bluuebunny/crossref_metadata_2025 huggingface dataset:
Antenatal care initiation in an ethnically dense socially disadvantaged maternal cohort
Authors: Puthussery S , Li L , Tseng P c , Puthusserry T
Published: November 2019

Background

Differential utilisation of antenatal care among ethnic minority mothers is a contributor to their increased risk of poor birth outcomes in developed countries. Links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood. This study investigated patterns of antenatal care initiation among an ethnically dense, socially disadvantaged maternal cohort.

Methods

We conducted a retrospective analysis of routinely collected anonymous data of live singleton births in a maternity unit serving an ethnically diverse population. We applied univariate regression models to examine the association between late antenatal care initiation and various predictor variables in particular ethnicity and area deprivation.

Results

Gestational week at antenatal initiation was available for 46, 089 births. One fifth (20.9%) of mothers initiated antenatal care after 12 weeks of gestation including 11.9% who had their first antenatal appointment at 13 -20 weeks (moderately late) and 8.9% who had it later than 20 weeks (extremely late). Among all the factors considered, late initiation was most strongly associated with non-White British ethnicity. Black African (34.2%) and Black Caribbean (29.0%) mothers were more than twice as likely to initiate antenatal care after 12 weeks of gestation compared to White British mothers [Odds ratio (OR)= 2.69 and 2.15 respectively). The odds did not increase with increasing area deprivation except for moderately late initiation in the most deprived and second most deprived areas [unadjusted OR = 1.54 and 1.24 respectively].

Conclusions

Non-White British ethnicity was the key predictor of late antenatal care initiation in our ethnically dense socially disadvantaged maternal cohort. Impact: Programs and policies should take in to account ethnic variations in antenatal care initiation while designing programs and policies to improve birth outcomes in ethnically dense socially disadvantaged areas.

Key messages

Non-White British ethnicity was the key predictor of late antenatal care initiation. Area deprivation per se appeared to have limited association with late antenatal care initiation.
Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan
Authors: Shah M , Jamali Q , Aisha F , Shahid F
Published: November 2019

Background

More than 2.5 million newborns die each year, contributing to 47% of under 5 mortality worldwide. Globally, Every Newborn Action Plan has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives. An international joint policy statement and endorsement from health professional associations also recommended practicing KMC for newborn care.

Methods

We conducted a qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother’s ability to practice KMC and the feasibility of implementing and improving these practices.

Results

Our study findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on strengthening of availability and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs. The study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility.

Conclusions

Ensuring facility readiness to initiate KMC, improving capacity of health providers, coupled with strengthened community mobilization, and targeting specific audiences may help policy makers and program planners to initiate KMC practice at health facility and keep KMC practice continued at household level.

Key messages

Introducing KMC at health facility followed by continuing practice at household level is feasible, even in a religiously conservative setting like Pakistan. Facility readiness, improved health workers’ capacity coupled with strengthened community mobilization targeting specific audiences could help scaling up this public health intervention in Pakistan.
Supporting child development to reduce child health inequalities in Belgium: a realist evaluation
Authors: Beauvarlet M , De Spiegelaere M
Published: November 2019

Background

Reducing social inequalities in child health is a major challenge in Belgium. In Brussels, 40% of children are born in a household below the poverty line. The most efficient way to reduce social inequalities in health is to address them on a structural level, via public policies that improve families’ income. But it is also proven that direct support of child development can reduce the risk of poverty in adulthood. Therefore, this study focuses on fields projects working directly with families living in poverty and aims to understand how, for whom and in which circumstances their actions can have effects on child’s development.

Methods

We conducted a realist evaluation of 30 field projects funded as part of the fight against child poverty and offering parenting support from prenatal period to the age of 6. Firstly, focus groups with the projects’ workers were conducted to identify the underlying mechanisms in their interventions and the contexts facilitating or hindering these mechanisms to achieve the desired effects. Secondly, these Context-Mechanisms-Outcomes (CMO) configurations are validated with project beneficiaries through semi-directed interviews, using picture telling.

Results

Despite the diversity of the actions carried out, common and transversal mechanisms are highlighted within 6 different CMOs that allow us to understand how and for whom those 30 projects work. Certain contexts - e.g. the characteristics of families, their feeling of freedom regarding the project, the density of projects network - can activate or hinder the mechanisms. We also note that workers tend to adjust their actions to support very vulnerable families for whom certain common mechanisms aren’t working.

Conclusions

This study, co-constructed through the collaboration of researchers and actors, could help workers to better understand and improve the mechanisms induced by their interventions, and stakeholders to recognise which projects are best suited to certain contexts.

