bluuebunny/crossref_metadata_2025 huggingface dataset:
Tetralogy of Fallot in infants less than one year old in the Valencia Region (Spain)
Authors: Cavero Carbonell C , Barrachina Bonet L , Fernández Rojas T , Moreno Marro S , Páramo Rodríguez L , Guardiola-Vilarroig S , Zurriaga O
Published: November 2019

Background

Tetralogy of Fallot (TF) is a rare disease characterized by the presence of 4 congenital heart defects (CHD). Objective: to describe the temporal trend and distribution of the TF in the Valencia Region (VR), in less than one year old, during the period 2007-2016.

Methods

Live births, stillbirths and termination of pregnancy due to fetal anomaly (TOPFA) between 2007-2016 with TF (code Q21.3 of the ICD10-BPA) were selected from the Congenital Anomalies (CA) population-based Registry of VR. The cases were confirmed through the review of clinical documentation. The prevalence of 10000 births with 95% confidence intervals (95%CI) was calculated for the period and for each year, and a descriptive analysis of sociodemographic and clinical variables was made.

Results

146 cases were identified (45.2% male, 31.5% female and 23.3% unknown), 89.0% were simple pregnancies and 54.8% were diagnosed prenatally. The overall prevalence of TF was 3.0/10000 births (95%CI: 2.5-3.5), being 2015 the year with the highest prevalence (4.3/10000 births) and 2011 with the lowest (1.8/10000 births). These changes were mainly due to the increase and decrease in the number of TOPFA respectively. 74.7% were live births, 22.6% TOPFA and 2.7% stillbirths. The prevalence in live births was 2.2/10000 births (95%CI: 1.8-2.6) and in TOPFA it was 0.7/10000 births (95%CI: 0.4-0.9), identifying an increasing trend during the period in the last one. 11.0% of live births died during the first year of life. 45.9% of the cases had another CA associated with the TF, being CHD in 52.7% of cases. 66.4% of the mothers were over 30 years of age, being the most frequent those between 30-34 years (30.1%).

Conclusions

The prevalence obtained in the VR was lower than that of EUROCAT 3.5/10000 births (95%CI: 3.3-3.6) during the same period. EUROCAT has also identified the difference between the prevalence in live births (2.9 (95%CI: 2.8-3.0)) and TOPFA (0.5 (95%CI: 0.5-0.6)), and the increasing trend in the last one.

Key messages

The prevalence of Tetralogy of Fallot obtained in the VR was lower than that of EUROCAT (European network of population-based registries for the epidemiologic surveillance of congenital anomalies). EUROCAT has also identified the difference between the prevalence of Tetralogy of Fallot in live births and termination of pregnancy due to fetal anomaly, and the increasing trend in the last one.
Autochthonous chikungunya and dengue fever outbreak in Mainland France, 2010-2018
Authors: Franke F , Giron S , Cochet A , Jeannin C , Leparc-Goffart I , de Valk H , Jourdain F , de Lamballerie X , L’Ambert G , Paty M C
Published: November 2019

Background

Aedes albopictus, vector of dengue and chikungunya viruses, is implanted in mainland France, exposing to the risk of autochthonous transmission. Since 2006, epidemiological and entomological surveillance activities aim to prevent or limit the occurrence of autochthonous cases. We aimed to describe episodes of transmission and control measures implemented in order to reflect on surveillance activities.

Methods

We reviewed all publications and documents produced on autochthonous transmission episodes in France and surveillance protocols. We reviewed surveillance activities, investigation methods and control measures implemented.

Results

Between 2010 and 2018, eight episodes of autochthonous dengue fever transmission and three of chikungunya were recorded in mainland France. All of them occurred in the South east of France, between July and October, when vector density was the highest. Transmission areas were limited to single domestic houses located in discontinuous urban areas. Only two episodes happened in two distinct areas. Chikungunya episodes led to 31 cases and dengue fever episodes to 23 cases. Most cases were identified by door-to-door investigations set-up in transmission areas. We isolated serotypes 1 and 2 for dengue and East Central South Africa lineage for chikungunya in autochthonous cases. Adulticide vector control measures were effective in controlling transmission.

Seven episodes of transmission were due to failure in identifying primary imported cases. Four episodes occurred because of the absence or the lack of vector controls measures around primary imported cases.

Conclusions

Surveillance activities, and autochthonous cases investigations, were effective in limiting the extent of transmission, but were highly demanding for surveillance actors. Identified causes of transmission highlight the need of regular awareness campaigns targeting physicians and biologists.

Key messages

Effectiveness of the surveillance system of dengue, chikungunya and zika viruses, and autochthonous cases investigations. Needs of awareness and training courses targeting health professionals to the risk represented by these viruses.
Self-rated health and attitude to cardiovascular prevention in male population in Russia/Siberia
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A
Published: November 2019

Objective

To establish the dynamics of the relationship to the prevention of cardiovascular disease, awareness, attitude to their health for 32 years (1984 -2016 yy.) In the open population among males 25-44 years in Russia / Siberia (Novosibirsk).

