bluuebunny/crossref_metadata_2025 huggingface dataset:
Building bridges between different professions and communities as a means to implement the Social Development Goals (SDGs)
Authors:   Organized by: WHO EURO, EUPHA,   Moderators: Natasha Azzopardi Muscat, President EUPHA, Anna Cichowska Myrup, Programme Manager Public Health Services, WHO Regional Office for Europe
Published: November 2019

Following the plenary at the Ljubljana 2018 conference presenting a Roadmap to implement the 2030 Agenda for Sustainable Development, this plenary will focus on building bridges between different professions and communities as a means to implement the Sustainable Development Goals (SDGs). Building on Health 2020, the European policy for health and well-being sets out five interdependent strategic directions: Governance: advancing governance and leadership for health and well-being;equity and social justice: leaving no one behind;partnerships for health: preventing disease and addressing health determinants by promoting multi- and intersectoral policies throughout the life-course;local action: establishing healthy places, settings and resilient communities; andUniversal Health Coverage: strengthening health systems for universal health coverage.

In this plenary, we will take the discussion one step further: What were the key decisions that were taken by policymakers and which partnerships made it happen? What ways of working did we adopt and how did we manage the necessary changes? The stage on how to develop leadership and innovation capabilities needed to achieve the SDGs will be set by the founder of the Presencing Institute, Dr Otto Scharmer. Three professionals (representing a research institute, an international health organization and a city council) reflect on the year 2018 and how their work, in partnership with other sectors, has shaped the future we are now in.

Keynote speaker

C. Otto Scharmer

Senior Lecturer, MIT Management Sloan School, Cambridge, USA

Panellists: Miklós Szócska

Director Health Services Management Training Center, Semmelweis University, Budapest, Hungary

Paula Vassalo

President of the European Dental Public Health Association (EADPH)

Ricardo Baptista Leite

Member of Parliament, Head of Public Health at Católica University of Portugal, and former Deputy Mayor of Cascais, Portugal
Bridging towards the future of public health in Europe (I). Where can and should we go from here?
Authors:   Organized by: European Commission, EUPHA,   Moderators: Isabel de la Mata, DG SANTE, European Commission, Natasha Azzopardi Muscat, President EUPHA
Published: November 2019

Europe is entering the third decade of the 21st century and health is on the agenda. Or is it? It seems that with Europeans healthier than ever and enormously improving our ability to prevent and treat current diseases, health seems to be a theme of the past. At the same time, the society is in turmoil and both old and new health challenges are threatening Europe. The changing demographics–climate change, urbanization, migration and ageing–the technological and digital revolution–given us both medical technology as fake news, genetic mapping and new addictions (gaming)–and the resurgence of old diseases such as measles, all lead to the necessity of bridging our previous successes with the need for a new public health in the future.

In 2019, several changes are occurring: we will have a new regional director for WHO Europe and we will have both a new European Parliament, a new European president of the European Commission, a new European Commission and a new European Commissioner for Health. And these changes have led to a new discussion on the necessity of health as a European topic.

In this plenary session, we will look at the priorities in public health from the perspective of the European Commission, the Finnish presidency of the European Council and the European Public Health Association. Finally, we have invited a young professional to reflect on the plans proposed in this session.

Panellists

Anne Bucher

Directorate-General for Health and Food Safety (DG SANTE), European Commission

Liisa-Maria Voipio-Pulkki

Ministry of Social Affairs and Health, Finland

Dineke Zeegers Paget

Executive Director EUPHA

Sara McQuinn

Coordinator EUPHAnxt
Community based approach to address health disparities among Roma in North Macedonia
Authors: Pavlovski B , Frishchikj J
Published: November 2019

Issue

Roma represent vulnerable group regarding health and health outcomes. Most health research and policies perceive Roma as a coherent group, although there are disparities within different subgroups. This is due to social determinants of health and other causes. Perceiving Roma community as monolith group may result in provision of activities for persons that don’t have need and leaving behind the vulnerable. Situation is similar with other marginalized and vulnerable populations.

Description

In 2016 started community based intervention including social accountability and legal empowerment regarding coverage,quality of health services and health rights violation. Work conducted in ShutoOrizari municipality with estimated 30.000 Roma. In 4 localities where most vulnerable Roma live, each comprised of 200 households. 2 persons from Roma NGOs and 4 community members work as team in 1 locality. Mapping of the community conducted and community inquiry. Findings shared with the community members. Findings used to conduct education of community and toconduct advocacy on local and national level with community participation in 2018for improvement of coverage and quality of services.

