bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visualising the complex relationships between ethnic group and health in Scotland: 2001-2013
Authors: Gruer L , Stanaway F , Bhopal R 
Published: November 2019

Abstract

Background
With growing numbers of migrants worldwide, accurate data are needed to assess the health of migrants and ethnic minorities, highlight inequalities and evaluate relevant policies and actions. To summarise and reveal the complexity of the findings, we developed data visualisation techniques based on epidemiological principles.

Methods
We used published results from the Scottish Health and Ethnicity Linkage Study (SHELS), a retrospective cohort of 4.62 million people linking census ethnicity data to health service and death records during 2001-2013. In tables mainly using rate ratios, we employed different colours to show health advantage, disadvantage or equivalence; different colour shades to represent degree of certainty, combining effect size and precision of estimate; and different font sizes for absolute rates, to highlight more common conditions. We ranked health conditions by age-adjusted rate within each ethnic group to show differences in burden of disease and disease priorities.

Results
Using 30 health outcomes for up to 11 ethnic groups, we show that ethnic differences vary greatly depending on outcome, sex and ethnic group. The patterns are complex with some ethnic groups showing strong advantages for some outcomes and strong disadvantages for others. Using absolute rates highlighted differences in common conditions such as myocardial infarction, COPD, and falls. Ranking conditions within ethnic groups showed that most ethnic groups have largely similar disease priorities.

Conclusions
Our approach helps reveal and interpret the complexity of ethnic health differences. Simplistic generalisations that the health of migrants or ethnic minorities is worse or better than majority populations are often misleading and best avoided. Using absolute rates and ranking conditions within ethnic groups are useful as large relative differences in disease rates between ethnic groups may not translate into different disease priorities.

Key messages
Statements that the health of migrants or ethnic minorities is worse or better than majority populations are often misleading and best avoided. Large relative differences in disease rates between ethnic groups may not translate into different disease priorities.
The European Semester 2015-2018: themes and progress of country specific recommendations on health
Authors: Clemens T , Azzopardi-Muscat N 
Published: November 2019

Abstract

Background
The European Semester (ES) is a policy coordination and scrutiny framework at EU-level for surveillance of fiscal and macro-economic policies in Member States. Health systems have not evaded that scrutiny. The analysis focusses on how health systems reforms are being endorsed in Country Specific Recommendations (CSRs) and how the ES process links to planning and implementation of national health system reforms over the period 2015-2018.

Methods
A descriptive content analysis of CSRs with a search for the keywords and phrases ‘health’, OR ‘healthcare’, OR ‘long-term care’ was performed for the years 2015-2018. Furthermore, CSRs addressing health systems were classified according to whether they were targeting access, quality or sustainability; and categorized regarding organisation and governance, financing, physical and human resources, and provision of services. Finally, implementation progress on the health CSRs was rated according to EC’s own evaluation scheme derived from the preceding year’s country report.

Results
CSRs with health system recommendations have featured continuously in the ES process each year and have stabilised in number. The themes of health CSRs are still dominated by financial sustainability, cost-effectiveness and of financing, although other health system goals and domains, particularly access, are increasingly addressed. There is a high degree of consistency on the content of health CSRs over the years for each country addressed. Progress with implementation of health CSRs is disappointing so far, based on the EC evaluations. No clear link between discontinuation of health CSRs and evidence of progress in implementing the CSR can be discerned.

Conclusions
The results uncovered some of the links between national and European institutions leveraging the ES to push health system reforms. However, a more balanced and long-term view is needed for the ES to contribute solidly to complementing national efforts in a complex reform context.

Key messages
Health CSRs are still dominated by financial sustainability considerations while other health system goals and domains are increasingly addressed. Progress with implementation of health CSRs is disappointing so far, although a longer-term perspective is needed to pay tribute to the complex reform environment of health system reforms.
Could increasing income in lone-parent households reduce inequality in child mental health problems?
Authors: Chigogora S , Pearce A , Viner R , Morris S , Taylor-Robinson D , Hope S 
Published: November 2019

