bluuebunny/crossref_metadata_2025 huggingface dataset:
The European Schools of Public Health: From theory to practice - two sides of a broken coin
Authors: Bjegovic-Mikanovic V
Published: October 2020

Introduction

Disease prevention and health promotion are closely related through the lifestyle concept and should be part of the postgraduate curriculum of every School of Public Health (SPH) in the European Region and beyond, especially concerning the modifiable behaviors of physical activity and healthy nutrition.

Methods

The Association of Schools of Public Health in the European Region (ASPHER) executed 2 surveys on the activities of its members between 2011 and 2015/16. A group of 48 SPH responded in both surveys. The performance of graduates was measured by a Likert scale of 1-5, applied to the 10 Essential Public Health Operations (EPHOs). Furthermore, we determined the delay in full implementation for the target year 2030. The target to offer both modules in 2030 has been set at 100% of all SPHs.

Results

For disease prevention as for health promotion, the 2nd Survey in 2015/16 shows slightly less positive results offering these two modules (72.9 vs. 77.1 and 81.3 v. 87.5%) as compared to the 1st Survey in 2011. The only exception is the use of social media which - as a method of teaching and training - increased for disease prevention from 20.8 to 37.5% of all SPH and for health promotion from 22.9 to 39.6%. Referring to the set target of 100% for running these two modules, considerable delays between 4 and 13.5 years accumulate for the target year 2030.

Conclusions

Except for the use of social media, progress towards 2030 is slow or even negative. Serious efforts have to be made by ASPHER to reverse this lack of progress.
Mapping the future of health promotion
Authors: De Leeuw E
Published: October 2020

The Ottawa Charter for Health Promotion was launched in 1986, and ten global conferences later its key calls to action have never been more poignant. To see health as a resource for everyday life in settings where people live, love, work and play, and recognizing equity and the social determinants of health as core to the success of healthy societies remains important. In the nearly 35 years since the Charter was published, we have seen a proliferation of health promotion research with ever greater insights in what drive the health and well-being of populations. Yet, at the same time we also witness a strong tendency to ground health (care) policy in biomedical and clinical evidence alone, and attribute health potential to lifestyle alone, rather than adopting a systems and social perspective of where health is created, grown, and celebrated. The causes for these diverging perspectives are complex, and are grounded in complexity. Humans and their socio-political systems, including the educational and political machines, tend to suffer from what the political scientist Charles Lindblom reputedly identified as the “Big Problem, Small Brain vs Small Problem Big Brain” phenomenon: researchers and intellectual are really good at pouring great volumes of thought and creative power into studying clearly defined issues, whereas politicians and bureaucrats face enormous problems and can get their heads around the multi-faceted solutions that need to be put in place. So - how do we make the complex palatable to the small brain? In this case - how can higher education systems be turned around to truly address the challenges of our and our children's time? The solution partially lies in the deployment of multiple network analyses of key stakeholders and the language they use to construct future realities: unless we have a clear map of the present and a much wider terrain before us to enter we will forever find it hard to navigate in the environmental and conflict dimension.
Preconception care from a public health perspective
Authors: Steel A
Published: October 2020

Public health researchers and practitioners are committed to developing, implementing and supporting initiatives that improve the health of the population. This presentation will provide an overview of the alignment between public health and preconception health. It will also overview ideas, theories and models that are central to the contemporary understanding of preconception health, such as epigenetics, the diverse preconception health behaviours and exposures that impact on outcomes, and the known barriers affecting the delivery of preconception care services. The presentation will draw on the principles of health promotion, health services research and epidemiology to provide a high-level understanding of the levers underpinning effective preconception health interventions at a policy, health services and grass-roots level.
Designing family-centred preconception services
Authors: Hall J
Published: October 2020

In order to support women and their partners to improve their health before pregnancy, we need to be able to identify who is likely to become pregnant within a given timeframe so that interventions can be targeted accordingly. There is no agreed, predictive tool currently available to do this. This presentation will describe the different ways of conceptualising the preconception population and how these populations can be identified to inform intervention delivery and development. We will overview what is known about the preferences of women and men with regards to preconception health services, with a particular focus on digital innovations, and will discuss how the effectiveness of preconception health interventions can be evaluated to contribute to the evidence base.
Health status and regularity of preventive activities among working population in Bulgaria
Authors: Georgieva S , Kamburova M , Stefanova P , Tsanova D
Published: October 2020

Background

Prevention is an important instrument for public health improvement and maintaining workability of active age people. National Health Insurance Fund of Bulgaria (NHIF) finances an annual regular check-up for people over 18 years of age. In addition, working people have access to preventive activities at their workplace. The aim of the study is to explore an actual regularity of preventive activities at active population in Bulgaria.

