bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for E. coli Susceptibility in Bloods Stream Infections in England Between 2013-2017
Authors: Aliabadi S , Honeyford K , Jauneikaite E , Muller-Pebody B , Costelloe C
Published: November 2019

Antimicrobial resistance (AMR) is a significant threat to global health. Escherichia coli is a frequent cause of Gram-Negative Bloodstream Infections (GNBSIs) and a key organism that contributes to the burden of AMR. This was a cross-sectional surveillance study that looked at 154,791 isolates between 1st January 2013 and 31st December 2017. Analysis was performed using routine surveillance data from Public Health England (PHE) containing data on the incidence and susceptibility results of E. coli bacteraemia. Exposure variables extracted were potential risk factors for AMR. The outcome variable was resistance to at least one antibiotic. Descriptive statistics and graphs were used to summarise the data. Associations between variables and the resistance to at least one antibiotic were assessed using univariate logistic regression. A multivariable logistic regression examined adjusted associations between the variables and resistance to at least one antibiotic. The final model included variables that showed strong evidence of association with resistance to at least one antibiotic. 43.2% of isolates were resistant to at least one antibiotic. Logistic regression showed an association between resistance of E. coli isolates to at least one antibiotic and children of school age (1.39 OR, 95% CI: 1.18-1.64; p ≤ 0.001), isolates taken from patients in Greater Manchester (1.50 OR, 95% CI: 1.41-1.60; p ≤ 0.001) and isolates taken from male patients (1.14 OR, 95% CI: 1.11-1.17; p ≤ 0.001), on adjustment. Visual assessment of trend graphs showed a decrease in resistance for common carbapenems and piperacillin/tazobactam. Prevalence of resistance has increased for common cephalosporins, gentamicin, and co-amoxiclav. Initial analyses suggest an increase in rates of E. coli resistance to at least one antibiotic in GNBSIs between 2013 and 2017 in England. Findings of this study have implications for appropriate antibiotic prescribing guidelines and for directing future AMR policies.

Key messages

Initial analysis of the dataset suggests that rates of AMR of E. coli in BSIs have increased between 2013 and 2017. There is evidence of an increase in E.coli infections that are resistant to cephalosporins over time and a decrease in E.coli infections that are resistant to carbapenems.
Factors associated with uptake of abdominal aortic aneurysm screening by older men living in Scotland
Authors: Kasengele K , Crilly M A , Nimmo F
Published: November 2019

Background

High uptake is essential for abdominal aortic aneurysm screening to be effective. The aim of this study was to assess the influence of rurality, social deprivation, clinic type, distance to screening clinic and season on uptake of abdominal aortic aneurysm screening by men aged 65 years.

Methods

Screening in Grampian was undertaken by four trained nurses in eight community and two hospital clinics. Men aged 65 years were invited for screening by post, with two further reminders for non–responders. Abdominal aortic aneurysm screening data are stored on the national ‘call-recall database’. The Scottish ‘postcode directory’ was used to allocate all invited men a deprivation index (Scottish Index of Multiple Deprivation), Scottish urban/rural category and distance to clinic. Multivariate logistic analysis was conducted using IBM-SPSS Statistics (version 24).

Results

A total of 12,281 men were invited for screening between 1st November 2013 to 31 January 2017. Overall uptake was 87 per cent. The detection rate was 12.0 per 1000 men screen (95 per cent c.i. 9.9 to 14.0). The prevalence of abdominal aortic aneurysms increased with increasing deprivation, whereas uptake declined with increasing levels deprivation. On multivariable analysis a one point increase in SIMD decile was independently associated with a 1.10 (95 per cent confidence interval 1.08 to 1.12) increase in the relative odds of being screened. Uptake was consistently lower in the ‘large urban area’ of Aberdeen city compared to the other five Scottish urban/rural categories. Uptake was lower at community-based clinics. Season and distance-to-clinic were not independently associated with uptake.

Conclusions

Social deprivation, urban/rural residence and clinic type were found to be independently associated with the uptake of abdominal aortic aneurysm screening among men.

Key messages

A more targeted approach is needed in the large urban area of Aberdeen because the impact of multiple social deprivation on uptake was found to be more substantial here. Encouraging high uptake remains essential for abdominal aortic aneurysm screening to be effective.
An international perspective on organisational strategies to foster skill-mix changes in healthcare
Authors: Kroezen M , Dussault G , Gericke C , Kuhlmann E
Published: November 2019

Background

The implementation of skill-mix innovations in healthcare organisations is a complex process which many factors affect, positively or negatively. Facilitators are factors which stimulate or expand skill-mix change, whereas barriers are factors that limit or restrict skill-mix change. This study provides an overview of the most common facilitators and barriers.

Methods

An overview of systematic reviews was conducted as part of a larger project studying skill-mix innovations. 20 reviews on organisational-level factors related to the implementation of skill-mix innovations were included. The evidence from the reviews was supplemented with country case studies.

