzi A , Santos-Hövener C , Mauz E , Lampert T , Hoebel J
Published: November 2019

Background

Prior research has identified perceptions of relative social status to affect mental health. We investigated whether migrants to Germany who perceive that they would have a higher relative social status if they were still in their country of origin experience more depressive symptoms than those who perceive no such status discrepancy.

Methods

Cross-sectional data were derived from a random sample of residents in the Berlin-Brandenburg region with a Croatian, Polish, Romanian, Syrian and/or Turkish citizenship (n = 728). Participants’ perception of their relative social status in Germany was measured using the MacArthur Scale of subjective social status (SSS). An adapted version of this scale was used to assess respondents’ hypothetical SSS in their country of origin if they had not migrated. Depressive symptoms were measured with the eight-item depression scale of the Patient Health Questionnaire. Diagonal reference models were used to examine whether discrepancies between the two status ratings were associated with depressive symptom severity.

Results

Most respondents reported a higher (35.6%) or similar (49.0%) hypothetical SSS in their country of origin compared to their SSS in Germany. Respondents whose SSS in Germany was lower than their hypothetical SSS in their country of origin experienced the most severe depressive symptoms. In the diagonal reference models, this association remained statistically significant (p < 0.05), even after adjusting for objective socioeconomic position and other covariates. The pattern was similar for both refugees and non-refugees.

Conclusions

Our findings indicate that perceptions of having a lower social status in Germany than hypothetically in one’s country of origin are concomitant with poorer mental health among migrants. Prospective data are needed to address questions of causation and the direction of effects.

Key messages

Migrants who perceived that they would have a higher social status if they had not left their country of origin reported higher depressive symptoms than those with no such status discrepancy. This association persisted after adjusting for objective socioeconomic position in Germany.
Salt reduction in bread: Is it enough? Preliminary results of a HIA in Portugal
Authors: Santos J , Braz P , Costa A , Costa L , Santos M , Brazão R , Alves J , Lopes I , Guerreiro A , Almeida T
Published: November 2019

Issue

Health Impact Assessment (HIA) is a methodology that aims at assessing the impact of policies in health. A pilot HIA is in progress to kick off the implementation of this methodology in Portugal with the support of the World Health Organization (WHO). In this context, the impact of a nation-wide policy that intends to achieve a maximum of 1 g of salt/100 gr in bread is under assessment.

Description of the issue

In 2017, Portugal approved a protocol between the industry and other stakeholders to gradually decrease the amount of salt in bread, as this is the main source of salt intake. The purpose of this study was to assess the impact in blood pressure from current (1.4 gr) to 1 g (29% reduction) of salt in bread. Data from two different surveys regarding blood pressure and salt intake was gathered. We estimated the decrease in blood pressure with respect to current average values according to sex, age, education and region.

Results

It is expected that a reduction of 29% in salt intake through bread contributes to a general decrease in systolic pressure for normotensive people (from 120.4mmHg to 120.0mmHg, p = 0.85) and hypertensive people (from 151.0mmHg to 150.1mmHg, p = 0.68), although not statistically significant. Older hypertensive individuals (65 to 75 years) are the group with the largest benefit (152.8mmHg to 152.0mmHg) but no statistical difference was found. Disaggregation by sex, region and education also didn’t show any statistical difference.

Lessons

The impact in blood pressure from a 29% reduction in salt intake from bread seems very small. We found no statistical significance between the current and expected values in blood pressure either for total or group stratification. The absence of statistical effect might be due to sample size as our sources only allowed us to work with aggregated data.

Key messages

Quality and access to data is needed to assess impact of policies. to increase effects in blood pressure either salt reduction from bread must be larger or a wider range of products should be considered.
Joint associations of fruit and vegetable consumption and physical activity with mortality risk
Authors: Mauramo E , Salmela J , Kanerva N , Lahelma E , Lallukka T , Pietiläinen O , Rahkonen O , Salonsalmi A , Lahti J
Published: November 2019

Background

Fruit and vegetable consumption (FVC) and leisure-time physical activity (LTPA) are associated with better health outcomes but less is known about their joint associations with the risk of mortality. We examined the joint associations of FVC and LTPA with premature mortality among midlife and ageing municipal employees, adjusting for key covariates.

