bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health of asylum seeker children in Finland: a total population health examination survey (TERTTU)
Authors: Skogberg N , Koponen P , Lilja E , Mustonen K-L , Garoff F , Ahmed A , Castaneda A E 
Published: November 2019

Abstract

Background
There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe, especially children and adolescents. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to inform evidence-based policy-making and development of services.

Methods
A sample of all first-time asylum applicants was drawn from the Finnish Immigration Services electronic asylum database. Data on 303 children aged 0-17 years was gathered with a standardised health examination (including a dental assessment for 7-17 year-olds) and face-to-face-interview including the Minimum European Health Module and somatic and behavioural symptoms over the past 30 days. Guardians of 0-12 year-olds were interviewed, 13-17 year-olds responded themselves. Participation rate was 72%.

Results
62% (95% CI 49,4-73,0) of 13-17 year-olds have had their growth and development monitored compared with 91% (95% CI 83,6-95,6) of 7-12 year-old and 86% (95% CI 79,4-91,0) of 0-6 year-olds. Long-standing health problems were more common among 13-17 year-olds (28%, 95% CI 18,2-39,7) and 7-12 year-olds (25%, 95% CI 16,8-34,2) compared 0-6 year-olds (13%, 95% CI 8,2-19,5). Sleep disturbances were more common among 13-17 year-olds (35%, 95% CI 24,2-47,4) and 7-12 year-olds (28%, 95% CI 19,6-37,5) than 2-6 year-olds (18%, 95% CI 11,3-26,7). Approximately fifth of children aged 7-17 years and slightly more than tenth of younger children had fears and anxieties. Signs of dental caries were found in 46% (95% CI 35,4-55,9) of 7-12 year-olds and in 23% (95% CI 14,1-35,1) of 13-17 year-olds.

Conclusions
Timely and accurate assessment of healthcare needs is crucial to support and improve the health and wellbeing of children and adolescents. Survey data will be used for developing the national initial health assessment protocol for asylum seeking children and adolescents.

Key messages
The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seeking adults, adolescents and children in Europe, allowing for examining family units. Health information on asylum seeking children and adolescents in Finland, is relevant for service development, also for other European countries.
The impact of Internet use on mental wellbeing and health behaviours among persons with disability
Authors: Szulc K , Duplaga M 
Published: November 2019

Abstract

Background
Disability is frequently related to the digital divide. However, the Internet may be also an opportunity for many people with disabilities, especially for those who suffer from difficulties in involving in social activities. For some of them, it is also a tool for undertaking professional tasks. The aim of the study was the assessment of the impact of the Internet on selected aspects of psychological wellbeing and undertaking health behaviours in persons with disabilities.

Methods
From the data set of the biannual Social Diagnosis survey, data of respondents confirming the status of disability were extracted. They were used for the development of multivariate logistic regression models for self-assessment of life, the prevalence of suicidal thoughts, feeling lonely, the use of psychological support and health behaviours. The impact of Internet usage was adjusted for sociodemographic variables. Weights provided by the study team were used in the analysis.

Results
The responses from 3231 respondents were used in the analysis. There were 33.1% of Internet users in the study group. Respondents with a mild disability made 25.3%, with moderate 39.4%, with severe 24.2%, and without an established degree of disability 11.1%. Logistic regression modelling revealed that Internet users more frequently assessed their lives as happy (odds ratio, 95% confidence interval (OR, 95%CI): 1.40, 1.13-1.75) and undertook some form of physical activity (2.32, 1.84-2.91). They also less frequently excessively consumed alcohol (0.51, 0.33-0.80). No relation was found for experiencing loneliness (0.89, 0.71-1.12), suicidal thoughts (0.998, 0.77-1.29), receiving psychological care (0.84, 0.62-1.14) and smoking (0.83, 0.66-1.04).

Conclusions
Although persons with disabilities suffer from digital divide, Internet use may exert a beneficial impact on their wellbeing and favour more beneficial health behaviours.

