bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of exclusive breastfeeding in Roma and non-Roma population in Serbia
Authors: Stamenković Ž , Bjegovic-Mikanovic V , Matejic B , Djikanovic B
Published: October 2020

Background

Exclusive breastfeeding is essential for early childhood development, although the use of adaptive milk formulas instead of breastfeeding is widespread nowadays. This study examined the prevalence of exclusively breastfed infants under the age of 6 months in non-Roma and Roma population and factors associated with this practice.

Material and Methods

This study is a secondary analysis of the Serbian Multiple Indicator Cluster Survey investigating non-Roma and Roma infants under the age of 6 months. The study included mothers of 321 non-Roma and 164 Roma infants younger than 6 months. Univariate and multivariate logistic regression served to analyze factors associated with the practice of exclusive breastfeeding.

Results

The prevalence of exclusive breastfeeding was almost the same among mothers in both non-Roma and Roma population (13.3% vs. 13%). Exclusive breastfeeding was significantly more often (p < 0.001) among wealthier women, multipara, and women who had not established menstrual cycle among both populations. Unexpectedly, in the non-Roma population, not staying in the same room with the newborn in the maternity ward increases the chance for the baby to be exclusively breastfed (OR 7.19, CI 95% 1.80-28.68). The same pattern has been observed in Roma population. Non-Roma mothers multipara are more likely to exclusively breastfeed their children than primipara (OR 7.78, CI 95% 1.09-20.93), while among Roma mothers, the inverse association has been found although not significant. Attending a childbirth preparation program more than 18 times increases the chances of infants being exclusively breastfed (OR 18.65, CI 95% 1.34-53.67). In the Roma population, there was no single woman that attended a childbirth preparation program.

Conclusions

The pattern of exclusive breastfeeding significantly differs between non-Roma and Roma populations. Preventive work should have a focus on strengthening support to mothers and medical staff in maternity wards.

Key messages

Understanding the predictors of exclusive breastfeeding can help in the process of creating health promotion programs that lead to more infants exclusively breastfed according to the WHO guidelines. Decision-makers and public health authorities should acknowledge the existing breastfeeding problems.
Risk for HIV acquisition among sub-Saharan African migrant travelers in Belgium and Portugal
Authors: Dias S , Loos J , Gama A , Simões D , Nöstlinger C
Published: October 2020

Migrants often travel back to the origin countries and to other European states after settling in the residence country. Mobility along with structural vulnerabilities may increase HIV acquisition risk. Knowledge on HIV risk exposure when traveling is limited, yet crucial to inform prevention. This study aims to explore risky sexual behaviors and assess HIV prevalence among sub-Saharan African migrants (SAMs) who travel, residing in two European cities.

Two cross-sectional biobehavioral surveys were conducted in Lisbon and Antwerp with a venue-based sample of 1508 SAMs. Descriptive and multivariable logistic regression analyses were performed to examine travel patterns and associated sexual risk behaviors.

Overall, 68.4% of participants had traveled to other countries after settling in the residence country; 41% had traveled back to Africa and within Europe, 25.2% only to Africa and 33.8% only to Europe. Among travelers who reported sexual encounters abroad (49.2%), condomless sex at last intercourse was high both abroad (62.5%) and in the host country (70.7%). Odds of condomless sex at the last sexual encounter in the host country were five times higher among those who also reported no condom use abroad [OR: 5.32; 95% CI: 2.98-9.25], controlling for gender, age, educational level, relationship status, survey country, partner type and origin, and number of sexual partners over the last year. Condomless sex was higher with a regular partner and with an African partner, both abroad (79.9% and 67.5%, respectively) and in the host country (81.3% and 74.6%, respectively). Among the 75 participants who tested HIV-positive (around 5%), more than half had travelled to other countries; of these, about half reported condomless sex with their last sexual partner abroad.

SAMs are a mobile population and are exposed to sexual HIV risk both while traveling and in host countries. Prevention interventions should address the complex interplay between migrants' mobility and HIV risk.

Key messages

Migrants often travel to their origin home countries and other destinations after having settled in host countries, and this mobility increases exposure to HIV risk. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants’ HIV risk related to their mobility.
Sodium intake in Italy from 2008 to 2019: results of the CUORE Project-Health Examination Surveys
Authors: Donfrancesco C , Lo Noce C , Russo O , Bellisario P , Galeone D , Vannucchi S , Giampaoli S , Galletti F , Palmieri L , Strazzullo P
Published: October 2020

Background

The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan 2014-2019, in collaboration with the Interdisciplinary Working group for Salt Reduction in Italy. To estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project.