Materials and Methods

Data were collected by documents review and direct individual self-administered questionnaire, within a larger research project on health of active population in Bulgaria. It includes 326 employees in a study representing different branches, companies and professions. The questionnaire consists of questions about: a) distribution of risk factors, b) knowledge and attitude to prevention as a tool for better health c) types and regularity of preventive activities. Data processing was performed by SPSS v.24.

Results

Three of four respondents have been diagnosed with chronic disease, 49.4% of them suffer from more than one disease. One third of observed people take more than one medicine. Despite NHIF offers free of charge and obligatory annual check-ups, only 46% of study subjects have undergone a preventive examination within the last year, 49.7% - between 2 and 5 years and 4.3% have done so more than 5 years ago or never, which decrease the effectiveness of preventive measures. Visiting regular check-ups is significantly lower for younger age groups (below 44 years; p < 0.05). Relatively large part of people measured blood pressure (88.5%), blood glucose (67%) and blood cholesterol (51.5%) during the last year in relation to any symptoms, but not within the regular check-up.

Conclusions

Study results confirm the current tendency for low coverage of annual check-ups of working population in Bulgaria. Potential of preventive activities is not rationally used because recommended regularity is not observed.

Key messages

Phenomena as polymorbidity and polypragmasia are widely distributed in Bulgarian active population. Potential of preventive activities is not fully used because recommended regularity is not observed. Despite Bulgarian NHIF finances obligatory annual check-up for people aged over 18 years, most people become subjects of medical examination in case of disease symptoms, rather than regular check-ups.
Midwifery leadership, advocacy and action to improve maternal health in PNG
Authors: Hall H , Kep J , Brown J , Pyakalyia J , King R , Mahmood A , Sitaing M
Published: October 2020

Background

The SDG target for maternal mortality is less than 70 per 100,000 live births; in Papua New Guinea, it is estimated to be 145. PNG will require significant resources and strong leadership to meet the 2030 target. The PNG Midwifery Leadership Buddy Program (Buddy Program), funded and coordinated by Rotary, offers an innovative model to improve maternal health, which may be transferable to other low-middle-income countries.

Objectives

The Buddy Program aims to build midwifery leadership resulting in improved outcomes in PNG. As partners, midwives from PNG and Australia undertake leadership training in Port Moresby and enter a reciprocal peer support relationship. Over 12 months, they support each other in their professional roles and progress a quality improvement project.

Results

Three cohorts of midwives (18 from each country), have participated in the leadership training and the first group has completed 12 months of peer support. Participants have reported increased confidence for leadership, action and advocacy. There has been some communication challenges and variation in expectations, predominately due to cultural differences. The Buddy Program has resulted in a number of tangible projects including the introduction of family planning education at a local school and University, introduction of respectful care in pregnancy charter and increased surveillance and treatment of pregnant women with anaemia. Interestingly, a number of participants have continued to support each other beyond the initial 12-month commitment.

Conclusions

Supportive partnerships that grow midwifery leadership hold significant potential to increase the quality of maternity care and reduce preventable maternal deaths in low-middle-income countries.

Key messages

Midwifery leadership plays a vital role in addressing the SDG targets for maternal health. The Buddy Program offers an innovative model to progress the agenda for universal access to quality maternity care.
The use of geospatial tools to study the evolution of TB incidence in North Portugal between 2008-18
Authors: Moreira de Sousa A , Gomes M , Capucho R , Carvalho C
Published: October 2020

Background

Tuberculosis continues to be a significant global health problem. Portugal isn't an exception to this health problem, being considered by the ECDC a high incidence country. According to the SDG target 3.3, the world must end the epidemics of tuberculosis by 2030. However, several parishes in Portugal continue to observe extremely high values of TB, taking into account the WHO goal for pre-elimination of 10 TB cases per million people.

Methods

A cross-sectional study was conducted with data from the Surveillance System of the National Program against Tuberculosis. Descriptive and regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. The geospatial analysis was carried out with ArcMap 10.7.1 using a five-year average of TB incidence. Animations and videos were made with Microsoft Office365 PowerPoint v2002.

Results

In the period 2008-2012, 55,7% of parishes had registered cases of tuberculosis. That value decreased to 50,6% parishes in the period 2014-2018. For the period of 2014-18, 30,3% of parishes had a five-year average incidence above 20/100.000 people (value defined as high-incidence by the ECDC) and 45,0% parishes an incidence above 10/100.000 people. With ArcMap HotSpot analysis was possible to observe the existence of a significant cluster of TB in the southwest of North Portugal. With animation analysis, it was also possible to see the global spatial reduction of TB cases between 2008 and 2018, and the ongoing problem of a high incidence of TB in specific regions of North Portugal.