Key messages

This realist evaluation enables to understand how for whom and in which circumstances field projects actions can have effects on child’s development and therefore take part in child poverty reduction. The realist approach used in this study, through the parallel evaluation of 30 different field projects, allows to refine hypothesis from one project to another, ensuring transferability of results.
Health and well-being of parents with 4-year-old children – a nationwide study in 2018 in Finland
Authors: Klemetti R , Vuorenmaa M , Ikonen R , Oksanen J , Lammi-Taskula J
Published: November 2019

Background

A nation-wide data collection on small children and their families’ health and well-being has been lacking in Finland. The aim of this study was to examine health and determinants of health among parents with a four-year-old child.

Methods

A nation-wide study for 4-year-old children (N = 8720) and their parents (N = 10 737) conducted in 2018. The families were recruited by public health nurses at child health clinics. Both parents had a possibility to answer a questionnaire considering questions on health, well-being and service use. General health of the parent was measured by one question (How do you find your general state of health?), depressive disorders by PHQ-2 and mental health by MHI-5. Data were analyzed by cross-tabulation. Results of logistic regression will be presented in the conference.

Results

Most participants were female (72%) and most families had two adults (93%). Mean age was 35 years and 58% were highly educated. Around 10% reported their health as average or poor, 19% had had depressive disorders within 12 months, and 6% had experienced mental distress. Single parents reported mental distress and depressive disorders significantly more often than the other parents. Average or poor health was reported significantly more often by female parents. Those with average or poor health or depressive disorders were significantly more likely to have one child, upper secondary education or less, or be outside of work. They felt themselves significantly more often lonely and unsatisfied with their life and family’s economic situation. They were also significantly more likely to report need of support for their own parenthood and partnership.

Conclusions

Health challenges among the parents were quite similar than those among the adults in same ages. However, detailed analysis is needed to find out the specific determinants affecting the parents and whole family’s life to be able to better support the families.

Key messages

Most parents with children aged 4-year-old were healthy and satisfied with their life. The parents having poor physical or mental health had also challenges in family life.
Sexual behaviour and attitudes among university students in Zagreb
Authors: Majer M , Puškarić Saić B , Musil V , Mužić R , Pjevač N , Jureša V
Published: November 2019

Background

Sexual behaviour of youth could have reproductive health outcomes with an impact on individual and general population health. The aim of this study was to determine sexual behaviour and attitudes among first year university students in city of Zagreb, Croatia.

Methods

Study included 298 first year students (61% of females) of Medical School University of Zagreb and 124 students (75% of females) of Catholic University of Zagreb in academic year 2017/2018. Data were collected by anonymous questionnaire School Health Survey, and analysed by descriptive statistics.

Results

Significantly higher proportion of Catholic University students have had sexual intercourse comparing to medical students of University of Zagreb (48% vs. 36%, P = 0.019). The age of first sexual intercourse for the most of students was from 16-18 years (73% of Catholic University students, and 79% of medical students). Contraception was always used among 54% of Catholic University students, and 67% of medical students, and never used among 11% and 4% of them respectively. Most of the students have gained information about human sexuality from the internet (26% of Catholic University students, and 30% of medical students), followed by friends (18%) and parents (11%) for Catholic University students, and television (25%) and friends (14%) for medical students. Most students expressed the attitude that sex education should be introduced in secondary schools (31% and 36%, respectively), followed by both, in primary and secondary schools (21%, and 30% respectively). Fourteen percent of Catholic University students and 7% of medical students thought that sex education should not be introduced to schools.

Conclusions

Results showed risky sexual behaviour of university students, especially Catholic University students, indicating the need of continuous education on reproductive health among youth.

Key messages

Results indicate the need of intervention and continuous education on reproductive health among university students in Zagreb, Croatia. Results showed insufficient use of contraception especially among Catholic University students indicating the need of education on reproductive health among medical and nonmedical students.
Maternal admissions to Intensive Care Units in France: trends in rates, causes and severity
Authors: Barry Y , Deneux-Tharaux C , Saucedo M , Goulet V , Guseva-Canu I , Chantry A A , Regnault N
Published: November 2019

Introduction

Maternal intensive care unit admission (ICU) is an indicator of severe maternal morbidity. This study aimed to estimate rates of maternal ICU admission during or following pregnancy in France, and to describe the characteristics of women admitted, the severity of their condition, associated diagnoses, regional disparities, and temporal trends between 2010 and 2014.

Methods

Women hospitalised in France in ICU during pregnancy or up to 42 days after pregnancy between 2010 and 2014 were identified using the national hospital discharge database (PMSI-MCO). The Simplified Acute Physiology Score (SAPS II) was used to estimate the severity. Trends in incidence rates were quantified using percentages of average annual variation based on a Poisson regression model.