Results

Organisational factors, such as physical proximity of services involved in the skill-mix or well-functioning information systems, are often discussed in the literature on skill-mix implementation at organisational level. The same applies to individual factors, such as required knowledge levels or (lack of) trust. Process factors and characteristics of the skill-mix intervention seem to play a less important role, even though coaching and support for professionals seem to facilitate the implementation process. The institutional environment mainly seems to have a hampering effect, especially related to a lack of financing, reimbursement issues or perceived fears of liability. Often, the implementation of skill-mix interventions at organisational level is approached by focusing on specific facilitators and barriers, yet little attention is paid to structural approaches.

Conclusions

There is no single appropriate strategy for implementing skill-innovations that will fit all organisations. Managers must adopt an optimal strategy when implementing skill-mix, usually involving a combination of approaches best suited to local factors, to their specific organisational context and to the individuals involved.
Intersectoral coordination and multiprofessional teams: merging primary care and social services
Authors: Sinervo T , Keskimäki I , Niiranen V , Laulainen S , Hietapakka L
Published: November 2019

Background

Since the 2000s, integrated care has been a policy aim in Finland. Reforms for creating larger care authorities have failed at national level, but municipalities have established regional joint health and social integrated care authorities. Our study focuses on integration of services for children and young people and adults’ psychosocial care. The aim is to evaluate integration in terms of success and its underpinning factors in two authorities with merged primary and specialised healthcare and social services.

Methods

South Karelia and North Karelia were selected as case studies, because these regions were pioneers in establishing integrated care authorities in 2010 and 2017. Document analysis and individual and group interviews with managers (32) and employees (22) were carried out; the analysis draws on Auschra’s classification of barriers and facilitators of integration.

Results

The regions (pop. 130.000-169.000) comprise a larger town, a specialised hospital and several rural municipalities. The integration of children’s and young people’s services is based on organisational changes, in which the services from primary healthcare, hospitals, social work and schools (pupils’ and students’ healthcare) were merged into one organisation. The health and well-being centres were created by bringing mental health, substance abuse services and social services into health centre facilities, but under their own managers. In both cases, the experiences are mostly positive but the success of implementation varies; commitment and cooperation between managers, shared goals and mutual understanding of each other’s work as well as the planning process were crucial factors to support implementation.

Conclusions

Comprehensive organisations with unified management foster integration. The implementation of multiprofessional work is facilitated by organisational culture and collaboration between managers.
A MOOC to disseminate key concepts related to the future challenges of the French health system
Authors: You C , Lissillour V , Lefébure A
Published: November 2019

Background

The increase of life expectancy creates critical health needs that developed countries health systems have to deal with. They are also confronted to persistent health inequalities. A common vision of these issues may not be shared by the health care professionals, decision-makers and citizens. In the context of the launch of new public health laws in France, the French School of Public Health (EHESP) decided to offer a MOOC entitled “Public Health and Health System: transition and transformation” (2019).

Objectives

The MOOC intends to raise awareness and increase understanding of public health challenges. It is designed for a wide audience of professionals, decision-makers and citizens in the French speaking world. The content was designed by a multidisciplinary team of academics from the EHESP (N = 50) and a network of health professionals (N = 21). The 6 modules address major themes of the recent health policies, e.g. social and territorial inequalities in health, health care security, health pathways, innovation or health democracy.

Results

Over the course of 6 consecutive weeks, almost 7800 people have enrolled in this e-learning. They are provided with short teaching videos (109 capsules of 4-5’) and webinars, have access to a number of supplementary reading material and a variety of self-assessment. Active learning is enhanced via forum involving peers and teaching staff. The full course represents around 20 hours of teaching. So far, completion rate has attained 13% which compares well with usual rate for MOOCs. Participants include a wide range of professionals, students and citizens from 87 different countries (72% from France) and 50% had a master or higher degree. The overall satisfaction rate is 98%.

Conclusions

This MOOC attracted the attention of a wide and diverse audience regarding the major public health issues. Some public health agencies have expressed interest in implementing the MOOC into their professional development program of their staff.

Key messages

Health system reforms are constantly implemented to face new public health challenges. A multidisciplinary MOOC can help raise awareness and understanding of the issue being addressed by new policies.
MANTRA: a serious game improving knowledge of maternal and neonatal health and geohazards in Nepal
Authors: Mueller S , Soriano D , Boscor A , Saville N M , Arjyal A , Baral S , Fordham M , Hearn G J , Kayastha R , Kostkova P
Published: November 2019

Background

Mobile technology is increasingly important for delivering public health interventions to remote populations. This research study developed, piloted, and assessed a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages. This unique mHealth intervention aimed at low-literacy audiences in low resource settings is part of the Maternal and Neonatal Technologies in Rural Areas (MANTRA) project: Increasing maternal and child health resilience before, during, and after disasters using mobile technology in Nepal. Specifically, we assess impact of the serious game to improve knowledge gain in our target audience.