Methods

Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from representative random samples of residents in all Italian Regions. A new survey was conducted in 2018-2019 involving random samples of residents in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the first seven regions examined in the 2018-2019 survey and the age range of 35-74 years.

Results

Within the 2008-2012 survey, mean level of sodium chloride per day in 642 men and 627 women were 10.6 g (10.3-11.0 g) and 8.0 g (7.7-8.3 g) respectively, whereas in the 2018-2019 survey the corresponding mean levels in 673 men and 709 women were 9.3 g (95% C.I.: 9.1-9.6 g) and 7.1 g (6.9-7.3 g), respectively. A sodium chloride intake level lower than the WHO recommended target of 5g/day (or 85 mmol/day) was detected in 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012 vs 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019.

Conclusions

These preliminary data show that the average habitual sodium intake in Italy is still higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of the WHO-NCD target.

Key messages

Habitual salt intake in the Italian general adult population is still higher than the recommended by the WHO. If confirmed, in the last ten years a reduction of habitual salt intake in Italian general adult population seems to be occurred.
Low-calorie-sweeteners in foods with front-of-package child-directed advertising in Brazil
Authors: Grilo M F , Ricardo C Z , Taillie L S , Martins A P B , Mais L A , Duran A C F L
Published: October 2020

Background

Low-calorie sweeteners (LCS) are currently found in ultra-processed foods, even in those with high content of sugar, without any front-of-package (FOP) information for LCS content. The aim was to assess the presence of LCS and the combination of LCS and added sugars in foods and beverages with FOP child-directed advertising in the Brazilian packaged food supply.

Methods

In this cross-sectional study, we used data from the nutrition facts panel (NFP) dataset that includes 11,434 unique foods and beverages collected in 2017 in the five largest food retailers in Brazil. We used information on the NFP and the list of ingredients to determine the presence of LCS and added sugars. A subsample of the packages had the available FOP advertising strategies classified using the INFORMAS methodology (n = 3,491). We estimated the prevalence of LCS and the combination of LCS and added sugar presence in the Brazilian food supply, and assessed the prevalence of foods and beverages with FOP child-directed advertising.

Results

Out of 3,491 products assessed, 8.9% of the products contained LCS, of which 12.9% were advertised towards children. Regarding the presence of LCS and added sugars, 7.3% of products presented that combination, with 14.6% of those having child-directed FOP advertising. The food groups with the highest prevalence of LCS were: sugary drinks (juices, nectars, fruit-flavored drinks, sodas and other beverages) (40.6%), breakfast cereals and granola bars (31.6%), and sweetened dairy products (23.5%). From those, 5.5%, 6.7% and 17.1%, accordingly, were advertised towards children.

Conclusions

In this sample, 9% of the foods contained LCS or a combination of LCS and added sugars. In products advertised towards children, we found higher rates of products with LCS and greater presence of LCS in beverages, breakfast cereals and granola bars with children-directed advertising.

Key messages

This study demonstrates that almost 9% of Brazilian packaged foods have LCS, and that 7% have both LCS and added sugars. In products advertised towards children, such rates were higher (13 - 15%). A clearer information on the front-of-package of foods and beverages regarding the presence of LCS in Brazil is necessary, particularly among those products advertised towards children.
Success of reformulation and health education in reducing sodium intakes across socioeconomic groups
Authors: Gressier M , Frost G , Sassi F
Published: October 2020

Background

The UK salt reduction programme started in 2005, consisting of education campaigns and a reformulation strategy. This programme is often cited as an example of a successful public health programme, and used as a model for other programmes. This study aims at assessing how the programme succeeded in reducing sodium intakes, and whether success was even across socioeconomic (SES) groups.

Methods

Food intakes for the UK adult population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (Y1) and 2016/17 (Y9). Year-specific sodium densities of foods were used to calculate the quantity-weighted average sodium density of all food and beverage consumed by the population. Using a decomposition approach (Griffith et al., Economica, 2017), changes in sodium density were attributed to either changes in food composition (change in sodium density), or changes in behaviour (type and quantity of food products consumed), stratifying by SES.

Results

The programme was linked to a 16% decrease in sodium intakes between Y1 and Y9, while sodium density decreased by 15%. This decrease was largely driven by reformulation (-12mg/100g), while changes in food choices had a smaller impact (-2mg/100g). This finding was consistent across SES groups, whether stratified by education or income, with no significant differences between SES groups in behavioural responses to the programme (changes in food choices).