Methods

Within the framework of WHO’s MONICA-psychosocial program random representative samples of the male population aged 25-64 years in Novosibirsk were examined: 1984-85 (n = 753); 1988-89 (n = 739); 1994-95 (n = 657); 2013-2016 (n = 427), used the ’Knowledge and attitude to one’s health’ scale.

Results

During the observation period from 1984 to 2016, the number of men 25-44 years old believed that they are ’healthy’ or have ’good health’, but at the same time, the number of those who believe that their health they care clearly is not enough. Most men were of the opinion that a healthy person can develop a serious illness within the next 5-10 years. The number of those who believed that preventive measures will help to avoid some serious diseases has increased. Men began to stop working more often, if they did not feel well, the number of those who reduced their work and had a rest increased. The number of men has grown, who believe that a preventive health check is useful and who has started to observe proper nutrition. The number of men who smoke has decreased.

Conclusions

The dynamics of attitude towards the prevention of cardiovascular diseases, awareness, attitude to their health for 32 years indicates that at present health has become a value dominant due to a new understanding of the importance of health in terms of adapting to modern economic requirements.

Key messages

The purpose of our study was to study the dynamics of awareness and attitudes towards one’s health for 32 years (from 1984 to 2016) in an open population of working-age men 25–44 years old. The purpose of our study was to study the dynamics of awareness and attitudes towards one’s health for 32 years (from 1984 to 2016) in an open population of working-age men 25–44 years old.
Long-term trends in adherence to prevention in female population aged 25-44 years in Russia/Siberia
Authors: Gafarov V , Panov D , Gromova E , Gagulin I , Gafarova A
Published: November 2019

Objective

To determine the 23-year trends 1994-2016 yy of adherence towards cardiovascular diseases prevention, behavioral characteristics and awareness about the health in general female population aged 25-44 years in Russia / Siberia.

Methods

Under the third screening of the WHO program MONICA and sub-program ’MONICA-psychosocial’ (MOPSY) random representative sample of women aged 25-64 years (n = 870) were surveyed in Novosibirsk in 1994; 284 persons in group 25-44y. In 2016 within the framework of the screening studies covered by state task reg.# 01201282292 a random representative sample of women aged 25-44 years was examined in the same district of Novosibirsk (n = 540). Questionnaire MOPSY ‘Awareness and attitude towards the health’ was used to estimate adherence towards cardiovascular diseases prevention, behavioral characteristics and awareness about the health.

Results

The analysis showed there is a positive trend in self-rated health in female population aged 25-44 years. Despite this 50% of women rate their health negatively and 96% consider the existence of high chance to be ill with serious disease within next 5-10 years. Majority of women believed in the possibilities of modern medicine for the prevention of heart disease but there is extremely low level of healthcare utilization as prevention measure and it doesn’t exceed 10% in those women (p < 0.05). There is a growth of job stress levels and upward trends in family status changes over 23 years in an open population of women aged 25-44 years. Some changes in behavioral status were found over 1994-2016 yy: increased share of people quit smoking and doing regular physical exercises, improved diet behavior.

Conclusions

We showed a positive trend in CVD risk factors prevention in women 25-44y. In spite of this, half of the women negatively evaluate their health and using of healthcare resources is deficient. There are adverse changes in the social gradient over the follow-up period.

Key messages

The purpose of this survey was to study the trends in awareness and attitudes towards cardiovascular prevention over 28 years (from 1988 to 2016) in an open female population of 25-44 years old. The purpose of this survey was to study the trends in awareness and attitudes towards cardiovascular prevention over 28 years (from 1988 to 2016) in an open female population of 25-44 years old.
Singular death-causes contribution to temporal trend-shifts of its major causes in Spain, 1975-2016
Authors: Cirera L , Ballesta M , Salmerón D
Published: November 2019

Background

Mortality is the arrow of aggregated individual’s life style of living beside the national public health and health care system outcomes. The contribution of specified death-causes to the temporal evolution of its great cause, is targeting the community framework for public health action reduction.

Objective

To assess yearly contribution of specified death-causes to temporal trend-shifts of its major death- cause in Spain, 1975 to 2016.

Methods

causes of death were selected based on magnitude and relevance in public health. Coding-linkage was established between ICD-9 to 10 revisions. Annual-standardized rates were calculated by the direct method according to the European Standard Population from 1975 to 2016. Linear trend period changes were measured through Joinpoint regression models as annual percentage change (APC) and 95% confidence intervals (CI). Joinpoint v4.0.4 and R v3.2.2 software were used at p < 0.05 for statistically significance level.

Results

Neoplasm rates have been going downwards (extreme years came from 162.2/100,000 inhabitants to 145.5) on ending year-periods of 1995-2008-2016. Lung and colorectal cancers replicated neoplasm shape in lower magnitudes. Cardiovascular displayed two decreasing trajectories in 1975-1993 and 1993-2013, and a last flat stage in 2013-2016, while cardiac ischaemia and ictus crossed their trend periods. Ictus has evolved quite in parallel to cardiovascular disease. Influenza and pneumonia conformed a close profile to respiratory great cause contribution, in different periods: 1975-1988 [-8.03% (-9.08, -6.96%)] and 1988-2016 [-2.38% (-2.85, -1.91%)]. Traffic accidents have been modulating external causes dropping shape with a nonsignificant slope period- trend in the 1994-2001 years.

