bluuebunny/crossref_metadata_2025 huggingface dataset:
Associated factors to the perception of clinical coordination in the Catalan national health system
Authors: Esteve Matalí L , Vargas I , Sánchez E , Cots F , Plaja P , Avecilla À , Ramon I , Medarde E , Colomés L , Vázquez for GAIA M L
Published: November 2019

Background

Clinical coordination across levels of care is a priority for health systems. The aim is to analyse the factors associated to a high perception of clinical coordination of primary (PC) and secondary care (SC) doctors of the Catalan national health system (NHS).

Methods

Cross-sectional study based on the self-administered online questionnaire COORDENA-CAT. Data collection: October-December 2017. Study population: PC and SC (acute and long term) doctors of the public Catalan NHS that had been working for at least one year in the organization, had direct contact with patients and related with doctors of the other level of care. The participation rate was 20.5%, with a sample of 3308 doctors. Outcome variable: perception of clinical coordination across levels of care. Explanatory variables: socio-demographic, employment characteristics, attitude towards work, type of area (according to type of hospital and managing entity), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression.

Results

Only 32.13% of PC doctors and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctor of the other level; finding that their practice influences the other care level; finding that the organization’s management facilitates coordination; working in an area where the same entity manages SC and majority of PC and to hold joint clinical case conferences are factors positively associated to a high perception of clinical coordination. Besides, there are other positively associated factors exclusive for each level of care.

Conclusions

Several common interactional and organizational factors are positively associated to a high perception of care coordination. Introducing policies to enhance such factors can foster care coordination in the Catalan NHS.

Key messages

This study found out factors associated to clinical coordination across care levels in each level. It helps to develop specific coordination policies by level of care to address those factors.
Healthcare Use in Multimorbidity Patients
Authors: Quinaz Romana G , Kislaya I , Cunha Goncalves S , Salvador M R , Nunes B , Matias Dias C
Published: November 2019

Background

The existence of multiple chronic conditions in the same patient is a public health problem, recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which in the context of continuous increase of life expectancy, imply a heavy burden to healthcare services.

Methods

We analysed the association between healthcare use (primary care, medical specialist consultations and hospitalizations) and multimorbidity in the Portuguese population aged 25-74 years old, using the Health Examination Survey (n = 4911) data. Logistic regression models adjusted for predisposing (age, education) and enabling (income, region of residence) factors were fitted separately for male and female. Odds ratios and CI95% were estimated.

Results

Prevalence of multimorbidity was 38.3% (95%CI: 35.4%; 41.3%). In males, after adjustment for confounding and when compared to patients without chronic conditions, multimorbidity was associated with greater use of primary care (OR = 3.7; CI95%: 2.3-5.8), medical specialist consultations (OR = 1.9; CI95%: 1.1-3.4) and hospitalizations (OR = 1.8; CI95%: 1.2-2.7). In female, statistically significant association between multimorbidity and healthcare use was observed for primary care (OR = 2.6; CI95%: 1.6-4.3) and medical specialist consultations (OR = 2.8; CI95%: 2.0-3.9), but not for hospitalizations. Both male and female with multimorbidity reported greater use of primary care, compared to individuals with only one chronic condition (OR = 2.4; CI95%: 1.3-4.4 and OR = 1.7; CI95%: 1.1-2.8, respectively).

Conclusions

Our results show a greater healthcare use in patients with multimorbidity, both in primary and hospital care. The availability of scientific evidence regarding the healthcare use, by patients with multimorbidity, may substantiate the discussion about the possible need for the Portuguese health system to adapt to these patients, with changes in policies that will allow better and more efficient treatment.

Key messages

This study may support the discussion about the adaptation of Portuguese health system to patitents with multimorbidity. Further discussion on policy change is needed, targeting an efficient management of these patients.
Does case management provides support for staff facing frequent users of emergency departments?
Authors: von Allmen M , Grazioli V , Kasztura M , Lemoine M , Chastonay O , Hugli O , Daeppen J B , Bodenmann P
Published: November 2019

Background

Frequent users of emergency departments (FUED; 5 ED visits during the preceding 12 months) account for a disproportionate part of ED visits, causing a wide range of work difficulties to ED staff potentially leading to FUED discrimination. Whereas case management (CM) tailored to FUED leads to a reduction in ED visits, CM impact on ED staff has not been explored yet. This study aimed to compare ED staff perceptions of FUED with and without dedicated CM support.

