bluuebunny/crossref_metadata_2025 huggingface dataset:
Potentially Preventable Hospitalizations for Chronic Conditions among Youth
Authors: Sentell T , Choi S Y , Ching L , Uchima O , Keliikoa L B , Irvin L , Pirkle C
Published: October 2020

Objective

Chronic, preventable conditions like diabetes and hypertension previously seen primarily in adults are increasing among young people. Chronic disease-related potentially preventable hospitalizations (PPH) are costly. The study goal was to quantify potentially preventable hospitalizations (PPH) for chronic disease in those aged 5-29 years in one diverse state of the USA.

Methods

With Hawai'i statewide inpatient 2015-2016 data across all payers, we used standard metrics to capture asthma, diabetes, and hypertension PPH. Denominators were obtained by age group, gender, race/ethnicity, and living in O'ahu vs. other Hawaiian Islands from American Community Survey data. A multivariable negative binomial regression model predicted having a PPH adjusting for age group, gender, race/ethnicity, and O'ahu residency.

Results

Six percent (775) of inpatient hospitalizations among young people, representing 455 unique individuals, were PPH for a chronic disease. The types of PPH inpatient hospitalizations include diabetes (436), asthma (261), heart disease (64) and hypertension (14). The number of PPH visits per individual ranged from 1-20 with a mean of 1.7 (SD: 2.28) visits. The total cost of these PPH during this 2-year time period was $16,762,262. Among unique individuals with a chronic disease PPH (N = 455), the mean age was 17.5 (SD: 8.2); 55% were male. In the multivariable model, those who were between 10-14 years (RR:0.47;0.32-0.69) and 15-19 years (RR:0.46;0.31-0.69) were significantly less likely to have a PPH compared to those aged 5-9 years. Other Pacific Islanders were significantly more likely to have a PPH (RR: 3.08; 2.05-4.63) compared to whites.

Conclusions

Many hospitalizations by those aged 5-29 years were PPH. Pacific Islander youth had PPH chronic disease disparities. Chronic disease prevention and management is critical. Solutions may include equitable chronic disease prevention policies and improving access to culturally relevant care.

Key messages

This study reveals important disparities in youth that may lead to future health risks as well as current poor outcomes.

Other Pacific Islanders were at significantly increased risk for PPH for chronic disease compared to other racial/ethnic groups from early childhood to young adulthood.
Using human-centered design to improve the quality of vaccine communication
Authors: Rath B
Published: October 2020

In recent years, one-on-one vaccine communication has become more important that ever. Research has shown that an intact parent-paediatrician relationship is the most important predictor for positive attitudes toward immunisation. Yet, much of the discussion around the benefits of vaccines and the risk of vaccine preventable diseases has also moved online. New communication channels and discussion fora are evolving rapidly, and their use may differ significantly among different sociodemographic groups.

These recent developments have implications for the work of policy makers. Public health messaging will need to be tailored to different subsectors of the population, such as those primarily interested in maternal-infant care, adolescent health, or travel medicine. Mobile applications, telemedicine, video blogs, and other digital fora provide room for science-informed vaccine communication extending beyond the brief conversations at the doctor's office. Each mode of communication may have its own impact, but pediatricians will need to get involved in bridging the communication gap between policy makers and public health agencies on one hand, and children and families on the other.

We will discuss the results of recent projects undertaken by the Vienna Vaccine Safety Initiative using the innovation technique of Design Thinking to move the experience of children and their caretakers back into the center of the conversation. We will provide practical examples of human-centered design i) to improve the understanding of individual-level disease severity in flu patients, ii) to empower parents to keep the vaccination records in their family up-to-date, iii) to improve safety reporting at the point of care, and iv) to enable migrant populations to report missed immunizations and other health needs. We will invite active discussion with the audience while providing critical analysis of lessons learnt and implications for health policy and future research.
Why should gender-sensitive health reports be intersectional?
Authors: Merz S , Jaehn P , Mena E , Pöge K , Strasser S , Saß A C , Rommel A , Bolte G , Holmberg C
Published: October 2020

Background

A key focus of both epidemiology and PHMR is the identification of health inequity between population groups and its determinants. However, scholars in the social sciences have criticised prevalent approaches of describing health differences according to single social categories like sex/gender or race/ethnicity, glossing over significant heterogeneity within and relations between presumed population groups. Applying these critiques to the field of PHMR, we would argue that intersectionality scholarship offers vital impulses for the study of health inequity by focusing on several, interrelated social categories and emphasising the structural determinants affecting unique population subgroups differently.

Methods

We mapped existing approaches to describing population differences in health. We also conducted a literature review on intersectionality scholarship in public health and then synthesised results to develop a conceptual framework for deploying intersectionality to epidemiology and PHMR.