Abstract

Half of lone-parent families in the UK live in relative poverty (income &lt;60% national median) compared to a quarter of two-parent families. Family hardship is associated with increased risk of child mental health problems (CMHP). Using data from the UK Millennium Cohort Study (∼18,000 children born 2000-02), we investigated whether equalising income between lone- and two-parent households could reduce prevalence and inequality in CMHP. Exposure was family structure (lone-/ two-parent household) at 9 months; mediator was equivalised weekly household income at 3 years(y); outcome was parent-report CMHP at 5y (Strengths and Difficulties Questionnaire; normal/ borderline-abnormal). The analytic sample comprised 11,193 children.
We modelled the relationship between family structure, income and CMHP in logistic marginal structural models, weighted for attrition to MCS at 5y, and adjusted for baseline and intermediate confounding. Prevalence of CMHP was assessed overall and according to family structure. Differences between lone and two-parent households were represented by risk ratios (RRs) and differences (RDs) [95% CIs]. We modelled a hypothetical increase in income for all lone-parent households, so that median income was equalised between lone- and two-parent households, and re-estimated prevalence, RRs and RDs.
Prevalence of CMHP was 8.5%. Children from lone-parent households were more likely to exhibit CMHP (RR 1.73[1.28-2.19]; RD 5.70[2.44-8.97]). Equalising income reduced prevalence (8.2%), and differences in CMHP by family structure (RR, 1.37[0.90-1.83]; RD, 2.86[-0.06-6.31]). Sensitivity analyses showed that associations between exposure, mediator and outcome were comparable in more recent MCS sweeps, indicating that these relationships still hold today. Inequalities in CMHP between lone- and two-parent families in the UK are large. Levelling up income for lone-parents households could reduce differences in child mental health problems related to family structure.

Key messages
Inequalities in CMHP between lone- and two-parent families in the UK are large. Levelling up income for lone-parents households could reduce differences in child mental health problems related to family structure.
How to enhance collaboration between primary care and public health?
Authors: Rechel B 
Published: November 2019

Abstract

Background
There are almost universal calls for improved collaboration between public health and primary care, but it is less clear how this can be achieved in practice. This presentation summarises key findings from an Observatory policy brief on how to enhance collaboration.

Methods
The policy brief iss based on a systematic review of the academic literature on collaboration between public health and primary care, searching the databases Medline and Embase for articles published since 2010. After title, abstract and full-text screening, 46 articles were retained and included in the review.

Results
Most academic articles on collaboration between primary care and public health are concerned with the United States and Canada. From the European countries, the Netherlands and the United Kingdom are most strongly represented. There is also a very uneven timeline in publication, with a spike in articles published in 2012, following an influential Institute of Medicine report. Research has identified organizational models of primary care that are conducive to collaboration with public health, as well as systemic, organizational and interpersonal factors that can facilitate or hinder collaboration. However, the relative importance of these factors remains poorly understood. Improved collaboration between public health and primary care promises to bring major benefits, but these are rarely documented in the literature so far. Furthermore, collaboration may also bring certain risks, such as competition over scarce resources.

Conclusions
The literature on collaboration between public health and primary care points to many illustrative examples, but also identifies relevant principles and factors that can hinder or facilitate collaboration. Policy interventions to improve collaboration will need to be mindful of potential risks and should aim to demonstrate benefits, which will help to increase buy-in from primary care and public health professionals and the public.
Panelists: Ilana Ventura
Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, Austrian Government, Vienna, Austria
Contact: ilana.ventura@sozialministerium.at
Birger Forsberg
International Health, Karolinska Institutet, Stockholm, Sweden
Contact: Birger.Forsberg@sll.se
Rémi Pécault-Charby
Caisse Nationale de l’Assurance Maladie, Paris, France
Contact: remi.pecault-charby@assurance-maladie.fr
A multicentre study of street foods purchased in urban areas of Central Asia: the FEEDCities Project
Authors: Sousa S , Lunet N , Gelormini M , Jewell J , Morais I , Albuquerque G , Casal S , Pinho O , Breda J , Padrão P 
Published: November 2019

Abstract

Background
Street food (SF) is a strong tradition in Central Asia, where urbanization and westernization of food habits is occurring. Research on SF consumption is scarce, and crucial to understand its implications for public health. This study aims to describe the SF purchases in urban areas of Tajikistan, Kyrgyzstan, Turkmenistan and Kazakhstan.

Methods
A cross-sectional study was conducted in Dushanbe, Bishkek, Ashgabat and Almaty in 2016/2017. SF markets (n = 34) and vending sites (n = 270) were selected by random and systematic sampling. Data on customers’ characteristics and food items purchased was collected by direct observation. Nutritional composition of the food items (n = 852) was obtained by laboratorial analysis (n = 582) or food composition tables and labels (n = 270).