Methods

Participants (N = 253) were ED staff (81 physicians; 172 nurses/assistant nurses) of two Swiss university hospitals, one with CM and one without CM support. Perceptions regarding FUED (i.e., knowledge and awareness of the issue extent; related work difficulties; FUEDs’ legitimate use of ED resources) were measured with a 25-item online survey (4 to 10-level Likert scales). Multivariable regression analyses were conducted to 1) explore the associations between CM implementation and FUED perceptions, and 2) test the moderating effect of profession (physician or nurse/nurse assistant) on these associations. All analyses were adjusted by gender and years of practical experience.

Results

Physicians with CM considered FUED as a less important problem (=.375, R2=.11, p <.05) and rated their knowledge of FUED issue higher (=.245, R2=.077, p <.05) compared to those without CM. In contrast, nurses without CM perceived fewer FUED-related work difficulties (i.e., feeling of failure and helplessness) than nurses with CM. (=-1.01, R2=.06, p <.05) No significant difference was found regarding ED staff’s perceptions of FUEDs’ legitimate use of ED resources and frequentation, nor on nurses’ knowledge of the issue.

Conclusions

These results suggest that CM intervention for FUED is a potential source of support for ED physicians working with FUED. Further qualitative research is needed to explore why nurses without CM support reported feeling less failure and helplessness regarding FUED.

Key messages

By highlighting a different impact of CM on nurses’ perception, this study illustrates where CM intervention might be improved. This study supports CM as a promising intervention for FUED by potentially having a positive impact on ED physicians’ perception besides the one previously proved on FUEDs’ number of visits and QOL.
Waiting times in cardiology and quality of care: analysis of performances in an Italian hospital
Authors: Olivero E , Bert F , Corezzi C , Rossello P , Alaria P , Siliquini R , Scarmozzino A
Published: November 2019

Background

The identification of diseases in an early stage is essential to improve prognosis and survival of patients. Consequently, waiting times for cardiological performances are widely recognized in Europe as evaluation items for healthcare quality. Our study aims to analyse waiting times of the main procedures in the cardiology ward of a huge hospital of Northern Italy and to compare them with the regional benchmark.

Methods

Data of the cardiology ward of “Molinette” hospital (Turin, Italy) about the waiting times for clinical procedures in the period 2016-2017 were collected. In particular, we gathered number of health care services and mean waiting times (MWT) for “Echocardiography” (EC), “First Cardiological Visit” (FCV), “Holter ECG” (HECG), “Percutaneous Transluminal Coronary Angioplasty performed within 2 days for people with myocardial infarction” (PTCA). We compared then our results with the benchmarks identified by the regional law.

Results

In the period considered, in “Molinette” hospital 11,565 ECs were performed, with a MWT of 31 days in 2016 and 16 days in 2017, well below the benchmark (40 days). The total number of FCVs was 5,156 with a MWT of 18 and 13 days in 2016 and 2017 respectively, again under the benchmark (30 days). The HECGs were 3,805, with a MWT of 53 (2016) and 32 (2017) days (benchmark 40 days). PTCAs performed within 2 days (benchmark 85%) were 160 (77.7%) in 2016 and 138 (85.2%) in 2017.

Discussion

In 2017, the waiting times of “Molinette” hospital were inferior to the regional benchmarks, for all the cardiological procedures considered. Shorter MWTs allow a more rapid planning of further diagnostic tests and treatments and, therefore, a consequent better quality of care. It’s important for European hospitals to assess and compare these indicators in order to guarantee a fast and appropriate care to their patients.

Key messages

Waiting times are an indicator of early diagnosis and treatment and are useful to assess the quickness and quality of health care provided in European hospitals. Cardiological procedures in “Molinette” hospital of Turin are provided with waiting times shorter than benchmarks. It would be interesting to compare these results with other big European hospitals.
Mergers of primary care organizations: a systematic review of the literature
Authors: Pascucci D , Sindoni A , De Vito C , Damiani G
Published: November 2019

Background

Mergers as large-scale collaborations in primary care organizations have become a commonplace in developed countries to offer economies of scale and more efficient delivery of care to population. The aim of this systematic review is to summarize the scientific evidence on the relationship between the increase in the size of organizations providing primary care services and their performance.

Methods

The PICO model was adopted and three electronic databases (Medline, Scopus, ISI Web of Knowledge) were searched using appropriate keywords. Screening by title and abstract and data extraction were performed by two independent investigators. Articles, written in English, evaluating the performance after increasing the size of an organization were included. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Process and outcome quality indicators were used for evaluation.

Results

From a total of 1337, 12 studies met the inclusion criteria and 103 indicators were identified: 59.2% did not show any variation, 33.9% improved significantly after the merger, 6.9% worsened after the merger. In particular, diabetes care did not show any statistically significant variation in 40.0 % of the indicators, while 10.0 % showed an improvement and 10.0% a worsening in clinical outcomes. A significant negative association was found between practice list size and reported non-urgent or urgent doctors’ availability (P < 0.05, both). The process of merging also created perceptions of takeover and had a negative effect on staff.