Results

Approach identified disparities among Roma.1256 persons surveyed from 4 localities. 4 localities have high unemployment rate (above 70%),monthly income related to the locality (p < 0.0002). Disparities in health and access to health services among localities noted. Self-reported health status is related to locality(p < 0.002). Coverage with health services also,including having registered gynecologist(p < 0.001),regular gynecological examinations(p < 0.00001),antenatal care(p < 0.0003).

Lessons

Identifying needs among Roma living in smaller localities enables tailoring of health interventions based on needs. Identification of the problems on micro level is relevant for the community concerned,increasing their involvement in demanding improvement and advocacy.

Key messages

Working in strictly defined localities/groups from Roma communities provides accurate insight in the health related issues. Working with defined localities/groups enables greater involvement of the community in advocacy for fulfillment of their rights.
1.B. Skills building seminar: How to include migrant and refugee populations health monitoring and surveillance in Europe
Authors:   Organised by: Robert Koch Institute Chair persons: Claudia Santos-Hövener - Germany, Nicole Rosenkötter - EUPHA (PHMR)
Published: November 2019

Objectives

The level of diversity in most European societies is increasing, especially due to ongoing migration to and within Europe. Migrants are very heterogeneous in terms of reasons for migration, region of origin and chances in the countries of destination and thus, differ greatly in regards to health resources and risks. It is crucial to gain valid data on migrant health status to inform policy makers in order to plan, implement and adjust health interventions and services. This highlights the importance of including migrant populations into health monitoring and surveillance. The objective of this workshop is 1) to demonstrate the importance of including migrants into health surveys, 2) to describe barriers that might hinder migrants from participating, 3) to critically appraise the strategies being used to include migrant populations and 4) to give clear recommendations on how to assure the responsiveness of migrant populations in health monitoring and surveillance. Three countries will present how they reach migrants with national health surveys and focus on selected strategies that increase accessibility of migrant groups. These approaches may include innovative sampling strategies, ways to bridge language gaps and enhancing participation of migrant groups in developing and conducting surveys. We will focus on different migrant groups, including refugees as a particularly vulnerable population. Following the presentations we will have enough time to discuss these strategies in terms of transferability and cost in order to synthesize ideas, learn from each other and discuss pitfalls and lessons learned.

Main messages

Europe is diversifying, and it is thus crucial to capture migrants’ health in health monitoring and surveillance. The national public health institutes are in charge of ensuring sufficient representation of migrant populations in health surveys and to tackle potential barriers. Cross-country collaboration allows sharing successful strategies.

Key messages

In a diversifying Europe, it is crucial to include migrant populations into health monitoring and surveillance. Approaches include include innovative sampling strategies, ways to bridge language gaps and enhancing participation of migrant groups in developing and conducting surveys.
France: A Public health system built on competing paradigms
Authors: Rozenblum S
Published: November 2019

Background

Although France helped establish public health as a scientific discipline, it is well known that the country was slow to implement public health measures on a national scale. The central government played a limited role in public health until the second half of the 20th century. Public health became a privileged space for political action in the 1990s, as a direct outcome of the “blood crisis” and a series of other health “scandals”.

Methods

A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results

Between the early 1990s and 2016, France saw the emergence of two competing understandings of public health. It was legally defined as a responsibility of the state to protect its population against disease risks and to ensure equal access to and representation in the healthcare system, captured by the notions of sécurité sanitaire (“health security”) and démocratie sanitaire (“health democracy”). Public health actions framed in the language of “security” changed its place in the hierarchical structure of the state. It both reinforced public health as a legitimate field of intervention (now presented as an important function of government, similarly to finance, foreign affairs, defense, etc.) and reinforced the central state, as the legitimate protector of population health and provider of public health services. The French public health arena also witnessed the (re)emergence of local and private actors, motivated by their own interests and competing understanding of public health.
Germany: The reformation of public health
Authors: Falkenbach M.
Published: November 2019

Background

Germany was amongst the most successful advocates and implementors of public health ideas in the 19th and early 20th centuries. Dominated by the social hygiene theory in the early 1900s population health was a main priority. With the recognition that bacteria caused diseases in both animals and humans municipal and national public health programs peaked resulting in increased research and education in the field. With the aftermath of WWII, public health in the country seemingly disappeared until the 70s when the AIDS epidemic forced it out of hiding.

Methods

A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results

Germany is still struggling to elevate public health to the same level of importance and respect that curative health enjoys. Despite its many shortcomings (limited tobacco control, the struggle to integrate public health and medicine, and the lack of recognition for public health scholars, researchers and doctors), largely due to its collapse after WWII, the German public health system can be seen as transformational in the sense that it is giving public health a new and perhaps more timely role namely that of a health advocate.