Findings

We identified four key principles through which the reporting on subgroup differences could be strengthened: addressing the internal heterogeneity of population groups; contextualising inequities and focusing on societal power relations rather than individual characteristics; deploying novel multivariable modelling approaches in data analysis; and aiming towards the empowerment of population groups rather than deploying deficit-oriented and paternalistic models.

Discussion

To be discussed are the unique contributions of intersectionality to PHMR compared to other approaches, for example from social epidemiology or medical anthropology.
Integration of refugees: the interactive dynamics of health, education and employment
Authors: Jervelund S
Published: October 2020

Background

Host countries have a great interest in the integration of refugees to decrease spending on social welfare services, increase social coherence and secure the labour force and economic growth. While recent political trends in the Nordic countries have been focusing on “employability” as a key to integration, the outcomes from education and employment on health has been less considered. The presentation sets the scene for the Nordic comparative research on refugee children and youth and motivates the focus on the interrelatedness of health, education and employment

Methods

The presentation will draw on existing theories and empirical literature as well as CAGE findings from comparative quantitative analysis of register data and qualitative studies based on interviews and observations.

Results

Socio-economic conditions impact health through many interrelated pathways, including risk and protecting factors in both the country of birth and in the host country, as well as age at migration. But poor health may also impair education and entry into the labor market, which is particularly relevant for the refugee population. Using a life course framework, the introduction will shed light on this interrelatedness reflected in the evidence from CAGE. Since varying welfare policies may shape the integration and life chances of young refugees in the Nordic countries differently, the gain of investigating this interrelatedness through Nordic comparisons will be underscored.

Conclusions

Welfare policies related to refugees need to take into account the interrelations between inclusive health care, successful education and entrance into the labour markets. Adapted educational programmes to catch-up with the majority population, training of integration officers at the local level and diversity competent health services may explain successful integration and give young refugees better life chances in exile.
Using social network analysis to analyze obesity and other public health issues related to food consumption
Authors: Casacuberta D
Published: October 2020

Digital social networks, such as Instagram, Facebook or Twitter are both repositories of cultural tendencies and common social interests, as well as devices to expand and extend such tendencies among the general population. A relevant number of such cultural tendencies do have an impact in public health. In this talk we will focus on one of the such common cultural tendencies: food consumption. People like to share recipes, new diets, pictures or what they are eating, and so on. Thanks to geolocalization, it is relatively easy to find out the geographical origins or such entries and posts, and see how a food consumption tendency is distributed around the world. Understanding how such digital entries are copied and distributed or “liked” by other users can help us to both see how a tendency generates and how it spreads, as well as its global and local acceptance by users. During the talk we will analyze how data obtained from such digital social networks, specially Twitter, Facebook and Instagram, are being used to analyze patterns of food consumption that can become public health problems, associated with obesity, anorexia, unhealthy diets, etc. We will focus on the epistemic innovations associated with these investigations, analyzing the strengths and weaknesses that have machine-based approaches versus more qualitative analyzes, and assess the epistemic reliability of those approaches.
Environment and health as a driver of transformation
Authors: Jevtic M , Bouland C
Published: October 2020

As technology progresses, social inequality grows, the gap widens, and the environment continues to suffer. Furthermore, the social environment in societies is “ruffled” and does not appear to be constructive toward well-being. New inequalities are emerging in the availability of technology, climate change, education. The achievement reports on the Sustainable Development Goals (SDGs), also point out to the need of reviewing individual indicators.

The UN Human Development Report estimates that children in highly developed countries have a 55% chance of obtaining high education, as opposed to children born in underdeveloped countries where only 3% of them have a chance of high education. In underdeveloped countries, according to the UN data, 17% of them die by the age of 20, while in developed countries this is 1%. The gap in the opportunities of young people in different living environments is quite pronounced nowadays. If this process does not get stopped, it can be irreversible.

The directions of transformation necessary to achieve the SDGs, while respecting the principles of equality, quality of life preservation and improvement, are divided into six groups. Transformations should aim at: an educated workforce, an innovative economy, gender equality and social protection, health and wellbeing for all, universal health care and support for healthy lifestyles. Transformation is also a prerequisite for: climate neutrality, circular economy, decarbonisation, renewable energy and industrial development. Sustainable agriculture and food production, conservation and restoration of natural resources, as well as sustainable, green urban environments and support for small communities also require radical changes. An indispensable factor for transformation is that both digital and modern technologies align with sustainable development, respecting human rights privacy and social inclusion.
A more comprehensive approach offering instruments in one portal to facilitate higher uptake
Authors: Rossmann C , De Bock F
Published: October 2020

The good practice portal of the Federal Centre for Health Education (BZgA) consists of a nationwide collection of projects and interventions to promote the health of socially disadvantaged groups at community/setting level. An exchange platform (inforo) is also offered via the operating agency, although its use is still limited. The results of the evaluation of the platform suggest that the provision of practical projects and exchange of knowledge alone is not sufficient to support policy makers and practitioners who want to promote health in the community/setting.