Results

In total, 16,011 women were admitted to ICU, representing an overall rate of 3.97 ‰ deliveries. The average annual decrease in this rate between 2010 and 2014 was 1.7% (IC95%:-2, 00%; -1, 45%; p < 0.0001) on average per year. The SAPS II score increased significantly from 18.4 in 2010 to 21.5 in 2014. Obstetrical hemorrhage (39.8%) and hypertensive complications during pregnancy (24.8%) were the most common reasons for admission. Within mainland France, we found notable disparities in maternal ICU admission rates between regions, from lowest in Pays-de-la-Loire region (2.69‰) to highest in Ile-de-France (5.05‰).

Conclusions

The rate of maternal ICU admission decreased from 2010 to 2014 in France, with a concomitant increase in case severity. Additional studies are needed to understand the territorial disparities identified in our study.

Key messages

The decreasing incidence of maternal ICU admission could be due to organisational changes with increased admission to intermediate care units. These changes have to be understood to accurately use maternal CU admission for maternal health surveillance.
A French network for prevention and reduction of reproductive risk in couples and pregnant women
Authors: Sunyach C , Perrin J , Bretelle F , Paris C , Garlantezec R , Belacel M , Pairon J-C , Sentilhes L , Delva F , Brochard P
Published: November 2019

Background

Since 2013, several international (ASRM, FIGO, ACOG) and French (ANSES) learned societies and the French National Health and Environment Plan (2015-2019) urged to take into account exposures to environmental reprotoxic substances during standard care of infertile couples and pregnant women. However perinatal health professionals hardly incorporate this recommendation into practice.

Objectives

To create a network of platforms to addressing the environmental aspects that can impact the pregnancy chances of infertile couples after ART and pregnancy outcomes.

We asked regional health authorities in France to provide funding for multidisciplinary hospital structures, in conjunction with clinical-biological reproductive health and gynecology-obstetric centers. Expertise, as well as information leaflets and risk detection tools have been shared.

Results

Platforms of counselling and prevention have been set up in the University Hospitals of Bordeaux, Marseille, Rennes, Créteil and Paris Fernand-Widal. Infertile couples and pregnant women, referred by reproductive physicians, benefit from personalized management of their domestic/professional reprotoxic exposures by addictology/tobacco, dietetics, occupational health and environmental pathology professionals. The network organizes an annual scientific day and a common database of exposure is being set up.

Conclusions

The PREVENIR (PREVENTION - ENVIRONMENT - Reproduction) network of platforms allows perinatal health professionals to refer their patients in order to optimize their chance of pregnancy through personalized and multidisciplinary care. The lifestyle changes initiated through this approach will also improve pregnancy outcomes and child health.

Key messages

A French network for the prevention and reduction of reproductive risk in infertile couples and pregnant women: the PREVENIR platforms (PREVENTION - ENVIRONMENT - Reproduction) is being established. Perinatal health professionals of multidisciplinary platforms engage into preventive actions to limit the exposure to environmental hazards during preconception and pregnancy.
First national results of the evaluation of the neonatal hearing loss screening programme in France
Authors: Doncarli A , Tillaut H , Goulet V
Published: November 2019

Background

The French newborn hearing screening programme set up in 2014 aims to identify affected children as early as possible to allow appropriate care. Our goal was to evaluate the implementation of this programme at the national level.

Methods

The programme consist in a screening using a test (T1) and a retest (T2) in the maternity hospital in all newborns. In some region, a delayed test (T3) is performed afterwards in children for whom it was not possible to confirm normal hearing. Children suspected of deafness subsequently enter the diagnosis phase. We defined evaluation indicators after stakeholders consultation. We developed a web application to collect aggregated data on live births. We estimated the rate of coverage, refusal, children suspected of hearing loss at the end of the screening phase and the prevalence of bilateral deafness.

Results

In 2015, one year after the initiation of the programme, the coverage rate was already very high (88%) and even more so in 2016 (96%). Parental acceptance was very good (refusal: 0.1%). By the end of 2016, 19 out 27 regions had added a T3. The rate of suspicion of bilateral hearing loss was decreased by using a T3 (1.4% vs 0.9%). Bilateral deafness rate, estimated after a 2-years follow up, was 1.3‰ although it was estimated only on 51.5% of suspected children for whom diagnosis data had been transmitted.

Conclusions

The objective of a 90% coverage set by the French ministry of health has been met after 2 years of operation of the program. T3 appears useful in relieving diagnostic structures from false positives. Our estimated prevalence of bilateral deafness could be more accurate if data collection was improved but is consistent with prevalence reported in North America.

