bluuebunny/crossref_metadata_2025 huggingface dataset:
Mediterranean diet and risk of first hospitalization for heart failure and atrial fibrillation
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Ruggiero E , Persichillo M , De Curtis A , Cerletti C , Donati M B , de Gaetano G , Iacoviello L
Published: November 2019

Background

We aimed to explore the association of a traditional Mediterranean diet (MD) with risk of first hospitalization for heart failure (HF) or atrial fibrillation (AF) in a population-based cohort from a southern Italian region.

Methods

Longitudinal analysis on 20,598 men and women (aged≥35 y) free from HF, AF and cardiovascular disease recruited in the Moli-sani Study (2005-2010). First hospital admissions for HF or AF were recorded by direct linkage with hospital discharge form registry. Dietary data were collected by the EPIC food frequency questionnaire, adherence to MD was appraised by the Greek Mediterranean diet score (MDS ranging 0-9). Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression.

Results

Over a median follow up of 8.2 y, we ascertained 661 HF events and 337 AF cases. A 2-point increase in the MDS was associated with a downward trend in the risk of developing HF (HR = 0.94;0.85-1.04) after adjustment for potential confounders, while no association was found with risk of AF (HR = 1.07;0.94-1.21). Analyses run separately by gender revealed that higher adherence to an MD was associated with lower risk of HF among women (HF = 0.83;0.72-0.95 for 2-point increase in the MDS) but not in men (HR = 1.07;0.93-1.22; p for interaction=0.011). No gender-related difference was observed for AF risk (p for interaction=0.62). Among women, higher intake of monounsaturated over saturated fats was associated with 38% (20% to 52%) lower risk of HF, while in men moderate alcohol intake was likely to reduce HF risk (HR = 0.87;0.70-1.08).

Conclusions

Closer adherence to a traditional MD is associated with lower risk of first hospitalization for HF among women but not in men. No association was found with risk of AF.

Key messages

A traditional MD reduces the risk of HF in women but not in men. Minor dietary changes inspired to a traditional MD could be valuable primary prevention measures for risk of HF.
Building bridges takes time: Views of healthcare professionals on health literacy and migration
Authors: Baumeister A , Aldin A , Chakraverty D , Seven ÜS , Anapa G , Jakob T , Skoetz N , Kalbe E , Woopen C
Published: November 2019

Background

Health literacy is an output of individual resources and capabilities, situational factors, environmental conditions, and the requirements of the health care system. As migration continues to increase globally, successful interaction between healthcare professionals and migrants can be important for a sustainable and resource-oriented promotion of health literacy. This study aims to explore challenges, needs and applied solutions of healthcare professionals in the interaction with migrants in Germany.

Methods

Five focus group discussions were conducted in Cologne, Germany. Participants were healthcare professionals (n = 30), including general practitioners, medical specialists in inpatient and outpatient care, and nurses. Discussions were audio recorded, transcribed verbatim and analysed by qualitative content analysis.

Preliminary results

Participants reported a lack of time and general uncertainty in dealing with the health literacy-related needs of the target population. Assumptions on discrimination through the health system and restrictive gender roles on the patients’ side were additional key challenges for a successful interaction. To bridge these barriers, some participants reported to invest time even beyond systemic conditions; most wished for professional interpreters or cultural mediators. Participants who themselves were migrants found this helpful for communicating information to patients and improving patients’ confidence in the recommended treatment. Using clinical staff as lay interpreters outside their own treatment situation was rated critical, as it can be associated with a considerable burden due to a further time restriction for their actual tasks.

Conclusions

Preliminary findings reveal that general problems in the health care setting (e.g. time pressure, ensuring patients’ compliance) can occur more intensively in migrant patients. Health professionals require support through the provision of state-funded professional interpreters.

Key messages

Health literacy related challenges become more visible in the context of migration and reveal general issues in the German health system that need to be solved for the benefit of the entire population. Research on health literacy in the context of migration is important in order to ensure the promotion and maintenance of health equally and effectively across populations.
Digital health literacy of health care profession students
Authors: Dratva J , Juvalta S , Gemperle M , Händler-Schuster D , Scheermesser M , Klamroth-Marganska V
Published: November 2019

Background

Digital transformation in health and health systems is a chance and a challenge for health professionals irrespective of their field. To maximize the benefit for patients high digital health literacy is required. A requirement not represented in health professions’ curricula in Switzerland. Little is known on the digital health competencies of students, on their utilization and views of digital media in the context of health, thus a cross-sectional survey was performed at a School of Health Professsions in Switzerland.

Methods

All BSc. students (N = 1200; nursing, midwifery, occupational health, physiotherapy and health promotion) received an online questionnaire covering utilization of various information resources, views on digital health & media and the German eHealth Literacy Scale (eHEALS, score 0 - 40). Descriptive and group analyses were performed, further adjusted analyses will be run.