Methods

Co-creation with the MANTRA team and local stakeholders in Nepal identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot game to the local cultural context. Through picture matching with immediate audio and visual feedback, the game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards. To assess the game, 35 participants were recruited in Kathmandu and villages in Kavre district. Sessions consisted of pre-test assessment, playing the game, post-test assessment, and a focus group to elicit qualitative feedback.

Results

The knowledge assessment quantified knowledge gain. Overall, the group averaged a normalized 6.8 point improvement (p = 0.000022). Change in the geohazard module was 9.5 points (p = 0.001), followed by maternal health (7.4 points, p = 0.007), and neonatal health (4.3 points, p = 0.83). Four learning objectives had statistically significant change (p < 0.05). Feedback demonstrated high engagement, motivation, and usability of the game.

Conclusions

This MANTRA study is a unique mhealth intervention of a serious game to teach core health and hazards messages to low-literacy audiences in rural Nepal. The pilot intervention demonstrated statistically significant knowledge improvement among participants.

Key messages

The pilot MANTRA mobile serious game intervention is a novel idea, to bring public health knowledge to difficult to reach vulnerable populations, including often ignored illiterate audiences. The pilot MANTRA mobile serious game intervention demonstrated a statistically significant knowledge improvement of geohazard, maternal, and neonatal health learning objectives among participants.
Goal-focused group intervention; sustainable health improvement but no effect on work participation
Authors: Fleten N , Fyhn T , Tveito T H
Published: November 2019

Background

Sick leave in Norway is high relative to other OECD-countries, but few of numerous work rehabilitation efforts are evaluated adequately. Financed by research and development grants from the Norwegian Work- and Welfare Directorate we explored the effect of goal-focused group intervention in the Norwegian Welfare organisation in Troms, Northern-Norway.

Methods

In a randomised controlled trial, we compared a goal-focused group intervention to receiving a 3-month membership card at a local gym. Main outcomes were work participation, self-rated health (0-100), functioning EQ-5D, and subjective health complaints, (29 items, 0-3). Most participants were long time sick-listed, and recruited from welfare service caseworkers. We collected surveys at baseline, 3 and 15 months, and corresponding register data on work participation.

Results

Participating persons, 89 in the group intervention and 63 in the gyms, were comparable in age and gender, 85% women. Self-rated health scores improved in both groups at 3 months. At 15 months, the control group were back at basis while improvement sustained in intervention group, Initial scores 50.9 (95% CI 47.4-54.4), 3 months 58.1 (52.4-63.8) and 15 months 58.6 (51.8-65.4). In favour of intervention the difference in difference of scores on subjective health complaints was 2.34, p=.056 at 3 months, and 4.01, p=.035 at 15 months. Mean total score on EQ-5D and daily living function improved significantly in the intervention group 8.09 - 7.67 (95% CI7.26-8.07), and 1.91-1.70 (1.53-1.86) respectively in 15 months. Work participation did not reflect these improvements. Both groups reached mean 98 workdays within 15 months follow-up.

Conclusions

Goal-focused group intervention has the potential to improve self-rated health and functioning, but gives no immediate effect on work participation.

Key messages

Goal-focused group intervention among sick-listed is cost effective focusing health related quality of live. Improving health and function is important but not sufficient to speed up return to work.
Assessment of the spatial accessibility to health professionals at French census block level
Authors: Gao F , Deguen S
Published: November 2019

Background

The evaluation of geographical healthcare accessibility in residential areas provides crucial information to public policy. This work developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the smallest available infra-urban level, that is, the Îlot Regroupé pour des Indicateurs Statistiques.

Methods

This study was carried out in the department of Nord, France. Healthcare professionals are geolocalized using postal addresses available on the French state health insurance website. ISA is derived from Enhanced Two-Step Floating Catchment Area (E2FCA) algorithm. We have constructed a catchment for each healthcare provider, by taking into account residential building centroids, car travel time as calculated by Google Maps and the edge effect. Principal Component Analyses (PCA) were used to build a composite ISA to describe the global accessibility of different kinds of health professionals.

Results

We applied our method to studying geographical healthcare accessibility for pregnant women, by selecting three types of healthcare provider: general practitioners, gynecologists and midwives. A total of 3587 healthcare providers are potentially able to provide care for inhabitants of the department of Nord. On average there are 92 general practitioners, 22 midwives and 21 gynecologists per 100,000 residents. The composite ISA for the three types of healthcare provider is 39 per 100,000 residents.

Conclusions

ISA is a multidimensional and improved measure, which combines the volume of services relative to population size with the proximity of services relative to the population’s location, available at the smallest feasible geographical scale. It could guide policy makers towards highlighting critical areas in need of more healthcare providers, and these areas should be earmarked for further knowledge-based policy making.