Conclusions

Public health in Germany has undergone a number of transitions throughout the past centuries moving from a practice initially based in economic theory with the goal of improving sanitation onto being increasingly supported by eugenics and with that the policing of an entire population to finally landing in the 21st century with the intention of advocating for European level public health agencies focusing on monitoring and reporting.
The politics of public health in the United Kingdom between medical, social, and local
Authors: Greer S
Published: November 2019

Background

Public health in the UK exists on a continuum from a national and medical pole to a local and social pole, with each end threatening obliteration as a distinctive field of expertise and action. The national-medical produces a subfield of medicine, with a range of highly developed skills including epidemiology. The local-social, manifested in social medicine as well as equivalent approaches in social work, education, and local government, produces health, which need not be medical, as a result of investment in integrated services that enable solidary, dignified communities. This model is more invested in local communities and local governments, and more likely to blur borders with social work, leisure, and other areas, and have an overtly social democratic ethics and set of arguments.

Methods

A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results

Public health in the UK has changed shape many times, from the end of most formal public health between 1948 and 1974, to the creation of a public health function in the 1980s, to the moment of divergence in 2012 when England reverted to a local public health and the devolved administrations did not.

Conclusions

The scope of public health might formally be the causes of avoidable ill health. In practice, the accepted expertise and autonomy of public health is found in narrower areas related to medicine: communicable disease control, health education, a few social services such as outpatient and outreach mental and sexual health, and the search for politically acceptable policies to address NCD threats. With public health moved to local government in England, its relationship with the NHS and medicine is likely to weaken further, to the likely detriment of the formal public health function and public health.
Are lifestyle behaviors correlated to mental health disorders in medical students?
Authors: Ben Ayed H , Jedidi J , Cheikhrouhou F , Ayadi A , Yaich S , Damak J
Published: November 2019

Background

Recently, there has been a renew interest to medical students’ mental health, which may be influenced by several sociodemographic and cultural factors, academic overload, but also by lifestyle behaviours. This study aimed to assess the correlation between major lifestyle behaviors and mental health in medical students.

Methods

A cross-sectional questionnaire survey was conducted among 521 medical students randomized from different levels, at Southern Tunisia Medical School, 2017. The 12-item General Health Questionnaire (GHQ-12) and the Simple Lifestyle Indicator Questionnaire (SLIQ) were used to assess mental health and lifestyle, respectively.

Results

The mean values of GHQ-12 and SLIQ were 4.1±2.8 and 6.2±1.4, respectively. According to SLIQ components, we noted an unhealthy lifestyle in 36.9%, 50.1% and 20.2% for diet, physical activities and stress level, respectively. The prevalence of psychological distress (GHQ-12≥4) was 50.1%. The GHQ-12 items analysis revealed that 235 cases (45.1%) were unable to concentrate, 237 cases (45.5%) felt unhappy and depressed and 195 cases (37.4%) had a loss of sleep over worry. Low family financial situation (Odds Ratio (OR)=1.5;95%CI = [1.1-2.3]), internship level, (OR = 1.8;95%CI = [1.1-3.3]) and medium/poor academic performance (OR = 2.2;95%CI = [1.5-3.2]) were significantly associated with psychological distress. Multivariate analysis showed that unhealthy lifestyle was independently associated with psychological distress (Adjusted OR = 5.8;95%CI = [2.4-14.8]).

Conclusions

Our study highlighted the magnitude of psychological distress in medical students. Unhealthy life style was a potential predictive of mental disorders. These findings are extremely useful for guiding future curricular changes upon entry into medical schools.

Key messages

Mental disorder prevalence ranked at an alarming rate among medical students. Promoting healthy life style represents a reliable tool to sustain a good quality of life for the future-doctors.
Italian adolescents and sexual health: what has changed during the last 20 years?
Authors: Kundisova L , Nante N , Lorenzini C , Valeri V , Messina G , Alaimo L
Published: November 2019

Background

In the majority of European countries, sex education is mandatory, but Italy is still an exception. Despite sexually transmitted diseases (STD) are believed to be less common today, long-time “forgotten” disease, as syphilis, are returning. The aims of study are i) to examine the knowledge and perceptions of adolescents regarding sex education and STD and ii) to compare our results with Italian national survey.

Methods

This descriptive cross-sectional study was conducted in 6 middle schools in Siena (Italy) during May-June 2018. Data were anonymous collected using a validate questionnaire previously adopted by the Italian National Institute of Health (NIH). The results were compared with the national survey realized in 1998 by NIH. The analysis was performed using Stata 12.