Results

453 students responded (female N = 368, male N = 26). Participation was 38% and highest in 1st students. Personal health information resources used most were: internet 82%, familiy&friends 70%, health professionals 66%, textbooks 40%. A majority rated digital media as important (66%) or rather important (30%) for their future professional activities. The overall eHeals-score was 28.6 (sd 4.93); critical evaluation and confidence in applying information scored lowest. Preliminary group analyses show significant increase by study year (1st 28.0, 2nd 28.9, 3rd 29.7, p = 0.01), while scores by gender or health profession were non-significantly different.

Conclusions

Almost all students in health professions use digital media for their own health information needs and consider digital media as highly relevant for their future career. Critical evaluation skills need to be strenghtend. Digital Health Literacy is only slightly higher in 3rd year students. Longitudinal data are needed to differentiate cohort from learning effects.

Key messages

Digital media are increasingly important in health systems, a view shared by future health professionals. Data indicate only a small increase of digital health literacy across three years of study. Curricula should include digital health competencies to ensure a highly digitally skilled health work force.
1.O. Workshop: Building bridges between environmental and Public Mental health
Authors:   Organised by: EUPHA (PMH), EUPHA (ENV) Chair persons: Jutta Lindert - EUPHA (PMH), Marija Jevtic - EUPHA (ENV)
Published: November 2019

Scope and extent as well as duration of mental health and mental disorders are influenced by various factors, such as environmental factors. Environmental factors relate to physical, chemical and built environment. We aim to build knowledge by providing 1) a case study on perception of climate change and possibilities and limitations of adaptation, 2) a review on mental and neuropsychiatric disorders in the light of the SDGs framework and 3) give an overview of research methods both, in environmental epidemiology and in neuropsychiatric epidemiology. By bringing together the two fields of expertise and the members of the section of Environment and Health and of Public Mental health we will not only build bridges between individuals but between disciplines which might lead to a joint research agenda.

Key messages

The scope of mental health changes with changes in the environment. Knowledge provides a strong bridge to link the environment with mental disorders.
“Brave men” and “emotional women”: A literature review on gendered norms towards patients with pain
Authors: Samulowitz A , Gremyr I , Eriksson E , Hensing G
Published: November 2019

Background

More women than men report chronic pain but despite the large body of research on sex differences there is a lack of knowledge on the influence of social and cultural gender. As gender norms can lead to gender bias in health care it is important to raise awareness about them. The purpose of this study was to illustrate gendered norms about men and women with chronic pain in scientific journals, and to analyze how societal norms are reproduced in health care.

Methods

A literature search of the databases PsycINFO, CINAHL and PubMed was conducted, January 2000 to April 2015, with the search term chronic pain combined with femininity, masculinity, gender bias, gender stereotypes and gender roles. A total of 77 articles met the inclusion criteria and were analyzed qualitatively. The integrative approach enabled a review of articles from both social and medical sciences, and to include qualitative and quantitative research. The material was sorted into theoretical categories and further coded into substantive categories.

Results

The included articles showed a variety of gendered norms about men’s and women’s experience and expression of pain, their identity, lifestyle and coping style. Women were described as emotional and hysterical, constantly dealing with mistrust from health care. Men were pictured as brave, stoic and struggling with their sense of masculinity. Prevailing societal norms are consolidated in health care, positioning the masculine man as the ideal patient.

Conclusions

Gender stereotypes are reproduced in healthcare, which can lead to gender bias in the treatment of patients with pain. The findings were used to develop a tool, “the pain cube”, aimed to improve health care providers’ consciousness about gendered norms.

Key messages

Men and women with chronic pain are depicted in a stereotypical way in scientific articles. Increased awareness about gendered norms can support health care professionals in providing equitable care.
Do financial difficulties affect health? A study among older adults in Switzerland
Authors: Dumontet M , Santos-Eggimann B
Published: November 2019

Background

In perspective of health promotion strategies among older adults, it is particularly important to identify socioeconomic determinants associated with the dynamic of health. In this study, we want to assess the role of financial difficulties on health among older adults.

Methods

We use cohort data coming from the Lausanne cohort 65+. Participants were community-dwelling older adults representative of the general population aged 65 to 70 years in 2004 and living in Lausanne (Switzerland). This cohort is a longitudinal survey and was designed as an annual survey where same individuals (N = 1564) are re-interviewed in successive waves. Wave 1 and wave 2 are considered as baselines. We perform our analysis on the 2006-2016 period (11 waves). We consider the health dynamic by estimating system GMM estimators. Our main explanatory variable is a proxy of financial difficulties: “Have you been confronted to financial difficulties in the last 12 months?”. We study the effect of this variable on several health indicators (self-rated health, number of medical conditions, depression, difficulties in activities in daily living) and evaluate if this effect is similar for these different dimensions of health.

Results

Our econometric analysis underlines the importance of using dynamic approach: health lag variables have significant effects (p < 0.01) and to control for endogeneity bias. We find no evidence of a causal link from having financial difficulties to health. The effect was non-significant for all health variables.