Results
A total of 714 customers were identified. The most commonly purchased foods and beverages were savoury pastries/snacks (23.2%), main dishes (19.0%), sweet pastries/confectionery (17.9%), tea/coffee (11.3%) and soft drinks/juices (9.8%). Fruit was the least frequently purchased food (1.1%). Nearly one-third of customers purchased industrial food items; this proportion was significantly higher in Kazakhstan (43.2%) and Turkmenistan (32.3%). The median energy content of a SF purchase ranged between 352kcal (Tajikistan) and 568kcal (Turkmenistan). The median saturated (SFA) and trans fat contents were 4.74g and 0.36g, respectively; the highest values were 9.01g for SFA (Turkmenistan) and 0.60g for trans fat (Kazakhstan), accounting for 40.6% and 27.3% of the maximum daily recommendations, respectively. Sodium-potassium ratio was far above recommended, reaching the highest values of 6.57 and 5.17 in Tajikistan and Kyrgyzstan.

Conclusions
Frequent purchase of industrial food reflects a shift to a westernized dietary pattern. Public health policies in these settings should aim to increase fruit availability and to improve SF nutritional composition, namely its lipid profile and sodium content.

Key messages
A relevant proportion of customers bought industrial foods, while fruit was rarely purchased, reflecting the nutrition transition process that is occurring in developing countries. Street food meals showed concerning levels of saturated fat, trans-fat and sodium, which must be considered when designing strategies targeted to improve the urban food environment in these settings.
Evaluation of communication skills among physicians: A systematic review of existing assessment tools
Authors: Gosselin Boucher V , Gemme C , Dragomir A I , Bacon S L , Lavoie K L 
Published: November 2019

Abstract

Background
The importance of physician training in communication skills for behavior change counselling in the context of chronic disease management is increasingly recognized. However, little is known about the quality, utility and psychometric properties of existing communication assessment tools.

Objective
This study systematically reviewed existing assessment tools used to evaluate communication skills among physicians.

Methods
A systematic review was conducted in accordance with the PRISMA guidelines (CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, SCOPUS) were searched up to December 2018, generating 3902 unique articles which were screened by two authors. A total of 57 articles met inclusion criteria and underwent full data extraction.

Results
Selected studies were published between 1990 and 2018. A total of 45 different assessment tools were identified. Only 47% of the studies mentioned any theoretical basis underlying the design of the tool. The most prevalent communication skills assessed were information giving (46%) or gathering (40%), eliciting patients’ perspective (44%) and agenda planning (37%). Forty-two percent were tool validation studies, but the majority (61%) reported on only one psychometric property. Study quality, using the modified COSMIN checklist, varied considerably, with an average score of 4.5/9 ± 1.3 representing moderate quality.

Conclusions
Despite identifying a high number of existing physician communication assessment tools, most were poorly validated and a high degree of heterogeneity in terms of skills assessed and study quality was observed. Most used in-person role-play exercises that are intrusive, expensive, and time-consuming, making them impractical for use within most medical contexts. Successful chronic disease management depends not only on feasible and effective communication skills training among physicians, but also on our ability to reliably assess skill acquisition.

Key messages
Training physicians’ behaviour change competencies is central to improving lifestyle changes among patients living with a chronic disease. Due to the major methodological shortcomings of existing communication assessment tools, we strongly recommend increased methodological rigor for the development of new tools.
Creating national guidelines for assessing functional and work capacity of recently settled persons
Authors: Henriksson M , Rask S , Anttila H , Kuusio H 
Published: November 2019

Abstract

Problem
The measurement of functioning in clinical practice should be systematic and comprehensive. However, different versions of the same functioning measure are used e.g. by physicians, psychologists, physiotherapists and occupational therapists. The TOIMIA network of experts aims to harmonize and develop the measuring of functioning in Finland.

Description of the problem
With increasing immigration to Finland, a specific need for guidelines on how to assess functional and work capacity of recently settled persons was identified. Led by the National Institute for Health and Welfare (mobiTARMO-project, 2017-2020), guidelines for assessing functional and work capacity in the integration phase are in preparation.

Results
The guidelines on assessing functional and work capacity in the integration phase include four principles: Functional and work capacity assessment should be done with culturally and linguistically appropriate methods.Assessment should be based on shared expertise of the professional and the client.Assessment should be comprehensive, and take into consideration physical, psychological, social and cognitive functional capacity, activities of daily living, and environmental factors.Assessment should be systematic and lead to further actions and necessary services.The national guidelines will be disseminated as free online access material in the Terveysportti health portal to professionals in clinical practice and research.

Lessons
There are specificities to the cross-cultural assessment of functional and work capacity of recently settled persons. National guidelines can be created through broad collaboration of different organizations, as in the TOIMIA network of experts in Finland.