Key messages

Indicator of healthcare access at fine spatial scale allows us to identify precisely critical areas where healthcare professionals need to be allocated. ISA is a multidimensional measure, which combines the volume of services relative to population size with the proximity of services relative to the population’s location.
Sexuality education in Europe – An assessment of the current state, challenges and good practice
Authors: Brockschmidt L , Ivanova O , Ketting E
Published: November 2019

Background

Comprehensive sexuality education is a crucial factor for protecting the health and well-being of children and young people. A recent assessment, conducted by the Federal Centre for Health Education and the International Planned Parenthood Federation European Network (IPPF EN), gives an up-to-date overview of the current status of sexuality education (SE) in schools in 25 European and Central Asian countries. It further provides information on challenges and good practice in this field.

Methods

Pre-tested questionnaires were sent to representatives of governmental (Ministries of Health or Education) and nongovernmental organisations (IPPF member associations) in 25 countries in Europe and Central Asia. All representatives of the nongovernmental (25) and two-thirds of those in governmental organisations (16) responded. The questions were grouped under five themes related to SE: legal framework, status of implementation, barriers and opposition, youth-friendly sexual and reproductive health (SRH) services, and national data on adolescent SRH.

Results

In 15 of the 25 countries surveyed, a legal framework exists (law/ policy/ strategy) which supports SE in schools. In 11 countries, SE is mandatory in schools, and in 10 countries SE clearly has a comprehensive character. In most countries, SE is integrated into broader teaching subjects, e.g. biology or life skills education. A lack of teacher training and of monitoring and evaluation of SE programmes has been identified in the majority of countries.

Conclusions

In the past two decades, remarkable progress has been made in developing and implementing SE in the region. Nevertheless, further improvements are urgently needed, as differences between and within countries persist. These include the quality and the comprehensiveness of SE programmes, the monitoring and evaluation of these programmes and the development and implementation of teacher training.

Key messages

Remarkable progress has been made in implementing sexuality education in Europe and Central Asia. Nevertheless, further action is needed to reduce differences in implementation and quality between and within countries.
Prevalence of gonorrhea and chlamydia in a community clinic for Men who Have Sex with Men in Portugal
Authors: Ribeiro S , de Sousa D , Medina D , Castro R , Lopes A , Rocha M
Published: November 2019

Background

Men who have sex with men (MSM) are at greater risk for sexually transmitted infections (STIs). Data on MSM chlamydia and gonorrhea prevalence estimates and associated risk factors is scarce. To our knowledge, this is the first study to describe the prevalence and the determinants of both chlamydia and gonorrhea infections in MSM in Portugal.

Methods

We conducted a cross-sectional study using data from 1,832 visits to CheckpointLX, a community-based center for screening blood-borne viruses and other STIs in MSM.

Results

Overall prevalence of chlamydia or gonorrhea in our sample was 16.05%, with 14.23% coinfection and 40.73% asymptomatic presentation among those testing positive. Anorectal infection was most common for chlamydia (67.26%), followed by urethral (24.78%) and oral (19.47%) infection. Oral infection was most common for gonorrhea (55.63%), followed by anal (51.25%) and urethral (17.50%) infection. In multivariate analyses, young age (U = 94684, p = 0.014), being foreign-born (χ2=11.724, p = 0.003), reporting STI symptoms (χ2=5.316, p = 0.021), inhaled drug use (χ2=4.278, p = 0.039) and having a higher number of concurrent (χ2=18.769, p < 0.001) or total (χ2=5.988, p = 0.050) sexual partners were each associated with higher rates of chlamydia or gonorrhea infection.

Conclusions

Young and migrant MSM are a vulnerable population to STIs, as are those who use inhaled drugs and those with a higher number of concurrent or total sexual partners. Although Portugal has no guidelines on chlamydia and gonorrhea screening, our results point towards a need for greater awareness about the importance of high frequency screening for those at increased risk (i.e. every 3 to 6 months).

Key messages

Higher prevalence was found in young and migrant MSM, those with higher number of concurrent or total sexual partners, and those who use inhaled drugs. There is a need for greater awareness about the importance of high frequency STI screening for MSM at increased risk.
How to reach migrant transgender women in Paris? An example of collaborative sexual health action
Authors: Deslandes A , Troude P , De la Rochebrochard E , Cabral C , Shelly M , Segouin C , Piron P
Published: November 2019

Issue

In France, screening for HIV and sexually transmitted infections (STIs) is provided by free HIV and STIs screening centers called CeGIDD. Despite a complete combined prevention offer, the number of new HIV diagnosis has been stable for years. Transgender women have one of the highest HIV prevalence.

Description of the problem

Transgender women are a hard to reach population with multifactorial barriers in their access to healthcare including fear of stigma, leading to late HIV diagnosis and untreated STIs. The CeGIDD of a university hospital in Paris aimed to reach this public working with two associations, creating a free, complete sexual health action outside the hospital in a safe environment.

Results

The CeGIDD identified a Parisian association, PASTT, which accompanies transgender women, mainly migrants, in accessing healthcare and social rights. Its active file is around 1500 persons a year, mostly resorting to prostitution. Another association, AREMEDIA, pioneer in outreach interventions, was involved. The partnership allowed access to the public and to gather the funds for the intervention. It included counseling, screening, Pre Exposure Prophylaxis (PrEP), and took place once a week in PASTT facilities. Any participant could be referred to other physicians if they needed it, even if they lacked health insurance coverage. From September 2017 to November 2018, 212 persons attended the consultation and 26 received PrEP.