Methods

Survey data collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, were linked with complete register data on mortality from Statistics Finland (4961 women, 1373 men; response rate 67%; written consent for register linkages 74%). FVC was dichotomised into daily or non-daily, and LTPA into high (>14 MET-hours/week including vigorous exercise) or low. Covariates included age, sex, marital status, socioeconomic position, binge drinking, smoking and self-rated health. Cox regression models were fitted. The follow-up continued until the event of death or the end of 2015.

Results

A total of 281 deaths occurred during the follow-up. The mortality rate was 7.1% in men and 3.7% in women. A gender interaction was found, showing differing associations for women and men. Men with both daily FVC and high LTPA had the lowest mortality risk (HR 0.19, 95% CI 0.06-0.63) after adjusting for covariates. Men with high LTPA and non-daily FVC also had a lower mortality risk (HR 0.51, 95% CI 0.29-0.90) compared to those with non-daily FVC and low LTPA. Women with daily FVC and high LTPA had a lower mortality risk initially, but after adjusting for covariates no statistically significant associations were observed.

Conclusions

The joint associations of FVC and LTPA with premature mortality differed between women and men. This could be related to gender differences in e.g. the causes of death, and further studies are needed to clarify this. Increasing FVC and LTPA might prevent premature mortality among men.

Key messages

Fruit and vegetable consumption jointly with physical activity decreased the risk of premature mortality among men only. Further studies are needed to clarify the gender difference which could be related to for example death causes.
Medical costs associated with childhood maltreatment history among Japanese older people
Authors: Isumi A , Fujiwara T , Kato H , Tsuji T , Takagi D , Kondo N , Kondo K
Published: November 2019

Background

Childhood maltreatment can have a significant impact on health across the life course, but its impact on health care costs in later life is unknown in Japan. This study aims to assess additional medical costs of Japanese older people with childhood maltreatment history.

Methods

Data from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based cohort of independent people aged 65 years or older across Japan were used and linked uniquely with the database of health insurance claims for residents of a city with more than 1.5 million citizens, aged 75 years or younger (N = 978). Average annual medical costs for April 2012 and March 2013 and April 2013 and March 2014 were calculated and compared between those who experienced childhood maltreatment and those who did not, using generalized linear models.

Results

4.5% of our sample witnessed their father physically abusing their mother, 1.9% were physically abused, 10.6% were emotionally neglected, and 5.7% were emotionally abused in their childhood. Average medical costs of those with any childhood maltreatment (N = 176, 18.0% of the sample) were significantly higher than those without maltreatment (549,468JPY vs. 413,013JPY (1USD is equivalent to 110JPY); p = 0.007). When examining the effect of each type of maltreatment, average costs of those with emotional neglect were higher than the counterpart (573,481JPY vs. 412,082JPY; p = 0.008). Average costs of those who experienced physical abuse were also higher than those who did not (726,254JPY vs 431,106JPY; p = 0.035). The effect of any childhood maltreatment remained statistically significant after older adults’ age and gender were controlled (p = 0.03).

Conclusions

Our findings suggest that childhood maltreatment is strongly associated with additional medical costs among older Japanese. If it was truly causal, it can be estimated that additional medical costs associated with childhood maltreatment can be more than 333 billion JPY per year nationwide.

Key messages

Average annual medical costs of older adults with any childhood maltreatment history were significantly 116,098 JPY greater than those with no maltreatment history. As for each type of childhood maltreatment, emotional neglect tends to increase medical costs in late adulthood.
Body size, Mental health and Inequalities: The burden of obesity in South Africa
Authors: Koupil I , Mchiza J , Hossin M Z , Parker W
Published: November 2019

Background

Given the substantial burden of obesity in South Africa, it is important to understand how specific aspects of socioeconomic position influence the risk of unhealthy weight in different gender or ethnic groups.

Methods

We investigated body mass index distributions among subjects aged 15+ years from the South African National Health and Nutrition Examination Survey. Determinants of underweight, overweight and obesity were studied in 1655 (73%) men and 3104 (74%) women who had data available on social and mental health characteristics. Logistic and multinomial regressions were used to study associations with weight categories.

