bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal immigrant status and signs of neurodevelopmental problems in early childhood
Authors: Schmengler H , El-Khoury Lesueur F , Yermachenko A , Taine M , Cohen D , Peyre H , Saint-Georges C , Thierry X , Melchior M 
Published: November 2019

Abstract

Background
A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of two-year-old children using standardized parent-report instruments.

Methods
We used data from the French representative ELFE birth cohort, initiated in 2011. The study sample included 9,900 children of non-immigrant French, 1,403 children of 2nd, and 1,171 children of 1st generation immigrant women followed-up to age two years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI).

Results
In fully adjusted linear regression models, maternal immigrant status was positively associated with M-CHAT scores, with stronger associations in children of 1st (β-coefficient: 0.19; 95% CI 0.08-0.29) than 2nd generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of 1st generation immigrant mothers native of North Africa (vs. non-immigrant French: 0.33; 0.16-0.49) or French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of 1st generation immigrant mothers, particularly from mostly non-francophone regions. Children of 1st generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores.

Conclusions
Our findings suggest that maternal immigrant status is associated with higher risks of early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Standardized screening instruments may aid the early detection and treatment of these difficulties, helping to address inequalities in neurodevelopmental health in children of immigrants.

Key messages
Children of immigrant mothers in a population-based sample appear to have elevated neurodevelopmental risks, as assessed by maternal report. This is in line with evidence from clinical samples. We found strong variations according to maternal region of origin, with the highest risks in children of 1st generation immigrant mothers from North Africa and French-speaking Sub-Saharan Africa.
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt; 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

Abstract

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

Abstract

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

Abstract

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.