Conclusions

Changing people's food environment, through reformulation to reduce the sodium density of foods, had a larger impact on sodium intakes in the UK population than efforts to change food choices, and produced consistent impacts across SES groups.

Key messages

Reformulation led to a consistent reduction of the sodium density of food consumed across SES. There was no evidence of adverse equity impact from changes in behaviour.
Information about organ donation: the perspective of people with limited health literacy
Authors: Rademakers J , Rolink M , Heijmans M
Published: October 2020

Background

In 2020, a new law on organ donation will come into force in the Netherlands. This law requires people to actively register their choice whether or not to be an organ donor after death. In this opt-out system, people who do not register themselves are automatically considered to be a donor. To inform the general public, the Dutch ministry of Health launched a communication campaign to inform the general audience. However, people with limited health literacy - 1 in three Dutch adults - have difficulties understanding health related information. Therefore, a study was performed to determine the appropriate information content and communication channels to better address the knowledge needs of this specific target group.

Methods

The study was done through (a) desk research and (b) 6 individual interviews and 4 focus groups with people with limited health literacy (total 30 people). The respondents were recruited through organisations that focus on specific populations with limited health literacy (limited reading and writing skills, minor intellectual disabilities, migrants).

Results

Most respondents had not heard about the new law on organ donation. Those who were aware of the law did not know what the law entails and what was required of them. The content of the information currently used were generally considered too difficult and abstract and did not give the respondents enough input on which to base a decision whether or not to be an organ donor. People with limited health literacy can mention specific topics on which they want information. Furthermore, they want practical help in registering their choice through the website. As information channels they prefer simple films and narratives of other people.

Conclusions

People with limited health literacy need more specific information on organ donation and what the new law entails. They have a preference for films and narratives. Furthermore, they need practical help in registering their choice.

Key messages

Current information on the new Dutch law on organ donation is too difficult and does not address the knowledge needs of people with limited health literacy. Films and narratives are preferred information channels of people with limited health literacy.
Evolution of Health literacy measurement tools
Authors: Corvo E , De Caro W
Published: October 2020

Introduction

This study aimed to provide a review of the tool characteristics and dimensions of health literacy measurement tools. Indeed, it is crucial to establish a clear correlation between what the tools detect and the definition of health literacy. The research question is therefore to what extent health literacy measurement tools are able to detect the ability and levels to make judgment and take decisions in everyday life concerning health.

Methods

A systematic review was conducted. PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases on Health literacy tools and instruments from 1990 through 2020. An environmental scan was conducted to identify other health literacy measurement tools. For each tool, researchers evaluated validation, items and conceptual dimensions, and psychometric properties.

Results

198 tools were identified, 96 measured general health literacy, 38 measuring comprehension, the others were aimed to assess health literacy for specific diseases or populations. Most tools are performance-based, require in-person administration, and are exclusively available in a pencil and paper testing mode. Reported administration times vary, from less than 1 to 30 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups.

Conclusions

The health literacy measurement tools currently available represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools are lacking key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. Furthermore, from a more practical point of view doubts emerged about the actual suitability of these tools in the day to day health care/promotion settings. Work is needed to develop more rapid and straightforward tools for practice.

Key messages

Measure health literacy save lives. Health literacy is a vital sign.
Forecasting emergency admissions in the city of Milan to predict overflow: a 2-day warning system
Authors: Murtas R , Decarli A , Russo A G
Published: October 2020

Background

The emergency department (ED) is one of the most critical area in any hospitals. In Italy, the mean waiting time is increasing causing potentially ED overflow and a detrimental effect on quality of care.

Methods

We collected total daily ED visits between 2014 and 2019 in the five major hospitals of Milan. To predict daily volumes, we used a regression model with ARIMA errors. Predictors included were weekly and yearly periodicity, meteorological and environmental variables, information on influenza epidemics and festivities. Parameters have been calibrated on training datasets (2014-2018) and successively validated on 2019, accuracy of prediction have been evaluated with the Mean Absolute Percentage Error (MAPE). Finally, we evaluated the impact of the COVID-19 outbreak calculating the proportion of ED accesses by triage levels, before and after the outbreak.

Results

Between 2014 and 2019 there have been 2 million of ED visits in the hospitals of Milan. We found different patterns of ED visits across age and days: children (0-14 years) tended to visit ED more likely on weekends while adults and senior people on Mondays. Results confirmed the role of meteorological and environmental variables, and the presence of yearly and weekly pattern. We found high correlation between observed and predicted value with a MAPE globally smaller than 8.1%. During the COVID-19 outbreak, the number of white triage ED accesses was reduced up to 71%.