Key messages
Internet access and use among persons with disabilities may be an opportunity for improved wellbeing. Persons with disabilities who are Internet users assess their lives as more happy and demonstrate more favourable health behaviours.
Breatsfeeding supression in a Spanish referral hospital (2011-17): a retrospective cohort study
Authors: Llupià A , Torà I , Cobo T , Sotoca J M , Puig J 
Published: November 2019

Abstract

Background
WHO recommends measuring the role of social determinants in the initiation of breastfeeding, given that they will have an impact on the health of these mothers and babies throughout their lives. The present study, the first in Spain, describes the onset of breastfeeding through maternal and pregnancy characteristics related to breastfeeding suppression with cabergoline.

Methods
We assessed 20965 opportunities of breastfeeding initiation, collecting data of deliveries that had an obstetric clinic history record and resulted with at least one alive baby at the Hospital Clinic of Barcelona (HCB) between January 2011 and December 2017. Adjusted odds ratios for cabergoline use during hospitalization considering maternal, neonatal and pregnancy characteristics were obtained.

Results
Adjusting for the set of variables, inhibition of lactation was significantly higher in women without or primary studies with respect to women with higher education (OR 2.5, CI95% 2.0-3.0) and living in economically more depressed areas (OR 1.08, 1.04-1.2). Breastfeeding was also more inhibited in women who did not express intention of natural birth (OR 2.3, 1.9-2.9), smokers (OR 2.2, 1.9-2.6), with more previous children (OR 1.2 for each sibling,1.1-1.3), in term versus pre-term birth (OR 1.3, 1.2-1.4), in women with multiple births (OR 1.6, 1.2-2.1) and with higher risk pregnancy (OR 1.3 per risk point, 1.2-1.4). According to the mother’s country of birth, and taking Spanish women as a reference, women born in Northern Africa (OR 0.2, 0.1-0.3), in India and Pakistan (0.2, 0.1-0.3), in Eastern Europe (0.4, 0.2-0.6) and Western Europe (0.5, 0.4-0.8) are less likely to inhibit breastfeeding. Chinese women are significantly more likelier to inhibit breastfeeding (OR 7 (5.7-8.6)).

Conclusions
Inequalities have been detected in the inhibition of lactation in puerperal women. Knowing these inequalities in breastfeeding initiation is the first step to address them.

Key messages
This is the first study to describe disparities in breastfeeding inhibition in puerperal women. Factors related to lower socioeconomic status and poor health are more likely associated with breatfeeding suppression.
The Entred 3 study: a national representative sample of people with diabetes, 3rd edition-France-2019
Authors: Henry V , Piffaretti C , Saboni L , Gane J , Fosse-Edorh S 
Published: November 2019

Abstract

Background
In France, more than 3.3 million people are pharmacologically treated for diabetes. The 3rd edition of the Entred study was launched in 2019 in order to establish an overview of the epidemiological situation of diabetes since the last studies performed in 2001 and 2007. The main objectives are to describe and assess trends in characteristics of people pharmacologically treated for diabetes, in cost of care and clinical care pathways, in quality of care, in quality of life and in mortality and to focus on specific populations.

Methods
A sample of 13’000 adults has been randomly selected from the two majors French health insurance systems database. Those patients are invited by their health insurance provider to answer to a short phone-based questionnaire and then to a self-administered questionnaire (mailed or by Internet). With the agreement of those patients, their physicians are suggested to answer a questionnaire to collect information concerning their clinical and biological results. A passive follow-up of the sample is implemented by extraction of participants’ reimbursement and hospital discharge data from the SNDS (Système National des Données de Santé) for 20 years (the 10 years previous to and the 10 years following the sampling).

Results
Results expected will present first rates of participation for patients and their physician. Also, a first feedback on the innovative processes of the study, collaborations between institutions and partners will also be presented.

Conclusions
The expected results of this surveillance system based on a complementary approach (self-questionnaire, medical questionnaires and medico-administrative data) are: health status, therapeutics, economic burden, social and the quality of care pathways, the ways to improve medical practice and the quality of life of people with diabetes. Entred 3 would also be a valuable tool for orientating prevention policies that could be transposed to other countries.