Conclusions

In terms of public policy, our results provide insight that policies allowing to limit short term financial difficulties are not essential to protect elderly against health deterioration.

Key messages

There is no evidence of a causal link from having financial difficulties to health. Policies allowing to limit short term financial difficulties are not essential to protect older adults against health deterioration.
E-health for healthcare system users & social and geographic health inequalities, literature review
Authors: Ramel V
Published: November 2019

Objective

EHealth has been taking a growing part in public health policies and seems to make it possible to break space and time barriers currently impacting health and well-being (by improving care coordination, prevention, decision support and helping care delivery). However, there is a growing literature on eHealth-related digital divides. We therefore need to understand better the interface between social and geographic vulnerabilities and eHealth services. Previous reviews of the literature started exploring it but lacked a sufficient framework that would be useful for health professionals to adapt to their practice.

Methods

We carried out a scoping literature review of these relationships in scientific literature since 2000 in Western countries in Scopus, PubMed, PsycArticles, SocIndex, PBSC.

Results

The links between eHealth oriented towards healthcare system users and social and geographic health inequalities (SGHI) can be observed at three levels: access to digital technologies, understanding of digital technologies and of the information provided (eHealth literacy) and adoption of these technologies to help improve one’s health. People’s vulnerabilities can become real inequalities regarding eHealth, in a cumulative way. Several types of vulnerabilities are analysed.

Conclusions

EHealth is more easily accessed by people who need it the least. These unintended consequences have to be taken into account while developing eHealth and more research needs to highlight them. This review contributes insights about eHealth and health inequalities descriptors thus describing better SGHI and of digital technologies fields. It presents a thorough description of this field which has not been sufficiently described in the literature. It is a large scoping review offering a knowledge cartography which purposely addresses the whole spectrum of these links. In the future, it will be interesting to perform further in-depth systematic analyses on specific sub-issues.

Key messages

EHealth is more easily accessed by people who need it the least. These unintended consequences have to be taken into account while developing eHealth and more research needs to highlight them. This review contributes insights about eHealth & health inequalities descriptors. It offers a knowledge cartography and a strong basis for further in-depth systematic analyses on specific sub-issues.
National survey on telemedicine education and training among medical students and residents in France
Authors: Ohannessian R , Yaghobian S , Iampetro T , Riom I , Salles N , Matthieu-Frtiz A , Moulin T
Published: November 2019

Telemedicine was defined in France in 2009 and until 2017 integrated into the official medical school and residency programs. A national survey among medical school deans indicated a lack of implementation of telemedicine education and training despite positive attitudes towards it. In September 2018, teleconsultation started to be reimbursed for all doctors and patients by the National Health Insurance.

The objective was to describe the knowledge, attitudes, and practices of medical students and residents in France on telemedicine. A national voluntary online questionnaire-based survey was conducted from December 15th, 2018 to March 3rd, 2019. The survey was shared by the French Society of Telemedicine (SFTelemed), the National Association of French Medical Students (ANEMF), and the National Union of Medical Residents (ISNI).

There were 3329 answers, with 67.5% of participants being women and 69.8% being medical students and 30.2% residents. In total, 82.8% declared telemedicine was relevant to improve access to care. 84.8% did not know telemedicine regulations at all. 86.9% declared they knew the definition of teleconsultation and only 40.3% for tele-expertise. 14.4% received telemedicine theoretical education, and 97.9% stated they were not trained enough. 7% practised telemedicine during their medical school education and 30% during residency. Among them 60.2% practiced telemedicine less than 5 occasions. Among those who did not practise telemedicine during their education, 82.6% answered that they would want to practice telemedicine before the end of their studies.

Medical students and residents in France have a positive attitude towards telemedicine, however, were limited to its practice. Majority of participants declared they want to be educated and trained for telemedicine during their studies. This is the first national scale study in the world and should be applied in France for other healthcare professionals and other countries.

Key messages

Telemedicine education and training should be provided to medical students and resident during their curriculum. Medical schools and residency programs need to integrate and apply telemedicine in their programs.
Why integration matters
Authors: Lomazzi M
Published: November 2019

M. Lomazzi will focus on the SBB example and the need to increase integration of oral and public health to rise the success of interventions.
Which are the communication styles of anti-tobacco spots that most impress adolescents?
Authors: Mannocci A , D’Egidio V , Guerra F , De Marco Y , Gualano M R , Firenze A , Giordano D , Boccia G , Siliquini R , La Torre G
Published: November 2019

Objectives

To evaluate emotions and opinions of Italian adolescents aged 13-18 years old about different anti-tobacco spots delivered by the mass media campaigns over the world.