Key messages

The universal newborn hearing screening program has been successfully set up in France in terms of coverage. Future work should focus on improving the collection of follow up data to better characterise diagnosed children.
Association between leisure-time physical activity and the risk of chronic diseases
Authors: Dedele A , Miskinyte A
Published: November 2019

Background

According to the World Health Organization, non-communicable diseases or chronic diseases, account for 71 percent of all deaths globally, affecting individuals of all age groups and countries. Epidemiological studies have shown an association between a lack of physical activity (PA) and the risk of raised blood pressure, increased body mass index and obesity that can lead to chronic diseases.

Methods

The aim of the study was to assess the relationship between leisure-time PA and the risk of chronic diseases among adult population. We conducted a cross-sectional study of 470 men and 641 women who participated in “The Impact of Sustainable Mobility, Physical Activity and Environmental Factors on Urban Population Health Study (ISMA)” in Lithuania. Leisure-time PA was self-reported and divided into three levels: low, moderate and high. Logistic regression was used to estimate adjusted odds ratios (ORs) of chronic diseases according to leisure-time PA.

Results

More than half (55%) of the study population engaged in a moderate intensity PA and 12% of participants engaged in a high intensity leisure-time PA. Men 1.6 times more often than women reported engaging in a high intensity PA in leisure time (p = 0.004). Adults who engaged in low intensity leisure-time PA had almost 3 times (OR = 2.91; 95% confidence interval (CI) 1.62-5.24) higher risk of chronic diseases, whereas those adults who reported moderate intensity leisure-time PA had an OR of 1.63 (95% CI 0.92-2.87) compared to individuals who engaged in a high-level PA.

Conclusions

Our findings suggest that high levels of leisure-time PA could reduce the risk of chronic diseases and this effect was significantly stronger in men.

Key messages

Global decline in PA is related to inaction during leisure time and sedentary behaviour at work and at home that has a major health impact worldwide. High levels of leisure-time PA are important factor for chronic disease prevention.
Unsatisfactory effectiveness of preventive programs for oncogynecological diseases in Bulgaria
Authors: Georgieva S , Stefanova P , Kamburova M
Published: November 2019

Background

Incidence rate and mortality of breast cancer and cancer of the cervix uteri in Bulgaria are higher in comparison with most countries of European Union (EU). Moreover, during the last three decades they have been increasing, even doubled for cervix cancer, although in developed countries there are proven effective prevention programs. The aim of the study is to explore how these programs are being implemented in Bulgaria and what caused their unsatisfactory results.

Methods

Data were collected by documents review and direct individual self-administered questionnaire among 186 women aged 30-69 concerning types and regularity of preventive activities.

Results

National Health Insurance Fund in Bulgaria defines as mandatory and finances a regular check-up annually for health insured people over 18 years of age. Mammography, as a screening of a breast cancer, was included in regular check-up package from the year 2011, once at every two years, for women aged 50-69. Papanicolau test for cancer of the cervix uteri wasn’t provided in the preventive package until the year 2017 when it was included only for women who complete 30 years of age in the current calendar year with intended regularity once at every two years. Women from other age groups currently are not covered with preventive examination for cervical cancer or they should pay for it which restricts accessibility and affordability of prevention activities. Study results indicates that every fifth of the investigated women have never had a prophylactic examination for breast cancer and cervical cancer. In addition, 69.4% of those who have such examination did not comply with the recommended regularity.

Conclusions

Screening programs against breast cancer and cancer of the cervix uteri are consistent with the recommendations of the oncology research societies but they being applied relatively soon in Bulgaria and some age groups are out of their coverage which decreases their effectiveness.

Key messages

Incidence rate and mortality of breast cancer and cancer of the cervix uteri in Bulgaria are higher than in most countries of European Union although there are proven effective prevention programs. Screening programs against breast cancer and cervical cancer are not effective because of their low accessibility and affordability and because they don’t comply with the recommended regularity.
Maternal perceptions of paediatric cancer and diabetes in Cameroon
Authors: Wamba A , Matchika Mégaptché M , Mambou Nouemssi J-P , Koki Ndombo P , Pondy Ongotsoyi A-H
Published: November 2019

Background

Maternal perceptions of paediatric cancer and diabetes are still poorly studied in Cameroon, while they are considered as an inevitable part of the chronic diseases. Little is known to what maternal representations of paediatric cancer or diabetes refer to. Their contents remain unknown; and they are rarely taken into account in training programs for health care providers and educators. Yet, when ignored, they can have consequences impacting the relational dimension of care, prevention of relapses, disease complications, health education and behaviour change.

Methods

Based on a critique of the psychosocial conceptual models used in prevention, this study combines a qualitative approach aimed at identifying and describing mothers’ perceptions about paediatric cancer and diabetes, transforming them into educational content that can be reused for the training of health care providers and educators; and a quantitative component, obtaining their impact on the therapeutic relationship and therapeutic compliance.