Key messages
Entred combines data from people with diabetes, their care providers and extractions of health insurance data. This is a valuable tool for orientating care and prevention policies in diabetes. Entred 3 is the continuation of two previous editions and should provide important information not available in administrative database, is a major tool for all stakeholders involved in diabetes care.
Education and hypertension in the CONSTANCES cohort: which factors mediate this association?
Authors: Neufcourt L , Deguen S , Bayat S , Zins M , Grimaud O 
Published: November 2019

Abstract

Background
Individual socioeconomic characteristics and in particular education have been shown to be strongly associated with hypertension (HTN). Few studies have examined the mechanisms involved in such associations and understanding them would help to reduce the burden of social inequalities. We aimed to investigate whether specific risk factors of HTN intervene as mediators in the association between individual education and HTN in a large sample of French adults.

Methods
In this cross-sectional analysis, participants are adults aged between 18 and 69 years old recruited to the CONSTANCES cohort over the period 2012-2015. We included behavioral (poor diet, physical inactivity, alcohol consumption), anthropometric (body mass index) and socioeconomic risk factors (income and longest occupation) as potential mediators. Analyses were stratified by sex. Natural direct and indirect effects of education on HTN were estimated using weighted Poisson regression models with inverse odds weighting.

Results
A total of 62,247 individuals (53% women, mean age 48±13 years) were included. Prevalence of HTN was 37.3% [95%-Confidence Interval (95%-CI) =36.6-38.0] in men and 23.2% [95%-CI=22.7-23.8] in women. We found a steep educational gradient of HTN in both sexes, larger among young adults in relative terms. Low education was strongly associated with HTN: RRTotal Effect=1.16 [95%-CI=1.12-1.21] in men and 1.26 [95%-CI=1.21-1.32] in women. Behavioral, anthropometric and socioeconomic risk factors accounted for 49% and 32% of the total effect in men and women respectively.

Conclusions
This study underlines the importance of education in inequalities in HTN and suggests that behavioral, anthropometric and socioeconomic risk factors substantially mediate the association between education and HTN. Future research using longitudinal data should be done to help understand the causal pathway linking education and HTN.

Key messages
A strong gradient of decreased prevalence of hypertension with higher individual education is observed in both sexes and in early adulthood, suggesting that prevention should start early. Behavioral, anthropometric and socioeconomic characteristics at adulthood substantially mediate the association between education and hypertension.
6.H. Workshop: Quality strategies in European health systems: assessing their nature, use and effectiveness
Authors:   Organised by: Observatory Chair persons: Ewout Van Ginneken - Germany, Niek Klazinga - Netherlands
Published: November 2019

Abstract

Quality of care is one of the most frequently quoted principles of health policy, and is currently high up on the agenda of policy-makers at national, European, and international levels. However, the understanding of the term and what it encompasses varies. Many organizations and movements, such as evidence-based medicine, health technology assessment, provider accreditation, clinical practice guidelines and patient safety, play an important role in improving quality of health care. However, this broad field of quality-related initiatives is fragmented, and there is often a lack of awareness about parallel activities because of different labels. Evidence on the effectiveness and cost-effectiveness of different quality strategies is not always readily available for policy-makers, who have to struggle with prioritizing initiatives for investment.
To provide a solid foundation for addressing these challenges, the European Observatory on Health Systems and Policies in collaboration with the OECD has put together a comprehensive study on health care quality, its interpretation and the evidence on different strategies aiming to assure or improve it. Drawing on this 2019 study, the workshop has the following objectives: Provide an understanding of the multidimensional concept of quality of care and its relation to health system performance as well as a comprehensive framework for looking at different strategies and their potential contribution to improving health care quality;Introduce key components of international and European governance for quality of care;Highlight the effectiveness, cost-effectiveness and implementation of selected quality strategies, with a focus on the European context:Health professional regulation, including education, licensing and registration, continuous professional development and mechanisms to ensure fitness to practice;External institutional strategies for health care organizations, including accreditation, certification and supervision;“Pay for Quality”, wherein financial incentives are paid to providers or professionals for achieving quality-related targets within a specific timeframe.Discuss and refine lessons learned through audience participation, and identify further areas for research and action.