Conclusions

The contribution of any singular causes of death into temporal development of its great causes, is a plausible tool for public health surveillance issues addressed to action.

Key messages

The great cause of death in temporal evolution is a moving aggregate result of its singular causes of death components over last time. Inflection-trends years-period of death causes are a plausible tool to public health surveillance.
Waterpipe Use Prevalence Rate in Turkey: A Meta-analysis Study
Authors: Aydoğan S , Aygar H , Önsüz M F , Metintas S
Published: November 2019

Background

The aim of the study was to perform a meta-analysis of studies about the waterpipe use prevalence in Turkey.

Methods

PubMed, Web of Science, Turkey Citation Index, TR Index and the Cochrane Library databases were screened both in Turkish and English languages to identify relevant studies by using keywords ’waterpipe use’, ’prevalence’ and ’Turkey’. Inclusion criteria; original and cross-sectional design, studies that done during and after the year 2010, studies that given the number of participants and number of people using waterpipe and studies that done in Turkey. Open Meta Analyst demo program was used to calculate the prevalence rate of the study groups. Since the articles were p < 0.001 in the heterogeneity test, prevalence rate and 95% confidence intervals were calculated from the number of cases using the random effects model in group analysis.

Results

As a result of first literature review 26 articles were reached. Duplications were eliminated and summaries of the remaining articles were read as double-blind. Ten studies were included in the study that were suitable for inclusion criteria and quality evaluation. Seven of the studies were conducted only in university students, while 3 were community-based. As a result of the analysis, 2399 of 8845 university students used waterpipe (31.0%; 95% CI: 27.3-34.7), while 356 of the 33,129 individuals used waterpipe (1.2%; 95% CI: 0.04-2.0) in community-based studies.

Conclusions

As a result of the comprehensive literature research, it was found that the studies on waterpipe use were less in literature and prevalence was higher than expected in university students.

Key messages

In university students, the use of waterpipe was more common than the community, and intervention studies about the use of waterpipe were needed. Waterpipe use and surveillance studies in the communities are important for taking preventive measures and monitoring health outcomes.
Geographic disparities in bladder cancer incidence among women in the department of Bouches-du-Rhône
Authors: Mantey K , Cortaredona S , Martin T , Daniel L , Clément C , Karsenty G , Pascal L
Published: November 2019

While the incidence of bladder cancer begins to decline in men it increases in women related to tobacco smoking. The study aimed to describe bladder cancer among women in the department of Bouches-du-Rhône and assess their spatial distribution in order to detect potential spatial clusters. Cancer incidence data were obtained from the departmental observatory of cancers REVELA13. The characteristics of the cases registered were compared to those describe at the national level. Age-standardized incidence ratios (SIRs) were calculated for each commune and bayesian smoothed risk estimate based on the Besag, York and Mollie model were computed for incidence mapping. The spatial scan statistic (SaTScan) was used to investigate local cluster. Spatial analyses were adjusted on various confounding factors as a French deprivation index, access to health-care services and population density.

During the period 2013-2016, 395 cases of bladder cancers were diagnosed in women. Departmental incidence was significantly higher (3.3 cases per 100.000 inhabitants) than the national incidence (2.3). Compared to men, bladder cancers among women were diagnosed at a more advanced stage of the disease (p < 0.01). SIRs geographical variations were related to access of care but none of the communes showed any significant excess of cases. However, one significant cluster including nine districts of the biggest city (Marseille) and one neighbouring commune (RR = 1.76) was detected in the south east of the department.

Spatial studies of bladder cancer in women rarely find over-incidence or clusters due to lack of power. However, this study has shown that geographical disparities exist in particular because of a lesser access to a specialist. Regarding the high prevalence of smoking among women in the south of France, practitioners need to think about bladder cancer in women with urinary signs.

Key messages

We identify for the first time a cluster of bladder cancers in women in France. Practitioners need to think about bladder cancers in women with urinary signs because this cancer will become a public health issue in the future.
Case-control study about exposure to BPA and DEHP and risk of endometriosis
Authors: Fiore M , Zuccarello P , Gulisano M , Monteleone M , Bonaccorso G , Oliveri Conti G , Copat C , Palumbo M , Ferrante M
Published: November 2019

Background

BPA and DEHP are endocrine disruptors. BPA-G and MEHP are their main metabolites. The main exposure route for human is the diet. Endometriosis is a pathology with uncertain etiopathogenesis, characterized by disturbances in sex hormones balance with a prevalence in women ranged from 1% to 7% in women aged 15-45 years.

Methods

A case-control study should highlight a possible relationship between exposure to DEHP and BPA and endometriosis. Patients (n = 40) with a surgical diagnosis of endometriosis will compose the group of cases; healthy women (n = 40) will compose the control group. Cases and controls will be studied by means of questionnaires and by means of urinary analysis of these endocrine disruptors concentration.