Methods

A multicenter cross-sectional study was conducted. Italian students from different regions were enrolled. A video that collected 7 anti-tobacco spots from all over the world. The spots describe the tobacco dependence, the health damages and the tobacco components using different communication styles (funny, scientific, dramatic, comedians, shocking, and sad). Information on age, gender, smoking status of family and peers were gathered. Descriptive and univariate analysis of emotional and cognitive reactions to spots were performed with respect to gender, smoking status of adolescents, their peers and parents.

Results

495 students were enrolled. 14% of them were current smokers. Two spots resulted to have most impressed the students: Sponge (29%) and Icons (18%). In the first spot the sponges represent human lungs, a pair of hands squeeze the tar from the sponge, revealing the cancer-producing tar that goes into the lungs of a pack-a-day smoker every year. The second one contrasts tobacco industry images such as a cowboy, a hip-hop DJ with a more accurate depiction of the repercussions of smoking: a dying man in a wheelchair who warns, ‘The reality is you can end up looking like this’. The reactions on these videos are disgust, reflection and sadness, respectively: Sponge 79%, 44% and 15%; Icons 60%, 3% and 20%. Univariate analysis showed differences by smoking status about video considered most impressive (p = 0.02) and by gender about the choice of spot in the role of the Minister of Health (p < 0.001).

Conclusions

The spot media campaigns that gave a clear and scientific message or that changed the “icon” of the smoker were preferred by adolescents. Further research is needed to study adolescents’ responses and smoking outcomes obtained by different anti-tobacco mass media campaigns.

Key messages

The study demonstrates the preference of adolescents for spot giving clear scientific messages or using strategies that fight manipulation of the tobacco industry and aimed at changing smoker’s icon. The present study underlines that it is necessary to monitor the effect of a multimedia campaign and to examine its longitudinal impact, especially its impact on smoking behavior.
Social network characteristics and alcohol use among young Swedes with different ethnic backgrounds
Authors: Miething A , Gustafsson N K , Rostila M , Rydgren J
Published: November 2019

Background

The study explores how social network determinants relate to the prevalence and frequency of alcohol use of members of social networks. In a so-called dyadic design we study how similar alcohol habits co-exist among individuals (egos) and their peers (alters), when variables such as ethnic background, network composition, and other socio-cultural aspects are considered.

Methods

The data were derived from a Swedish survey entitled “Social Capital and Labor Market Integration: A Cohort Study.” The study participants (egos; n = 1989) were around age 23 at the time of the interview. A so-called dyadic design was applied, which means that all components of the analysis refer to ego-alter pairs (n = 7828).

The outcome variable considered how alcohol prevalence and frequency of binge-drinking co-exist between egos and their alters. The independent variables also measured mutual attributes and behaviors - whether egos and alters were at the same age and sex, had same ethnic background, were relatives or friends, had similar religious affiliations, or intensely interacted with friends.

Results

The analysis revealed that ego-alter similarity in terms of age, sex and ethnic background predict ego-alter similarity in alcohol use and binge-drinking. For example, if egos and alters shared a similar ethnic background, their risk of alcohol use was at least 30 percent higher as compared to those with different ethnic backgrounds. Relative to ego-alter pairs with mixed ethnic backgrounds, the odds of binge-drinking were highest for ego-alters pairs with Yugoslavian background (OR 1.76; 95% CI 1.27-2.42), followed by those with Iranian (OR 1.57; 1.04-2.35) and Swedish background (OR 1.28; 0.84-1.95).

Conclusions

We conclude that network similarity (i.e., homophily) is an important explanation for the co-existence of alcohol use among members of peer networks. Alcohol use is more common in homogeneous peer dyads representing population groups with higher use.

Key messages

Peer similarity predicts alcohol use and binge drinking. Ethnic similarity of peers is associated with increased alcohol use and binge drinking.
Personalized action plans for patients with multiple chronic diseases in Andalusia
Authors: Carriazo A M , Cosano I , Lama C , Bedoya J J , Ollero M , Lafuente N , Rodriguez S , Rodriguez-Acuña R
Published: November 2019

Issue/problem

Complex chronic patients (CCPs) present multiple chronic conditions and complex healthcare needs. Comprehensive care by multiple healthcare professionals at different settings is required to improve their outcomes. This challenge is faced by the Andalusian Public Health System (APHS), responsible for the provision of healthcare and public health services to the entire Andalusian population (8.5 million inhabitants).

Description of the problem

Almost 250000 CCPs have been identified within the APHS in 2018. The very complex ones (4%) utilise up to 30% of primary care and hospital resources.

The Comprehensive Healthcare Plan for Patients with Chronic Diseases was launched in 2012 to ensure the comprehensive care for these patients with a multidisciplinary response. Together with the Integrated Care Process Healthcare for Multimorbidity Patients, set the scene for implementing integrated healthcare with coordination of professional services and/or centres over time, helping to decrease clinical variability and improve quality of care.