There is a need for advice on needs assessment, selection and appropriate implementation of health promotion measures. A comprehensive approach currently being tested in the field of activity promotion for older people is the provision of a web-based “toolbox” comprising the following tools: assessment instruments for analysing the need for health promotion measures, a user-friendly intervention/project database and broader evidence synthesis documents, as well as information on project management (organisational, legal, financial).

Following the example of other best practice portals, a ranking methodology was developed to make the level of effectiveness of interventions visible and the evaluation requirements transparent. Evidence synthesis documents provide an entry point to learn more generally what works in a particular area of health promotion. In order to make the “toolbox” accessible to policy-makers and practitioners, information from previous studies was used in the development with regard to content and graphical presentation.

BZgA is currently working on integrating evidence into the good practice portal. The evaluation of the toolbox in a small area of health promotion will provide initial insights into the inclusion of evidence and its added value. This presentation will conclude with a discussion of possibilities for improvement, challenges and limitations of this approach.
The added value of European collaboration to improve the uptake of best practices
Authors: Maassen A , Sostongs C
Published: October 2020

In 2019, members of the EuroHealthNet Partnership established the first Thematic Working Group on Health Promotion and Disease Prevention Programme Registers with the intention of becoming 'the competence engine for Programme Registers in Europe.' The group's objectives include to exchange experience, to initiate joint projects, to identify and further develop common topics relevant to Programme Registers, and to share findings in scientific papers and international conferences. Through such activities, the group builds the foundation for a more systematic and scientific European approach to translating evidence into practice and provides a forum for liaison and exchange between EU Member States, the European Commission, and international partners.

Programme registers are only as relevant as they are influential in professionals' and policy makers' decision-making around intervention selection. Facilitating uptake of best practices requires an understanding of incentives, disincentives and decision-making processes, as well as how to make the programme registers more prominent and user-friendly. Outcomes from the 2020 Working Group meeting in Cologne will be presented, including case studies from across Europe, as well as recommendations to improve the uptake of best practices, tailored to portals at different stages of development.
Feasibility and acceptability in health centers of screening for chlamydia in deprived population
Authors: Lobertreau E , Goethals L , Oriol M , Vincent I , Amsallem E
Published: October 2020

Issue

The French Health Insurance (FHI) is in charge of the governance of 100 Health Examination Centers (HEC). HEC provide evidence-based interventions in prevention, focused on deprived population. In France, Chlamydia trachomatis (Ct) infection is the most sexually transmitted infection, especially among young women.

Description of the problem

To assess the feasibility of systematic screening Ct infection, in HEC, among 18-25 years women and 18-30 years men, with a focus on self-sampling. Pragmatics questions were: how the youth accept the screening of Ct infection (especially the self-taken vaginal swabs)? Was the feasibility and Ct positivity similar between deprived and non-deprived population (according to the EPICES score)? A cross-sectional multicenter survey was performed in 13 HEC in January 2018.

Results

Screening was proposed to 1702 eligible young people (sexually active and no recent Ct treatment). 90.3% [88.8-91.6] accepted and participated: 44% women, 54% deprived people. Among women, 76.8% [73.4-79.9] used self-taken vaginal swabs, others urinary tests. Rates did not differ according to deprivation (p = 0.96). Screening was performed in 1487 people (96.7% for deprived vs 97.7% for non-deprived population, p = 0.258). Ct detection rate was 4.7% [3.7%-5.9%], significantly higher for deprived population (6.5% vs 2.5%, p < 0.001).

Lessons

The results demonstrated the feasibility of Ct screening in HEC with a good acceptance among youth even among young deprived. The performance rate of the test was similar according to deprivation. However, deprivation was associated with having a positive Ct result. This feasibility led to the implementation of Ct screening in all HEC.

Key messages

Chlamydia trachomatis screening can be easily implemented even in deprived populations that accept and perform it as well as non-deprived populations. Promoting access to Chlamydia trachomatis screening to deprived populations might contribute to reduce social inequalities in health.
Are vaccine shortages a relevant public health issue in Europe?
Authors: Filia A , Rota M C , Grossi A , Martinelli D , De Graaf T , Dominguez A , Tuells J , Sormunen P , Jønsrud K , Rezza G
Published: October 2020

Background

National immunisation programmes depend on an adequate supply of vaccines but shortages have become more frequent globally in recent years. Vaccine shortages can lead to missed opportunities for vaccination and a greater risk of occurrence of vaccine-preventable diseases (VPD).