Conclusions

Results permitted to develop a 2-day ED warning system combining forecast data provided by ARPA Lombardia. This is crucial in a system where inappropriate emergency admissions are still high where the analysis conducted during the COVID-19 pandemic period suggested a dramatic reduction in the number of daily ED access of lower triages.

Key messages

The ability to forecast future demands would be a valuable support in a system of limited resources, which must therefore be used in the best way. Environmental and meteorological variable have a moderate effect on emergency admissions.
Using Structural Equation Modelling to Untangle Pathways of Factors Associated with Type 2 Diabetes
Authors: Duan M , Dekker L H , Carrero J J , Navis G J
Published: October 2020

Background

Risk factors for type 2 diabetes (T2D) are multi-facet and interrelated. We aimed to apply structural equation modelling to examine and quantify pathways of modifiable risk factors related to incident type 2 diabetes.

Methods

Analysis was based on 68 649 participants (35-80 years, without diabetes at baseline) from the Lifelines cohort study. We proposed a conceptual model that illustrates the pathways of risk factors related to incident type 2 diabetes: socio-economic status (income and education) → lifestyle behaviors (diet quality, physical activity, TV watching, and smoking) → clinical markers (blood lipids and obesity status) → incident type 2 diabetes. Structural equation modeling was performed to test this proposed model.

Results

After a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified. The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (β: 0.213 ), followed by HDL-cholesterol (β: -0.141). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest direct effects on all lifestyle behaviors.

Conclusions

Using this innovative approach, our analysis provides a more nuanced assessment of the interplay of type 2 diabetes risk factors, compared to traditional risk estimates. Our results indicated that reducing large waist circumference may be prioritized as the main target for the prevention of type 2 diabetes, and lifestyle interventions are urgently warranted with additional support for those with a low education.

Key messages

Our study elucidated the multiple causal pathways to type 2 diabetes in a prospective setting. Our results identified the most critical targets for future prevention strategies for type 2 diabetes.
The effect of COPD on length of stay and in-hospital mortality of diabetic patients
Authors: Di Martino G , Di Giovanni P , Cedrone F , D'Addezio M , Masciarelli M , Meo F , Scampoli P , Staniscia T
Published: October 2020

Background

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. It is currently one of the leading cause of death worldwide. Metabolic syndrome has been recognized as one of the most relevant clinical comorbidities associated with COPD. Diabetes is more prevalent in COPD than in the general population, ranging between 10.1-23.0%. However, the link between COPD and diabetes is much less clear. The aim of this study was to investigate the effect of COPD on diabetic patients, focusing on length of stay and in-hospital mortality.

Methods

The study considered all hospital admissions of diabetic patients aged over 65 years performed between January 2006 and December 2015 in Abruzzo, a region of Italy. Data were collected from all hospital discharge records. A 1:1 propensity score-matching algorithm was used to match patients with and without COPD, according to their baseline characteristics. Logistic regression analysis was performed to evaluate the risk of in-hospital mortality and prolonged length of stay among diabetic patients with COPD.

Results

A total of 140,556 ?patients were included: 18,379 with COPD and 122,177 without COPD. After matching procedure, 36,758 patients were included into the analysis: 18,379 with COPD and 18,379 controls. After matching, all the baseline characteristics resulted well balanced, with a standardized mean difference less than 10% for all the variables considered. COPD patients showed a higher risk of in-hospital mortality (OR: 1.10; 95%CI 1.01-1.20; p = 0.036) and length of stay over 15 days (OR:1.18; 95%CI 1.06-1.31; p = 0.002).

Conclusions

In a cohort of Italian patients, diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD. Defining the causes of these differences would improve public health surveillance systems and policies.

Key messages

Diabetes is more prevalent in COPD than in the general population. Diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD.
Predicting difficult discharge from surgical wards: a cohort study in an Italian sample
Authors: Corradi A , Bert F , Corsi D , Kakaa O , Scarmozzino A , Siliquini R
Published: October 2020

Background

Poor discharge planning (DP) can increase costs for European hospitals and worsen patient's experience. Validated scores are used in internal medicine to identify clinical or social difficulties in discharges upon admission but there is a lack of such a tool in the surgical context. This study aims to detect early predictors of difficult discharge.

Methods

Socio-demographic and clinical data from 15,165 surgical Hospital Discharge Records (SDOs) of the Molinette hospital of Turin, including an additional pre-surgery evaluation of social vulnerabilites from a subgroup of 388 patients, were collected between 2017 and 2019. Outcomes were length of stay (LOS), discharge destination (home, Long Term Care - LTC). Descriptive analysis and multivariable regressions were performed.