Conclusions

TB continues to be a significant health problem in North Portugal. The spatial analysis pointed to a specific area of North Portugal that needs priority action. Videos produced by the Department of Public Health may guide health professionals and policymakers for future strategies to be implemented to reach SDG3.

Key messages

The importance of desegregated spatial data for TB elimination. The elimination efforts must be scaled up in specific areas to achieve SDG3.
National immunization policies and practices for migrants in EU/EEA countries
Authors: Marchetti G , Giambi C , Del Manso M , Ranghiasci A , Nacca G , Dente M G , Marceca M , Adel Ali K , Declich S
Published: October 2020

Background

Migrants represent a potential vulnerable group and adequate health protection, including vaccine preventable diseases prevention, should be ensured. The aim of this survey was to map national immunization policies and practices targeting asylum seekers, refugees and irregular migrants in EU/EEA countries.

Methods

A web-based cross-sectional survey was conducted in 28 EU and 2 EEA countries within the ECDC funded Vaccine European New Integrated Collaboration Effort (VENICE) Project in the period January-April 2018.

Results

All countries but one completed the survey and 28 countries offer vaccination to migrants. A national regulation/legal framework supporting migrant immunization is available in most countries. This is specifically established for migrants' health services for 5, part of the National Immunization Programme (NIP) for 15 and both for 3 countries. All the vaccinations included in the NIP appropriate for age are offered to children/adolescents in 27 countries and to adults in 13. In 15 countries offering only certain vaccinations to adults, priority is given to DT, MMR and polio. Vaccinations are mainly given at holding/community level and only 5 countries vaccinate at entry level. A vaccination card is delivered in 23/28 countries to children/adolescents and 24/28 to adults. Recording of individual data vary highly: for children/adolescents and adults, respectively, 15 and 12 countries use an electronic database, 5 and 4 use only paper registry, 2 and 3 use both electronic and paper registries, while 6 and 9 countries do not record information at all. Individual and aggregated data are not made available from the sites where vaccinations are delivered to other local or national institutions in 13 and 15 countries.

Conclusions

Although policies about immunization of migrants are available in most of EU/EEA countries, there are important differences as to their objectives and implementation, especially methods of recording and transmitting data.

Key messages

Given the survey results and the migrants’ mobility, it is important to share data within and across countries to better respond to migrants' immunization needs. Strengthening partnerships between countries of origin, transit and destination, and sharing documentation may ensure the completion of vaccination series and avoid unnecessary revaccinations.
Preparedness and response in Portuguese emergency plans - Interaction with public health
Authors: Leiras G , Martins A
Published: October 2020

Background

Articulation between Civil Protection and Public Health authorities is of paramount importance to control, reduce and prevent threats to the health of the population in situations of crisis or catastrophes. National Civil Protection Authority produces Emergency Plans which describe the role of every stakeholder in emergency situations. Role and importance of Public Health and Public Health Authorities is not always present or well described and known amongst stakeholders.

Methods

Data was collected from all Districtal Emergency Plans (n = 18). Each document was analysed considering time frame, refences to Public Health and Health Authorities, definition of roles, communication channels, coordination and inclusion of intersectoral communication flow. Quantitative analysis included absolute and relative frequencies and qualitative analysis to all parts related to the terms “Public Health” and “Health Authority”. Each document was reviewed by 2 independent researchers.

Results

From 18 Districtal Emergency Plans (DEP) analysed, 94,4% (n = 17) had references to Public Health, but none referred the role of Public Health Officers. Only 16,7% referred to Health Authorities, although 94,4% mentioned the law 135/2013, defining the role and attributes of Health Authority. In 72,2%, coordination of Public Health Measures was attributed to the National Medical Emergency Institute. Epidemiological surveillance and Public Health Emergencies were referred in 55,6%, and attributed to the Regional Administration of Health.

Conclusions

Public Health Authorities and Public Health Medical Officers role in articulation with National Civil Protection Authority in emergency situations lacks severely, with this role being replaced by other entities. This is of great concern regarding management and control of diseases, particularly communicable diseases.

Key messages

Public Health Authorities lack the necessary involvement in Emergency Plans and emergency situations. Public health measures are coordinated by other entities rather than Public Health Authorities.
Food Waste reduction: a proposal from ATS Val Padana (Italy)
Authors: Troiano G , Servegnini M , Cirrincione M L , Frittoli E , Firmi A M , Clasadonte V
Published: October 2020

Background

It is currently estimated that 1.3 billion tons of food are wasted in the world and that 14% of total waste comes from collective catering. Specifically, the percentages waste in school catering are highly variable, ranging from 11.9% to 27.5%. In order to deepen the phenomenon, ATS Val Padana has started a project in some middle schools in the areas of its competence.