Methods

The EU-Joint Action on Vaccination is a European Commission-funded project* which aims to strengthen cooperation between European countries against VPDs, including improvement of vaccine supply and preparedness. In this context, from February to May 2019, we conducted a survey amongst persons in charge of national immunisation programmes or of vaccine supply/procurement in EU/EEA, to collect information on vaccine shortages in the previous three years.

Results

Twenty-one of 28 invited countries responded, of which 19 reported at least one shortage, for a total of 115 shortage events. The median number of shortages per country was 5 (range 0-15). At the time of survey completion, there were ongoing shortages in six countries. DT/dt-containing combination vaccines, hepatitis A, hepatitis B and BCG vaccines were the most frequently involved vaccines. Supply and production issues, and global shortage, were the most frequent causes. Median duration of shortages was five months; 34% caused a disruption in immunization services. Procurement and purchase methods varied by country. Only half of countries have recommendations or procedures in place to address shortages.

Conclusions

Vaccine shortages are a serious public health issue in the EU. Causes are complex and multifaceted and more research is needed to understand the economic and market-related causes. Improved communication between public health authorities, manufacturers and regulatory agencies is essential. Procurement and tender mechanisms should be improved. In case of vaccine shortages, all countries should have procedures or recommendation in place regarding the use of alternative vaccines or vaccination schedules.

Key messages

Vaccine shortages are a relevant public health issue in the EU. More research is needed on the complex and multifaceted causes of vaccine shortages. Timely communication between supply and demand is needed and procurement and tender mechanisms should be improved.
Introducing Critical Tiriti Policy Analysis: A new tool for anti-racism from Aotearoa New Zealand
Authors: Came H , O'Sullivan D , McCreanor T
Published: October 2020

Issue/problem

Te Tiriti o Waitangi (te Tiriti) was negotiated between the British Crown and Indigenous Māori in 1840. Māori understood the agreement as an affirmation of political authority and a guarantee of British protection. The Crown understood it as a cession of sovereignty. Te Tiriti places a mandatory obligation on the Crown to protect and promote Māori health that has not been upheld.

Description of the problem

Ethnic inequities in health outcomes have been allowed to flourish in Aotearoa. We explored to what extend te Tiriti could be a anti-racism tool that health policy could be usefully evaluated against?

Results

We introduce Critical Tiriti Analysis (CTA) a new form of critical policy analysis. CTA involves reviewing policy documents against the Preamble and the Articles of the Māori text of te Tiriti o Waitangi. The review process has five defined phases: i) orientation; ii) close reading; iii) determination; iv) strengthening practice; and v) Māori final word. We present a working example of CTA using the New Zealand Government’s Primary Health Care Strategy. This policy analysis found poor alignment with te Tiriti overall and the indicators of its implementation that we propose.

Lessons

This paper provides direction to public health practitioners wanting to improve Māori health outcomes and ensure Indigenous engagement, leadership and substantive authority in the policy process. It offers an approach to analysing policy that is simple to use and, inherently, a tool for advancing social justice.

Key messages

CTA is an anti-racism tool for holding the Crown accountable for Māori health. CTA could be adapted and applied in other colonial contexts to advance Indigenous health.
Societal Impact of Pain thematic network – from European recommendations to national implementations
Authors: Badreh S , Kynman S , van Griensven J , Branco M , Votta M , Morlion B
Published: October 2020

Issue

Pain puts a serious burden on individuals and society. The Societal Impact of Pain (SIP) aims at improving pain care policies by gathering a broad coalition of multi-disciplinary organisations.

Description of the problem

Uncontrolled pain can decrease people's quality of life and has a serious impact on individuals and society. The SIP Thematic Network focuses on improving policy-making via the creation of a network of stakeholders by sharing best practices and available data to draft recommendations with the goal to call for a European Framework addressing the societal impact of pain. SIP has been selected in 2018 as a Thematic Network as part of the EU Health Policy Platform and produced a Joint Statement that focuses on four key areas: (1) Indicators, (2) Research, (3) Education, and (4) Employment. The Joint Statement has been used as a basis for projects and initiatives at national level, aligned with the four key priorities.

Results

Nine SIP national platforms have been established in Belgium, Finland, France, Ireland, Malta, Netherlands, Portugal, Slovenia, Spain under the guidance of the European SIP platform. Each platform has identified one or more key areas of the Joint Statement to take concrete actions for implementation. For example, SIP Belgium released a national SIP Joint Statement with the goal to improve the (re)integration of pain patients in the workforce and society.