Results

The results show that caregivers (healers, physicians), children, mothers and their close family are involved in the relational component of care; the Cameroonian mother expects that the therapist consulted should be a psycho-oncologist or a psycho-diabetologist, who can (power) and knows (knowdlege). Maternal perceptions determine the techno-therapeutic dimension, and may, if ignored, threaten therapeutic adherence, leading to abandonment.

Conclusions

This study suggests integrating maternal perceptions of cancer and diabetes with the messages used to elaborate languages for health education and caregiver training, to associate the healers to the early screening of cancer and diabetes, and to their educational, preventive and therapeutic care. Also suggested by this research is consideration of the relational dimension as a care service, and maternal perceptions as an illness that will need to be treated like cancer and diabetes.

Key messages

Associate the healers to the early screening of cancer and diabetes, and to their educational, preventive and therapeutic care. Considering relational dimension as a care service, and maternal perceptions as an illness that will need to be treated like cancer and diabetes.
Network of Vascular Centers in the Russian as a way to reducing mortality in the working population
Authors: Zubko A , Sabgayda T , Shelekhov P , Zaporozhchenk V , Zemlyanova E
Published: November 2019

Over the entire period of the state program aimed at reducing mortality from circulatory system diseases initiated in 2008 the number of Vascular Centers has increased from 85 to 140. According to the federal statistical observation form, the rate of Vascular Centers per 100 000 population increased 1.5 times from 0.066 to 0.095 in 2008 and 2017 respectively. As a result, the number of treated patients increased 6.3 times - from 53.1 to 327.3 per 100 000 population. During the analyzed period, the mortality rate of patients of Vascular Centers decreased from the average of 9.3% for all Vascular Centers in 2009 to 7.6% in 2017 (χ2 = 248.6, p < 0.0001) reflecting accumulation of experience of care delivery within the framework of the state program.

The majority of patients with myocardial infarction and cerebrovascular diseases received treatment in the Vascular Centers. In 2017, 76.6% of all patients were admitted to Vascular Centers. From 2008 to 2017, the mortality from circulatory diseases in urban males of working age decreased by 36.1% (from 354.6 to 226.6 per 100 000 population), while cardiovascular mortality in rural males decreased to a greater extent - by 41.0% (from 394.2 to 232.0). Female mortality from circulatory system diseases (the level of which was initially five times lower) decreased to a lesser extent: from 67.0 to 44.5 per 100 000 urban females of working age (1.5 times - by 33.6%), and was even more pronounced in rural females - from 90.8 to 55.4 (by 39.0%).

Therefore, along with the increase in the number of Vascular Centers the volume of specialized care including high-tech, increases while mortality decreases, reflected by the decreased mortality from myocardial infarction and other forms of acute ischemic heart disease. However, the activity of Vascular Centers did not affect the rate of mortality from cerebrovascular diseases in the Russian population.

Key messages

Through the activity of regional vascular centers since 2008 substantial reducing of patients’ mortality was registered from myocardial infarctions and other acute forms of ischaemic heart disease. Mortality from myocardial infarction has decreased in the last decade faster than in the period up to 2009.
Clustering & trajectories of multimorbidity across the lifecourse: a 70 year birth cohort study
Authors: Khanolkar A R , Patalay P
Published: November 2019

Background

Multimorbidity (≥2 chronic diseases) is increasingly prevalent in ageing populations and presents a public health challenge in successful disease management. Most evidence for multimorbidity at different ages comes from cross-sectional data, hindering understanding the extent and types of multimorbidity across the lifecourse, how they develop and associated risk factors. The aim of this study is to investigate the clustering and patterning of multimorbidity over the lifecourse using one of the longest running national birth cohort studies.

Methods

This ongoing study is based on the National Survey of Health & Development (NSHD), a birth cohort study following 5,362 individuals born in 1946 with detailed sociodemographic and clinical data collected from 22 waves across the lifecourse till date. This study will investigate the trajectories and clustering of 24 diseases (physical and mental health) and potential differences by sex and socioeconomic status using mixed-effects linear spline modelling.

Results

Preliminary analyses indicate that as expected, the rates of many conditions increase with age (e.g. 13% obese at age 43 to 31% at age 69), increasing the likelihood of individuals suffering from multiple conditions with age. At age 63, 73% with diabetes had hypertension, increasing to 85% with hypertension at age 69. We will estimate longitudinal trajectories of multimorbidity for individuals and whether the age of onset and rate of accumulation vary by sex, life-period and SES. Given the longitudinal nature of the data, we will investigate the extent to which multimorbidity earlier in the lifecourse predicts the rate of further multimorbidity later in the lifecourse.