Results

Since 2016, Personalized Action Plans (PAPs) were introduced as key-elements to provide a holistic care coordinated at primary healthcare, including: taking patient’s individual needs, preferences and own resources as a starting point for their evaluation and the development their PAPs,involving of patient’s informal caregivers,involving all relevant care levels and health disciplines,ensuring the multidisciplinary care with a coordinating team.

Lessons

PAPs are a key element in the healthcare process for CCPs, and the assessment of its implementation in Andalusia is contributing to generate evidence within the Joint Action on Chronic Diseases (CHRODIS+, www.chrodis.eu).

Key messages

PAPs implementation and assessment are crucial to better address CCPs health needs, facilitating a patient-centred healthcare approach, and contributing to a European model of care. Involving patient, family carers together with the professional team facilitates achieving better healthcare outcomes.
Sugary drink consumption and cancer risk: results from NutriNet-Santé prospective cohort
Authors: Chazelas E , Srour B , Kesse-Guyot E , Julia C , Deschamps V , Galan P , Hercberg S , Latino-Martel P , Deschasaux M , Touvier M
Published: November 2019

Background

The objective was to assess the associations between the consumption of sugary drinks (sugar sweetened beverages and 100% fruit juices), artificially sweetened beverages and cancer risk.

Methods

Overall, 101,257 participants aged ≥18y (mean age: 42.2) from the French NutriNet-Santé cohort (2009-2017) were included. Consumptions of sugary drinks and artificially sweetened beverages were assessed using repeated 24h-dietary records, designed to register participants’ usual consumption for 3,300 different food and beverage items. Associations between beverage consumption and the risk of overall, breast, prostate and colorectal cancer were assessed by multi-adjusted Fine&Gray Hazard models, accounting for competing risks.

Results

The consumption of sugary drinks was significantly associated with overall cancer risk (n = 2,193 cases, sHRfor a 100mL/d increase=1.18, 95% confidence interval 1.10 to 1.27, P<.0001) and breast cancer risk (n = 693 cases, sHRfor a 100mL/d increase=1.22, 95% confidence interval 1.07 to 1.39, P = 0.004). The consumption of artificially sweetened beverages was not associated with cancer risk. In specific sub-analyses, the consumption of 100% fruit juice was significantly associated with overall cancer risk (n = 2,193 cases, sHRfor a 100mL/d increase =1.12, 95% confidence interval 1.03 to 1.23, P = 0.007).

Conclusions

In this large prospective study, the consumption of sugary drinks was positively associated with overall and breast cancer risks. Of note, 100% fruit juices were also positively associated with overall cancer risk. These results need replication in other large-scale prospective studies. They suggest that sugary drinks, which are massively consumed in Western countries, may potentially represent a modifiable risk factor for cancer prevention.

Key messages

In this large prospective study (n = 101,257), the consumption of sugary drinks (including 100% fruit juice) was associated with an increase in overall and breast cancer risk. In specific sub-analyses, 100% fruit juices were also associated with an increased risk of overall cancers. The consumption of artificially sweetened beverages was not associated with cancer risk.
An automated diagnostic device for children under 5 years of age: A proof-of-concept study in Malawi
Authors: Shah M , Jenda G , Nsona H , Gigi E , Dadlani P , Swedberg E
Published: November 2019

Background

Automated diagnostic device to measure child’s vital sign is a global unmet demand. Having separate diagnostic devices to measure multiple vital signs is more expensive, and can be complex for health workers. An automated “all-in-one” device would help avoiding extra costs as well as maintenance challenges associated with multiple devices. In addition to improve classifying childhood illness, such an automated device would also increase adherence to guidelines, optimal use of antibiotics, and a reduction of unnecessary referrals.

Methods

We studied an automated device in Malawi, which was designed to measure multiple key vital signs (SPO2, respiratory rate, temperature) among newborn, infant and children <5 years. The device collected photoplethysmogram (PPG) signals for SpO2 via a universal pediatric sensor, placed on child’s finger. Temperature was measured via infra-red signal from child’s forehead. Accelerometry measures respiratory rate, by placing the device around the child’s belly. The CO2 sensor data together with video recordings of child’s respiration offered the reference for child’s respiration count.

Results

Preliminary analyses of valid PPG signals, video annotated respiratory count and CO2 sensor data revealed the following key results:

- For SPO2, the performance of the target probe among 170 subjects appears extremely well with even the smallest and largest children.

- Among 145 subjects with valid CO2 data, 93 subjects were fully calm and had a regular breathing pattern. Comparing accelerometry measurements from 93 calm subjects with the reference data, the root of mean square error (RMSE) was only 1.18 respiration per minute (RPM). Excluding four outlier measurements from 145 subjects’ dataset, the RMSE for the remaining 141 subjects was 1.76 RPM.

Conclusions

This study results demonstrated the proof of concept that the device measures key vital signs among newborn, infants and children <5 years, using a reusable single-based probe.