Lessons

The selection of SIP as a Thematic Network on the EU Health Policy Platform provided opportunities to identify the key areas for impactful pain policy work and led to concrete actions for implementation on national level. More at www.sip-platform.eu

Key messages

Continuation of the dialogue on the EU Health Policy platform is important to improve existing policies and to increase collaboration amongst all key stakeholders. Structured implementation of policy recommendations on national level is important in order to improve pain care.
Sports betting in Serbia- National survey on lifestyles in Serbia: substance abuse and gambling
Authors: Todorovic J , Terzic-Supic Z , Piperac P , Divjak J
Published: October 2020

Background

Sports betting has been one of the gambling games which are strongly associated with problem gambling. The aim of our study was to examine the association of social (socio-demographic and socio-economic) and lifestyle characteristics of sports bettors in Serbia.

Methods

The cross-sectional study was the secondary analysis of the data from the National Survey on lifestyles in Serbia: substance abuse and gambling, conducted during 2014. The questionnaire consisted of 158 items. The first part was on socio-demographic characteristics. The second was on lifestyle characteristics with Beverage Specific Quantity Frequency - BSQF Instrument developed during Standardized measurement of Alcohol-related troubles-SMART project, Kessler psychological distress scale, Problem Gambling Severity Index (PGSI), use of illicit drugs, and prescription/ non-medical prescription drug use. The sports betting was assessed with yes/ no question: 'Have you played sports betting in the past 30 days?'

Results

The 10% of participants reported sports betting in the past 30 days. The sports betting was associated with being male (OR:11.22, 95% CI: 7.62-16.53), aged 18-44 (OR: 2.33, 95% CI: 1.78-3.07), living in urban areas (OR: 1.79, 95%CI: 1.41-2.28), being single (OR: 1.35, 95 % CI: 1.06-1.72), having secondary education (OR: 1.47, 95% CI: 1.09-1.98), being unemployed (OR: 2.71, 95% CI:1.35-5.45), employed (OR: 3.00, 95 % CI: 1.53-5.90), or student (OR: 3.86, 95% CI: 1.83-8.17), binge-drinking (OR: 1.94, 95% CI: 1.39-2.71), non-medical prescription drug use (OR: 1.78, 95% CI: 1.22-2.59) and low/ moderate (OR: 12.82, 95% CI: 8.50-19.33), and problem gambling (OR: 43.38, 95% CI: 11.75-160.11).

Conclusions

The association of sports betting with risk behaviors among young males should be a concern for public health authorities.

Key messages

The prevalence of the past 30 days betting in Serbia is 10%. Sports betting is associated with risk behaviors.
Health and wellbeing of sexual minority youth – the School Health Promotion study in 2019 in Finland
Authors: Klemetti R , Luopa P , Kivimäki H
Published: October 2020

Background

Sexual minority youth have an increased risk for depression, anxiety disorders and bullying. In addition, particularly boys have an increased risk for sexual harassment. However, information on their general health and wellbeing is scarce. The purpose of this study is to examine the general health and wellbeing of sexual minority youth compared to heterosexual youth.

Methods

Data from the national School Health Promotion study 2019 were used including youth from comprehensive (N = 87026), upper secondary (N = 44498) and vocational schools (N = 23366). The proportion of sexual minority youth in comprehensive school was 8.5%, in upper secondary school 10.3% and in vocational school 7.5%. Each of the following issues was asked by using one question: general health, life satisfaction, loneliness, and worry about own mental health. Anxiety was measured by GAD-7 (Generalized anxiety disorder) and depression by PHQ-2 (Patient health questionnaire). Data were analyzed by school level and sex using cross-tabulations with Chi-square tests.

Results

Response rate at comprehensive school was 73% and at upper secondary school 69% but at vocational schools it couldn't be estimated reliably. Sexual minority youth reported significantly more often poor or average general health (44.2% vs. 18.2%) and loneliness (26.5% vs. 8.5%) but less often life satisfaction (50.0% vs. 78.5%) compared to heterosexual youth. They had significantly more often experienced depression (40.4% vs. 14.5%) and anxiety (31.4% vs. 10.4%) and worried more often about their mental health (65.6% vs. 28.5%) than other youth. Differences remained after stratifying the data by school level and sex.

Conclusions

This large population-based study including both sexual minority and heterosexual youth suggests that sexual minority youth have poorer outcomes in general health and wellbeing than heterosexual youth. More detailed analyses are needed to find out associated factors.

Key messages

Sexual minority youth at each school level and all sexes had poorer outcomes in each studied health and wellbeing indicator compared to heterosexual youth. Low-threshold services and support as well as more accepted atmosphere in society are essential to guaranteeing better health and wellbeing for sexual minority youth.
Describing the objective and subjective mental health care needs of minor refugees in Germany
Authors: Fretian A , Podar D , Razum O , Namer Y
Published: October 2020

Background

Half of the estimated 70.8 million forcibly displaced people are under the age of 18. Clinical studies assessing prevalence of mental illness, commonly depict them as a particularly vulnerable group. However, screening instruments are not enough when establishing the need for mental health care. By supplementing them with subjective measures, we aim to provide insight into the mental health care needs of otherwise overlooked groups.