Results

From 691 questionnaires, 540 returned fulfilled (78% response rate). The majority (95%) of respondents considered sex education “important” and thought it should be guaranteed by the school; 48% described information received so far as “sufficient”, 40% as “adequate”. “School” was indicated as the principal source of information (44%), instead of “friends” which resulted in 1998. The respondents were asked to choose from the list the STDs they knew: 96% indicated “AIDS”, 62% “syphilis”, 38% “HBV” and 36% “gonorrhoea”. In comparison to 1998, knowledge of syphilis has decresed (2018:17% vs. 1998:62%) and HBV (2018:38% vs. 1998:58%). Regarding STD, the “mass media” were cited as the principal source of information (56%), followed by “school” (41%) and “General Practitioner” (20%).

Conclusions

In comparison to 1998 sex education in Italian schools improved, but the knowledge of adolescents regarding the STD worsened. This result can be attributed to the fact that the survey of 1998 was realized during the years when the AIDS awareness was higher. It is necessary to further improve the sex education in Italy in order to prevent STDs.

Key messages

The “forgotten” sexually transmitted diseases are becoming common again, the adequate sex education in schools is necessary to prevent them. In confrontation to 1998, the sex education in Italian schools improved, but the knowledge of adolescents regarding the STD worsened.
Psychosocial difficulties, obesity and disadvantage in a cohort of Irish children
Authors: Dow M , Brinkley A , O’Malley G , Murrin C
Published: November 2019

Background

Childhood obesity is stabilising in Ireland, but less so in children from disadvantaged backgrounds. There is also evidence for a relationship between psychosocial difficulties and obesity in youth, but findings are often mixed. This study aimed to describe the relationships between psychosocial difficulties, obesity, and disadvantage in a national cohort of children in Ireland.

Methods

Participants (n = 7275) were surveyed and measured at age nine and thirteen as part of the Growing Up in Ireland study (GUI). Psychosocial difficulties were measured using the Strengths and Difficulties Questionnaire (SDQ). Disadvantage was represented by the education status of the primary caregiver. BMI was calculated using measured height and weight. Weight status categories were created using the UK 1990 Growth Data. Correlation analyses were used to examine the relationship between child BMI and SDQ scores. Associations between weight categories, psychosocial difficulties and education status were examined using Chi-square analysis.

Results

In children whose parents had secondary education, the obesity rate was 27.9%, compared to 24.7% in those with a college degree (p < 0.01). This relationship was also significant at age thirteen (<0.01). Furthermore, BMI was positively correlated with SDQ total score, (r=.107, p = 0.01) at age nine and at age thirteen (r=.089, p = 0.01). A significant association was also found between weight status categories and psychosocial difficulties at ages nine (p < 0.1), and thirteen (p < 0.1). Further findings will be reported following a preliminary longitudinal analysis.

Conclusions

Obesity is associated with psychosocial difficulties, as well as the education status of the primary caregiver, in a large sample of Irish children. These findings are important for understanding the relationship between childhood obesity and psychological health and have implications for the treatment of obesity in young people.

Key messages

There are higher rates of obesity in children whose parents do not have a college degree. Childhood obesity remains a serious public health issue, and is associated with psychosocial difficulties in an Irish cohort of children.
Sustainable Development Goals and the challenge of Human resources for health in Congo
Authors: Ndziessi G , Bileckot R
Published: November 2019

Background

In order to achieve the Sustainable Development Goals (SDGs), equitable access to skilled and motivated health workers within a performing health system is need to be ensured. The health system in Congo is characterized by low quantity and quality of Human resources for health (HRH), which constitutes an important barrier to achieving to expanding coverage and integrated primary health care.

Objectives

To estimate needs of HRH in Congo from 2019 to 2030 and analysed the capacity of the country to address the estimated needs.

Methods

Cross-sectional study was conducted in Ministry of Health from June to November 2018. Data from 2011 national HRH Census was used as the baseline for projections. We performed annual projections based on current numbers of midwives, nurses and physicians. Health workforce-population ratios by year in national and department level were provided. Population estimations were computed using Spectrum software assuming a 3% growth rate. Mapping for distribution by department was performed used QSGI software.

Results

In 2019, Congo has 4849 midwives, nurses and physicians, including 465 doctors, 912 midwives and 3469 nurses. All of Congo departments have not surpassed the availability threshold of 4, 5 midwives, nurses and physicians per 1000 inhabitants in 2019. In overall, this ratio will rise from 0.9 per 1000 inhabitants in 2019 to 0.42 per 1000 inhabitants in 2030 due to the retirement. Needs for additional workforce were estimated at 29416 midwives, nurses and physicians by 2030, average of 2451 per year. However, current national production capacity of human resources for health is very low and will not cover the estimated needs as scheduled.

Conclusions

There is a crisis in the health workforce in Congo, expressed in acute shortage. Results highlight needs of building adequate policies to address production and management of the health workforce, to come close to reaching the MDGs for health.