Key messages
Jointly agreed principles on how to assess functional and work capacity in the integration phase benefit professionals and clients. National guidelines can be created, disseminated and taken into practice through broad collaboration.
Rural primary care: a scoping review
Authors: Bosmans M , Boerma W G W , Groenewegen P P 
Published: November 2019

Abstract

Background
Access to primary care is unequally distributed. Especially in rural and remote areas access to primary care services is problematic. As many countries, large and small, recognize the challenge of providing accessible and good quality primary care and implement different strategies to address this challenge, there are opportunities for cross-national learning. The main aim of this report is to provide information on best practices and solutions to counter the risk of a primary care vacuum in rural and remote areas.

Methods
In this scoping review of the literature on primary care in rural areas we made an inventory of evidence from research of the past 10 years. The research literature from January 2008 to June 2018 was captured through searches of the databases of Medline, Cochrane and EMBASE. In addition, we included relevant grey literature from within the WHO European region.

Results
The following four groups of strategies have been identified and can be used to address rural primary care shortages: substituting roles within multidisciplinary primary care teamssmart recruitment, retention and training strategies focused on staff in rural areasimplementing technological innovations in information and communicationas a short term solution: promoting the mobility of health care workers and patients

Conclusions
The evidence base with regard to interventions to improve access to primary care in rural areas is narrow, lacking sufficient methodologically sound research, making definitive conclusions about their effectiveness impossible. Additionally, the available evidence is biased towards programmes targeting physicians. Nevertheless, the literature does offer indications of promising intervention types, and provides valuable recommendations for their implementation.

Key messages
Implementation of strategies should always be accompanied by systematic monitoring of outcomes. Interventions should include primary care workers other than physicians.
Income inequality in disability-free life expectancy in Denmark
Authors: Brønnum-Hansen H , Foverskov E , Andersen I 
Published: November 2019

Abstract

Background
The state old-age pension in Denmark is adjusted in line with the projected increasing life expectancy without taking social inequality in health and life expectancy into account. The purpose of the study was to estimate income disparities in life expectancy and disability-free life expectancy (DFLE) at age 50.

Methods
By linking nationwide register data on income and mortality each individual at any age was divided into equivalised disposable income quartiles and life tables were constructed for each quartile. Data from the Danish Survey of Health, Ageing and Retirement in Europe (SHARE) was linked to register data providing access to information on respondents equivalised disposable income. Finally, data from the life tables were combined with prevalence on activity limitations by income quartiles from SHARE to estimate DFLE by Sullivan’s method. Differences in DFLE were investigated and decomposed into contributions from mortality and disability effects.

Results
A clear social gradient was seen for life expectancy as well as DFLE. Thus, life expectancy at age 50 differed between the highest and lowest income quartile by 8.0 years for men and 5.0 years for women. The difference in DFLE was 11.8 and 10.3 years for men and women, respectively. For men the mortality effect from the decomposition contributed by 4.1 years to the difference of 11.8 years in DFLE and 3.9 years to the difference in expected years with disability of 3.8 years while the disability effect contributed by 7.7 years.

Conclusions
The study quantifies social inequality in health in Denmark. Although income inequality in life expectancy and DFLE can partly be explained by loss of income due to chronic diseases, one would expect a welfare state to provide better financial security for citizens with health problems. Furthermore, the marked social disparity when approaching retirement age is questioning the fairness of implementing a pension scheme independently of socioeconomic position.

Key messages
Disability-free life expectancy differs between income quartiles by more than 10 years. Pension age follows the projected increasing life expectancy independently of socioeconomic position. This seems unfair.
Skills building seminar: Making the elevator pitch work: how to convince a policymaker in less than 2 minutes
Authors:   Organised by: EUPHA, EUPHAnxt Chair persons: Dineke Zeegers Paget - EUPHA, Maaike Droogers - EUPHA
Published: November 2019

Abstract

Since a number of years, EUPHA, the European Public Health Conference and other associations, have been working hard to translate the evidence in a such a format that policymakers take notice. The work by WHO Europe on ‘telling the public health narrative’ or providing factsheets and infographics is an example. EUPHA has organised several skills building workshops on translation of evidence in the past years (e.g. 2018: You say tomatoe, I say tomato). The European Public Health Conference introduced the so-called pitch presentations (at Glasgow 2014), where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), a way to learn to present key messages from research in just a few minutes.
But what should you do, if you meet your policymaker in the hallway or in an elevator? Can you present your work, including key messages, without slides? And in less than 2 minutes? You should be able to.
In this skills-building workshop, we will select a number of abstracts that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work?

Key messages
Being able to present your key messages anywhere, anytime is needed.
Panelist
Anne-Marie Yazbeck
Chafea, Luxembourg
Contact: Anne-Marie.YAZBECK@ec.europa.eu
Ivan Erzen
Slovenia
Contact: Ivan.Erzen@nijz.si