Results

Less than half of the subjects had healthy weight, 22% were overweight and 29% were obese. The proportion of healthy weight decreased and the risk of obesity increased with age up to 65 years. African women had a particularly high risk of overweight and obesity compared to men (age adjusted OR 4.65, 95% CI 3.94-5.50). The effect of gender was smaller in non-Africans (age adjusted OR 3.02, 95% CI 2.41-3.79; test for statistical interaction p = 0.004). Employment and higher education were associated with higher risk of overweight and obesity and a lower risk of underweight. Married subjects were at a higher risk of overweight and obesity. In men, higher income was associated with overweight and obesity. We found weak evidence of poor mental health being associated with unhealthy BMI.

Conclusions

There are social gradients and gender and ethnic differences in how underweight, overweight and obesity are distributed in the South African population. A high prevalence of obesity among women and positive associations of education, employment and income with overweight and obesity call for investments into health literacy. Action is also needed to prevent undernutrition among socially disadvantaged groups, and men in particular.

Key messages

There are strong social gradients and important gender and ethnic differences in how underweight, overweight and obesity are distributed in the South African population. High prevalence of obesity in women and positive associations of socioeconomic position with obesity indicate poor health literacy. Undernutrition needs to be reduced among socially disadvantaged.
Trends of sarcopenia and physical activity in elderly Koreans using KNHANES 2007-2017
Authors: Ahn H S , Kim B W , Park Y , Ki Moran
Published: November 2019

Background

Sarcopenia is one of risk factors for prevalence of chronic diseases which is associated with aging. Distribution of sarcopenia in Korea is important because Korea is one of the most rapid countries in population aging. This study aimed to understand trends in PA in elderly Koreans (≥65 years of age) and identify the proportion of sarcopenia in elderly Koreans based on a reference cutoff value of handgrip strength (28.6kg for men and 16.4kg for women).

Methods

This study was performed using data from Korea National Health and Nutrition Examination Survey (KNHANES) between 2007-2017. Physical activity on walking (2007-2017), aerobic exercise (2014-2017), and muscle strength (2007-2017) were analyzed to understand trends of physical activity participation in elderly Koreans. Furthermore, using handgrip strength data from KNHANES (2014-2017), the study examined how sarcopenia has distributed in elderly in Korea.

Results

The proportion of elderly Koreans engaged in walking decreased from 46.8% (age standardized) in 2007 to 35.7% in 2017, and the proportion of elderly Koreans engaged in aerobic exercise decreased 41.1% in 2014 to 29.4% in 2017. Even though, the proportion of elderly Koreans engaged in muscle strength increased from 11.6% in 2007 to 17.5% in 2017, the proportion of sarcopenia in elderly men increased from 22.6% in 2014 to 29.3% in 2017 and the proportion of sarcopenia in elderly women increased from 19.3% in 2014 to 30.1% in 2017.

Conclusions

During the past 10 years, the participation in muscle strength has increased, while the participation in walking and aerobic exercise has decreased in elderly Koreans. Nevertheless, the proportion of sarcopenia in elderly Koreans has increased. This analysis provides evidence of necessity of public health efforts to implement sarcopenia reduction interventions and examine the correlation between sarcopenia and physical activity pattern in elderly Koreans.

Key messages

Although the participation of physical activity has decreased, the participation of muscle strength has increased in elderly Koreans (≥65 years of age). The increased proportion of sarcopenia in elderly Koreans showed the necessity of new public health intervention to reduce sarcopenia in spite of growing trends of muscle strength in elderly Koreans.
Suicidal ideation among Tunisian adolescents and the association with adverse life experiences
Authors: Sahli J , Mannai J , Zedini C , Limam M , Merzougui L , Ajmi T , Mtiraoui A , Mellouli M , Ghardallou M El
Published: November 2019

Background

Youth suicidality is a significant public health problem. Understanding the factors leading to suicide is essential to implement effective preventive efforts. In this context, this study was conducted to assess the link between suicidal ideation and adverse life experiences among Tunisian school aged youth.

Methods

A cross-sectional survey was conducted among a sample of 2020 secondary school adolescents in 2016. An anonymous self-administered questionnaire was used to collect data. The adverse life events measured were: domestic violence, parental divorce, physical aggression, sexual abuse and a familial antecedent of suicide.