Results

52.3% of patients were male and the median age was 61 (IQR 22). Median LOS was 6 days (IQR 6) but 15 (IQR 30) for patients discharged to LTC. 18.7% were admitted through the Emergency Department (ED) with a median LOS of 7 (IQR 10). 17.6% of the subsample declared living alone. Linear regression showed associations between discharge to LTC, admission through ED, diagnosis of neoplasia and a longer LOS (Bs 10.76, 5.21 and 2.57 respectively, p < 0.001). Logistic regression showed associations between admission by ED, age and discharge to LTC (OR 1.77 and 1.02 respectively, p < 0.001). Preliminary analysis of the subsample did not show any new association with social vulnerabilities, but 98.2% attended elective surgery and thus probably had time to prepare for discharge.

Conclusions

Surgery LOSs are extremely diversified among patients. This study identified several predictors of difficult discharge, mainly admission through ED, discharge to LTC and diagnosis of neoplasia, suggesting difficulties handling an unexpected event by patients' relatives. Further studies gathering patients' data at admission are required in order to develop a predictive tool useful for European hospitals.

Key messages

Clinical (cancer) and social (sudden event, no housing solutions) factors can determine a difficult discharge for European patients and should be investigated to anticipate discharge planning. Elective surgery patients seem less prone to social vulnerabilities (e.g. living alone), probably because relatives have time to prepare, while ED patients often need help in the discharge process.
Analysis of hospitalization trends for ambulatory care sensitive conditions in Piauí/Brazil, 2009-18
Authors: Sousa R , Silva F , Silva R , Santos R , Mouta J , Cardoso T , Cardoso O
Published: October 2020

Introduction

Hospitalizations for ambulatory care sensitive conditions (ACSC) are hospitalizations that can be potentially preventable through care at the first level of contact for health care. In fact, the actions offered in a timely and effective manner can reduce the risk of unnecessary hospitalizations by preventing diseases, controlling acute episodes and managing chronic diseases.

Aim

Analyze the trends in hospitalizations for ACSC in Piauí, Brazil, from 2009 to 2018.

Methods

Ecological time-series study based on data from the Hospital Information System (SIH) of the public health system (SUS), which comprised all hospitalizations of residents of Piauí, Brazil, in the period from 2009 to 2018. The explanatory variables were the hospitalizations for ACSC groups. For temporal trend analysis, the Prais-Winsten linear regression model was used in the Stata version 14 program.

Results

567,577 were recorded as ACSC, representing 35.3% of the total hospitalizations (1,608,263). Most hospitalizations for ACSC were caused by infectious gastroenteritis (33.5%). The risk of hospitalization for ACSC decreased 36.8%, showing a significant reduction in the trend of the hospitalization rate (Annual Percent Change - APC: -4.6%; 95%CI: -6.4; -2.8). There was a greater decrease in the risk of hospitalization for asthma (70.3%), hypertension (66.4%) and infectious gastroenteritis (61.8%). However, a significant increase was identified for skin infection (6.1 times) and diseases related to prenatal care and childbirth (3.2 times).

Conclusions

The reduction in hospitalizations due to ACSC is a result of the strengthening of Primary Health Care as the Brazilian health system organizer and the implementation of the Mais Médicos Program, which enabled the presence of doctors in family health teams, especially in places that had not previously been attended. It is also necessary to develop new studies to expand the discussions and debates on these findings.

Key messages

Hospitalizations reflect the living conditions of individuals, with social changes being perceived by changes in hospitalization patterns over time. The strengthening of primary care policies in Brazil was able to reduce hospitalizations for ACSC and it is necessary to further strengthen these practices to improve people's health care.
Public health competencies in global health education and demand of the global health labour market
Authors: Czabanowska K , Krasna H
Published: October 2020

Background

Many competencies frameworks exist worldwide and it is well known that competence-based education supports employability. However, little research exists regarding public health graduates' employment outcomes. This paper aims to stir the discussion about the expectations of the global health employment market and the competencies, which should be developed in graduates of public health programs with global orientation.

Methods

Material from in three different studies is used, including a systematic review of public health competency frameworks, scoping review of employment outcomes of students earning public health degrees, and analysis of 16 years' worth job postings with focus on competencies related to climate change.

Results

Employers currently value competencies, such as the knowledge of climate mitigation/adaptation, climate-health justice, direct/indirect and downstream effects of climate on health, health impact assessment, risk assessment, pollution-health consequences and causes, Geographic Information System (GIS) mapping, communication/writing, finance/economics, policy analysis, systems thinking, and interdisciplinarity.