Key messages

At current production capacity, Congo has not the number of physicians, nurses, and midwives it needs to address HRH shortages in the national Health system by 2030. The health human resources crisis in sub-Saharan Africa countries will be a major obstacle to achieving the Millennium Development Goals.
Effectiveness of Prompt Mental Health Care: Preliminary results from a randomized controlled trial
Authors: Knapstad M , Lervik L V , Saether S M M , Aaroe L E , Smith O R F
Published: November 2019

Background

Prompt Mental Health Care (PMHC) service is a Norwegian initiative, adapted from the English ‘Improved Access to Psychological Therapy’ (IAPT), aimed at improving access to primary care treatment for anxiety and depression. Thus far, both PMHC and IAPT have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. This study investigates the effectiveness of PMHC compared to treatment as usual (TAU) at six months follow-up.

Methods

Randomized controlled trial with parallel assignment in two PMHC sites from November 2015 to March 2018. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression. These were randomly assigned on a 70:30 ratio. Main outcomes were recovery rates and changes in symptoms of depression and anxiety between baseline and follow-up. Primary outcome data were available for 73%/67% in the PMHC/TAU group. Sensitivity analyses based on observed patterns of missingness were conducted.

Results

A reliable recovery rate of 58.5% was observed in the PMHC group and 31.9% in the TAU group, yielding a between-group effect size (ES) of 0.61 [95% CI 0.37-0.85, p<.001]. The differences in degree of improvement between PMHC and TAU yielded an ES of -0.88 [95% CI -1.23-0.43, p < 0.001] for symptoms of depression and -0.60 [95% CI -0.90-0.30, p < 0.001] for symptoms of anxiety in favour of PMHC. All sensitivity analyses pointed in the same direction with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms.

Conclusions

The PMHC treatment was substantially more effective than TAU in alleviating symptoms of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access of effective treatment for adults who suffer from anxiety and mild to moderate depression.

Key messages

This study is the first to evaluate the effectiveness of an IAPT-like treatment model in terms of a randomized controlled trial. Prompt Mental Health Care was substantially more effective than TAU in alleviating symptoms of depression and anxiety at 6-months follow-up.
Speedy, predictable and secure cancer care? Introducing cancer patient pathways in Norway
Authors: Melby L , Håland E
Published: November 2019

Norway introduced cancer patient pathways (CPPs) in 2015. CPPs are standardised patient pathways, based on current guidelines for cancer diagnostics and treatment. The aim is to speed up patient assessments and start of treatment and minimise waiting times, in order to make the assessment period as predictable as possible. Each CPP are divided into phases, and each phase should be completed within a defined time period. The aim of this paper is to describe and discuss how healthcare professionals work to realise the objectives of the CPPs and how they reflect upon them as tools for achieving predictable and secure cancer care.

The paper departs from an ongoing study (2017-2020) investigating the introduction of CPPs in Norway. The study has a qualitative cross-sectional design and focuses on four CPPs: breast-, prostate, and lung cancer, and malign melanoma. Data are mainly collected through interviews. The study setting is four hospitals, and study participants are hospital staff, including physicians, nurses, clerical workers and managers (N = 60).

Preliminary results show that keeping the waiting times has become a major concern, and national statistics are published showing if the hospitals keep the defined time limits. From the perspective of healthcare workers, CPPs may contribute to a predictable assessment period for patients, and thereby creating a more secure experience. However, predictability and security rest on patients being informed about receiving care organised through a CPP. We found that in many instances this was not the case.

Our study indicates that most effort in hospitals is directed towards reducing waiting times, and we argue that publishing of statistics may be an incentive for hospitals to reorganise their resources and prioritize cancer patients before other (elective) patients. Further development of the CPPs should encourage informing and supporting patients so they can have the most predictable and secure experience as possible.

Key messages

Patient pathways is an incentive to reorganise resources to reach defined time limits in cancer diagnostics. Short waiting times are positive for patients, even if survival rate is not necessarily affected.
Estimation of the epidemiological impact of the organized screening program for colorectal cancer
Authors: Barre S , Leleu H , Taleb S , Vimont A
Published: November 2019

Introduction

Colorectal cancer (CRC) is the third most common cancer and the second most deadly in France. A CRC national organized screening (OS) program was set up in France in 2009. It targets asymptomatic people aged 50 to 74 year with medium risk of CRC. OS program is based on fecal immunochemical test (FIT) followed by colonoscopy. Participation rate over the last period showed a participation rate of 34%, far from the European standards and the 45% target objective of the French cancer plan.