Key messages

Automated diagnostic device measures key multiple key vital signs (SPO2, respiratory rate, temperature) among newborn, infant and children <5 years. Such an automated device may have potential to ensure accuracy in diagnosis, increasing adherence to recommended guidelines, optimizing use of antibiotics, and reducing unnecessary referrals.
Minority stress, intra-minority stress and social anxiety: Examining an extended psychological mediation framework among sexual minority men
Authors: Mahon C , Kiernan G , Gallagher P
Published: November 2019

Background

Compared to their heterosexual counterparts, sexual minority men (SMM) are at an increased risk of social anxiety disorder. Distal (i.e., everyday discrimination) and proximal (i.e., internalised homophobia, rejection sensitivity, concealment of sexual orientation) minority stress processes are associated with heightened social anxiety for SMM. Stressors emerging from within the sexual minority male community, termed intra-minority stress, and psychological processes that may foster resilience (i.e., a sense of coherence, connectedness to the LGBT community) are less explored in this area. This study examined potential pathways between everyday discrimination, intra-minority stress, proximal minority stressors, resilience and social anxiety.

Methods

Self-identified SMM (N = 255) residing in the Republic of Ireland completed an online survey containing measures of minority stress, intra-minority stress, resilience and social anxiety. Structural equation modelling was used to examine the model.

Results

The model yielded a good fit to the data, X2(16) = 26.61, CFI = .99, TLI = .97, RMSEA = .05, and SRMR = .03. Rejection sensitivity and a sense of coherence had a significant indirect effect in the relationships between both exogenous variables (i.e., discrimination and intra-minority stress) and social anxiety. There were no significant pathways to social anxiety involving concealment of sexual orientation, internalised homophobia or LGBT community connectedness.

Conclusions

For SMM, minority stress processes and intra-minority stress are important determinants of social anxiety. Our findings demonstrate that proximal minority stressors may operate differently in a social anxiety context for SMM in western European countries. A sense of coherence was an integral factor in the model and demonstrated the strongest association with social anxiety.
Risk of fall among the hospitalized over-49 population. A retrospective cohort study in a hospital
Authors: Gilardi F , Mariani T , Liotta G , Musolino M , Caredda E , Morciano L , Giliberti C , Morbidelli S , Lucaroni F
Published: November 2019

Background

Despite the copious efforts made to prevent the problem, inpatient falls remain one of the most common adverse events in hospitals, with high risks in term of morbidity and mortality rates, as well as high costs for the healthcare system. This study aims to evaluate the inpatient falls incidence rate in a hospital in Rome, Italy.

Methods

A retrospective cohort study has been set out based on data collected by a Risk Management Unit concerning the falls of patients over 49 years, which happened in the hospital between 1st July 2008 and 30th June 2013. Data collected from the incident report forms were inserted in a database and analyzed using the statistical program SPSS, 20.0 Illinois version.

Results

During the period observed, 516 falls were reported. Patients who fell had a mean age of 68.8 years (SD ± 16.2). The falls are distributed for these age groups: 109 (21.1%) in 50-64; 129 (25%) in 65-74; 181 (35.1%) in 75-84; 97 (18.8%) in > 84. Fall incidence rate was calculated on the overall number of hospital admissions in the observed period (N = 35,812) (1.44 per 100 hospital admissions IC95% 1.32-1.56). Most of the patients were men (333; 64.5%) and older than 75 (53.9%). Inpatient falls were more frequent in the medicine wards (incidence rate 2.2 per 100 hospital admissions, IC95% 1.85-2.55,). The 51.6% of falls happened during the night shift. Severe outcome resulted in 13.6% of falls. Most of the falls (52.3%) happened within three days from the hospital admission. At multivariate analysis, a period of 2-3 days from hospital admission is the main risk factor to determine severe outcomes such as death or cranial trauma (p = 0.02; OR 2.87 IC95% 1.16-7.09).

Conclusions

The study contributes to measure the phenomenon in older adults and age group 50-64, identifying a specific indicator to properly measure inpatient falls incidence rate in the elderly. The study gives indications on the main risk factors related to this adverse event and on prevention strategies.

Key messages

Falls in hospital is an important adverse event not only in the elderly. The first period of three days from the hospital admission constitutes the main risk factor for the falls.
WHO Approach
Authors: Kuchenmueller T
Published: November 2019

Despite considerable investments into the generation of research worldwide, research is frequently not used in practice or policy. A substantial body of evidence is showing that using research requires significant and planned change at individual, organizational and systems levels.

To support and guide WHO Member States in the endeavor of strengthening evidence-informed policy-making, the WHO Regional Office for Europe launched the Evidence-informed Policy Network (EVIPNet) Europe at the end of 2012. It is a capacity building initiative that aims to create, train, guide and institutionalize innovative, multisectoral and multidisciplinary partnerships and teams at the country level. Assisted by EVIPNet Europe, these teams initiate and implement national research-to-policy processes, such as developing user-friendly evidence briefs for policy on high-priority policy issues targeted and tailored to policy-makers, holding policy dialogues, and creating linkages and exchange between the research and policy communities.