Lessons

Working together with several associative partners presents many challenges, from the definition of the objectives to operational coordination. Overcoming these difficulties lead us to reach a new public with a high risk for STIs and HIV.

Key messages

Community based sexual health actions dedicated to transgender women are a successful way to reach this public. The safe environment provided by the association is a great opportunity to familiarize them with the medical staff and to empower them regarding healthcare.
Identifying patients at risk of readmission for heart failure in the French national claim database
Authors: Constantinou P , Pelletier-Fleury N , Olié V , Gastaldi-Ménager C , Juillière Y , Tuppin P
Published: November 2019

Background

To reduce readmissions for heart failure (HF) among HF patients, most at-risk individuals could be targeted to benefit from adapted interventions. A better understanding of HF readmission predictors could help clinicians and regulators identify patients most at-risk. We focused, in particular, on distinguishing HF severity from overall health-state severity.

Methods

We studied predictors of HF readmission available in administrative data in a nationwide cohort of patients aged 65 years or older surviving an index hospitalization for HF in 2015 (N = 70 657). To take into account the competing mortality risk, we estimated subdistribution hazard ratios (sdHRs) of HF readmission and cause-specific hazard ratios (csHRs) for HF readmission and for death without HF readmission, over a 1-year follow-up period. We then computed cumulative incidences and daily rates of HF readmission for specific risk-groups.

Results

31.8% of patients were readmitted at least once for HF, among which 27.2% (8.6% of study cohort) were readmitted 30 days after discharge. 17.6% of patients died without any HF readmission. HF severity and overall health-state severity were the strongest HF readmission predictors (sdHRs 2.66 [95% CI: 2.52-2.81] and 1.37 [1.30-1.45] respectively, when comparing extreme categories). HF severity and length of index stay were more strongly associated with the rate (csHRs) of HF readmissions, whereas overall health-state severity and age were more strongly associated with the competing rate of death without HF readmission. Risk-groups defined upon HF severity and overall health-state severity had approximately 40% of separation in HF readmission proportion (21.9% versus 60.4%).

Conclusions

Our results stress the importance of considering both HF severity and overall morbidity and of accounting for the competing mortality risk to identify patients at-risk of HF readmission. Such patients could benefit from targeted transitional or post-discharge HF care.

Key messages

Heart failure patients can be stratified into risk-groups of readmission using administrative data. Identifying at-risk patients could help clinicians and regulators to target interventions.
Cardiovascular disease risk factors of military: A comparative assessment with civilians
Authors: Bell Ngan W , Essama Eno Belinga L , Essam Nlo’O A S P , Lemogoum D , Roche F , Mandengue S H , Bongue B
Published: November 2019

Background

Cardiovascular diseases are the leading cause of death in the world. Military population that seemed immune to these pathologies is now as exposed as the general population. The effective response to this public health problem first requires the identification of the level of exposure of populations. Thus, the objective of our study was to determine the prevalence of Cardiovascular Disease (CVD) risk factors of the Cameroonian military population compared to civilians.

Methods

We conducted a cross-sectional study. It involved subjects aged 18 to 58 years, recruited from October 30, 2017 to November 13, 2018 at the Fifth Military Sector Health Center. Five cardiovascular risk factors were assessed, smoking, harmful alcohol consumption, obesity/overweight, hypertension and diabetes. The STEPwise model proposed by the World Health Organization (WHO) was used to estimate the risk of cardiovascular diseases. Mann Whitney and Fisher exact tests were used for statistics comparison.

Results

The study included 489 subjects, 270 military personnel and 219 civilians. The median age of the two populations was not significantly different (30 years versus 33 years, p = 0.6939). The proportion of smokers was higher in the military (12.59% versus 9%, p = 0.0011). Alcoholism was also higher in the military population (60.74% versus 13.24%, p = 0.0000). Similarly, military personnel were more obese than civilians (58.15% versus 40.18%, p = 0.0000). Distribution of hypertension and diabetes was not significantly different between military and civilians (18.15% versus 16.89%, p = 0.8113) and (1.48% versus 3.20%, p = 0.2321) respectively. The proportion of subjects with a high cardiovascular risk was higher in the military (14.81% versus 7.76%, p = 0.0162).

Conclusions

CVD risk factors are more prevalent in Cameroonian military population than in civilians. This result suggests that, in addition to national preventive campaigns, special attention is needed for military population in Cameroon.

Key messages

Cardiovascular disease risk factors are more prevalent in Cameroonian military population than in general population. in addition to national preventive campaigns, special attention is needed for military population in Cameroon.
The Role of Niacin in Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis
Authors: D’Andrea E , Hey S , Ramirez C L , Kesselheim A
Published: November 2019

Background

Niacin remains a therapeutic option for patients with cardiovascular disease, but recent studies have called into question the effectiveness of other HDL-C-raising drugs. We evaluated the evidence supporting current FDA-approved uses of niacin in cardiovascular prevention settings.