Conclusions

The effects of mergers are conflicting and there is little evidence that the performance is associated with the size of the structures involved. Assessment on the impact of primary care mergers should to be related to the population needs and the context where these processes are carried out.

Key messages

Merging processes may lead to contrasting results. To assess periodically and systematically the impact of mergers in a continuous quality improvement cycle.
A qualitative study on cancer patientś experiences with financial burden and financial distress
Authors: Schröder S L , Schumann N , Richter M
Published: November 2019

Background

Financial toxicity was hardly examined in the context of public health. It is proven that financial distress following a cancer diagnosis can have an impact on the quality of life and mortality. Additionally, it was found that subjective indicators of financial toxicity have a stronger effect than objective indicators. Nevertheless, less is known about how higher costs can impact on the individual patient’s well-being. The aim of this study was to analyse the major drivers that lead from financial consequences to subjective financial distress in a country with statutory health insurance.

Methods

Qualitative semi-structured interviews were conducted with 39 cancer patients, aged between 40 and 86 years, in Germany. Inductive content analysis of data was performed and the individual patient's pathways are recently compared and contrasted.

Results

Above all, we found that financial distress is not only induced by higher costs and lower available money. Moreover, independently of whether patients experienced any financial decline, they experienced making financial adjustments and feeling financially stressed. The preliminary results show that the patient's ability of good money management and trust in one’s own skills being able to get along with less money might predict psychosocial consequences.

Conclusions

Screening instruments for financial toxicity are important to effectively detect patients whose quality of life might be worsened by their financial situation. It might be that rather financial skills than the amount of costs are important indicators of financial distress.

Key messages

Even cancer patients experiencing almost no financial decline during the period of cancer treatment might experience lower quality of life caused by financial distress. The ability and trust in oneself money management might have the strongest impact on subjective financial stress.
Experience of clinical nursing guidelines development in Kazakhstan
Authors: Umbetzhanova A , Bekbergenova Z h , Koikov V , Baigozhina Z , Zhunussova D , Kabdullina G , Abdrakhmanova A
Published: November 2019

Issue/problem

Since 2019, Kazakhstan has been implementing a project to develop standards for nursing services. The aim of project is support of practical nurses with the latest available evidence via development of clinical nursing guidelines (CPG) as well as standard operational procedures (SOP), sustainable development of this area.

Description of the problem

As part of reforming the system of nursing education in Kazakhstan, applied baccalaureate for nurses was introduced. Shortcomings of current nursing education, the introduction of digitalization and e-health, poor quality of medical services, justified need of standardization. Within the framework of the project, development groups including nurses and medical specialists were organized. The following priority topics were selected: management of diabetes, asthma, CHF, prevention of CVD. Development group uses a guide for adaptation which was prepared by project international partners from Finland. Three trainings were conducted for nursing professionals. These trainings step by step provide comprehensive knowledge on adaptation process. recommendations to local conditions.

Results

The main outcome of the joint work is the training of a nursing research committee, who will be responsible for sustainable development of this direction. The second result is guidelines for nurses, which are very demanded in the field. The third outcome is reflexing and gaining experience in overcoming barriers for further work.

Lessons

Adaptation of CPG is preferred approach for countries with a low level of socio-economic development because of less resource, time consuming. The adaptation process requires work commitment, a sufficient level of English proficiency, respect of authorship, but taking into account local conditions.

Key messages

Adaptation of nursing CPGs is an important part of standardization of medical services in order to improve the quality of medical care. Thorough planning of the process, training of development group will allow overcome barriers to implementation.
The endless story of copayment insurance in Slovenia - is it necessary?
Authors: Albreht T
Published: November 2019

Issue/problem

Slovenia maintains its specific type of voluntary health insurance, which is actually a complementary health insurance (CHI). The main criticism against it was in its regressivity as the premium is flat-rate, equal for all insured.

Description of the problem

The share of CHE in total health expenditure (THE) has been growing until recently and now represents roughly 15% of THE. Even if remains an important source of financing, there are still pressures to abolish it. The present government again set its abolishment as one of the priorities. As much as it is regressive in essence, some of the negative effects of regresivity were offset by the State stepping in by paying the copayments for those citizens who are in need of social cash benefits.

Results

CHI contributed to the stability of the funding of Slovenia’s health care system. The space for the increases has become very limited as it covers up to 90% of the price in the case of many medicines, several dental procedures, rehabilitation and similar services. That means that additional increases with offsets to CHI from the compulsory health insurance are not possible. When the need for these emerges, CHI will not be a solution anymore, which means that an alternative needs to be found. From the several options we explored, the most probable is a gradual increase in the compulsory health insurance contributions.