Conclusions

The public health workforce needs to be equipped with the capabilities which trespass disciplines, professional silos and paradigms in order to be effective and able to address multiple challenges and global disruptions including climate change, as well as to lead through insecure contexts. More systematic research is needed on tracking the employment outcomes of the global health workforce, which may help to adapt public health competencies frameworks and education programs to the changing demands of the global health employment market.
Transnational collaboration for global health education: Romania as West-East hub
Authors: Ungureanu M , Paina L , Brînzac M G , Cherecheș R M
Published: October 2020

Background

Similar to many Eastern European countries, Romania has faced significant health professional outflow in the past decades. However, in the recent global context, this pattern is slightly changing and increasingly more complex. Although Romania is not yet experiencing significant inflows of already trained health professional, it has gradually become a preferred destination country for Western students pursuing a medical degree. Moreover, Romania has become attractive as a setting for students in high income countries with an interest in global health. The aim of this paper is to describe how Eastern European countries can provide global health training opportunities for Western students.

Methods

The paper describes a case study of global health education through a global health practicum program managed by the Department of Public Health at the Babeș-Bolyai University in Cluj-Napoca, Romania.

Results

The global health program is designed to provide a rich, hands-on practical approach to public health issues for students in health professions. The program has an internship format, with a minimum length of four weeks, organized as either a research project, medical shadowing, community practice, or rural health program. It builds on four key elements: customized placements in public health organisations; academic support and mentoring; instruction conducted in English; and additional cultural elements. For the past ten years, the program has included over 50 participants from the United States of America, UK and Denmark.

Conclusions

The program implemented by the Department of Public Health revealed the importance of a blended approach - academic-based, and practice-oriented - to providing global health training for health professionals. This approach is vital for preparing the future health workforce towards implementation of SDGs and could serve as a model for other collaborative initiatives.
Transdisciplinary action for global health: the cases of vaccine hesitancy and Ebola epidemic
Authors: Agartan T I , Atobra D
Published: October 2020

Background

The storm of increasing global disease burden and health threats calls for the combined utilisation of all disciplines to promote global health. In practice, natural sciences and clinical perspectives still dominate global health discussions and proposed solutions, with little room for effective collaborations with social sciences and humanities. The aim is to examine the extent of multidisciplinary collaborations in global health, identify and analyse the types of actors and disciplinary approaches employed, and the modes or patterns of multidisciplinarity. Vaccine hesitancy and refusal, and the Ebola epidemic of 2014-16 serve our analysis as two case studies of recent global health threats, that brought various global health actors together in diverse projects:

Methods

A literature review was conducted using the PubMed database and Google Scholar over a period of five years (2014-2019).

Results

The findings suggest that different social science and humanities disciplines were involved in solving global health threats at different stages and in various ways. We identified two types of collaboration: 1) Reactive collaborations where a team of health experts in the natural sciences turn to social sciences only because of challenges in implementing the project. 2) Interactive collaborations, that aim to involve social sciences in the early stages of research, development, and implementation of programs to understand and work effectively within the cultural and social contexts of communities affected by health emergencies. This type of interaction pays more attention to affected populations and the health workers, who are responsible for implementing the SDGs and global health interventions.

Conclusions

Disciplinary hierarchies are huge barriers to solving global challenges. A transdisciplinary framework has most potential to respond effectively to global health threats and action is needed to implement this approach in global health education.
Various vaccination policies: how to protect our children best!
Authors: Illy K
Published: October 2020

It is an interesting debate whether young (and incapacitated) children shouldn't be protected from the irresponsible behavior of their parents. In many European countries it is a legal obligation to use special seats when transporting a young child in a car. And if you don't, you will be fined. This measure exists in order to protect children from dangerous behavior of adults. In fact, it is hard to understand why we find it so difficult to apply the same attitude regarding parents who put their children deliberately at risk when not vaccinating their children. They not only put their own children at risk but also children who are too young or too vulnerable to be vaccinated.

The degree of vaccination differs largely between the European countries. In some countries we see a good and safe degree of vaccination, in other countries it's extremely low. In the latter situation, especially vulnerable children are at risk of contracting potentially lethal infections. As a result, there is a wide range of options that health care professionals, politicians and policymakers are discussing about.