Methods

The systematic review included clinical trials involving niacin as a treatment for cardiovascular disease. The meta-analysis included randomized clinical trials reporting niacin’s effect on at least one long-term outcome: cardiovascular disease, coronary heart disease mortality, acute coronary syndrome, stroke, revascularization, major adverse cardiac events (MACE). Databases were searched up to October 2017. Study-level data were extracted and inverse-variance weighted methods were used to produce pooled risk ratios using random-effects models for between-study heterogeneity. Meta-regression analysis was used to assess the association between change in HDL-C and the log risk ratio of the pooled results.

Results

Out of 119 clinical trials, 17 documented niacin’s effect on at least one cardiovascular disease outcome. The meta-analysis covered 35,760 patients with history of cardiovascular disease or dyslipidemia. Cumulative evidence found no preventive effect of niacin on cardiovascular outcomes in secondary prevention. Stratified meta-analysis showed an association between niacin monotherapy and reduction of some cardiovascular events (acute coronary events, RR 0.74, 95%CI 0.58-0.96; stroke, RR 0.74, 95%CI 0.59-0.94; revascularization, RR 0.51, 95%CI 0.37-0.72). These results were mainly driven by two trials conducted in the 1970s and 1980s.

Conclusions

Niacin might have some use in lipid control for secondary prevention as monotherapy, perhaps in patients intolerant to statins, but evidence is from older studies on a population potentially not representative of current-day patients.

Key messages

Niacin might have some use for cardiovascular secondary prevention in patients intolerant to statins, but evidence is from older studies on a population not representative of current-day patients. The FDA has to review the approved indications for Niacin in cardiovascular secondary prevention.
The need for a transformation health systems research programme in Europe
Authors: Ricciardi W
Published: November 2019

Over the last decades, European health systems have faced growing common challenges: ageing related issues and continuous financial pressures call for innovative solutions on how to organise health care in an equitable and efficient manner. To address this situation there is an urgent need to bring in innovation and research evidence, in order to identify and implement more effective and sustainable ways to organise, manage, finance, and deliver high quality care to all European citizens. TO-REACH has been working to develop a Strategic Research Agenda which has the ambition to address the increasing challenges faced by health systems, directed to those policy areas relevant in the coming years. This living document will help preparing an European research programme that will maximise value of research public investment in this field by helping avoid duplication and failed implementation while ensuring systematic prioritisation of research areas that face greatest changes and highest need.
State of vaccine confidence in the European Union in 2018
Authors: Larson H , de Figueiredo A , Karafllakis E , Rawal M
Published: November 2019

Background

High confidence in vaccination programmes is crucial for maintaining high coverage rates. Across the European Union (EU), however, vaccine delays and refusals are contributing to declining immunisation rates in a number of countries and are leading to increases in disease outbreaks.

Methods

We assessed the overall state of confidence in vaccines among the public in all 28 EU member states and among general practitioners (GP) in ten EU member states, conducting the largest ever study on attitudes to vaccines and vaccination in the EU, eliciting the views of approximately 28,000 respondents across the 28 EU member states.

Results

We found that a number of member states (including France, Greece, Italy, and Slovenia) have become more confident in the safety of vaccines since 2015, but that the Czech Republic, Finland, Poland, and Sweden have become less confident. While GPs generally hold higher levels of vaccine confidence than the public, the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe and 29% and 19% respectively do not believe it is important. Countries whose GPs hold higher confidence in vaccines tend to have a larger proportion of the public expressing positive vaccination beliefs.

Conclusions

Even countries with well-established vaccination programmes and high levels of confidence are not immune to rising vaccine hesitancy. There is a need for continuous monitoring, preparedness and response plans to maintain and increase confidence in the importance, effectiveness and safety of vaccines, among both the public and health professionals.
Smokeless tobacco and waterpie use and risk of lunbg cancer
Authors: Paudyal P , Memon A , Rogers I
Published: November 2019

Background

Over 300 million people worldwide use smokeless tobacco (ST) with rates of use exceeding that of cigarette smoking in much of South-East Asia and amongst certain groups in the Middle East. This study investigated the association between consumption of ST use and waterpipe smoking and lung cancer risk.

Methods

A systematic review and meta-analysis was carried out to summarise the findings from the epidemiologic studies of the risk of lung cancer associated with ST use and waterpipe smoking. Search was carried out in MEDLINE, Embase, Web of Science and OpenSIGLE to identify studies published before 18th October 2018. A combination of MESH terms and keywords were used including lung cancer, smokeless tobacco, snuff, snus, betel quid, gutka, naswar, zarda, shisha. Only studies adjusted for cigarette smoking or conducted in non-smokers only were included in the analysis. Random effects meta-analysis was carried out to pool the risk estimates and subgroup analyses was carried out by tobacco type and in studies of non-smokers.