Conclusions

CHI in Slovenia remains a controversial topic although its criticism has lost edge recently. Partly, this was due to the clear demonstration of its contribution to the stabilisation of the THE in the times of austerity. On the other hand, the mass of money in the compulsory health insurance has increased due to the economic growth and the need to offset costs to CHI was reduced. But, as there is little space left for such actions with the new crisis, a clear scenario on how to address the need for additional funds in the health care system is needed.

Key messages

Complementary health insurance contributed to the stability of health expenditure during crisis. The main alternative to CHI is its full inclusion into the compulsory health insurance.
Calculation of road accessibility for the rural population in the Shikoku Island of Japan using GIS
Authors: Katayama R , Defratti M , Inoue T , Peters L
Published: November 2019

Background

The United Nations has defined 17 Sustainable Development Goals as a blueprint for helping ensure the health and well-being of our world by 2030. The global goals address challenges we face including poverty, inequality, climate, environmental, peace and prosperity. The goals each have targets and indicators to help measure success. Indicator #9.1.1 is defined as “Proportion of the rural population who live within 2 km of an all-season road”, which can aid in understanding multiple areas of human well-being including access to food, health care, education and in support of economic development. By understanding access to infrastructure, we can focus on affordable and equitable access for all. We focused on the Shikoku Island of Japan and calculated indicator #9.1.1 using spatial analysis.

Methods

We utilized data from three sources listed below. Cho-cho-moku boundaries population data from the Esri Japan corporation. Metropolitan Employment Area data from the Center for Spatial Information Science at the University of Tokyo. Emergency transport road data from the MLIT of Japan. We conducted proximity analysis with Geographic Information System (GIS) and estimated population of the target area using the area ratio of the target area to the original Cho-cho-moku area.

Results

The percentage of the rural population who live within 2 km of an all-season road is 79.5% and those who have no access to an all-season road in the Shikoku Island is 20.5%.

Conclusions

We found the proportion of the rural population that cannot reach an all-season road by calculating indicator #9.1.1. 20.5% of the rural population in the Shikoku Island of Japan may have difficulties accessing essential services such as health care, education, food, and may have difficulties with economic development. By understanding accessibility to road infrastructure, we were able to identify areas at risk for access. We can work towards creating more equitable access in a next step.

Key messages

By conducting spatial analysis with GIS, we can identify areas at risk for access to infrastructure. we can focus on creating more affordable and equitable access for all by understanding access to infrastructure such as health care, education and food.
How the Euripid collaboration contributes to affordability of medicinal products
Authors: Habl C
Published: November 2019

Issue

National authorities for pricing and reimbursement of medicinal products need up-to-date, easy accessible and unbiased information on the availability and prices of medicinal products in their fellow countries. Such information is needed for informed decision making, very often by countries who have an element of external price referencing (EPR) integrated into their national drug policy. EURIPID (www.euripid.eu) is a voluntary, non-profit collaboration between mainly European countries on building up and maintaining a database with information on national prices of medicinal products. It makes prices of price regulated medicinal products more transparent via an on-line accessible, comprehensive, reliable, and easy-to-use database.

Challenges of the database are to bring the numerous products of the currently 28 countries to a common platform in a standardised format and to translate the products and their presentation into English language (especially those who have no centralised EMA marketing authorisation),to present four comparable price types (e.g., to which Danish price type does the British NHS price compare),to calculate or approximate missing price types,to provide additional information allowing to indicate the real price of the product rather than its list price.

Results and lessons learned

The participating countries agreed by online voting to share information on Managed Entry Agreements (or related arrangements) and provide volume information for the reimbursed products in the database. The countries also agreed to provide background information on the national pricing system. In the last EU period the Collaboration developed a Technical Guidance Document on External Price Referencing that regulates in 12 principles the “Do’s and Don’ts of ERP”.

In the new grant period a stakeholder dialogue platform will be established to strengthening the cooperation within the EU in the field of pricing of medicinal products.

Key messages

The Euripid database is a valuable tool that is aiding countries to perform price comparisons for ERP or price monitoring for medicinal products in a standardised format. ERP is still widely used in Europe. The new activities of Euripid (e.g., a website offering information to the public), will contribute to a fair use of ERP and thus improve national decision making.
Employment program graduates of internship of higher education institutions of Kazakhstan
Authors: Abdrakhmanova A , Baigozhina Z , Bekbergenova Z h , Umbetzhanova A , Kabdullina G , Koikov V
Published: November 2019

Background

Employment of graduates of medical universities is one of the traditional problems of health care in the Republic of Kazakhstan (RK). The annual graduation of medical universities of RK exceeds 4500 young specialists. Despite this, as well as the positive dynamics of employment, the health care industry continues to experience a shortage of medical personnel.