Results

BPA values ranged between 0.05-8.55 and 0.05-1.84 in cases and in controls, respectively; BPA-G values ranged between 0.05-16.1 and 0.05-7.38 in cases and in controls, respectively; total BPA values ranged between 0.05-3.26 and 0.05-3.51 in cases and in controls, respectively. DEHP values ranged between 13.63-57.78 and 16.66-61.93 in cases and in controls, respectively; MEHP values ranged between 1.74-6.16 and 4.26-14.16 in cases and in controls, respectively; total DEHP ranged between 15.27-63.93 and 21.72-72.73 in cases and in controls, respectively. A reverse correlation was found between endometriosis and phthalates, while a direct correlation was found between BPA and endometriosis.

Conclusions

The direct correlation between BPA and endometriosis suggests the decreasing the use of plasticizer in food packaging and the importance to implement interventions and strategy to minimize exposure. The reverse correlation between endometriosis and DEHP could be explained by the small size of sample and by the monitoring of urine that are representative of a short-time exposure.

Key messages

Improve epidemiological studies with analysis of alternative matrices that are more representative of long-time exposure. Implement interventions and strategy to minimize exposure to plasticizer.
Huge mortality fluctuations in working ages in Russia after 1991: is alcohol affordability in charge?
Authors: Gil A
Published: November 2019

Background

Mortality rates from various causes of death significantly fluctuated inRussia after1991,with especially profound amplitude observed in working age populations.This study was aimed to investigate association between affordability of alcohol(AA),pattern of alcohol drinking(PAT),and several selected mortality indicators in which large alcohol-attributable fractions were assumed.

Methods

Econometric estimation of AA was based on calculation of the ratio of index of real disposable income to vodka price index adjusted for consumer price index.PAT was defined as the index of proportion of strong alcohol beverages sold a year in retail.Spearman’s rho andKendall’s tau-b correlation coefficients were estimated to assess strengths of bivariate associations between AA,PAT and indices of all-cause mortality,of mortality from external causes(EC) and from diseases of circulatory system(CSDs)at working ages(M:16-59;F:16-54yrs)in a time-series analysis between1991 and2016.All indices were calculated with1991 taken as the reference year. All primary data were obtained from the Russian Federal StateStatistics Agency“RosStat”.

Results

All-cause mortality and mortality from CSDs in both males and females quite precisely repeated fluctuations of AA between 1991 and 2005(tau-b>0.600,p<0.050; rho>0.700,p<0.050). Same moderate to high strength associations were observed between mortality fromEC and AA for 1991-2003.The strongest moderate to high strength associations between PAT and all-cause,CSD and EC mortality were observed during the period after1995, when pattern of drinking began changing towards consumption of low alcohol content beverages, especially beer. PAT repeated fluctuations of AA between 1991 and 1999.

Conclusions

Our findings further support alcoholic hypothesis of huge mortality fluctuations in Russia during the period after 1991, suggesting that alcohol affordability had played the key role before 2005 and pattern of drinking influenced on mortality decline after 2005.

Key messages

Fluctuating affordability of alcohol was one of the major determinants of alcohol consumption, and, consequently, of fluctuations of alcohol-attributable mortality in Russia between 1991 and 2005. The ongoing from 1995 change of pattern of alcohol consumption from spirits to low alcohol content drinking likely significantly contributing to mortality decline observed in Russia after 2005.
Study of the factors associated with the delay of health consultation of victims of rape in Senegal
Authors: Leye M M M , Diongue M , Tal Dia A
Published: November 2019

Introduction

Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay of consultation of victims of rape at the level of health structures at the level of health facilities in Senegal.

Methodology

A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded during the period from 2006 to 2015. An exhaustive recruitment of all the files of the girls or women victims of rapes answering the criteria of inclusion has been made. The uni and multivariate analyzes were carried out respectively using the software Epi Info 2000 and R 2.2.9.

Results

At the end of the collection, 1,037 cases of rape were enlisted at the national level. The average consultation time at the health facility level was 14.6 days ± (37.9). The delay in consultation (> 24 hours) was noted in 38.6% of victims of rape. Victims of rape residing in the southern axes (ORaj = 4,31 [1,15-16,14]), north (ORaj = 4,22 [1,26-14,14]), major (ORaj = 1, 67 [1.04-2.68]), married (ORaj = 3.44 [1.58-7.5]) with pregnancy after the aggression (ORaj = 34.03 [15.47-74.85 ]) or an abortion (ORaj = 5.45 [1.04-24.47]) were more at risk of delaying consultation after rape.

Conclusions

The delay of consultation makes difficult the medical and judicial care of the victim of rape. Thus, it is important for health and judicial authorities to raise awareness about the harmful consequences of sexual violence and the therapeutic benefits and the reparation of the harm suffered by the victim in case of rape.