Key messages
Quality of care is a political priority and an important contributor to population health. Within an overall strategic framework, understanding the potential of different quality strategies is key. Evidence on the (cost-)effectiveness of different quality strategies is variable but largely inconclu-sive. Maintaining an overview and identifying areas for action is paramount for policy-makers.
Key components of international and European governance for quality of care
Authors: Palm W , Peeters M , Garel P , Daval A , Shaw C 
Published: November 2019

Abstract
The legal status and binding nature of various international governance and guidance instruments to foster and support quality strategies in European countries differs substantially. This presentation introduces and discusses the four main elements of an integrated international governance framework for quality in health care: i) raising political awareness of the relevance of health care quality and creating a common vision on how to improve it; ii) implementing this vision into actual policy frameworks by sharing experience and practice between countries; iii) developing and providing standards and models (voluntary or mandatory) that can be transposed into national policy; iv) measuring, assessing and comparing quality by developing better information, better indicators and methodologies as well as dissemination strategies.
The presentation will also focus on how quality in health care is addressed through EU policy, first through EU provisions and policies that are meant to ensure free movement of citizens and goods and establish an internal market, and by means of more horizontal and generic EU policies on quality and safety that stem from the mandate to support, coordinate or supplement national policies. It will further highlight how EU integration and policy touch upon quality in health care and how the approach has evolved over time.
Screening for tuberculosis among newly arrived migrants in France. Results from a practice study
Authors: Luan L , Charlois C , Leroy H , Cordel H , Figoni J , Méchaï F , Lachatre M , Mechain M , Vignier N 
Published: November 2019

Abstract

Background
Screening of active and latent tuberculosis among migrants is a public health concern but physicians’ practices are poorly known. The study aimed to evaluate physicians’ practices in France.

Methods
A national survey of physicians’ practices about infectious diseases prevention among migrants was conducted in 2017-2018 and broadcasted by several scientific societies.

Results
In total, 367 physicians answered; 53.1% were primary care physicians, 34.3% “TB involved physicians”, and 85.5% were involved daily with migrants. Screening by chest X ray is recommended by 84.8%, 71.9% and 38.4% of participants for migrants from high- (&gt;100 cases/100,000 p.a.), medium- (&gt; 50/100,000), and low-incidence countries respectively. One physician in two declares considering migration conditions in his/her decision of screening migrants from low incidence countries. Primary care physicians are less likely to offer screening (aOR= 0.21[0.09-0.48], p &lt; 0.001). About screening prescription, only 55.6% consider it their responsibility. TB control centres are designated by 56.7% of respondents. Concerning screening for latent tuberculosis infection (LTBI), 61.8% and 34.0% offered screening for children under the age of 15 and for all migrants (adults and children) from high incidence countries respectively; physicians working in Paris and its region being less likely to offer it (aOR=0.45 [0.28-0.71], p = 0.001 and aOR=0.43 [0.27-0.69] p = 0.001 respectively). Among those screening children, 88.1% recommend treatment if facing a positive result, most often with a 3-month isoniazid rifampicin double therapy, and 11.4% offer follow up alone.

Conclusions
Physicians’ practices in France regarding screening of tuberculosis among migrants are heterogeneous. Which population should be targeted for LTBI screening remains unclear in the context of contradictory national and international recommendations. The results of our study raise the issue of knowledge, and adherence to these guidelines.