Methods

To take effective measures to improve the employment performance of graduates of medical education organizations, to cover the shortage of medical personnel, an analysis was made of the employment of graduates of internship programs at 8 medical universities for the period from 2014-15 to 2016-17 school years

Results

For three years, medical schools of RK prepared 12019 people, of whom 8921 people studied under the state and 1343 under the rural grant. The total number of employed was slightly more than half of the graduates-6533, which amounted to 54.4%. At the same time, the number of those employed in urban hospitals is 1.5 times higher than the number of those employed in rural medical organizations. High percentages are persons who have continued their studies in residency/magistracy, and this figure tends to increase every year. The trend towards an increase is maintained by the free distribution index for pregnant women and people caring for children under the age of 3 years, for a total of three years it was 1,452 (12.1%) of a person. At the same time, those employed in rural health facilities are only 19.1% of those who studied under the grant and 31.5% of those who studied according to the rural quota.

Conclusions

Thus, the percentage of employed graduates, as well as graduates who studied under the state and rural grant, barely exceeds 50%. Even the employment of persons trained in rural quotas in rural health care facilities is only 31.5%. Universities do not fully monitor the employment of graduates, especially those who studied under a state or a rural grant.

Key messages

To create and implement an electronic platform with a complete database of students and graduates. To monitor employment and track the graduate’s work route; to organize employment services at universities.
Health promotion, community-campus-local authorities partnership and new health professional profile
Authors: Motamed S
Published: November 2019

Issue

Meinier is a county near the city of Geneva, Switzerland. Following an initial study aiming to identify its residents’ health needs, the local authority formally engaged our Institute to try to resolve the problems disclosed, which were of socio-economic and psycho-social nature. Our objective was to demonstrate that a collaborative approach to implementing effective intersectorial health promotion works at county level and that there is a need for a new role for public health, working at county level.

Description of the problem

Numerous meetings of the inhabitants gradually developed into a community-wide dialogue, leading them to clearly define their requirements. Old people felt isolated and wished to remain in the village, rather than enter a nursing home elsewhere. Young families could not get established because of a lack of available housing and nonexistent day care facilities for children. Social links between people had diminished. Further difficulties arose from poor mobility.

Effets

Given these findings the inhabitants drew together to develop a more equitable society, in a partnership between the authorities and our Institute. A participative intersectorial approach allowed a global program to be put together, which particularly united housing, urbanism, ecology and mobility. The project, driven completely by community participation, is now in its fourteenth year, its 40 million dollar budget adopted by community vote.

Results

One prominent aspect is the new village center, with its sheltered housing for the elderly, affordable accommodation for young families, child day care, a games library, shops and a restaurant as well as an intergenerational park and living space.

Lessons

The learning and experience gained in terms of community participation and of behavioral and social health determinants has been very important for all concerned.

Key messages

A collaborative approach to implementing effective intersectorial health promotion works at county level. There is a need for a new health professional profile (the county practitionner).
Health promotion among the unemployed: an international systematic review
Authors: Hollederer A
Published: November 2019

Issue

The interactions between unemployment and health create a need for specific interventions for health promotion and prevention.

Description

This overview provides information on how health promotion for the unemployed has been approached with an analysis of controlled intervention studies between 1996-2016. The literature search consulted 11 international databases in medicine, social sciences and psychology. A total of 30 health interventions for the unemployed were identified, with 43 articles that included the effects of intervention.

Results

A controlled-study design was used in 14 studies. The health promotion measures were generally based on individual counselling, case management, training or group services. The overview demonstrates the breadth of variation in target groups and types of measures. Their result indicators for health and labor market integration vary substantially. Effects are rather moderate or low in magnitude and the effect mechanisms often remain unclear. Effects weaken over time. While success is more common in the areas of health, physical activity, nutrition and stress relief, there was no impact on smoking behavior.

Lessons

A significant evolution can be observed in the quality and quantity of health promotion over time. There is a need for further research on the effectiveness and sustainability of interventions.

Key messages

There is evidence of improved health and labor market integration for established approaches like the JOBS Program and JobFit. Intervention strategies should be developed that take account of the diversity of the unemployed and their different needs.
Impact of community gardens on the sustainability of lifestyles: baseline data of the JArDinS study
Authors: Tharrey M , Perignon M , Scheromm P , Mejean C , Darmon N
Published: November 2019

Introduction

Despite growing evidence for the multiple health benefits of community gardening, longitudinal studies based on quantitative data are needed. JArDinS is a quasi-experimental study aimed at assessing the impact of community garden participation in the adoption of more sustainable lifestyles.