In many European countries we see a lively discussion about the issue of mandatory vaccination. It is a political and often emotional debate. The question is: does mandatory vaccination help? And what exactly does it imply? In this presentation the advantages and disadvantages of the various mandatory policies will be discussed along with the question how changes in vaccine legislation may influence vaccine acceptance.
Cultural Concepts of Substance Use and Idioms of Distress in Male Syrian Refugees in Germany
Authors: Lindert J , Neuendorf U , Schaefer I
Published: October 2020

Background

The study of substance use disorder among communities affected by mass violence has not received equal attention as other health concerns. This has led to the majority of psychosocial interventions in post-conflict zones being unresponsive to substance use-related problems among refugees. This study focused on gaining an in-depth understanding of the lay discourses and cultural concepts around substance use among male Syrian refugees in Germany.

Methods

Purposive and convenience sampling strategies were used for the recruitment of participants. The interview schedule was piloted among experts prior to conducting fieldwork. Inclusion criteria were a recent arrival from Syria. The study utilized a qualitative methodology, consisting of semi-structured group interviews with a native-speaking professional translator. The interviews were audio-recorded, transcribed and analyzed using an inductive thematic approach.

Results

Participants were refugees aged between 18 - 60 years (n = 19). The narratives revealed three themes. Firstly, the characteristics of Syrian society featured particularly in the participants' narratives. Society's rejection of substance use, generally enforced through taboos (e.g. halal/haram) was described and placed in contrast to a more liberal German society. Easier access and an open attitude to drug use in Europe were seen as problematic by some. The social stigma attached to mental health issues was discussed in participant narratives. Stigma was interpreted as both a cause for the development of a disorder as well as an exacerbating factor. Family was perceived as a protective force against substance use and the development of disorders. Thirdly, substance use was understood as one strategy of coping with stress, experience of violence and displacement.

Conclusions

Substance use may be seen as both an expression and a product of social suffering caused by the experience of war and displacement.
Problem Management Plus (PM+) for Syrian refugees in the Netherlands
Authors: Sijbrandij M , de Graaff A , Cuijpers P , Kieft B
Published: October 2020

Background

Refugees are at considerable risk to develop common mental disorders and related somatic health symptoms. In order to meet the mental health needs of individuals affected by crisis worldwide, the World Health Organization has developed a set of transdiagnostic low-intensity psychological interventions. These interventions, including Problem Management Plus (PM+) and its variants, are delivered by trained non-professional counsellors under supervision of local clinicians. The EU H2020 STRENGTHS project evaluates the effectiveness of these interventions across refugee settings in Europe and the Middle East. This presentation will present the results of a pilot randomized controlled trial (RCT) on individual PM+ in the Netherlands.

Methods

Syrian refugees (N = 60) with elevated levels of psychological distress (10 item-Kessler Psychological Distress Scale >15) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 >16) were randomized into PM + (N=30)) or care-as-usual control (CAU; N = 30). The main outcomes were symptoms of depression and anxiety at 3 months. Secondary outcomes were functioning, symptoms of posttraumatic stress disorder, service utilisation and health costs.

Results

At 3 months follow-up, the PM+ group had significantly lower scores than control for depression (d=.52?) and anxiety (d=.48), symptoms of posttraumatic stress disorder (d=.66, p = .006?), functional impairment (d=.73, p = .009) and self-identified problems (d=.81, p = .005). PM+ potentially may be cost effective with an ICER of €5,047, (95% CI €0, €19773) per additional recovery achieved.

Conclusions

PM+ delivered by non-specialist peer-refugee helpers has the potential be effective in reducing depression, anxiety, improving functioning, and reducing health costs. Larger RCTs on the effects of PM+ are currently conducted within the EU STRENGTHS project.
Young refugees’ pathways in(to) education - teacher and student voices: opportunities and dilemmas
Authors: Eide K , Hauge H A
Published: October 2020

Background

The study's aim is to gain more knowledge about what may promote or inhibit young refugees' successful educational and psychosocial transitions in the early resettlement period. Experiences during resettlement can be crucial for young refugees' long-term education and mental health outcomes related to potentially traumatizing experiences before and during their flight, worries about family members and friends who still live in unstable conflict areas, and pre-migration/flight/post-migration stressors.

Methods

The study applied a qualitative, ethnographically oriented approach, based on semi-structured interviews and observations in five upper secondary schools in four municipalities in Norway. The researchers conducted interviews with 47 young refugees and 46 teachers and other school staff members.

Results

The findings on educational transitions are related to motivation and mastery, time spent on education, language related issues and teachers diversity competence. The psychosocial findings highlight the impact of refugee students' relationships on wellbeing and functioning in school and outside. Three central dilemmas can be drawn from the findings that school staff can encounter in their work to support young refugee: 1) Seeing the individual and group-level challenges, 2) sustaining motivation vs preparation for future demands, and 3) balancing educational and psychosocial demands.