Key messages

Rape. Violence.
Benzodiazepine use and occupational injuries: a systematic review and meta-analysis
Authors: Riccò M , Bragazzi N L , Mezzoiuso A G , Balzarini F , Garbarino S
Published: November 2019

Objective

To investigate whether use of benzodiazepine is associated with increased risk of occupational injuries.

Methods

PubMed, Cochrane, Embase and CINAHL databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based.

Results

A total of 20 studies met inclusion criteria, 75% of them of low quality, involving 328,805 occupational injuries from 9 different countries, with an estimated prevalence of benzodiazepine positivity of 5.3% (95%CI 4.2-6.3), significantly greater in mining industries (15.7%, 95%CI 10.8-42.2), agriculture (11.1%, 2.3-19.8), and lower in commercial drivers (0.9%, 95%CI 0.1-2.4). Among the retrieved studies, 9 were based on laboratory analyses, 7 were questionnaire-based retrospective analyses, 5 were analyses of institutional databases. In 7 cases (all questionnaire bases), rather then benzodiazepine use, a proxy was reported (e.g. sedative, anxiolytics, etc). While no increased risk for occupational injuries was found among cross-sectional studies based on laboratory specimens (OR 0.59 95%CI 0.25-1.38; I2 63%), in questionnaire-based case control studies reporting the regular uptake of benzodiazepine was associated with higher risk for occupational injury (OR 2.11 95%CI 1.30-3.43, I2 55%).

Conclusions

These results suggest an elevated risk of occupational injuries among individuals who have reported chronic use of benzodiazepines, while no actually increased use was reported from specimens associated with the occupational injury. Even though benzodiazepines have the potential to increase injury rates among chronic users, it is reasonable to understand the underline disorders (e.g. sleep deprivation, anxiety, etc) rather than benzodiazepine use per se as the actual risk factors to be specifically addressed.

Key messages

Benzodiazepine use has the potential to increase the risk for occupational injuries, however evidence is conflicting. Underlying disorders causing the uptake of benzodiazepines rather than the drugs ’per se’ are apparently associated with increased risk for occupational injuries.
The role of civil society in child safety in Europe
Authors: Scholtes B , Schröder-Bäck P , Brand H
Published: November 2019

Introduction

The complexity of injury and the multi-sectoral nature of its prevention demands a whole-of-society approach. Engaging with civil society in a form of collaborative governance is central to this approach. Civil society, defined as neither state, nor market, nor family, includes organisations such as advocacy groups, charities, professional associations etc. This study looks at the role of civil society organisations in the implementation of child injury prevention interventions in Europe.

Methods

The method was built upon an existing approach, known as ’organigraphs’. Mintzberg and van der Heyden developed the approach to depict how organisations actually work. We further developed its practical application to explore how interventions in child safety are developed, implemented and monitored across the local, regional, national and EU levels. Professionals working in child safety in 25 European countries were asked to draw organigraphs for an intervention in one of four child injury domains: road, water, home safety or intentional injury prevention. The analysis focused on the action surrounding civil society actors, represented by the connectors leading to and from those actors.

Results

We received 44 organigraphs in total from 31 participants in 24 countries; nine for intentional injury prevention, nine for water safety, 12 for road safety and 14 for home safety. Civil society actors were present in the majority of Organigraphs and they played multiple and diverse roles including: ’advising’, ’funding’ and ’implementing’ child safety initiatives.

Conclusions

The role of civil society, described in this data set, appears to be relatively well-developed. Strong, functional and long-standing partnerships between civil society actors across policy sectors and government may lead to greater capacity to address the complexity of child injury.

Key messages

Effective child injury prevention requires multi-sectoral action to address its complexity. Stakeholders come from the public and private sector and from civil society. Greater engagement with civil society may represent an opportunity for countries and regions to improve their response to the challenges of injury prevention among children.
Optimising message framing to advance cancer prevention pricing interventions in the UK and US
Authors: Buckton C H , Ikegwuonu T , Lee J G L , Carey R , Cristello J V , Trucco E M , Golden S , Conway D I , Hilton S
Published: November 2019

Background

One-third of the burden of cancer is associated with four health harming behaviours - tobacco use, alcohol consumption, poor diet and physical inactivity. The growing evidence base supporting price-related policies to curb over consumption is of interest to governments globally. However, implementation requires public and policy-maker support. The aim of this study is to enhance our understanding of the features of message framing that influence public support for price-related policies in relation to tobacco, alcohol, and sugar.

Methods

We conducted 18 semi-structured interviews (9 UK and 9 USA) exploring knowledge, attitudes, and beliefs of 4 price policies in relation to tobacco, alcohol and sugar. Interviewees included cancer policy advocates, cancer survivors and members of the public. We used NVivo 12 to organise the data for inductive and deductive thematic analysis.

Results

Common supportive features included: (i) highlighting the health benefit (eg reduced cancer risk), arising from impact on purchasing behaviour; (ii) indirectly making the health harm associated with consumption clear. Common unsupportive features included: (i) policy effectiveness will depend on size of the financial penalty and consumer response; (ii) such policies are unfair on sensible consumers and potentially regressive. Interviewees were more supportive of price-related policies for products containing tobacco where they perceived a stronger association with cancer risk.