Materials and

Methods

Gardeners starting gardening in a community garden in Montpellier (France) were recruited in 2018. Volunteers with no experience in community gardening and matched for age range, gender, household income and household composition were recruited in a control group. A recruitment goal of 80 participants per group was determined to detect a 30% increase in F&V supply in the gardeners group. Participant were issued with three tools: a Food Supply Dairy to collect data on monthly household’s food supply, a triaxial accelerometer to measure physical activity and an online questionnaire on mental and social health, sensitivity to food waste, and connection with nature. Measures have been collected at baseline and will be repeated 12 months later. Data collected are examined conjointly to assess the sustainability of lifestyles in its social/health, environmental and economic dimensions. Change of outcomes after 1 year will be compared between the natural experiment and the control groups, to evaluate the effect of access to a community garden on the sustainability of lifestyles.

Results

A final number of 77 participants per group were enrolled at baseline, which is 4% less the original recruitment goal. Baseline data for the natural experiment group and the control group are currently being analysed and will be presented.

Discussion

This study will provide valuable information about the potential of community gardens to favor sustainable lifestyles, based on a robust quasi-experimental design allowing causality evaluation. Findings could help developing policies toward more sustainable urban planning favoring both human and environmental health.

Key messages

For the first time, the JArDinS study will allow testing, the impact of community gardens on the sustainability of lifestyles. Results will help orient urban planning decisions towards healthier options.
Re-imagining risky health behaviour as salutogenic practice
Authors: Cross R
Published: November 2019

Background

Much has been written about the problematic risky health practices that some young women in western cultures engage in defined as, for example, drinking alcohol to excess, smoking and taking drugs. Conversely the literature is more limited with regards to the meaning that young women attribute to such ’unhealthy’ practices. Exploring and understanding meaning is important in order to design more effective health promotion interventions.

Methods

This paper will present findings from 22 in-depth interviews with young women aged 18 - 14 years in post-compulsory education who were invited to talk about health and risk. Discourse analysis was used to explore the data drawing on feminist and governmentality perspectives.

Results

The data presented complex constructions of risk taking in health drawing on intertwined discourses of moralism, healthy citizenship, idealised femininity and health as a gendered pursuit. However, the young women also constructed their ’unhealthy’ practices in alternative, more agentic, resistant and philosophical ways.

Conclusions

Based on these latter findings it is proposed that some risky health behaviours should be interpreted as salutogenic rather than pathogenic in nature. Subjective constructions of risky health practices as salutogenic should be taken into account in risk communication strategies and interventions in public health.

Key messages

Exploring and understanding meaning is important in order to design more effective health promotion interventions. Subjective constructions of risky health practices as salutogenic should be taken into account in risk communication strategies and interventions in public health.
Health Promotion: a multidisciplinary analysis of the factors affecting practices of professionals
Authors: Bou Monclús M A , Casamitjà Sot M T , Mallolas Jimenez J , Sunyer Serrat J , Mantas Jimenez S , Turró Garriga O , Ferrer Morell N , de la Peña Torres L , Mir Coll M T
Published: November 2019

Background

The coordination and degree of involvement of health professionals is essential for the success of the implementation of health promotion programmes.

We belong to a regional multidisciplinary research group on Health Promotion. The aim of this study was to better ascertain how to empower the health professionals and general population.

Methods

A qualitative study was conducted among doctors, pharmacists, nurses, psychologists and veterinarians between March 2017 and December 2018. Six focus groups, with 32 women and 20 men purposively selected, were formed to determine the barriers and facilitators for the implementation of Health Promotion in their daily work and to assess their recommendations. Theoretical saturation was reached, and validity of the study was ensured by triangulation.

Results

The main barriers were: lack of training on Health Promotion which led to demotivation and distrust of own capacities, work overloaded and not valued neither by colleagues nor institutions, weak coordination between care and professional levels, inexistence of common guidelines, a health model based on disease and not addressing the social determinants of health, and, finally, legislation not being adequate. Volunteering, motivation and commitment of professionals were the most outstanding facilitators. Participants highlighted the need for all health professionals to be trained and to improve the budget for Health Promotion. They proposed that all health-related university degrees should incorporate a subject on Health Promotion. Likewise, better coordination between care and different professional levels is required, and the existing legislation should be enhanced for better promoting health.

Conclusions

The Health in All Policies approach should be provided with enough resources and consider all health disciplines. Further multidisciplinary studies are needed to make the system more people-centred.

Key messages

More training of health professionals’ skills and improved budget are required to implement health in all policies. Health Promotion policies need coordination and multidisciplinary guidelines.
Age-related and seasonal change in serum osmolarity and water intake in a healthy population
Authors: Nishikawa T , Miyamatsu N , Higashiyama A , Nishida Y , Kubota Y , Hirata T , Sugiyama D , Kuwabara K , Miyamoto Y , Okamura T
Published: November 2019

Background and aim

Few studies have clarified the seasonal and age-related change of serum osmolarity and water intake, which is thought to be associated with heat stroke and ischemic stroke. We investigated the association between them in a healthy population.