In this presentation, an overview of EVIPNet Europe’s mandate, approaches, tools and activities will be given. Participants will gain an understanding of how knowledge brokering and integrated, interactive mechanisms can help to bridge the gap between research and policy and improve health outcomes.
Tackling the challenges
Authors: Bekker M
Published: November 2019

In this presentation, information about common challenges of evidence-informed policy-making process in health care and ways to tackle them will be given to the participants. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science.
2.O. Workshop: Climate change and the impact on public and occupational health
Authors:   Organised by: Academic Collaborative Centre Environment and Health Chair persons: Peter Van Den Hazel - EUPHA (ENV), Moniek Zuurbier - Netherlands
Published: November 2019

Objectives

Climate change has an impact on people’s physical, mental, and community health. This impact can arise directly and indirectly. Some natural disasters are exacerbated by climate change, like floods, heat waves, storms, wildfires, and landslides. Some effects occur more gradually for example from changing temperatures. Heat waves can weaken the infrastructure (transport, construction) and make food systems less secure (infections, less access). But heat waves can also directly cause severe health effects. Heat waves are examples of direct and indirect climate impacts on society’s physical and mental health. Climate change creates visible impacts in many countries. The number of heat waves increased across the globe the last few decades. This change has an impact on communities’ health both in private life settings as in occupational settings. There is an overlap of impact which influences the effects seen in both settings. The awareness of this overlap is not clear for most stakeholders. Health advisories before, during and after heat waves do not consider this issues in their health promotion activities.

This workshop aims at describing different ways how public health could benefit of a more integrative approach of health promotion by linking messages directed at the general public and the occupational work force. Therefore, examples on national as well as regional and local level are presented discussed with specific emphasis on requirements and processes for success on one hand and obstacles on the other.

The examples reflect different European regions and country heat waves plans as well as results from the EU-funded projects HEATSHIELD and SCORCH.

Key messages

Heat will be an increasing issue in public health. Health advisories need to be improved during periods of heat.
Preventing heat stroke and heat illness on the workplace: a study on knowledge, attitudes and practices of safety representatives from Northern Italy (2016-2017)
Authors: Ricco M , Vezzosi L , Balzarini F , Giosuè Mezzoiuso A
Published: November 2019

Introduction

Heatwaves (HWs) and rising environmental temperatures are significant health threats also for workplaces. This study will investigate knowledge, attitude and practices towards heat-related health issues in a sample of safety representatives from Northern Italy (SRs).

Methods

A cross-sectional questionnaire survey was conducted in 2016-2017 among 327 SRs. Knowledge status was measured both in general and focusing on first-aid issues. Assessment of risk perception included severity and frequency of heat-related events. Multivariate logistic regression analysis assessed individual and work-related characteristics associated with SRs’ risk perception.

Results

258 questionnaires were retrieved (participation rate 78.9%; mean age 48.2±25.2 years). Knowledge status was relatively good on technical/preventive issues (62.3%%±16.8) and first aid measures (67.1%±25.2), but a large share of respondents ignored the risk from exertional heat stroke (35.7%), and for heat strokes elicited by non-environmental heat (e.g. machineries, use of protective equipment, etc. 47.7%). The majority of respondents acknowledged the high frequency of HW events (90.7%), but only 44.6% agreed on their potential health threat. had received A specific first-aid formation was reported by 49.2% of respondents, while 10.9% had any previous interaction with heat-related disorders. Specific countermeasures had been put in place by parent company in 3.9% of cases. Eventually, previous participation to formation courses was associated with higher risk perception regarding severity and frequency of HW (OR 3.18 95%CI 1.40-7.23, OR 5.54 95%CI 1.59-19.23 respectively), while previous interaction with heat-related disorders apparently raised the perceived severity of heat-related health risk (OR 3.92 95%I 1.10-13.14).

Conclusions

Although SRs exhibited a fairly good understanding of heat-related health issues on the workplaces, our findings also suggest the need to enforce specific countermeasures.
Socioeconomic consequences for adults with atrial septal defect: A register based follow-up study
Authors: Nyebo C , Fonager K , Larsen M L , Andreasen J J , Lundbye-Christensen S , Hjortdal V E
Published: November 2019

Background

Atrial Septal Defect (ASD) is considered one of the most benign defects among congenital heart disease. The very good short and midterm outcomes after closure in the recent decades has led to believe that the ASD population is almost comparable to the background population after treatment. However, recent studies indicate that these patients are much more affected by their disease than first assumed. In this nationwide cohort study, we report the first long-term follow-up of use of permanent social security benefits and work participation in adults with ASD.

Methods

All Danish patients born before 1994 and diagnosed with ASD between 1959-2013 (n = 2,277) were identified from the Danish registries. A comparison cohort was created using the Danish Civil Registration System, matching every verified ASD patient with 10 persons from the general population on gender and birth year. We used Cox proportional hazards regression to compare the risk of receiving permanent social security benefits in the ASD patients compared with the matched cohort. Using the DREAM database we calculated the proportion of patients and controls not working at the age of 30 years.