Methods

Data were collected between February and November 2019 in German schools and refugee accommodations via tablet based self-assessment. Adolescents between 12 and 18 years of age coming from Syria, Afghanistan, and Iraq were invited to participate. The Hopkins Symptom Checklist-37 (HSCL) was used to measure internalizing and externalizing symptoms (i.e. objective need; cut-off score = 69). A single item was used to assess the subjective need for mental health care: “Do you think that you have emotional difficulties for which you need help?”

Results

A total of 259 participants completed the questionnaire. While 22.4% reported an emotional issue for which they need help (missing values=22.4%), the HSCL (α=.90) identified 10.4% of participants to be at risk for a mental health disorder (missing values=18.5%). Most participants (62.5%) reported neither objective nor subjective care need. However, 23.7% (n = 36) of those not identified as at risk said they have emotional difficulties, while 5.9% (n = 9) of those at risk stated they do not have an emotional issue.

Conclusions

Our sample showed lower levels of mental health issues as measured by the HSCL, when compared to samples of refugee minors in Germany (33.7%) and Norway (17.2%). Especially vulnerable groups are those who report problems, but are not identified by the screening measure as at risk and those identified as at risk, but do not perceive to have mental health difficulties. Public health interventions need to develop tailored strategies to reach these groups.

Key messages

Screening instruments are not enough when establishing the need for mental health care of vulnerable populations. Subjective and objective need should be considered when establishing who gets mental health care.
Health behaviours of education professionals: any room for improvement? A study of French employees
Authors: Vercambre M-N , Temam S , Billaudeau N , Kab S , Zins M
Published: October 2020

Background

Education professionals have a role to play in health education, both as knowledge providers and role-models. To appraise their health awareness, we compared their health behaviours to those of non-education employees.

Methods

Using inclusion data of the CONSTANCES French cohort (2012-2019) and adjusting for important confounders (sex, age, education,...), we alternately compared three indicators of risky conducts (at-risk drinking, current smoking, past year-cannabis use) and two indicators of unhealthy lifestyle (low physical activity, overweight/obesity) between education professionals (n = 14730) and a random sample of non-education employees (n = 34244). Among education professionals, we distinguished between teachers (n = 12820), school principals (n = 372), principal educational advisers (n = 189), school health professionals (n = 128), and school manual/service staff (n = 1221).

Results

Teachers were less likely than non-education employees to be at-risk drinker, to smoke, to have used cannabis in the past year and to be overweight/obese. Other non-teaching education professionals were also rather less involved in risky conducts than non-education employees. Nonetheless, school principals and principal educational advisers reported more often low physical activity and school principals and manual/service staff were more prone to overweight/obesity than non-education employees.

Conclusions

In this large nationwide sample of French employees, education professionals were rather less involved in risky conducts than other non-education employees with a similar demographic and socioeconomic profile. Yet, non-teaching education professionals showed punctually unhealthy lifestyle indicators, suggesting a window of opportunity to improve both their own health and, indirectly through role-model, that of the youth with whom they interact daily.

Key messages

Education professionals, especially teachers, appear more health-conscious than average. There may still be room for improvement toward a healthier lifestyle. In addition, the average observed may be quite far from the recommended public health target, so that any action to enhance education professional’s health behaviours will have societal benefits.
Disability pension among persons with chronic illness: Differential impact of a Danish policy reform
Authors: Mathisen J , Jensen N K , Bjorner J B , Brønnum-Hansen H , Christensen U , Thielen K , Gadeberg A K , Andersen I
Published: October 2020

Background

Denmark implemented a reform in 2013 that tightened the disability pension criteria and expanded a subsidized job scheme. Before the reform, disability pensions were most often granted because of chronic disease and more often to persons with low job qualifications. However, no evaluation has assessed whether the effects of the reform differ according to social class. This register-based, nation-wide cohort study investigates potential differential impact of the reform according to labor market affiliation.

Methods

A pre-post study design was used to compare the probability of being granted disability pension or flexi-jobs five years after vs. five years before the reform. Data were available from 480,809 persons between 40 and 65 years of age who suffered from at least one of six types of chronic disease. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated.

Results

The probability of being granted disability pension was halved after the reform (HR = 0.49, CI: 0.47 - 0.50). The impact was strongest for persons previously receiving cash benefits (HR = 0.38, CI: 0.33-0.43) or sickness absence benefits (HR = 0.31, CI: 0.24 - 0.39). Also, the impact was stronger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being granted flexi-job decreased by one fourth (HR = 0.76, CI: 0.74 - 0.79).

Conclusions

After the reform, it was less likely for persons with chronic illness to be awarded disability pension or subsidized job-schemes. The impact on disability pensions was largest among those who were already outside the labor market or work in manual jobs.