Conclusions

This study reveals important differences in levels of persuasiveness arising from the framing of messages to promote price-related policies. The results informed the identification of 4 frames to be tested in a multi-factorial quantitative study, currently under way. These frames can be characterised as: F1 - To reduce the financial strain on healthcare systems; F2 - For the protection of children; F3 - To reduce cancer risk; and F4 - To reduce the risk of other non-communicable diseases.

Key messages

Tailoring the framing of price-related policies in relation to the product they are applied to may increase public acceptability. This may in turn facilitate their implementation.
Feasability of a regional assessment of needs for palliative care
Authors: Thiriet L , Tahon M , Matz S
Published: November 2019

Objective

The coverage of need for palliative care is in the heart of national and local concerns. This feasibility study of an assessment of needs from SNDS data was done to check if this type of data permit to obtain a diagnosis of the management of the need and how measurement accuracy SNDS data used in the valuation model may be a decision-making tool.

Study design

In this observational descriptive and analytical retrospective cohort study, the use of palliative care was identified by a code “palliative care” when there was a contact while a sliding twelve-month period before death with an establishment of care in France.

Patients: Patients dead in 2014 residing in Hauts-de-France were included if causes of death were identical to a defined list of diseases.

Methods

Factors influences on palliative care access was analysed by logistic regression. Among other analyzes, survival was studied by cox model.

Results

In medicine obstetric surgery, 28,4% of the 37502 insured adults had palliative care. For the adults, palliative care access was multipied by a factor of 0.94 (p = 0.02798) when men, 0.78 (p = 0.00483) with AME or CMU, 0.97 (p < 2e-16) with age, 0.90 (p < 2e-16) with the increase of the deprivation index, 1,01 (p < 2e-16) with interventional act and instantaneous death rate was multiplied by a factor of 1,0035 (p < 2e-16) with the use of palliative care.

Conclusions

The estimation model of the need has probably induced a selection bias. The lack of code in primary care, the modality to be authorized to offer palliative care and the coding advocated by the health insurance have probably induced a ranking bias. Those results consistent with the literature have suggested that the SNDS was reliable for this type of assessment.

Key messages

Coverage of need for palliative care was identified. The SNDS (French Insurance Database) was reliable for this type of assessment.
Energy policy as a social determinant of Australian health equity
Authors: MacDougall C , Delany-Crowe T , Baum F , Fisher M , McGreevy M
Published: November 2019

Background

Intersectoral action on social determinants of health to reduce health inequities requires policy research beyond the usual social and human services. We ask how Australian energy policy affects health equity.

Methods

Document analysis and policy case studies on how goals, objectives and strategies of all Australian energy policies address equity.

Results

Energy policy affects health via risk from unreliable energy; difficult transitions to renewables; disproportionate effects on poorer people faced with high energy bills versus other basics; ecological degradation; cost pressures on businesses and governments; job losses and policy paralysis about renewable energy and climate change. Policy features subsidies for the disadvantaged; privatisation and artificial markets; differing geographical distribution of resources and high level political conflict about whether it can deliver on 3, or only 2, of the ’energy trilemma’ of reliability, affordability and ecological sustainability. Mining, industrial and political interests, powerful enough to orchestrate the downfall of Australian prime ministers, actively close policy links between health, climate change and energy. Bridging energy and health policy requires political support for market solutions involving renewables; community generation of renewable energy; solutions for rural and remote areas; and global treaties. Intergenerational equity is a strong policy lever.

Conclusions

Health in All Policies approaches can creatively engage with the language and concepts of energy policy via the daily conditions of living, inequity and climate change. When it is difficult to engage, researchers can connect with non-government organisations who bridge sectors through simultaneous advocacy for equitable health, climate and energy policies.

Key messages

Powerful interests burn bridges between health equity and energy policy. Local and global policy levers harmonising terminology differences build bridges between energy, climate change and health equity.
1st European Academy for Healthcare Leaders: high training on leadership to manage health systems
Authors: Villani L , Frisicale E M , Parente P , Cacciatore P , Carini E , Gentili A , Grossi A , Pezzullo A M , Favaretti C , Ricciardi W
Published: November 2019

Background

Nowadays having leadership skills is critical to manage healthcare systems. The World Health Organization Collaborating Centre on Health Policy, Governance and Leadership organized the 1st European Academy for Healthcare Leaders in Rome from 15th to 17th November 2018. Senior officials of the Ministries of Health of 16 Members Countries of the WHO European Region attended and actively participated to the event, led by experienced Italian and European experts. The Academy could be considered a moment of high training on leadership and governance of health systems.

Objectives

The event was aimed at creating effective networks among participants to share ideas and strategies to improve leadership skills, providing practical tools to be applied in healthcare systems and to develop a common and transferrable leadership framework in Europe. Frontal lectures and interactive workshops covered three main areas: leadership skills, current challenges of health systems and sustainability of health systems today.