Results

ASD patients had a higher risk of receiving permanent social security benefits (hazard ratio 2.3 (95% confidence interval 2.1-2.6)) compared with the comparison cohort; 24% of the ASD patients was receiving permanent social security benefits at the end of follow up compared with 12% of the comparison cohort. At the age of 30 years, the proportion not working was 28% in the ASD cohort and 18% in the comparison cohort. Of patients not working 23% had a psychiatric diagnose compared to 6.8% of the controls.

Conclusions

The risk of receiving permanent social security benefits was twice as high in patients with ASD and the work participation was reduced compared with the background population.

Key messages

The poor affiliation to the work force and high prevalence of psychiatric morbidity is worrying. It demands for an increased psychosocial support by professionals caring for patients with ASD.
RT Accidents mortality in Italy: a population-based study in Piedmont on Vulnerable Road Users
Authors: Pitidis A , Mamo Carlo , Dalmasso Marco , Costa G
Published: November 2019

Background

Among the largest Italian Regions, Piedmont (Northern Italy) had in 2017 a crude rate of road traffic accidents (RTA) deaths greater than the national average. RTA injuries remain a leading cause of injury deaths in Italy. Among them in both Piedmont and Italy many victims are vulnerable road users (VRU): pedestrians, cyclists and users of motorcycles or motorpeds. The study was aimed to describe their mechanisms of injury.

Methods

Observational study of the resident population in Piedmont from 2003 to 2015. Transportation Injuries (ICD-10: V01-V99) were considered, because of their greater comparability rate in bridge coding studies. A number of 5,185 RTA deaths was observed. Role, type of vehicle of the victim and collision were studied.

Results

Piedmont in 2017 had a RTA mortality rate (6.35 deaths per 100,000 inhabitants) greater than Italy (IRR = 1.13, 95% CI: 1.00 - 1.29; p < 0.02), 48.4% of the victims were VRU similarly to national data (49.8%). In the period the proportion of VRU on RTA deaths steadily increased from 25.6% in 2003 to 49.1% in 2015, in a significant way (z = 2.79; p = 0.005), because in a context of marked reduction of RTA mortality (-54.5%), the regional trend for VRU shows only a slight decrease (-12,6%). The VRU were: pedestrians (47.0%), motorized two-wheels users (37.4%) and cyclists (15.6%). Among pedestrians 63.9% deaths were caused by collisions with mainly automobiles (82.1%) and heavy vehicles (12.7%). In case of collision the prevalent causes of death were head injuries (41.5%) and multi-trauma (31.8%). Similar patterns were observed for cyclists, while in motorcyclists 56.5% of deaths were due to loss of control or fixed object.

Conclusions

VRU injuries remain a public health and social concern. Yet despite their extent, this problem is still not adequately considered in public health prevention programs. The observed mechanisms of injury evidence the importance to enhance the protection of VRU in road traffic circulation.

Key messages

In Italy, vulnerable road users are becoming a major group among road traffic injury deaths, because they not follow the general trend of large decrease of RTA injuries. Largest VRU group are pedestrians such as cyclists they are hit by cars or heavy vehicles with major trauma, in the motorized two-wheels loss of control and collision with fixed object are important.
The impact of the housing situation on the health-related quality of life of refugees located in North Rhine-Westfalia, Germany
Authors: Belau M
Published: November 2019

Background

In 2015 and 2016, more than one million people fled to Germany from war-affected countries - mainly from Syria, Afghanistan and Iraq. Nevertheless, little is known about health-promoting and health-damaging living conditions in refugees located in Germany. Strengthening healthy living conditions could be a measure to increase health-related quality of life (HRQoL) of refugees.

Methods

The analyses were based on data from the FlüGe Health Study. The study was conducted in the period from February to November 2018 and included interviews and examinations. Participants were recruited from shared (n = 182) and private accommodation (n = 144) in several cities in North Rhine-Westphalia in Germany. The effect of housing situation on health-related quality of life as estimated from a modified version of the SF-12 questionnaire was examined using univariable analyses.

Results

Three hundred and nine participants ranging in age from 18 to 75 years (Mean 32.4, SD 0.61) gave complete replies. The majority was males (73.0%) and more than half of the respondents (58,4%) were in a partnership. Univariate analysis showed no statistically significant difference in HRQoL scores among participants from shared and private accommodation in physical scale (Mean 51.7, SD 10.05 vs. 49.7, SD 10.88; p = 0.096) and mental scale (Mean 41.9, SD 14.7 vs. 44.3, SD 14.2; p = 0.134).

Conclusions

From the data it appears that refugees living in shared and private accommodation in Germany have HRQoL scores indicating a relatively moderate HRQoL in physical scale and low HRQoL in mental scale compared to the German population.