Key messages
Physicians’ practices in France concerning active and latent tuberculosis screening among newly arrived migrants are heterogeneous. Many physicians involved in migrants’ care ignore or do not adhere to current national guidelines, especially concerning LTBI screening among newly arrived migrants.
Workshop: Addressing the mental health needs of lesbian, gay, bisexual, and transgender populations
Authors:   Organised by: EUPHA (SGMH) Chair persons: John Pachankis - USA, Arjan Van Der Star - EUPHA (SGMH)
Published: November 2019

Abstract

Today a large number of studies from different parts of the world clearly show that compared with heterosexuals lesbian, gay, bisexual, and transgender (LGBT) individuals have an increased risk of mental health problems, especially depression, anxiety and suicidal behaviour. To meet this increased risk of mental health problems, many governmental public health agencies call for policy and intervention programs addressing specific needs of LGBT individuals. Despite the clear need for evidence-based care, prevention, and treatment specifically tailored to LGBTQ people, there are currently few such programmes due to lack of sufficient research.
This workshop will give examples of studies on mental health care needs among LGBT individuals and effect of evidence-based training for mental health providers, as well as, studies showing improvements of mental health after treatments. Dr. Corina Lelutiu-Weinberger (Rutgers University, USA) will present results from a newly conducted study of LGBT-affirmative mental health training for health care providers in Romania. Dr. John Pachankis (Yale University, USA), will present results showing improvements in mental health among transgender individuals after receiving gender-affirmative surgical treatment, using a total population dataset from Sweden. Dr. Igor Grabovac (Medical University of Vienna, Austria) will present health and well-being disparities based on sexual orientation among older LGBT individuals in England. The situation for LGBT individuals varies greatly across Europe. The level of acceptance for minority sexual orientations differs greatly by country, and in many countries, LGBT people are also subject to legal discrimination concerning basic civil rights, e.g. regarding recognition of same-sex unions. During the workshop, Dr. Richard Bränström (Karolinska Institutet, Sweden) will present data on experiences of discrimination in health care settings and openness with sexual and gender identity to mental health providers among LGBT populations across all 28 European Union Countries.

Key messages
Today a large number of studies from different parts of the world clearly show that compared to heterosexuals LGBT individuals have an increased risk of mental health problems. Access to supportive mental health care for LGBT individuals varies greatly across Europe and dissemination of targeted LGBT-affirmative evidence-based interventions needed.
Web-based training and supervision for LGBT-affirmative mental health practice: A randomized controlled trial
Authors: Lelutiu-Weinberger C , Pacjankis J E 
Published: November 2019

Abstract

Background
Lesbian, gay, bisexual, and transgender (LGBT) individuals in most countries remain stigmatized, requiring culturally sensitive mental health care to foster coping and resilience. This trial tested the efficacy of an LGBT-affirmative mental health training for psychologists and psychiatrists in Romania, where such resources are scarce. The trial compared in-person and web-based training modalities.

Methods
Participants were randomized to a 2-day training either in-person (n = 56) or via web by viewing the live-streamed training (n = 54), and assessed pre- and 5-, 10- and 15-months post-training, with optional monthly web-based supervision (n = 47) after the first follow-up. Generalized linear mixed models were conducted to assess for change across time.

Results
The sample (M age=34.98) was mostly female (88%) and heterosexual (84%). Trainees, regardless of in-person or web-based attendance, reported significant decreases from baseline to 15-month follow-up in explicitly (b = 0.21, 95% CI 0.06 − 0.37, p &lt; 0.01) and implicitly (b = 0.26, 95% CI 0.10 − 0.41, p &lt; 0.001) assessed homonegativity, and significant increases in LGBT-affirmative clinical skills (b = -1.19, 95% CI -1.41− -1.00, p &lt; 0.001), beliefs (b = -0.17, 95% CI -0.31 − -0.03, p &lt; 0.05) and behavior (b = -1.17, 95% CI -1.72 − -0.61, p &lt; 0.05).

Conclusions
Training in LGBT-affirmative mental health can change provider attitudes and practice in high-stigma countries. The fact that web-based trainings were equally efficacious as in-person trainings suggests that such education can have widespread reach. As LGBT individuals represent one of the highest-risk global populations for mental health problems driven by stigma, findings hold strong public health potential. Future research should assess the impact of such trainings across high-need settings and include patient outcomes.