Results

The 3-days event gave the opportunity to discuss the main issues in Public Health highlighting how to be an effective leader in healthcare. Leadership should enable the translation of knowledge into productive action pathways, providing health equity and improving population’s health. At the end of the event, participants filled a survey and the results showed high satisfaction about contents (100% out of 16 participants).

Conclusions

Health systems need to change in order to face the formidable challenges of our times. This event empowered the participants in order to support the creation of strategies and to develop leadership tools to apply at country level. The experiences, ideas and good practices shared during this event strengthened a collaborative network and have been useful to identify common goals and solutions.

Key messages

These kinds of events are fundamental to improve knowledge about leadership in healthcare. Leadership should have a major role to play in healthcare worldwide.
Personalized Care Plan for non dependent old persons decrease significantly caregivers’ burden
Authors: Arlotto S , Gentile S , Durand A C , Bonin Guillaume S
Published: November 2019

Objectives

Informal care provided by family caregivers in old persons is associated to a high risk of burden and poor health status. This study aimed to analyze the impact of a Personal Care Plan (PCP) attributed to non dependant old persons living in the community on caregiver burden, satisfaction and frailty.

Methods

This non interventional longitudinal study was performed in the south East area of in France: olds persons asking for a PCP (>70 years old, with no disability and no severe chronic disease, living at home) and their caregiver were included with a 6-months follow up. Dyads were visited at home by social workers. Caregivers Burden has been assessed with Mini-Zarit and frailty status with FiND (Frail Non-Disable).

Results

876 dyads (old persons: female 77.6%, aged 82.2 ± 5.8 years old; caregivers: 64.5% female, 29% spouse, 61% children; 64% with frailty and 38% with high burden; high burden being significantly associated with frailty) were eligible for a PCP. Among them, 564 PCP were financed, mainly: housekeeping and meal preparation. For those old persons who had PCP, near half of their caregiver decreased the time spent to these activities. With the PAP, 88% of the caregiver had a lower burden level, only 6% had a persistent high burden; 61,5% were totally satisfied. Frailty status was not modified.

Discussion

Our study highlight that the burden occurs also in non dependent old persons’s caregivers. Social support implementation for activity of daily living had a major impact on the burden but not on the caregiver frailty, which means that determinants of caregiver’s frailty are more complex and further studies are needed.

Key messages

Social support implementation for activity of daily living have a major impact on the burden; the burden occurs also in non dependent old persons’s caregivers. Personalized plan implemented to support activity of daily living improve caregiver burden even in non-dependent old persons.
Predictors of nursing-home entry for elders in Belgium
Authors: Berete F , Demarest S , Charafeddine R , Tafforeau J , Van Oyen H , Bruyère O , Van der Heyden J
Published: November 2019

Background

Due to the aging of the population the demand for long-term care services is expected to rise during the coming years. For a better planning of health care resources policy makers have to be aware of risk factors associated to nursing home entry (NHE). The present study aims to identify predictors of NHE in a representative sample of Belgian community dwelling older residents.

Methods

Date from the participants of the Belgian health interview survey (BHIS) 2013 aged 65 years and over were individually linked with longitudinal data from the Belgian compulsory health insurance data (BCHI) over a 5-year period (2012-2017). Institutionalized BHIS participants were excluded, resulting in a final database of 1,927 individuals. A multivariate Cox proportional hazards model was fit to estimate the hazard of NHE. The model examined the hazard of NHE over the follow-up period in function of predisposing, enabling and need variables observed at baseline. All analyses were done using SAS 9.3 taking into account the survey design settings.

Results

Over the follow-up period, 169 out of 1,927 individuals entered in NH (56% males, mean age =74.7±0.25). Significant predictors of NHE were older age (hazard ratio (HR) =2.40, CI = 1.23-4.67 and HR = 6.19, 95% CI = 2.75-13.92, respectively for 75-84 years and 85+ years compared to 65-74 years), living condition (HR = 4.28, 95% CI = 1.01-18.19 for living alone), severity of limitation in ADLs (HR = 2.61, 95% CI = 1.39-4.88 for moderate limitation and HR = 2.40, 95% CI = 1.10-5.26 for severe limitation, compared to those without limitation).

Conclusions

Apart from age and living condition, the ADLs limitations were the strongest predictors of NHE. Public health action to reduce NHE of older people should first of all focus on preventive action at middle age which will reduce activity limitations at later age.

Key messages

Risk profiles for NHE are highly dependent individuals. NH should be more specialized with qualified professionals.
Access to emergency care units by socially vulnerable patients: a qualitative research
Authors: Vieille M , Rotily M , Apostolidis T , Persico N , Galinier A
Published: November 2019

Background

The increasing prevalence of chronic diseases, the decline in medical demography, the ramp up of new information and diagnosis technologies, together with the growing health social inequalities urge decision makers to rethink the access to emergency care units (ECU) and reduce the rate of multiple admissions, especially for people living in vulnerable conditions. Beyond the medical causes of access to ECU, it is crucial to understand the psychosocial representations of patients and health professionals.