Methods

The epidemiological impact of the DO-CCR was estimated from the results of an individual simulation model adapted from the MISCAN-Colon model, calibrated and transposed to the French context. The model simulates the natural history of CRC in a cohort of 5,000,000 individuals from birth to death. The simulated population reproduced the age and sex structure of the French population. Current screening strategy was simulated for the entire population. A first analysis was conducted to estimate the individual impact of screening by sex and by age of screening initiation and cessation. A second analysis was carried out to estimate the global impact of the based on various participation rates.

Results

FIT every 2 years, from the age of 50, is associated with a reduction in the CRC incidence of 21% for women and 24% for men and a reduction in CRC mortality of 43% for women and 51% for men. At the current level of participation, the OS reduces incidence by 5% and mortality by 14% (2,200 CCR and 2,600 deaths per year) compared to no OS. The impact would be reduced by an additional 3% and 8% for participation rates of 45% and 65% respectively, a decrease of 1,300 and 3,500 cases per additional year. Similarly, mortality would decrease by an additional 8% and 22% for participation rates of 45% and 65%, respectively additional decreases of 1,400 and 4,000 deaths per year.

Key messages

These results confirm that in a population at medium risk for CRC, the OS is an effective strategy for reducing incidence of CRC. Increasing participation rate to reach the Cancer Plan’s objectives remains a key issue in France.
Barriers and facilitators on cervical cancer screening among HIV women in Cote d’Ivoire
Authors: Mensah K , Pourette D , Duschene V , DeBeaudrap P , Dumont A
Published: November 2019

Background

With 50,000 death every year, cervical cancer is the fourth most common cause of death by cancer in sub-Saharan countries. Due to high risk human papilloma virus (hr-HPV) persistence on the cervix, leading to pre-malignous lesions, the disease is more frequent among HIV-positive women. In low- and middle-income countries, cervical cancer screening strategy relies on visual inspection with acetic acid, an operator-associated technic. As an alternative, HPV-based detection and its better performances are considered as it could lead to a potential screening uptake and women empowerment through self-sampling. Côte d’Ivoire, with a high HIV prevalence, is considering this innovative strategy. Yet, few studies analyzed the potential socio-cultural factors associated with cervical cancer screening in this context. Our study aims to assess beliefs and perceptions toward cervical cancer among HIV positive women in Abidjan, Côte d’Ivoire.

Methods

We performed in-depth interviews with 21 HIV positive women randomly attending a health center or member of a women’s association, in November 2018. All interviews were recorded and transcribed. A theoretical framework with the Health Belief Model and the PEN-3 was used to categorize women’s perceptions, enablers, nurturers, perceived gravity and self-efficacy about cervical cancer, screening and self-sampling technique introduction.

Results

Positive findings were knowledge about cervical cancer, awareness about women’s vulnerability and HIV status role on it and relationship to caregivers. Fear appeared as a barrier to screening but also a facilitator among women with health awareness. Negative findings were reluctance for HIV-associated diseases, poor screening knowledge and lack of resources to get treated. Self-sampling introduction was disregarded due to lack of self-confidence.

Conclusions

This study provides useful information for counselling and opens the door to HPV-based screening implementation.

Key messages

Beliefs and perceptions about cervical cancer screening among HIV women need to be assess before implementing a new strategy. Cervical cancer screening uptake will need to address fear, self-confidence and stigma.
Employment two years after breast cancer diagnosis: role of household characteristics, CANTO cohort
Authors: Caumette E , Dumas A , Pinto S , El Mouhebb M , Bovagnet T , Meglio A Di , Lemonnier J , Everhard S , Vaz-Luis I , Menvielle G
Published: November 2019

Background

Breast cancer is associated with a high 5-year survival rate and more than half women are still of working age at diagnosis. Many studies evaluated the clinical determinants of return to work (RTW) but few investigated RTW in relation to family factors. Our objective was to study the role of household characteristics in non-RTW two years after breast cancerdiagnosis.

Methods

We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Patients had to be under 57 and have a job at diagnosis. We performed logistic regressions to model non-RTW two years after diagnosis in relation to household characteristics at diagnosis (marital status, children, support from partner), adjusting for tumor characteristics, health status at baseline and one year after diagnosis, and household income at diagnosis. In a second step, we conducted analyses stratified for household income at diagnosis.

Results

In total, 1874 women were eligible. Being in a relationship did not impact non-RTW (OR = 1.43 [95% CI 0.95-2.16]). Among the 1566 women in a relationship, being married was associated with elevated odds of non-RTW(OR = 1.37 [0.96-1.94]). Having children(OR = 1.17 [0.81-1.69]) or receiving support from their partner (OR = 1.17 [0.77-1.78]) was not associated with non-RTW. However, the situation differed in low-income households(<2500€) among whom being married was associated with more elevated odds of non-RTW(OR = 1.94 [0.97-3.88]). No clear association was observed between having children (OR = 1.85 [0.85-4.03]) and non-RTW, but living with at least two children (OR = 2.76 [1.14-6.70]) and receiving support from their partner (OR = 2.28 [1.01-5.17]) was associated with increased odds of non-RTW.