Methods

We conducted a cross-sectional study using database from Kobe Orthopedic and Biomedical Epidemiologic (KOBE) Study. Among 1138 healthy Japanese participants in the baseline survey, 1010 (women 704 and men 306) participants were eligible for the present study. Daily non-alcohol drink (NAD) intake was estimated according to food frequency questionnaire. Alcohol beverage and water in the meal or soup were excluded from the counting. Serum osmolarity (Osm/L) was calculated by Worthley’s formula: 2 (serum sodium (mEq/L)) + (blood urea nitrogen (mg/dL))/2.8 + (glucose (mg/dL))/18. The seasons the surveys were conducted were categorized into 4 groups, March-May (Spring), June-August (Summer), September-November (Autumn), and December-February (Winter). The association between serum osmolarity and daily NAD intake was analyzed using linear regression models.

Results

The seasonal change was observed in the serum osmolarity and daily NAD intake; serum osmolarity increased in spring and summer and daily NAD intake increased in summer. The serum osmolarity increased by aging in any seasons, while daily water intake didn’t. There was no significant association observed between serum osmolarity and the daily NAD intake, even after adjusting for sex, age, and season.

Conclusions

Serum osmolarity showed seasonal and age-related changes, but the serum osmolarity in subjects who had the daily habit of high NAD intake was not necessarily low.

Key messages

Serum osmolarity increased by aging and in spring and summer. Serum osmolarity was not associated with non-alcohol drink intake.
Measuring health literacy: performance-based versus perception-based measures
Authors: Lorini C , Lastrucci V , Bonaccorsi G
Published: November 2019

Background

Many performance-based or perception-based measurement tools of health literacy (HL) have been developed. The aim of this study is to compare the results of performance-based versus perception-based measures of HL in a population-based sample in Florence (Italy).

Methods

223 subjects were interviewed. To measure HL, HLS-EU-Q16 (perception-based measure of general HL) and NVS (performance-based measure of functional HL) were used. Sociodemographic characteristics were collected.

Results

The majority of the subjects had high school (36%) or university (44%) degree and gets to the end of the month quite or very easily with financial resources available (69%). Considering age classes, 22% was 18-45, 26% 46-55, 34% 56-65, 18% 66-70 year-old. According to HLS-EU-Q16, 11.8% had inadequate, 55.5% problematic and 33% sufficient HL; considering NVS, 11.7% had high likelihood of limited HL, 28.7% possibility of limited HL, 59.6% adequate HL.

The percentage of people with low HL was higher for HLS-EU-Q16 than for NVS in each category of age class, educational level, and financial resources. For both measures, the percentage of people with low HL increased with age, becoming more similar for older people: for HLS-EU-Q16, from 59.2% for 18-45 to 78.4% for >65 years old; for NVS, from 20% for 18-45 to 67.5% for >65 years old. Similar results were observed for educational level and financial resources: for both tests, the percentage of people with low HL increased with the decreasing of educational level or financial resources; for the worst situations (less than high school diploma or having not enough financial resources), the percentage of people with low HL become similar comparing the two tests.

Conclusions

Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects, but in the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result.

Key messages

Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects. In the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result.
Perceptions of health professionnals in a French social marketing campaign against smoking
Authors: Quatremère G , Guignard R , Andler R , Pasquereau A , Nguyen Thanh V
Published: November 2019

Background

In 2016, Santé publique France, the French national public health agency, launched a social marketing campaign aiming at triggering quit attempts among smokers: “MoisSansTabac”, inspired by the British “Stoptober”. Every year, smokers are encouraged to quit smoking for 30 days in November, health professionals are encouraged to participate in the campaign to support them. In 2018, pharmacists received a poster (“Here, we help smokers stop smoking”) and self-help kits to distribute to smokers. Measuring the perceptions of health professionals is crucial to have a complete overview of the impact of the campaign and to identify ways of improvement.

Methods

A qualitative evaluation of the 2018 edition has been performed to collect the perceptions of general practitioners (GPs) and pharmacists about the intervention and services provided through the campaign (quitline, website, mobile app, self-help kit). In December 2018, semi-directed interviews were conducted with 24 GPs and 24 pharmacists. A diversity of profiles was ensured (professional settings, geographic area, age, gender, smoking status). A content analysis was performed.