Results

Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months with no gender difference (16.3% among girls and 17.3% among boys, p = 0.62). Among the participants, 26.7% experienced at least one adverse life experience. Those who reported domestic violence (Odds Ratio = 8.93; 95% CI = 6.84–11.66), parental divorce (Odds Ratio = 3.02; 95% CI = 1.57–5.79), physical aggression (Odds Ratio = 6.97; 95% CI =5.14–9.46), sexual abuse (Odds Ratio = 8.69; 95% CI =3.94–19.15), familial antecedent of suicide (Odds Ratio = 8.17; 95% CI = 5.75–11.60) were associated with increased odds of suicide ideation.

Conclusions

The prevalence of suicidal ideation observed in the survey area was relatively high and associated with all the measured life adverse events. These factors should be included in a suicide screening tool to be integrated in a suicide prevention program.

Key messages

Suicidal ideation among adolescents was associated with all the measured life adverse events. Identifying adolescents at higher risk of suicide and help them to cope with their adverse experiences could be effective to prevent taking action to attempt suicide.
Adopting healthy habits through the collaboration of health, education and culture systems
Authors: Puljak A , Bajs M Maric , Sostar Z
Published: November 2019

Background

The ’Adopt healthy habits’ program is a health promotion program that links the health system, education system and the City of Zagreb library. It is based on the association of mental, physical and emotional health factors. It is done through work in smaller groups, using educational interactive materials and methods with selected books in accordance with the topic of the workshop and with the practice of applying the adopted knowledge.

Methods of work

The methodological basis of the programs are health workshops conducted in the libraries of the City of Zagreb in cooperation with the primary schools. They imply working with students by acting on risk factors: obesity, physical inactivity, smoking and low self-esteem. The skills used are promoting health, cognitive-behavioral methods, health education, kinesiology, nutrition and bibliotherapy.

Objectives

Educating students about the importance and ways of adopting healthy habits and gaining self-esteem and reducing the occurrence of risky behaviors. Long-term objectives are improvement of the psychophysical development of students, increase of the population of the City of Zagreb with balanced dietary habits and regular physical activity and normal body mass index and reduction of the occurrence of chronic non-communicable diseases in adulthood.

Results

In the period from 2015 to 2018, a total of 141 workshops were conducted through which 3,106 pupils were educated. The workshops were conducted in 12 primary schools of the City of Zagreb and 5 of the related city libraries.

Conclusions

Interactive approaches in the creative environment proved to be the most appropriate in educative work with children. It is necessary to continue to implement this form of primary prevention on a wider population.

Key messages

Adopting healthy habits in childhood is the basis for primary prevention of chronic non-communicable diseases. Multidisciplinary approach to health education in youth assures a more permanent adoption of positive health behavior.
An ordinary life with chronic condition as a goal for medicine
Authors: Gaille M s , Camus M s
Published: November 2019

Background

Social sciences and humanities have developed a significant interest about chronic condition since the 1960, examining the “biographical disruptions” it seems to entail and the coping capacities of individuals. The present study, funded by IreSP, aims at developing a new conceptual and normative perspective: to explore the idea of “normal” life with chronic condition. This perspective allows for taking into account the expression of the wish for a “normal life” actually expressed by persons with chronic condition. On the basis of this research perspective, the present study aims at assessing the possibility to live such a life with chronic condition as a goal for the health care systems. As it may have substantial implications in terms of health care organisation and orientation, this research is important to ground public health policies.

Methods

1.Review of literature (philosophy of the forms of life and of ordinary life, social sciences’ critical assessment of the “injunction to normality”, ethnographic works on the expression of the whish for a normal life)

2.Analysis of the theoretical and ethical resources of the philosophical works by G. Canguilhem and K. Goldstein

Results

-Elaboration of a philosophical conceptual and normative frame based on the notion of “ordinary life” and of a “reinvented normality”

-Attention paid to the “milieu” of life of the person and its adjustment to her capacities.

-Identification of the technological tools and care practices contributing to such a reinvention.

Conclusions

The study presents the conceptual and normative results of a philosophical analysis careful of the challenge raised by the wish for a “normal life” expressed by people with chronic condition. It proposes some conceptual and normative tools to answer this challenge. It formulates this challenge as an issue for the health care systems and the organisation of medical care, its places (institutions of various types and/or home) and its goals.