Methods

23 socially vulnerable patients who have already been admitted within the last 3 months and ECU health/social professionals were interviewed face-to-face by a psychosocial scientist using a semi-directed approach, in 3 hospitals. The thematic content of data was analyzed in order to identify salient social representations of access to ECU.

Results

27 themes emerged to understand the issue of the access to ECU, joining into 5 main categories: perceived needs for access to ECU, perception of precariousness, the relationship of patients and professionals with the healthcare system, the shared experience of aggressiveness in ECU, expectations in post-emergency support. As regards the needs for access to ICU, several issues were identified: exemption from making upfront payments, needs for listening, support, reinsurance, privacy and consideration of emergency professionals, referral by general practitioners (GP), difficult access to GP, needs for immediacy and timely healthcare services, permanent opening of ECU. As regards the experience of ECU professionals: ambivalent emotions towards socially vulnerable patients, a recurrence of passages leading to a reduced medical attention, a feeling of failure to care for vulnerable patients, coping strategies in caring for these patients.

Conclusions

Our results bring several leads to improve the organization and the management of healthcare in ECU and in primary care for socially vulnerable patients.

Key messages

To identify the psychosocial rationales of access to emergency care units provides several leads to build a more efficient healthcare policy and reduce the burden of overloaded services. To reduce the overburden of emergency services can only be achieved by a global approach of the access to both emergency and primary care and a better support after emergency discharge.
Effective elements of Dutch care-physical activity initiatives for low socioeconomic status adults
Authors: Mulderij L S , Wolters F , Wagemakers M A E , Verkooijen K T
Published: November 2019

Background

In care-physical activity (care-PA) initiatives, primary care and sports collaborate to stimulate PA among adults at risk of lifestyle related diseases. Preliminary results of Dutch care-PA initiatives for low socioeconomic status (SES) adults indicate that these initiatives successfully lower participants’ body weight and improve quality of life. However, insight into elements that make these initiatives work is lacking. Therefore, this research aims to unravel the effective elements of care-PA initiatives for low SES adults.

Methods

Concept Mapping (CM) was used as tool to identify and cluster the effective elements. Nineteen Dutch health promotion experts individually listed as many elements as they felt were of importance to the effectiveness of care-PA initiatives. Next, each expert was asked to cluster the elements and to score them on importance. Then, CS Global MAX software was used for multidimensional scaling and a hierarchical cluster analysis to develop a cluster map. Finally, the cluster map was presented, discussed, and refined in a group meeting with 11 of the experts.

Results

The experts came up with 113 unique effective elements of care-PA initiatives for low SES adults, clustered into 11 clusters: 1) approach of professionals, 2) barriers experienced during the programme, 3) local embedding, 4) customisation of the programme to target population, 5) social support, 6) methods within the programme, 7) competencies of professionals, 8) accessibility of the programme, 9) actions within the programme, 10) recruitment of participants, and 11) intersectoral collaboration.

Conclusions

A valuable overview of the effective elements of care-PA initiatives for low SES adults was created. The results can be used to improve existing care-PA initiatives and to develop new ones targeted at low SES adults at risk of lifestyle related diseases. This may eventually help to reduce health inequalities between low and high SES adults.

Key messages

Concept mapping has been a useful group-based tool to obtain information on the effective elements of care-PA initiatives, in which individual input from health promotion experts has been collected. The overview of effective elements of care-PA initiatives for low SES adults as presented in this study is valuable for the development of care-PA initiatives specifically targeted at low SES adults.
Understanding racism in Swedish healthcare
Authors: Hamed S H , Ahlberg Beth , Bradby Hannah , Thapar-Björket Suruchi
Published: November 2019

Background

Despite the removal of the term ’race’ from statutory documents in Sweden, after the Second World War, racism continues to exist in various institutions including healthcare. Racism can persist in the absence of a biological notion of ’race’ but becomes harder to explain when there is no official recognition. There is evidence of discrimination by patients and healthcare professionals, although fragmented and under-researched. As healthcare should be built on equity and solidarity, accounts of racism constitute a serious breach. Our research focuses on conceptualising racism in healthcare in Sweden to develop means of improving equity in care for populations characterised by migration-driven diversity.

Methods

Data from 28 qualitative interviews with both patients and healthcare professionals in Sweden was collected.

Results

Preliminary results indicate that patients from minority ethnic groups report that healthcare providers deem their symptoms as insignificant, due to their ethnicity. Consequently, they experience a loss of integrity and trust in healthcare, often leading them to avoid seeking healthcare. Healthcare professionals conceptualise racism in varied ways, ranging from denying racism, normalising and individualising racism to viewing racism as a structural problem. Patients did not report their experiences of racism, as racism was often subtle. Likewise, healthcare professionals mostly chose not to report their experiences for fear of being constructed as difficult colleagues.

Conclusions

The lack of space for discussing racism within healthcare constitutes a problem for healthcare professionals and patients and contributes to rendering experiences of racism invisible. This may be detrimental for achieving responsive healthcare and creates an unhealthy working environment for some healthcare professionals.

Key messages

Promoting a constructive dialogue on racism in healthcare. Aiding in developing anti-racist practices in healthcare.