Results

While health professionals had generally poor awareness of the intervention, their opinions were divided depending on their professions. GPs did not feel sufficiently associated nor did they understand how they could specifically participate during this one-month event while they support smokers all year long. Pharmacists were pleased to be involved: they felt recognized in their role as health counselors although their participation remained low. Help cessation services were positively perceived. Some health professionals expected to have a more clearly defined role and to get evidence on the effectiveness of the intervention.

Conclusions

To improve the acceptability and effectiveness of “MoisSansTabac”, there is a need to rethink the place of health professionals and how to communicate with them about the campaign.

Key messages

’Mois Sans Tabac’ is a social marketing intervention which is considered acceptable by general practitioners and pharmacists but improvements are necessary. Health professionals could get more involved in the campaign if their role was better defined.
Self-Reported Muscle Strength As A Strategy For The Prevention Of Non-Communicable Diseases
Authors: Rincon F , Peña J , Yanez C , Castillo C , Téllez A
Published: November 2019

Background

Muscle strength is considered as a health indicator and an independent predictor of future disease. For this reason, the evaluation of this component in the young population is recognised as a fundamental strategy for the prevention of non-communicable diseases. Field tests are the techniques most commonly used to evaluate muscle strength. However, an alternative method that could be applied in epidemiological studies is self-report questionnaires. The aim of this research was to evaluate the ability of a self-report questionnaire to correctly rank the levels of muscle strength in college students.

Methods

A cross-sectional study was developed in 135 students from the Areandina University in Bogota, Colombia. For the evaluation of muscle strength, two tests were applied. The first was the application of the handgrip protocol using an adjustable handle Digital Grip Strength Dynamometer. The second was the application of protocols to a maximum repetition in 6 different exercises. For the assessment of self-perceived strength, the third question of the International Scale Fitness Questionnaire (IFIS) was applied. The IFIS response options are presented on a Likert scale with five possible answers: “very poor”, “poor”, “average”, “good” or “very good”. An analysis of variance (ANOVA) was applied to evaluate the ability of the IFIS questionnaire to rank muscle strength levels correctly.

Results

Overall, 70.3% of the participants were men, and 29.7% were women. The results of the field tests and the self-perception of muscle strength were significantly higher in the male group than in the female group (P < 0.001). Students who reported having good or very good muscle strength in the questionnaire had a better result in the field tests compared to those who reported average, poor or very poor muscle strength levels (P < 0.005).

Conclusions

The IFIS questionnaire was able to rank real muscle strength in university students correctly.

Key messages

The IFIS questionnaire is a valid alternative to detect students with a potential risk of chronic non-communicable diseases. The epidemiology surveillance systems in Colombia should include the application of self-report questionnaires that evaluate potential risk factors.
Lifestyle, environmental exposures and male fertility in healthy young men in North Italy
Authors: Zani C , Zani D , Donato F , Marullo M , Viola G C V , Lorenzetti S , Montano L
Published: November 2019

Background

Human semen quality is affected by metabolic, lifestyle and environmental factors. We planned a randomized controlled trial to evaluate the effects of lifestyle changes on semen quality in healthy young men living in Italian highly polluted areas. We present here some preliminary baseline data on the association between lifestyle and semen quality.

Methods

150 non-smokers, non-alcohol drinkers and non-obese young healthy men, aged 18-22 years, have been assigned to an intervention or control group according to a 1:1 randomization plan. The intervention group follows a 4-month nutritional pathway based on a Mediterranean dietary pattern and receives suggestions on practice of physical activity. All subjects undergo urologic examination, measurement of weight, height and abdominal circumference, an interview on lifestyle variables, and provide blood and semen samples in fasting conditions, at the enrollment and at the end of the intervention and follow-up (after 8 months). Adherence to Mediterranean diet is assessed using the “PREvención con DIeta MEDiterránea” (PREDIMED) tool, and physical activity using the “International Physical Activity Questionnaire” (IPAQ). Automated sperm analysis for all semen parameters is performed on the SQA-V GOLD.

Results

The data of 101 subjects living in a highly industrialized area in North Italy (mean±SD: age: 20.3±1.2 years, BMI: 22.3±2.2) were analyzed. The sperm cell concentration was higher in subjects with IPAQ score > median than those with lower values (68.3±48.6 vs 63.7±47.0 106/mL). Total percent motility was higher in subjects with abdominal circumference < median (50.7±13.6 vs 41.2±18.8, p = 0.004), in subjects with IPAQ score > median (48.2±16.8 vs 44.2±16.8), and in subjects with PREDIMED score > 7 (47.6±18.8 vs 45.0±15.0).

Conclusions

These preliminary data suggest that semen quality is associated with abdominal fat and physical activity in healthy young men.

Key messages

The semen quality is a sensitive marker of the health status and is predictive of disease occurrence. Our study suggests that semen quality is associated with lifestyle aspects in healthy young men.