Objectives

The project, started in 2016, was composed by 6 phases: 1) Nutritional inspection in schools to evaluate the waste; 2) Administering of a questionnaire to the students to evaluate the eating habits and opinions about the offered menu; 3) Selection of a pilot school; 4) Implementation of a new menu built on the basis of students' preferences; 5) Organization of 2-hour educational meetings for each class of the pilot school to educate students; 6) Nutritional inspection after menu modification and meetings.

Results

7 schools were examined; 1335 students involved (of which 49.3% females). The total waste was on average 36%, with higher peaks related to the side dish (66%) and fruit (39%); the first dish remains the most popular dish with a waste of 14%. The school with the highest number of students enrolled in the canteen (152) was selected for menu modification and meetings. After about 3 months it was observed: a 11% reduction of the total waste. There was a statistically significant reduction in relation to the gap for the first and the side dish. For the second dish there was a 7% increase in waste.

Conclusions

The overall reduction of waste shows that targeted actions on menus, built on the basis of student preferences, can be an effective tool to reduce the food waste.

Key messages

An important percentage of waste comes from collective catering or from school catering. Menus, built on the basis of student preferences, can be an effective tool to reduce the food waste.
Relation between cognitive disorders and type of physical activity: Results of the FréLE cohort
Authors: Dupré C , Barth N , El Moutawakkil A , Béland F , Roche F , Bongue B
Published: October 2020

Background

Few previous cohorts have studied the different type of physical activities and the degree of cognitive decline. The objective of this work was to analyze the leisure, domestic and professional activities with mild and moderate cognitive disorders in older people living in community.

Methods

The study used data from the longitudinal and observational study, FrèLE (FRagility: Longitudinal Study of Expressions). The collected data included: socio-demographic variables, lifestyle, and health status (frailty, comorbidities, cognitive status, depression). Cognitive decline was assessed by using: MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment). MoCA was used with two cut-offs (26 and 17) so as to define mild and moderate cognitive disorders Physical activity was assessed by the PASE (Physical Activity Scale for the Elderly), structured in three sections: leisure, domestic and professional activities. Spline and proportional hazards regression models (Cox) were used to estimate the risk of cognitive disorders.

Results

At baseline, 1623 participants were included and the prevalence of cognitive disorders was 6.9% (MMSE) and 7.2% (MoCA), mild cognitive disorders was 71.3%. The mean age was 77 years, and 52% of the participants were women. After a 2 years long follow-up, we found 6.9% (MMSE) and 6% (MoCA) cognitive disorders on participants. Analyses showed that domestic activities were associated to cognitive decline (HR = 0.52 [0.28-0.94] for MMSE and HR = 0.48 [0.28-0.80] for MoCA). No association were found with leisure and professional activities, and no spline were significant with mild cognitive disorders.

Conclusions

Analysis showed a relationship between cognitive disorders and type of physical activity, thanks to the use of specific questionnaire of elderly and two global test of cognition. These findings will contribute to the debate on the beneficial effects of physical activity on cognition.

Key messages

This work allowed to compare two test of cognition and their link with physical activity. It contributes to the debate on the beneficial effects of physical activity on cognition. The work allowed us to see the effect of the different types of physical activity and the impact of the statistical method on the results.
Aerobic or strength training and flexibility activities and mild cognitive impairment: CETI cohort
Authors: Dupré C , Bongue B , Fruteau de Laclos L , Blais J , Sirois M-J
Published: October 2020

Background

Previous studies have been notably criticized for not studying the different types of physical activity. The objective of this work was to examine the association between types of physical activity and cognitive decline in older people.

Methods

This is a sub-group analysis from the CETI cohort, a multicenter prospective study conducted by the Canadian Emergency Team Initiative Program (CETIE), between 2011 and 2016. Participants were community-dwelling seniors aged ≥ 65 years, consult emergency services for minor injuries with follow-up at 3 and 6 months. Physical activity was assessed by the RAPA (Rapid assessment of Physical activity), which describes the level of aerobic activities and the overall level of muscle strength and flexibility activities. The cognitive status was assessed with the Montreal Cognitive Assessment (MoCA) and the Telephone Interview for Cognitive Status (TICS), using their current cut-offs (MoCA <26/30 and TICS < = 35/50) for mild cognitive impairments (MCI). Logistic regression, COX models and splines were used to examine the association between the type of physical activities and the onset of cognitive impairment.

Results

At inclusion, 281 individuals were free of MCI, or 43.8% of the total sample, with an average age of 73 years. During follow-ups, MCI appeared in 31.7% of participants initially free of it. The risk of MCI was lower with higher muscular strength & flexibility physical activities (HR = 0.84 [0.70-0.99]), while the relationship with aerobic physical activities was not significant.