Conclusions

The family environment is associated with non-RTW among the poorest women but not the others.

Key messages

Among the poorest women, the family environment is associated with non-RTW. Among all women, the family environment is not associated with non-RTW.
Traditional Eastern European diet and its relationship with mortality: results from the HAPIEE study
Authors: Stefler D , Brett D , Sarkadi Nagy E , Kopczynska E , Detchev S , Bati A , Malyutina S , Kubinova R , Pajak A , Bobak M
Published: November 2019

Background

Cardiovascular disease (CVD) and cancer mortality rates in Eastern European countries are among the highest in the world. Although unhealthy diet is an important risk factor for both of these chronic diseases, traditional eating habits and their health effects in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European population-based cohorts.

Methods

We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) multi-centre prospective cohort study based in Russia, Poland and the Czech Republic (age range at baseline: 45-70 years). Diet was assessed by food frequency questionnaire, and we constructed an Eastern European diet score (EEDS) from nine food groups considered as “traditional” in this region. The relationship between EEDS and all-cause, CVD and cancer mortality was calculated with Cox-regression models.

Results

From the 18,852 participants, 2,234 died during the average follow-up of 11.7 years. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.20; 95% CI 1.05-1.38) and CVD deaths (1.32; 1.05-1.64) compared to those with low adherence. The association with cancer mortality was not significant (1.12; 0.90-1.40). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while processed fruit or vegetable consumption showed consistent inverse associations.

Conclusions

Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

Key messages

This work indicates that traditional dietary habits in Eastern European countries may be one of the reasons for the poor health status of populations in this region. Public health nutritional interventions which target traditional but unhealthy foods, such as lard, have the potential to considerably improve population health in Eastern Europe.
Potentials of school nursing for strengthening health literacy: a 2017/18 German longitudinal survey
Authors: de Buhr E , Tannen A
Published: November 2019

Background

Health literacy (HL) plays a key role in explaining health disparities. School nurses provide health related expert knowledge and skills within the school setting. A positive effect on the HL of children but also their teachers and parents is assumed and supported by some research but gaps persist in the available data.

Methods

As part of a pilot school nursing project, which placed school nurses in 28 public schools in two German states, all teachers, parents and students (11+ years) attending the schools were invited to participate in a 2017 baseline (T0) and 2018 follow-up (T1) survey. Adult HL was measured using the HLS-EU-Q16 and child HL with the HLSAC. Bi- and multivariate analyses were carried out.

Results

Comparing T0 and T1, HL scores improved in all populations. In East Germany (Brandenburg), the percentage of teachers with problematic or inadequate HL decreased from 56.6 (N = 173) to 51.5 (N = 173) and among parents from 45.7 (N = 1719) to 43.2 (N = 1080). In West Germany (Hessen), the percentage of teachers with problematic or inadequate HL also decreased, from 43.7 (N = 201) to 42.2 (N = 263), and among parents from 42.2 (N = 2013) to 34.9 (N = 1251). The percentage of children that scored in the moderate or high HL brackets increased from 77.9 (N = 898) to 82.2 (N = 736) in Brandenburg and from 84.9 (N = 1379) to 86.5 (N = 1487) in Hessen. There were strong statistical relationships between child/parental HL and child health behaviors in all datasets. The T0 and T1 comparison showed some improvements over time.

The presence of school nurses in public schools seemed to increase health awareness, thus contributing to a “healthy school.” After a short period (18 months) and despite a rather nonspecific spectrum of interventions, the HL of all relevant target groups improved. Further research is needed to quantify the relative contribution of the school nurses to improvements in HL, for example, by implementing a HL curriculum in a controlled setting.

Key messages

The presence of a school nurse seemed to increase health awareness contributing to a “healthy school.” After 18 months of intervention, the health literacy of children, parents and teachers improved.
Association between occupational situation and health literacy: A Danish population-based survey
Authors: Wagner Svendsen I , Busk Damgaard M , Kronborg Bak C , Tang Svendsen M , Berg-Beckhoff G
Published: November 2019

Background

It is well known, that health literacy is associated with health, and that occupation and health is associated as well. But current knowledge on the relationship between occupation and health literacy is scarce. The aim of this study was to examine the association of occupation with health literacy.