Results

The search yielded 1796 articles, of which 24 studies (19 studies of ST, four of waterpipes and one of both) including 6777 lung cancer patients were included in the meta-analysis. Lung cancer was found to be positively associated with waterpipe smoking (pooled OR 3·06 (95%CI 1·68 – 5·60) and betel quid tobacco chewing (pooled OR 1·77 (95%CI 1·06 – 2·95)). Among non-smokers, any type of ST use was associated with lung cancer (pooled OR 1·46 (95%CI 1·04 – 2·07).

Conclusions

Our study suggest positive associations between ST use and waterpipe smoking and lung cancer risk. Given the high prevalence of ST use in much of the developing world, public health policies and international tobacco control efforts should focus on aiming to reduce ST use in addition to cigarette smoking.

Key messages

The risk of lung cancer is approximately three times higher in waterpipe smokers than in non-smokers. International tobacco control efforts should focus on aiming to reduce smokeless tobacco use in addition to cigarette smoking.
Mapping variation in breast cancer screening: Where to intervene?
Authors: Padilla C , Soler Michel P , Vieira V
Published: November 2019

Introduction

Mammography screening can reduce breast cancer mortality among women aged 50 years and older. Small geographic areas with lower breast cancer screening uptake may reflect gaps in screening efforts. Our objective was to identify the geographic variations of breast cancer screening uptake among women aged 50-74 years in the Lyon Metropole area, France.

Methods

We used spatial regression models within a generalized additive framework to determine the clusters of census blocks with significantly lower risk of breast cancer screening uptake. Census block-level data on breast cancer screening participation rates were calculated for women aged 50-74 years who did a mammography between 2015-2016 after being invited with a letter by the cancer screening organization. Using smoothed risk maps adjusting for covariates, we estimated the impact of the spatial distribution of deprivation index, part of opportunistic screening on breast cancer screening participation.

Results

Between 2015 and 2016, the participation rate of organized breast cancer screening was 49.9%. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived. However, women living in rural areas with fewer certified mammography services than in urban areas had the highest participation rate. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas.

Conclusions

Our analysis indicates that depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors is important for implementing an appropriate prevention intervention.

Key messages

Spatial analysis for cancer screening can help to improve health initiatives. This study contributes to a better understanding of the cluster-specific factors that explain geographic disparities.
Impact of Danish ban of industrial produced trans fatty acids on serum cholesterol levels 1993-2006
Authors: Bjornsboe K , Jakobsen M U , Bysted A , Fagt S , Christensen T , Joergensen T
Published: November 2019

Industrially produced trans fatty acids (ITFA) increase the LDL:HDL ratio and hereby the risk of cardiovascular disease (CVD). Therefore, ITFA has been reduced in Western Europe over the last decades but is still high in Eastern Europe and in subgroups of the EU population. Regulatory interventions are the only way to minimize ITFA intake for all. The Danish ITFA ban (2004) can elucidate the impact of elimination of ITFA on CVD. In Denmark cardiac mortality declined by 70% through 1980-2009. Data on ITFA intake and blood lipids from the 1990s, where the average Danish ITFA intake was about 3 g/d, and up to today are needed to study the correlation between intake of ITFA and serum cholesterol (CHOL). The Danish food composition databank has been updated with TFA intake values. Hereby the correlation between ITFA intake and CHOL level in Denmark from 1993 -2006 can be investigated.

Methods

Ecological analyses of ITFA and CHOL in participants from 3 cohorts: Diet, Cancer and Health (1993-1997); n = 57,054; 50-64 yrInter99 (1999-2001); n = 6,784, 30-60 yrHealth 2006 (2006); n = 3,471, 18-69 yr

Results

ITFA-intake was 0.02 g/d in Inter99. Data will be extended to include ITFA intake data of all cohorts as well as age adjusted correlations with CHOL.

Mean CHOL all men (n = 31,675) declined from 6.3 ± 1.0 in 1993 to 5.4± 1.0 in 2006

Mean CHOL all women (n = 34,675) declined from 6.6 ± 1.5 in 1993 to 5.4± 1.1 in 2006

Similar declines were found in participants without self-reported hypercholesterolemia:

Mean CHOL men (n = 28,999) declined from 6.1 ± 0.9 in 1993 to 5.1± 1.0 in 2006

Mean CHOL women (n = 32,593) declined from 6.5 ± 1.5 in 1993 to 5.2± 1.1 in 2006

There was a significant decrease in CHOL (p < 0.0001) from 1993, where average Danish intake of ITFA was about 3 g/d to 2006 where ITFA was banned

Conclusions

Data show a non-treatment related significant decline in CHOL. Data from 2000 and 2006 are collected in younger populations, which may explain lower CHOL levels.