Key messages

The rates of disability pensions and subsidized job-schemes decreased after the reform. The impact was larger for persons outside the labor market and for those working in manual jobs.
Development and empowerment of community health promoters in Prilep – North Macedonia
Authors: Shapkoski V
Published: October 2020

Hidden discrimination in treatment, inability to pay for health services, insufficient information about health and social rights, are just some of the obstacles faced by Roma population and other marginalized communities in terms of achieving health rights in North Macedonia. Previous experience has shown encouraging community activism and following social determinant in the exercise of health rights are of particular importance for achieving positive outcomes.

Therefore, in the past year, a group of 18 Roma community activists called Community Health Promoters was formed. Their task was to monitor community movements, share promotional materials, initiate discussions on health care topics, identify what problems citizens are experiencing especially the ones that may be a sign of systemic barriers. What is also very important and, to our opinion, a revolutionary step to building up this group is that we had additional 4 non-Roma activists who voluntarily applied to be part of it. Community Health Promoters by the end of the previous year reached the number of 22 people (18 Roma and 4 non-Roma).

More than 100 individual cases and 2 major systemic barriers to the exercise of rights have been identified - the first concerned the right to health insurance for persons who have just turned 18 years and are not in regular education, and the second on inadequate regulation in the new Law on Social Protection, regarding the obligation for the beneficiaries to seek allowance from his/her adult children not living in their household. In both cases, written reactions were submitted to the competent bodies. In the first case, a notification was received that a technical solution to the problem was already been prepared, and in the second case, within one month, an amendment to the Rulebook was made, for more appropriate regulation.

Through these two cases, it has been demonstrated that this approach is critical to achieving adequate and equal access to health protection for all.

Key messages

If the legislation is not for all, it is not a right but a privilege. Community-based work is the only way to find out if the laws are applicable for all or just for the few.
Urbanization, Poverty and Child Health: Findings from Taiwan Birth Cohort
Authors: Chiang T L , Chiang W L , Chang L Y
Published: October 2020

Background

We are living in an urban age. This study aims to examine whether living in big cities can be of help to reduce the health gap between the rich and poor children.

Methods

Data for the analysis came from the Taiwan Birth Cohort Study with a nationally representative sample of 18,814 children who completed the first (6-month) and eighth (12-year) waves of household interview survey. Poverty was defined as parental income below US$1,000 per month. Residence area was grouped into two groups: big city and non-big city; big city was defined as a national or provincial city. Children's health at age 12 was rated by mothers and divided into two groups: poor and non-poor. Multiple logistic regression was used to examine the joint effect of urbanization and poverty on children's health.

Results

We found that children who lived in poverty were more likely to have poor health than those who did not live in poverty (28.2% v 19.9%). When children were grouped according to the combination of residence at age of 6 months and 12 years old, we found that the prevalence of poor health at age 12 was the highest for poor children who lived continuously in big city (35.8%), followed by poor children who moved to big city (30.0%), poor children who lived continuously in non-big city (26.7%) and poor children who left big city (25.0%). Importantly, the prevalence of poor health for non-poor children was much lower and varied less across different residence groups, ranging from 19.7% to 21.4%. The interaction of poverty and urbanization on children's health was statistically significant (p < 0.05) in multiple logistic regression analysis.

Conclusions

Our findings suggest that living in big cities be detriment to the health of children in poverty and widen the health gap between rich and poor children. Thus it is extremely important to shape urbanization for children, particularly for poor children.

Key messages

The poor children who live in big cities are more likely to have the worst health. We shall pay attention to the joint effect of urbanization and poverty on children’s health in order to reduce health inequalities.
Assessing and implementing practical ways to address slum health determinants: Learning from India
Authors: Agarwal S , Verma S , Verma N , Kothiwal K
Published: October 2020

Issue

There is a need for adaptable/scalable methods to understand environmental determinants of health and well-being in slums of LMIC cities. Catalysing grassroots actions to reduce health inequalities is needed with strong community leadership in slums.

Methods

Conducted in 2016-2017 in Indore (3 m population), India this practice undertakes qualitative health assessments using simple, actionable indicators with community knowledge and prioritizes solutions. Participatory neighbourhood level assessment of sewerage, toilets, garbage disposal and water supply by slum women was done using three colour scale: red for poor condition, yellow for moderate condition and green for good condition across 24 slums. Since slum women live these challenges daily, they can assess conditions. A qualitative adaptation of WHO's Urban HEART, this practice seeks to learn how slum women assess conditions, implement actions for improvement of slum environment.