Conclusions

These results showed a potential link between strength & flexibility activities and cognitive impairments, but not with aerobic physical activities. Further analyses are needed to examine whether these relationships persist as a function of the adjustment variables, or statistical methods. This study contributes to the debate on the evaluation of physical activity in the elderly, and its link with neurodegenerative diseases.

Key messages

This study analyzed the link between types of physical activity and mild cognitive disorders. The aim is to put in place preventive policies of aging, specially in neurodegenerative diseases. The work allowed us to see the effect of the different types of physical activity and the impact of the statistical method on the results.
Does early identification of work-related stress in primary health care effect pharmacy dispensing?
Authors: Bjerkeli P , Skoglund I M , Holmgren K
Published: October 2020

Background

The study is part of a randomised controlled trial with the overall aim to evaluate if use of the Work Stress Questionnaire (WSQ), combined with feedback at consultation, can be used by healthcare professionals in primary health care to prevent sickness absence. The specific aim of the present study was to investigate whether there were differences in pharmacy dispensing of prescription medications between the intervention group and the control group.

Methods

The study was a randomized controlled trial. Non-sick-listed employed women and men, aged 18 to 64 years, seeking care at primary health care were eligible participants. The intervention included general practitionerś (GP) training to use the WSQ, early identification of patientś work-related stress by the WSQ, and GPś feedback on the WSQ results during the consultation. Pharmacy dispensing data from the Swedish Prescription Drug Register for 12 months following the intervention were analysed using Mann Whitney U tests and chi-square tests. Primary outcomes were the number of different medications used, type of medication and number of prescribing clinics.

Results

The study population included 271 individuals (132 in the intervention group and 139 in the control group). The proportion of individuals who collected more than 10 different medications was higher in the control group than in the intervention group (15.8% versus 4.5%, p = 0.002). In addition, the proportion of individuals filling prescriptions issued from more than three different clinics was higher in the control group than in the intervention group (17.3% versus 6.8%, p = 0.007). The number of different medications used per individual did not differ significantly between the control group (median 4.0) and the intervention group (median 4.0, p-value 0.076).

Conclusions

Systematic use of the WSQ combined with training of GPs and feedback at consultation may affect certain aspects of pharmacological treatment in primary health care patients.

Key messages

Systematic use of the WSQ combined with training of GPs and feedback at consultation may affect certain aspects of pharmacological treatment in primary health care patients. Patients in the intervention group had less polypharmacy and filled prescriptions issued from a smaller number of different clinics than controls.
Prolonged family separation is associated with increased risk of mental disorders among refugee fathers
Authors: Hvidtfeldt C , Petersen J H , Norredam M
Published: October 2020

Background

Refugees resettled in Western countries experience long periods of family separation due to waiting first for asylum, and then for family reunification. This study aimed to examine if family separation is associated with psychiatric disease among refugee fathers.

Methods

We traversed full-population Danish administrative data since 1986 to establish a cohort of refugee fathers from nuclear families in which the father was the first to arrive and resettled alone during 1995-2015, and where the mother and children were later family reunified. We followed these fathers for up to 24 years from the day their residence permit was issued until their first psychiatric diagnosis, emigration, death, or study end, whichever came first. Using Cox proportional hazard regression, we estimated the temporary and longer-term risks of psychiatric disorders for i) the total family separation period, and ii) the family separation decomposed into time waiting for, respectively, asylum and family reunification.

Results

6176 fathers were included in the study. The HR assessing the temporary risk of psychiatric disorders was 2.23[95% CI: 1.72-2.89] for separated fathers compared with those who were already family reunified. As to the longer-term risk, compared with fathers separated for 0-9 months, the HR of psychiatric disorders was 1.54[1.08-2.21] after +9-12 months of separation, increasing to 1.84[1.29-2.62] after +24 months of separation. The decomposition analysis revealed that +6 months of waiting increased the risk of any psychiatric disorder by approximately 40% for both time waiting for asylum and time waiting for family reunification.

Conclusions

Strong evidence supports that fathers waiting for their wives and children face an increased risk of psychiatric disease. Countries receiving refugees should be aware that delayed family reunification can lead to adverse mental health effects.

Key messages

Family separation is associated with an increased risk of psychiatric disease among refugee fathers—both while the fathers are separated from their families and after family reunification. The risk of psychiatric disease is more than double among refugee fathers still separated from their family compared with those who have been family reunified.
Physical activity benefits the elderly with Parkinson’s disease
Authors: Lee S
Published: October 2020

Background

Growing number of ageing population adds to the increase in the number of the patients with Parkinson's disease (PD). PD is an idiopathic and progressive disease that significantly affects patients' daily activities and quality of life. The current study sought to explore the role of physical activity as correlates of coping strategies for the elderly with PD.