Conclusions

The teachers experience dissonance from trying to combine loyalty to the educational system with establishing friendly relationships, being close strangers with students they see as having unrealistic aspirations. They guide them into choosing vocational education, leaving both the teachers and their students in a situation where they see few desirable outcomes of education during resettlement. The reasons for, and potential solutions to this problem can be seen in conjunction both with educational policies and with prevailing norms for student behaviour.
13.A. Workshop: Responding to COVID19 in Europe: a tale of five countries
Authors:   Organised by: EUPHA Infectious diseases control section Chair person: Aura Timen - Netherlands
Published: October 2020

Since emerging from a market in Wuhan China in December 2019, SARS-CoV-2, the pathogen causing COVID-19, has spread worldwide. On January 30th 2020 the World Health Organization declared the COVID19 outbreak a Public Health Emergency of International Concern, and declared it a pandemic on March 11th 2020. With over 2.4 million cases and 180,000 deaths reported by mid-June, Europe has been the second most affected region in the world. Individual countries such as Italy and the UK have been amongst the hardest hit in the world. However, the COVID19 situation in Europe is marked by wide variations both in terms of how countries have been affected, and in terms of how they have responded.

The proposed workshop will provide compare and contrast the situation and response in five countries in the European region: The UK, Italy, Poland, Portugal and Sweden, moderated by a firm and charismatic chair. This interactive workshop will enable better understanding of the disease's spread and trajectory in different EU countries. International comparisons will help to describe the growth and scale of the pandemic in the selected EU countries. The choice of countries reflects those that have reported high and low incidence and mortality, as well as represent a range in the strictness of the control measures implemented, from full lockdown to the most permissive. The session will go beyond describing those and will be an opportunity to discuss the pros and cons of these different approaches and lessons learnt around the different components of the response such as case identification, contact tracing, testing, social distancing, mask use, health communication and inequalities. We plan to have short and effective 5 min presentations followed by a longer and constructively provocative moderated discussion.

Importantly, the five European case studies will offer ground to discuss the public health principles behind outbreak management preparedness and balancing public health with other imperatives such as economic ones, but also social frustration. The audience will be engaged through a Q&A session.

Key messages

The approach to managing the COVID19 outbreak has varied among European countries, and the optimal approach is likely to be context specific. The effect of the pandemic will be long term and public health imperatives must take population attitudes and behavior as well as economic and indirect health effects into account.
13.E. Workshop: How to improve the uptake of best practices?
Authors:   Organised by: BZgA (Germany), Santé Publique France, RIVM (Netherlands), EuroHealthNet,   Chair persons: Yvette Shajanian Zarneh - Germany, Anne-Catherine Viso - France
Published: October 2020

Background

Several countries have a health promotion and disease prevention programme register (also known as good/best practice portal), designed with the aim of supporting policy and practice with evidence-based information. While some of the programme registers have been in use for many years (USA, the Netherlands, Germany, etc.), others have been established recently (France) or are even under development (Slovenia). Though there are differences in terms of categorising good/best practice, all prevention programme registers have many things in common, for instance submission and review processes. Another similarity lies in the common challenges by all programme registers, which relate to the question: “How to improve the uptake of good/best practices?”. Finding answers to this question might contribute to one of the major Public health challenges of today: The translation of evidence into practice.

Objective

The organisers of the workshop will present different strategies and approaches to improve the uptake of the prevention programme registers, and discuss the successes and challenges of different strategies with workshop participants, as experience shows that more is needed than just offering the prevention programme registers. Today we know that a range of framework conditions must be in place to ensure a supportive environment for the use of the portals. This starts with needs analysis, support in the selection of the most appropriate good/best practices and their transferability and goes as far as capacity building, incentivisation and fostering feedback on adaptations.

In detail, the presentations will address: How to build capacity to best use good/best practice (by Netherlands); Whether and how a more comprehensive approach offering instruments for needs assessment, general information and good/best practice in one portal might facilitate uptake (by Germany); and Dissemination strategies: experience and lessons learned (by France) and the added value of European collaboration to improve the uptake of best practices and create a “centre of excellence” for health promotion portals in Europe with the objective to: discuss which framework conditions are most relevant to improve uptake of good/best practicesdiscuss successes and challenges of different strategies.

Key messages

This workshop will give participants insight into most relevant approaches and infrastructures to improve uptake of good/best practices. It will discuss which different strategies followed by several countries might be successful.