Key messages

The wish for a “normal life”, “a life like everyone’s life expressed by persons with chronic condition should by taken into account by the health care system. Philosophy offers some conceptual and normative tools to medical care to answer this wish.
Economic burden of diabetes in France between 2012 and 2017 based on French national claim database
Authors: Denis P , Aguadé A , Lesuffleur T , Pestel L , Nicolas M , Rachas A , Gastaldi-Menager C
Published: November 2019

Background

The aim of this study is to assess the economic burden of diabetes in France based on a top-down allocation of health care expenditure, and to analyze structure and trends of expenditure between 2012 and 2017.

Methods

Using information about 57 millions of individuals from the general scheme insurance database (87% of the French population), we applied algorithms based on ICD-10 diagnoses, long-term diseases, and specific treatments. All reimbursed expenditure (drugs, medical visit and other ambulatory care, hospitalization, disability/sickness benefits) were extracted for each individual. A top-down method was used to allocate expenditure to diabetes. To analyze trends, we applied the same methodology from 2012 through 2017.

Results

In 2016 (results for 2017 will be available for the conference), among the 137 billion euros reimbursed, 6.8 billion (5%) were attributed to diabetes and 3.2 million people were concerned (5.5% of the population). Drugs represented the main expenditure item (31% of the average annual expenditure per patient related to diabetes), followed by nursing (18%) and medical devices (17.5%). From 2012 to 2016, the number of people with diabetes increased by 11.4% (+322 700) with an increase by 2.7%/year, the expenditure attributed to diabetes increased by 2.3%/year. The average expenditure per patient in 2016 was about €2150, slightly decreasing from 2012, mainly due to price controls on antidiabetics drugs which permits to limit expenditure growth.

Conclusions

Our study shows the high economic burden of diabetes in France with a detailed analysis of expenditures and their main drivers. With the arrival of innovation and predicted increase of the number of patients partly related to ageing process, control of expenditure must be a priority. The developed tool will help decision makers to monitor the burden of diabetes but also to provide stakeholders with a better understanding of trends and regulating actions.

Key messages

Diabetes represents a high proportion of healthcare expenditure in France. With the arrival of innovation and predicted increase of the number of patients partly related to ageing process, control of expenditure must be a priority.
Tuberculosis screening for foreign students change: good saving and bad idea?
Authors: Gerbaud L , Chabanas B , Perrève A , de l’ADSSU Bureau
Published: November 2019

Issue

There was a mandatory screening of tuberculosis (TB) for the 60.000 foreign students (out of European Union) annually newcomer in France. It was organized by screening centers of the Office of Immigration and Integration, a State agency. There was a link with university students’ health services (USHS) by systematic exchange of data, and sometimes the USHS was in charge of this screening and financed for that. In March 2016, a law, applied since January 2017, stopped this obligation, and transferred the responsibility of a “preventive survey” to USHS, without any means and financing.

Problem

As the decision was made without any data, thanks to the national network of UHSH, we made a brief national survey showing a 2,7 to 7,9/1.000 incidence, from year to year, 40% being active. About 50% of the cases came from North Africa and China. These data did not changed the decision, and we present its consequences in one French University, which was a previous TBI screening center. We computed all the cases of TB known in our USHS, since 2010, completed by the data form health authorities.

Results

Since screening is not anymore mandatory we faced a global refusal from Chinese and Moroccan students arguing that there was no TB in their country. Number of foreign students and their origin were approximately stable from 2010 to 2016, and mean TB incidence was 1,97/1.000. Students from China and North Africa represented half of the cases and 40% were latent TB. Since January 2017, TB incidence lowers to 1,51/1.000. Latent TB represent less than ¼, and there was no more cases screened from North Africa and China, while there was no change in foreign students origins, showing a significant degradation of screening effectiveness.

Lessons

The main reason for screening cessation was to save public money. Due to important lack of knowledge among French state authorities, we couldn’t change a decision which threatens the TB epidemic control.

Key messages

Cost saving policy reduced the effectiveness of tuberculosis screening. Health policy decisions may not take into account epidemiologic objectives.