Methods

We employed a four-year follow-up study design using data drawn from the Survey of Health Ageing and Retirement in Europe (SHARE) - waves 4 and 6. A total of 421 who ever diagnosed or currently having PD (Wave 4) were followed-up (Wave 6). Cross-lagged associations were examined between self-rated health, limits of daily activities, psychological distress, CASP - quality of life scale (Control, Autonomy, Self-realization, Pleasure), and life satisfaction. A path model was developed to examine if moderate to vigorous physical activities mitigated negative effect of PD.

Results

ANOVA showed that well-being index in the older adults with PD decreased at follow-up point across the measured variables, self-rated health (p < .001), limits of daily activity (p < .001), depression (p < .001), loneliness (p < .001), CASP (p < .001) and life satisfaction (p < .001) after controlling for socio-demographic and other health variables. Moderate to vigorous level of physical activity appeared to significantly mitigate the negative effect of PD.

Conclusions

In order to improve the quality of life among the elderly with PD, multilayer intervention should be coupled with the medical treatment. Public health should design and implement enduring rehabilitation program and adaptive physical activity intervention that help psychological and behavioral adaptation process to chronic illness for Parkinson patients. Mobility assistance services or home care products can relieve the difficulties to perform activities of daily living of the elderly with Parkinson's disease.

Key messages

Parkinson patients are more likely to experience difficulties to perform activities of daily living. Physical activity intervention can enhance living of the elderly with Parkinson’s disease.
Nutritional critical points of the cook & chill system and development of corrective actions tools
Authors: Barocco G , Cella M , Sarto D , Pernarcic A , Longo T , Calabretti A , Bogoni P
Published: October 2020

Background

In Italy almost one in 10 people eat a meal in collective catering (CC) every day.

The WHO and FAO emphasize the need to guarantee adequate amounts of antioxidants and protective phytochemicals, essential for the many metabolic functions, by intake of minimally processed foods. It is strategic to ensure protective meals for all CC users, especially hospital patients and the elderly. Recently the Public Procurement (PP) have more often chosen Cook & Chill (C&C) systems, characterized by the administration of meals stored between 0 and +3 C ° for 20 - 30 days. The aims of the project were to: evaluate the qualitative - quantitative profile of the effective protective molecules in C&C meals, determine any nutritional critical points (NCPs) - corrective actions (CAs) of C&C, identify rapid and cheap methods for monitoring the nutritional quality of meals and identify portable systems easy to use by non-professional operators in the chemical-analytical sector.

Methods

The NACCP process indicated by the Ministry of Health has been applied. In 2019 over 120 foods collected at different stages of the production of a C&C were sampled. The University of Trieste has performed over 850 analyses. The outcomes were compared with the food composition database by the agency of the Ministry of Agriculture (MA).

Results

The quantitative profile of the protective molecules present in C&C meals was in many cases reduced by 15 to 75% compared to the MA database. The protective capacity of some meals administered is comparable to that of ultra-processed food. The NCPs - CAs have been determined to ensure an adequate content of protective compounds in C&C meals. Rapid screening systems with chromatographic and optical techniques were identified. Portable systems with immediate analytical response will be developed.

Conclusions

The results of the project can significantly orient PP towards choices that: adhere to the WHO recommendations and adopt nutritional quality monitoring tools.

Key messages

Include nutritional quality criteria for choosing collective catering systems. Monitor the nutritional quality of collective catering through rapid screening systems.
Food additives: distribution and co-occurrence in 126 000 food products of the French market
Authors: Chazelas E , Deschasaux M , Srour B , Druesne-Pecollo N , Hercberg S , Esseddik Y , Szabo F , Slamich P , Gigandet S , Touvier M
Published: October 2020

Background

More than 330 food additives (e.g. artificial sweeteners, emulsifiers, dyes) are authorized in Europe, with a great variability of use across food products. The objective of this study was to investigate the distribution and co-occurrence of food additives in a large-scale database of foods and beverages available on the French market.

Methods

The open access Open Food Facts database was used to retrieve the composition of food and beverage products commonly marketed on the French market (n = 126 556), based on the ingredients list. Clustering of food additive variables was used in order to determine groups of additives frequently co-occurring in food products. The clusters were confirmed by network analysis, using the eLasso method.

Results

53.8% of food products contained at least 1 food additive and 11.3% at least 5. Food categories most likely to contain food additives (in more than 85% of food items) were artificially sweetened beverages, ice creams, industrial sandwiches, biscuits and cakes. The most frequently used food additives were citric acid, lecithins and modified starches (>10,000 products each). Some food additives with suspected health effects also pertained to the top 50: sodium nitrite, potassium nitrate, carrageenan, monosodium glutamate, sulfite ammonia caramel, acesulfame K, sucralose, (di/tri/poly) phosphates, mono- and diglycerides of fatty acids, potassium sorbate, cochineal, potassium metabisulphite, sodium alginate, and bixin (>800 food products each). We identified 6 clusters of food additives frequently co-occurring in food products.