Results

Context responsive actions included submitting community petitions and reminders to Municipal authorities by slum women to repair sewerage lines, construct toilets, increase regularity of garbage collection and improve public water supply in slums. Of 24 slums assessed in 2016, 6 were designated as “red”, 14 as “yellow” and 4 as “green” on condition of toilets and sewerage. On garbage disposal and water supply, 8 slums were designated as “red”, 10 as “yellow” and 6 as “green”. With coordination with Municipal authorities in 2017, slums on “red” reduced to 3 in each group, those assessed as “green” increased to 10 with improved conditions.

Lessons

This approach helps slum communities to assess problems and implement solutions. The methodology is simple, low-cost, easily understood by less educated, academics, policy makers and uses community wisdom. It is adaptable for NGOs, relevant policies/guidelines in LMIC cities. This collective community health assessment directly catalyses demand side action.

Key messages

Collective efficacy is a group’s shared belief in its ability to utilize information, pursue actions to overcome obstacles accomplishing a valued goal. This method is key to replicate this practice. People’s efforts to bring public services to the slums through collective action can reduce urban health inequality.
Health promotion in Swiss municipalities: towards proportionate universalism
Authors: Amstutz D , Villa O , Georges A , Lutz A , Zuercher K , Pasche M
Published: October 2020

Background

Health promotion goes beyond the health sector. Municipalities, the local public authorities in Switzerland, have a crucial role to promote population health in all their decisions.

Initially developed by Promotion Santé Valais, the label “Healthy municipality” exists in the canton of Vaud since 2015. The label takes stock of existing measures in health promotion and prevention in all sectors and incentivise new interventions. The labelling process respects different criteria and is validated by an external committee. It is voluntarist, free of charge for the municipality but requires time and intersectoral communication. This abstract explores equity in the uptake of the label.

Results

In Vaud, 17 municipalities have been labelled “healthy”. Two external evaluations by Swiss universities highlighted that small villages are less involved in the label than urban areas. To achieve health equity, we need to identify and approach municipalities with limited human and financial resources, that might be less active in health promotion and/or whose population is socioeconomically disadvantaged. Preliminary results indicate that municipalities below 1000 inhabitants, in rural areas, should be targeted first. We are currently investigating the barriers and facilitators for them to enrol in the label.

Lessons

As labels rewarding healthy cities are expanding worldwide, it is important to document and reflect on who benefits from them, and who does not. Our practice is now focusing more on villages in rural areas, with less resources than urban settings. We investigate their needs regarding the type of support that we, public health professionals, can provide. Proportionate universalism principles should also apply to advocacy for health promotion, at the municipality level.

Key messages

To achieve health in all policies, the role of municipalities is essential. More efforts in health promotion should target specifically small and rural municipalities, with limited resources.
The inflammatory potential of the diet is prospectively associated with subjective hearing impairment
Authors: Andreeva V A , Péneau S , Julia C , Shivappa N , Hébert J R , Wirth M D , Touvier M , Hercberg S , Galan P , Kesse-Guyot E
Published: October 2020

Background

Age-related hearing loss is prevalent yet insufficiently addressed by public health research. Subjective hearing loss has been highlighted as a key determinant of reduced quality of life, while chronic low-grade inflammation is an established determinant of adverse age-related outcomes. To our knowledge, this study was the first to investigate the link between the inflammatory potential of the diet and hearing loss.

Methods

We prospectively studied 3,435 French adults enrolled in the SU.VI.MAX (1994-2002) and SU.VI.MAX 2 (2007-2009) cohorts. The inflammatory potential of the diet was estimated by the Dietary Inflammatory Index (DII) using established methodology and repeated, baseline 24-h dietary records. Subjective hearing impairment was assessed after a median of 12 years by 3 Yes/No items and by a composite score, dichotomized for analyses. We fit multivariable logistic regression models adjusted for pertinent covariates.

Results

Compared to men, women exhibited higher DII (more pro-inflammatory diet) and less hearing impairment (both p < 0.0001). Given significant interaction results, sex-specific models were fit. Among men, a significant positive association between DII (continuous scale) and inability to follow a conversation in a noisy place was found (OR = 1.10; 95% CI: 1.02, 1.18), while the inverse association was seen among women (OR = 0.92; 95% CI: 0.87, 0.98). Regarding the need to turn up the volume on the television/radio, a significant positive association with DII (continuous scale) was found only among men (OR = 1.09; 95% CI: 1.01, 1.18). The only significant association with the composite score of subjective hearing loss was found among women, when modeling DII as quartiles (OR Q3 vs Q1=0.74; 95% CI: 0.57, 0.97).

Conclusions

The findings among men support the hypothesis that a pro-inflammatory diet could increase risk of age-related hearing loss, whereas the findings among women were unexpected and merit further investigation.

Key messages

Given rapid population aging worldwide, there is an urgent need for public health research on modifiable risk factors of hearing impairment. The role of diet in hearing impairment is complex and likely sex-specific; a pro-inflammatory diet might be a risk factor for hearing impairment, especially among men.