Conclusions

Understanding patterning and trajectories of multimorbidity over the lifecourse and associated inequalities will better inform health care provision planning including appropriate window periods for intervention, specifically for the disadvantaged at higher risk of high multimorbidity.

Key messages

This is the first study to investigate trajectories of multimorbidity with data from birth to old age. Understanding how early life factors predict later life multimorbidity will better inform healthcare planning.
Validation of a national algorithm for diabetes screening
Authors: Lavranos G , Chrysostomou C , Leonidou M , Prodromou M
Published: November 2019

Background

The continuing upward trend in diabetes diagnosis across the world has led governments to adopt new treatment programs. According to the International Federation for Diabetes (2017) Europe and in its Member States spent from 10% to 20% of healthcare costs, for diabetes. The purpose of this study is to assess the feasibility of an algorithm to identify both the regulatory needs of diabetic individuals and to screen for undiagnosed individuals in the community.

Methods

The population sample consisted of 2100 people. The survey was conducted in two phases over the period 2017-2018. In the first phase we identified the 188 already diagnosed people with diabetes who were asked to answer a questionnaire comparing their current standard of care to NICE indicators. In the second phase, the remaining 1912 non-diabetic patients were asked to answer the Findrisk questionnaire. Those who were classified as high risk and very high risk were selected and referred to a clinical laboratory where they were subjected to a glucose curve to detect any diagnosis.

Results

The diabetes prevalence at the onset of the study was 9% (188/2100 people). Fifty-two new incidents were diagnosed. Thirty-six new cases were diagnosed by randomized glucose values after triple check and symptomatic diabetes symptoms consistent with the World Health Organization’s recommendations on diabetes diagnosis. Sixteen new cases were diagnosed via OGTT. The prevalence of diabetes at the end of the survey reached 11.4% (240/2,100 people)..

Conclusions

It has been found that one person in every forty in the general population suffers from diabetes without been yet diagnosed. Deviations from international diabetes standards have been observed. A new diabetes strategy should be implemented in the future, allowing the catholic implementation of the Findrisk Diabetes Prevention tool every ten years.

Key messages

Despite existing guidelines and recommendations, very few diabetic patients fulfill NICE follow up criteria. FINDRISK and OGTT can be used as part of a cost-effective national diabetes screening algorithm.
Current and future burden of prostate cancer in Tunisia projections to 2030
Authors: Cherif A , Dhaouadi S , Osman M , Hsairi M
Published: November 2019

Introduction

Prostate Cancer is the second most common cancer among men worldwide. Current and future estimates on the burden of cancer are needed. The aim of this study was to assess prostate cancer burden in Tunisia in terms of disability adjusted life years (DALY) in 2017 and to perform projections by 2030.

Methods

DALYs for cancer are the sum of years of potential life lost due to premature mortality (Years Life Lost YLL) and the years lived with disability (YLD). Estimated data related to Burden of disease (Incidence rate, death rate, DALY, YLL and YLD)are obtained by the Institute for Health Metrics and Evaluation (IHME). Demographic data were provided by the National institute of statistics. The projection of DALYs for prostate cancer through 2030 was performed by a Poisson Regression analysis with Age -Period -Cohort (APC) using SPSS software, while using IHME estimated data for the period 1990-2017.

Results

In 2017, prostate cancer incidence rate and mortality rates among males in Tunisia were 24.17/100000 persons years and 7.08/100000 persons years respectively. Prostate cancer DALY values were 6548 (114 /100000). The number of YLLs was 5712 with a higher contribution of YLL in DALYS (87.2%). Without effective interventions, the number of DALYs due to prostate cancer would reach 10105 in 2030 with a standardized rate of 113/100000 persons years (IC 95% = [110/100000 to 116/100000].

Conclusions

The burden of prostate cancer in Tunisia in 2017 is relatively high and will still rising until 2030. This highlights the urgent need to focus resources on disease prevention and in the improvement of treatment.

Key messages

The burden of prostate cancer is high in Tunisia in 2017. Need to focus ressources on disease prevention and in the improvement of treatment.
Lung Cancer burden of disease in The Northern Tunisia
Authors: Cherif A , Dhaouadi S , Osman M , Hsairi M
Published: November 2019

Introduction

Lung Cancer is one of the leading cancers and major causes of death among men worldwide. Current estimates on the burden of cancer are needed to plan and evaluate cancer control policies. This study aimed to estimate the lung cancer burden in Northern Tunisia in terms of disability adjusted life years (DALY) from 2007 to 2009.