Key messages

Cholesterol decline significantly in Danish participants simultaneously with ITFA elimination. Results are important for decision makers in countries which consider ITFA regulation.
Effects of salt reduction on cardiovascular risk factors. The STRIVE-study
Authors: Toft U , Riis N L , Lassen A D , Trolle E , Bjørnsbo K S
Published: November 2019

Potential adverse effects of reducing salt intake in the general population are discussed. This study aims to explore the effect of gradually reducing salt intake in a real-life setting.

The study was a 4-month cluster RCT with families randomly assigned to either A) salt reduced bread, B) salt reduced bread and dietary counselling or C) standard bread (control) Participants in intervention A received bread gradually reduced in salt content from 1.2 g salt/100g (regular) to 0.6 g salt/100g in ryebread and 0.4 g salt/100g in wheat bread. Participants in intervention B received the same bread as intervention A but in addition, they received dietary advise on how to further reduce their salt intake and promote potassium. The control group received regular bread (blinded). Changes in outcomes were assessed using linear mixed models.

Results

A total of 89 Danish families (155 adults; 156 children) participated in the study. A total of 291 (94%) participants completed the intervention. Results are preliminary. Intention to treat analyses showed no significant effects of the salt reduction intervention on changes in systolic and diastolic blood pressure, plasma triglyceride. A small, but significant (-0.26 mmol/l; P = 0.02) decrease in total plasma cholesterol was shown in intervention group A. Per protocol analyses, including only participants in the intervention groups that decreased their salt intake by at least 20% from baseline to 4-month follow-up, showed a significant decrease in diastolic (-3.5 mmHg; P < 0.0001) and systolic (-6.3 mmHg; P < 0.0001) blood pressure, total cholesterol (-0.25 mmol/l; P = 0.0009), LDL cholesterol (log. transformed) (-6%; P = 0.03) and plasma triglyceride (log. transformed) (-17%; P = 0.04). No significant effects were found for HDL plasma cholesterol, aldosterone, renin, plasma glucose and HbA1c.

Conclusions

Reduced salt intake were associated with beneficial changes in cardiovascular risk factors. No adverse effects were observed.

Key messages

Reduced salt intake were associated with benificial changes in cardiovascular risk factors. No adverse effects were observed.
5.O. Workshop: Climate change and energy issues in our life-course and our environment
Authors:   Organised by: EUPHA (ENV) Chair persons: Peter Van Den Hazel - EUPHA (ENV), Marija Jevtic - EUPHA (ENV)
Published: November 2019

Globalization and economic trends bring enormous changes to civilization. Growth in demographic, economic and human activities alters the natural global environment beyond safe or sustainable borders. Energy domain is one of these borders we cross. These changes pose threats to human health and with the rise in temperature the visible symptoms are seen in the difficulty of securing sufficient and clean energy, as well as the appropriate supply of health-safe food and water.

Overall progress made through the use of renewable energy sources should reduce risks and allow for the improvement of basic living conditions. However, a significant shift in reducing inequalities and improving global quality of life and health indicators requires transformation of many sectors.

The calculated health impacts and health costs from Western Balkan coal plants are a case study that show 3,000 premature deaths, 8,000 cases of bronchitis in children, and other chronic illnesses; costing both health systems and economies a total of EUR 6.1-11.5 billion. Another example illustrates how schools can contribute to change. Results from behavioral change studies show the audience in which frame they fit in their possibilities to influence their behavior towards their living environment. Followed by a discussion on strategic choices on how to motivate people to protect their environment and climate.

Key messages

Energy issues are a main driver in reducing health risks. Knowledge about framing our values towards climate change might change our behavior.
Climate and energy issues as preconditions for health and well being
Authors: Jevtic M , Bouland C
Published: November 2019

Globalization and modern economic trends bring enormous changes to civilization. The human health pattern also changes and the overall system becomes more complex. Exponential growth in demographic, in economic and in human activities alters the natural global environment beyond safe or sustainable borders, which refers to energy for the future, as well as climate change in the broadest sense. These changes pose threats to human health and with the rise in temperature the most visible symptoms are seen in the difficulty of securing sufficient energy amount, as well as the appropriate supply of health-safe food and water. Global influences on the health of the population require changes in different sectors (economy, health, economy, etc).

Even though, World Meteorological Organization data show that the five-year average global temperature from 2013 to 2017 was at a record level, and that in 2017 it was one of the three hottest years. Today, about 3 billion people have no access to safe food and/or water and are also exposed to significant air pollution. Nearly one billion people have no electricity in the household, and 13% of the world’s population has no access to modern electricity. Air pollution indoors by using combustible fuels for domestic energy caused 4.3 million deaths in 2012 (women and girls accounted for 6 out of 10). Energy has a dominant contribution to climate changes and accounts for about 60% of overall global greenhouse gas emissions.

Overall progress made through the use of renewable energy sources should reduce risks and allow for the improvement of basic living conditions. However, a significant shift in reducing inequalities and improving global quality of life and health indicators requires transformation of many sectors. Energy, therefore, is crucial for almost every challenge the world is facing today (climate change, food production, health systems, etc.). SDG 7 is particularly important and is linked to other SDGs.