Methods

Between 2016 and 2017 a random sample of the Danish population participated in a cross-sectional national representative survey using the short version of the European Health Literacy Survey Questionnaire. 15,682 adults aged 25 years or older was invited, and 8,997 residents participated. Data on occupational situation were obtained from nationwide administrative registries, which contains information on employment and public benefits. Logistic regression was conducted for the binary outcome of health literacy and the exposure variable of occupational situation. Model was adjusted for sex, age, immigration, education, cohabitation and income. Subsequently, a mediation analysis was conducted to analyze if health literacy was a causal pathway in the association between occupational situation and health.

Results

Respondents receiving unemployment benefits had a significantly higher risk of inadequate health literacy [OR = 1.66 (p < 0.001)] compared to respondents who were employed. The associations were also significant for social assistance [OR = 1.63 (p < 0.001)], employment and support allowance [OR = 1.59 (p < 0.001)], and sickness benefit [OR = 1.55 (p < 0.001)]. Mediation analysis showed, that the association between employment status and health were partly mediated by health literacy.

Conclusions

Results are important to understand the health disparities in connection to occupational situation, health literacy, and health. As a mean for health promotion, interventions to improve health literacy should be planned for groups receiving public benefits and when health information is delivered for these groups the level of health literacy should be considered.

Key messages

Association between employment status and health were partly mediated by health literacy. Interventions to improve health literacy should be planned for groups receiving public benefits.
Information seeking and knowledge on in-home care services in a representative sample in Switzerland
Authors: Mantwill S , Dawson-Townsend K
Published: November 2019

Background

In Switzerland the use of in-home care services has increased steadily in recent years. Contributing to this trend are a growing aging population and changing family structures. In-home care services are embedded in complex financing systems, which require considerable efforts and capacities to navigate, and if not well understood, can lead to inefficient usage of healthcare services. The aim of this study is to assess information seeking behavior and knowledge on in-home care services in the Swiss general population.

Methods

Data comes from a cross-sectional online survey, using a representative sample from Switzerland (N = 1050), conducted in September 2018. The survey included items on information seeking behavior (sources, difficulties seeking information), as well as general and financial knowledge on in-home care services.

Results

50.1% had sought information on in-home care services at least once. Logistic regression shows that age (β=.01, p<.005) and gender are significant predictors for information seeking, with women being more likely to have sought information (β=.26, p<.05). Those with highest education are less likely to have sought information (β=-.55, p<.05). About 1/4 of participants indicate having had some difficulty when seeking information, including being worried about the quality of information. 84.8% indicate to have at least some knowledge about in-home care financing. Whereas the majority is relatively well informed on the financing of in-home care services, such as “acute and transitional care”, participants have overall relatively little knowledge on additional financing mechanisms, such as supplemental benefits. Multiple regression shows that age significantly predicts financial knowledge (β=.04, p<.001).

Conclusions

The study shows that knowledge gaps exist, which may hinder effective and efficient use of in-home care services, as well as a potential lack of available and clear information to make appropriate decisions on services.

Key messages

Important knowledge gaps on in-home care services exist in Switzerland. The study indicates a potential lack of available and easy-to-understand information on in-home care services in Switzerland.
A life course analysis of income and incident AMI - a Danish register based cohort study
Authors: Lund R , Kriegbaum M , Andersen I , Hougaard C O , Brønnum-Hansen H
Published: November 2019

Background

Social inequality in ischemic heart disease has been related to socioeconomic position in childhood, early and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences has not been investigated.

The aim was to investigate the association between relative level of accumulated income across the life course and Acute myocardial infarction (AMI) from age 60+ and to study if the associations differ by gender and exposure in different age groups (30-39 years, 40-49 years and 50-59 years).

Methods

All Danes born 1935-54 N = 1,235,139 were followed-up in registers for incident AMI (ICD8: 410, ICD10: I20, I21) from age 60+, (42,669 cases). The The Accumulated Proportional Deviation from Median Equivalized Income = APDMEI for each gender/age /calendar year strata was constructed and divided in quartiles. The analyses stratified by birth cohort included all Danes born in 1955-70 (alive and reached age 40) N = 1,144,264, 1945-64 (alive and reached age 50), N = 1,434,769, 1935-1954 (alive and reached age 60) N = 1,235,139 including outcomes in the following 10 year period. Cox’s proportional hazard models adjusted for educational level, ethnic background and birth cohort.

Results

Among men, those in the lowest APDMEI quartile had a HR 1.40 (1.35-1.45) of AMI compared to the highest quartile, second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women the lowest quartile had a HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age-groups.

Conclusions

The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.

Key messages

Accumulated low income is associated with higher AMI risk in both men and women, but with larger relative differences between high and low accumulated income in women. This study adds a new approach to the study of inequalities in AMI by integrating duration and extent of low income into a relative measure of accumulated income.