Methods

DALYs for cancer are the sum of years of potential life lost due to premature mortality (YLL) and the years of productive life lost due to disability (YLD).We calculated YLL by multiplying the number of deaths by the standard life expectancy at that age using the mortality data of the Global Cancer statistics 2012 (Globocan 2012) and the population data provided by the National institute of Statistics. We used the model life-table West with a life expectancy at birth of 82.5years for women and 80 years for men.YLD were computed by multiplying the number of new cases by the average duration of the disease calculated with the DiSMoDII software. The disability weight employed was 0.917 for lung cancer; a discounting rate of 0.03 was applied. The Incidence data were obtained from the Cancer Registry of the North region of Tunisia 2007-2009.

Results

The incidence rate of lung cancer in the northern region of Tunisia between 2007 and 2009 was 28.8/100000 persons years for males and 3.1/100000 persons years for females. Lung cancer death rate was 27.8/100000 persons for males and 1.65/100000 persons for females. Lung cancer DALY values were 10404 for males (410/100000) and1251 for females (50/100000). The percentage of YLL in DALYS was 93.3% for males and 51.7 % for females. The highest proportion of YLL was observed for the age group 60-69years for both sexes.

Conclusions

The burden of lung cancer especially among males is very important. This highlights the importance of promoting the preventive measures such as the Tobacco control including tobacco cessation.

Key messages

Burden of lung cancer among male is very high in Tunisia. Importance of promoting preventive measures such as tobacco control.
Identifying barriers to organizational health literacy in public health departments in Germany
Authors: Mehlis A , Hornberg C
Published: November 2019

Background

To master challenges to their environmental health, people have to have health literacy (HL). At a national and communal level, focus is shifting from individual HL to health care organizations. They have to raise their organizational health literacy (OHL) to help their users to access information and services. In Germany, public health departments are responsible for environmental health at a population level while the environmental administration is responsible for health-related environmental protection. To date, there is no research on the OHL of public health departments in Germany. Which are the barriers that keep public health organizations from raising their OHL as well as from making better use of possible synergies with the environmental administration?

Methods

The study consisted of interviews with experts from public health (n = 7) and environmental departments (n = 5) at communal (n = 8) up to federal state level (n = 4). Experts were asked for their insight on barriers for OHL as well as for cross-sector collaboration. They were selected for a wide range in socioeconomic factors and administrative levels. The interviews were recorded between 10/2018-04/2019. After transcription the anonymized interviews underwent qualitative content analysis.

Results

In twelve interviews 10.4 h of audio were recorded. Content analysis revealed 13 barriers for OHL. Several of those had been described for hospitals before while others, like low responsiveness to the needs of the public, were unknown so far. Preliminary results also indicated several barriers for cross-sectoral cooperation as well as recommendations to overcome said barriers.

Conclusions

Interviews with public health and environmental administrative organizations turned up 13 barriers that keep them from raising their OHL. Implementing preliminary recommendations could result in better cooperation, in higher OHL, higher environmental health and therefore contribute to public health in the general population.

Key messages

Interviews with experts from public health and environmental administrative organizations in Germany turned up barriers that keep them from raising both their OHL and cross-sectoral cooperation. Implementing preliminary recommendations could result in higher OHL of public health departments and higher environmental health of the general public and thus contribute greatly to public health.
Assessing the use and understanding of the Portuguese Heat–Health Warning System (ÍCARO)
Authors: Leite A , Santos A J , Silva S , Nunes B , Mexia R , Rodrigues A P
Published: November 2019

Background

Heatwaves can lead to increased mortality. Portugal has a Heat-Health Warning System (HHWS) in place (ÍCARO system). Researchers at the Instituto Ricardo Jorge send a daily report with heat-related mortality forecasts to key stakeholders (e.g. Heat-Health Action Plans (HHAP) staff). HHAP practitioners issue warnings and implement measures to prevent heatwaves-related mortality. ICARO is amongst the recommended data sources to assess risk and issue warnings but its use and understanding is unknown. Therefore, we aimed to assess ÍCARO’s use and understanding by key HHAP practitioners.

Methods

We conducted semi-structured interviews with national and regional HHAP practitioners. Interviews were recorded, transcribed, and analysed using thematic content analysis. Intercoder reliability was applied to a sample of segments from 5 of 6 interviews.

Results

We conducted 6 interviews with 9 professionals (mean time 52 minutes). We identified 4 categories: Report’s content and presentation, Report’s reception and communication, ÍCARO and risk assessment, Other issues. Practitioners use ÍCARO and perceived it as very relevant tool. However, they mentioned several questions on its interpretation. Practitioners also felt their questions were not fully answered, given researchers’ use of statistical terms. Finally, practitioners referred the need to assess risk at the local level, information not currently provided. We also identified the need for improved communication and report’s clarity.