Conclusions

Food additives are widespread in industrial French products and some clusters of additives frequently co-occurring in food products were identified. These results pave the way to future etiological studies merging composition data to food consumption data to investigate their association with chronic disease risk, in particular potential 'cocktail effects'.

Key messages

Food additives are widespread in industrial French products and some clusters of additives frequently co-occurring in food products were identified. These results pave the way to future etiological studies to investigate their association with chronic disease risk, in particular potential ‘cocktail effects’.
Healthcare workers’ and pregnant women’s perceptions of digital tools to improve antenatal care
Authors: van Pelt S , Massar K , van der Eem L , van der Pijl M , Shields-Zeeman L , de Wit J B F , Ruiter R A C
Published: October 2020

Background

To reduce maternal mortality in rural Tanzania, the need to improve antenatal care remains an urgent priority. Digital health tools are seen as a promising instrument to increase the quality of healthcare in developing countries, but it remains unclear to what extent they are perceived as beneficial during the antenatal care visit. Therefore, the aim of this research was to identify factors that could improve the quality of antenatal care in rural Tanzania, and whether digital health tools would change healthcare workers' and pregnant women's perceptions of quality of care.

Methods

Semi-structured in-depth interviews were conducted with sixteen healthcare workers and nineteen pregnant women, recruited from various health facilities in Magu District, Tanzania.

Results

Both healthcare workers and pregnant women possess a positive attitude towards antenatal care and acknowledge its importance. However, they also expressed a need for (structural) improvements in antenatal care services, particularly increased availability of diagnostic tests, and increased performance and motivation of healthcare workers. In addition, healthcare workers indicated a need for more training and better supervision. While both groups expected quality of care to increase should a digital health tool be implemented, they placed more focus on investing in health infrastructure, like the availability of medication and other materials, than investments in digital health.

Conclusions

Infrastructural improvements, including better communication between healthcare workers and pregnant women, as well as training opportunities and supportive leadership, are necessary before a digital health tool can be expected to increase the quality of antenatal care.

Key messages

Both healthcare workers and pregnant women acknowledged the need for higher quality antenatal care. Both groups suggested a number of infrastructural improvements, among which the use of a digital health tool.
Mixed-method study on internet use and information-seeking during transition to motherhood
Authors: Middleton N , Koliandri I , Hadjigeorgiou E , Karanikola M , Kolokotroni O , Christodoulides V , Nicolaou C , Kouta C
Published: October 2020

Background

Traditional approaches to antenatal education have been questioned as to their effectiveness. The use of the internet for information-seeking is very prevalent, however sources are of varied quality. We explored the information-seeking behaviour of pregnant women in the context of health literacy skills and informed decision-making.

Methods

In a mixed-method descriptive study, 12 focus groups with a culturally diverse set of pregnant women and new mothers (N = 62), a non-participant observation study of antenatal education classes and a web-based questionnaire survey were performed (N = 200). The survey explored use and critical appraisal of internet sources of information, perceived role in assisting decision-making, user-provider interaction, alliance and autonomy in decision making.

Results

Six themes emerged: in a generally “unsupportive system”, pregnant women want to have a “confident voice” but find themselves “self-navigating” in parallel worlds of formal and informal information, using a process of “supplementing and filtering”, sometimes instinctively and selectively, ending up in a state of “doubt and faith” with regards to the trustworthiness of the information and physician dominance in communication, while the “art of communication” is essential to break the cycle. Internet information-searching is very prevalent, even though 60% characterize the information as misleading and 90% would like health professionals to recommend trusted sites. While the majority report discussing this information with their healthcare providers, only 57% characterize the reception as positive.

Conclusions

Women want to have control over decisions affecting their pregnancy. While the internet is a prevalent information source, they value the communication with their healthcare providers and want direction. Maternity healthcare professionals need to recognize the phenomenon, offer appropriate guidance and support shared decision-making.

Key messages

“Traditional” antenatal education arrangements are not effective in supporting informed decision-making. In a landscape of prevalent internet use, a shift is needed from current practices of unguided information-searching.
Risk factors for distress during online health information seeking behavior in parents
Authors: Kubb C , Foran H
Published: October 2020

Background

Parents use the Internet commonly for themselves and to search for information about their children's health. However, health-related information from the web has the potential to trigger anxiety and stress. The understanding of contributing factors for distress during health-related information search processes and which factors could be targeted for prevention is still limited.

Methods

Parents living in Austria with a child between 0 and 6 years were randomly assigned to search the web for current somatic health issues related to self- or child-symptoms. The task was performed on a desktop computer with a timeframe of 15 minutes. The stress level was assessed immediately before and after the search task with the State-Trait Anxiety-Inventory (STAI). Recruitment was terminated early due to the coronavirus disease 2019 pandemic outbreak (sample size prior to COVID-19, N = 53).