Conclusions

Our study stresses the need for an integrated collaboration between experts within HHWS and HHAP. Despite ICARO’s understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO interpretation. Practitioners’ needs should be considered when developing or revising tools. We are currently implementing some of these recommendations in an attempt to close the gap between researchers and practitioners.

Key messages

Portuguese Heat–Health Action Plans practitioners use heat-related mortality forecasts (ICARO) and perceived it as very relevant instrument. However there find ICARO’s interpretation challenging. Portuguese Heat/Health Action Plans Practitioners’ needs should be considered when revising or developing tools, and notes should be added to clarify statistical/technical concepts.
Environmental health risks perceptions: results from cross-sectional surveys in Southeastern France
Authors: Bocquier A , Cortaredona S , Andrieu-Semmel M , Dagnet L , Pouget V , Urban-Boudjelab S , Verger P
Published: November 2019

Background

In accordance with commitments made as part as the European conferences on environment and health in the 90s, France has adopted national environmental health plans since 2004. These plans include regional offshoots to take local specificities into account. To guide stakeholders in defining this plan in Southeastern France, studies were carried out to document general population environmental health risks perceptions and practices.

Methods

Data come from the Southeastern Baromètre santé environment, random cross-sectional telephone surveys carried out in 2007 and 2017 among the population aged 18-75 years (n = 1415 and 1960 respectively). They focused on people perceptions’ about environmental health risks (e.g., air pollution) and actions to reduce them, trust in sources of information, and their practices. We performed descriptive analyses of the 2017 data, and logistic regression models adjusted for sociodemographic variables to test time evolutions.

Results

In 2017, the main environmental health risks perceived were pesticides, carbon monoxide, and air pollution (over 90% of the participants thought they carry high health risks). As in 2007, over 90 % thought the air quality had been worsening. The most efficient ways to reduce air pollution were the improvement of public transportation, of bike paths and the development of car sharing. Between 2007 and 2017, self-reported use of soft mobility and/or car sharing increased from 54% to 66%; and consumption of organic food increased from 40% to 69%. Participants perceived physicians as the most trustful source of information about environmental health.

Conclusions

Habitants from Southeastern France are highly concerned by environmental health risks, especially pesticides and air pollution. They call stakeholders to take actions to reduce these risks, but appear to have changed some of their own practices too. These results helped stakeholders to define priorities of the current regional environmental health plan.

Key messages

The general population was highly concerned by environmental health risks (especially pesticides and air pollution), and has become aware of the necessity of changing its own practices. Such results about the regional population main concerns have been used to define regional priorities for actions.
Effect of outdoor air pollution on respiratory deseases in the District of Tunis
Authors: Lahchaichi A , Bellali H , Harizi C , Ben Alaya Bouafif N , Talmoudi K , Chahed M K
Published: November 2019

Background

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most common chronic obstructive pulmonary diseases worldwide. The objective of this study was to analyze the relation between the daily levels of air pollution indicators and the number of emergency department visits (EDV) for asthma and COPD exacerbation in the District of Tunis.

Methods

We conducted a retrospective ecological study. We collected daily morbidity data from the emergency register of Ariana Mami Hospital from 1 January 2007 to 31 December 2014. We investigated the association between daily EDV for asthma or COPD exacerbation and daily concentrations levels of air pollutants by simple Pearson correlation and by binomial negative regression using generalized linear models (GLM).

Results

For morbidity data, we recorded 19127 EDV for asthma (10771, 56.3%) and COPD exacerbation (8356, 43.7%) between 2007 and 2014. We observed a rising trend in the number of EDV for COPD since 2007 with winter seasonality. Regarding the profile of air pollution in the study region, we have exceeded the thresholds of all standards for PM10, exceeding the Canadian standard for O3. However, no threshold exceeded for NO2 and SO2. In the univariate analysis, there was a positive correlation between the daily number of EDV for asthma and COPD exacerbation and NO2 ambient concentration (r = 0.121, p < 10-3) and O3 level (r = 0.066, P < 10-3). Multivariate analysis showed a significant positive association between the daily number of EDV for asthma and COPD exacerbation and NO2 daily concentration (Adjusted OR = 1.033, CI = [1.011 - 1.055], P < 10-3) with a delayed effect of 10 days for NO2 and 12 days for O3.

Conclusions

The exacerbation of asthma and COPD was correlated to the NO2 outdoor air concentration level, with an immediate and other delayed effect of 10 days, also with the 12-day lag from the elevation of O3.

Key messages

Ambient air pollution is a major risk factor for respiratory health. Reducing NO2 emissions could decrease morbidity and direct health care costs of respiratory diseases.