Results

Multiple linear regression was used to predict parents' stress change during the search task based on health anxiety, attitude towards online health information, eHealth literacy, couple satisfaction and parental burden. Health anxiety, attitude towards online health information and eHealth literacy did not significantly contribute to predict parents' stress change (STAI state anxiety change), however couple satisfaction (β = -.393, t = -2.46, p = .018) and parental burden (β = -.388, t = -2.30, p = .026) did. Higher parents' baseline level of stress immediately before the search task was only associated with higher levels of parental burden (β = .882, t = 4.00, p < .001).

Conclusions

The results of this study indicate the importance of the relational level, rather than the individual level, in understanding stress during online health information seeking among parents. Future research should incorporate relational variables like parental burden and couple satisfaction into theoretical models and test their influence on online health distress in larger samples.

Key messages

Family and relational variables should be considered in future research investigating distress during online health information seeking for oneself or by proxy. Fostering parents' couple satisfaction and reducing parental burden may can contribute to lower stress levels after symptom-related online searches.
Shaping Baby Buddy Cyprus: eHealth literacy for the transition to parenthood
Authors: Middleton N , Christodoulides V , Hadjigeorgiou E , Nicolaou C , Gourounti C , Leiweiber J , Gouni O , Baum A , Kolokotroni O
Published: October 2020

Issue

The transition to parenthood presents opportunities to promote mother-child health. Though of varying quality, internet information-seeking is prevalent while attendance in antenatal classes is low. Digital innovation can support access to timely and valid information for all, key component of WHO's Respectful Maternity Care.

Description of the problem

”Baby Buddy Forward” assessed the cross-national transferability of the innovative Baby Buddy (UK) healthy pregnancy and early parenthood app to the medicalized and decentralized birth environment in Cyprus. Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to engage with the professional and mums-to-be community and deliver a locally relevant resource to enhance user-provider communication and shared decision-making.

Results

We (a) assessed available resources in a structured quantitative and qualitative rating exercise, (b) identified gaps and priorities in an eDelphi survey (N = 275 mums and 193 professionals, re-rated at annual Midwifery conference), (c) gained in-depth understanding of information-seeking behaviours in a series of focus groups with a diverse set of mums-to-be (N = 100) and (d) explored perceptions about the use of internet for information in pregnancy and the quality of communication with professionals in a questionnaire survey (N = 200). New health communication material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework.

Lessons

In a “changing landscape” of antenatal education, Baby Buddy functions as “proof of concept” for cross-national innovation exchange. Beyond a learning experience, the use of PAR provided ground for building transdisciplinary alliances and creating a public health digital resource to enhance the health literacy of new parents and support the educational role of maternal and child health professionals.

Key messages

Digital resources can reduce social disparities, enrich the user-provider exchange and support the educational role of professionals. PAR provides a framework for co-creation and sense of common purpose.
Privileged access to drugs in Russia and differential inflation of its monetary substitute
Authors: Vlassov V , Kornilov M
Published: October 2020

Background and Objectives

One of the most acute problems of current healthcare in Russia is the absence of drug provision in ambulatory care. Only invalids and war veterans are eligible for the free drugs. In 2005 this and other natural privileges were monetized - eligible people were offered to opt out for the money equivalent. The aim of this study was to evaluate the effectiveness of the monetary substitution of the social services, specifically the inflation of the money substitution of drugs.

Materials and Methods

We use the official state statistics and evaluate the inflation using the official inflation rate and using the BigMac Index from 2005 to 2019.

Results

Over the past 10 years, the nominal value of the monetary equivalent of the set of social services has grown by 149% in nominal prices (from 450 to 1121 roubles, years 2005-2018). Official inflation over these years was 197%. Measured by BigMac Index the set of social services depreciated from 10.7 to 8.3. The cost of the drug provision subset had depreciated even more - from 9.52 to 6.39 units. The pensions during this period had increased in nominal, inflation-adjusted monetary size, and as measured by BigMac index. A set of social services in the natural equivalent decreased by 22.4%. The drug subset had depreciated even more - by 67.1%.

Conclusions

During the period from 2005 to 2019, the cost of a set of social services provided to the eligible citizens in monetary terms grew, while inflation-adjusted value and in physical terms it depreciated. Especially significant was the decrease of the value of the drug provision due to incomplete indexation for inflation. The decrease in the real value of the set of social services provided to vulnerable groups of citizens is an alarming trend. It is long lasting, and reflect the low priority of the drug provision for the decision makers.

Key messages

The value of the drug provision package is insufficiently corrected for inflation. The depreciation of the drug provision is long term and different from the other components of social support.