bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical challenges experienced by researchers in community-based participatory research
Authors: Wilson E , Kenny A , Dickson-Swift V 
Published: October 2020

Abstract

Background
Political, economic and climate events continue to bring the dismantling of communities and creation of new ones. Understanding successful models of adaptation and working with communities to address their health and wellbeing needs requires ethically sound public health research. Community-Based Participatory Research (CBPR) has been proposed as an equitable, empowering partnership approach to collaborative health research that encapsulates analysis, advocacy and action for the future wellbeing of communities. Meanwhile, a strong interest in ethical implications of CBPR continues in international literature, yet with a notable lack of research that captures the experience of researchers who had ethical challenges in their CBPR studies. The aim of this research was to address this lack of evidence by exploring those experiences of CBPR researchers internationally.

Methods
An innovative data collection method was designed utilising a purpose-built blog. This internet-based, qualitative online study enabled asynchronous international data collection on the blog. Participants were researchers with experience of CBPR and were recruited through social media platforms. Blog narratives of first-hand experiences of CBPR researchers were analysed using thematic analysis.

Results
The themes that emerged from blog data analysis were researchers' challenges with balancing participant protection and autonomy, dealing with partnership tensions, and the enduring impacts on the researchers.

Conclusions
This study enhances our understanding of ethical challenges in CBPR with evidence of enduring impacts on researchers of the 'tightrope' they walked in the interests of maintaining research integrity and ethical responsibility towards their partnering communities. Challenges arose largely from complexities of CBPR coupled with rigid regulatory structures of human research ethics review that struggles to respond adequately in the interests of communities and researchers.

Key messages
At this critical time for the future of humanity, communities can benefit from CBPR. A positive way forward for ethical review of CBPR exists for those with power to make a difference.
DNA debate. An online public engagement initiative
Authors: Mayeur C , Van Hoof W 
Published: October 2020

Abstract
Because of personalized medicine and the need for massive data sharing, genomics is becoming everybody's business. There is a need to raise public awareness and to make citizens' voices heard on the ethical, legal, and societal issues (ELSI) in genomics. Therefore, Sciensano - the scientific Institute of Public Health in Belgium - organized an online public debate on the use of genomic information in health care, to produce recommendations based on citizens' values for health policymakers, related experts, and stakeholders.
To launch this public debate, Sciensano created an interactive website with a discussion platform. We provided more than 75 high-schools with an educational package to help them organize the debate in classrooms, and organized an essay contest. We developed an online teaser test, based on 15 ethical dilemmas in genomics, and a short information video. The DNA debate was covered by national newspapers, television, and radio stations.
In total, 1106 users voiced 1247 opinions on the website. Preliminary results from the qualitative analysis of these contributions show great diversity in societal norms and values surrounding genomics. The general interest for the DNA debate indicates that citizens realize that genomics can have a big impact on the organization of health care and that they are willing to contribute to the discussion about how genomic information should be governed in society.
This DNA online debate shows that citizens can make meaningful contributions to a complex field like ELSI in genomics. Continued involvement of the public in the governance of genomic information in society is vital. It ensures that societal norms and values guide the technology and not the other way around.

Key messages
The online DNA debate raised public awareness and made citizens’ voices heard on the ethical, legal, and societal issues in genomics. Continued involvement of the public in the governance of genomic information in society is vital.
Life expectancy and healthy life years associated with diabetes in Germany
Authors: Baumert J , von der Lippe E , Paprott R , Du Y , Reitzle L , Heidemann C , Schmidt C , Scheidt-Nave C 
Published: October 2020

Abstract

Background
While life expectancy (LE) is rising, years lived with severe health impairments especially due to chronic diseases also increase. Diabetes is one of the major chronic diseases with high potential for co-morbidity and premature deaths needing life-long care. Therefore, information about loss in LE and healthy life years (HLY) in people with diabetes compared to people without diabetes is essential for assessing the burden of diabetes.

Methods
Data on all-cause mortality rates for the general population of Germany in 2014 was drawn from the Federal Statistical Office; mortality rate ratios for people with diabetes compared to people without diabetes were based on claims data from about 70 million people covered by statutory health insurances in 2014. Data of three nationwide health telephone surveys conducted among adults in Germany 2009-2012 (n ∼ 60,000) were used to assess severe health impairments defined as self-reported limitations in daily activities due to diseases for at least six months in people with and without diabetes. Based on these figures, estimates on LE and HLY could be calculated by sex and 5-year age-groups for people with and without diabetes aged ≥ 30 years.

Results
In both sexes and in all 5-year age-groups, LE and HLY were substantially lower for people with than for people without diabetes. For example, among women in the age group 30-34 years, LE and HLY estimates were 48.0 and 36.4 years for those with diabetes compared to 54.9 and 47.6 years for those without diabetes; in men, these figures were estimated as 42.6 and 32.4 years for those with diabetes compared to 50.3 and 44.1 years for those without diabetes. Differences in LE and HLY between people with and without diabetes attenuated with increasing age.

Conclusions
The present study revealed substantial reductions in LE and HLY related to diabetes and underlines the importance of integrating both figures in a national diabetes surveillance.

Key messages
There are substantial differences in life expectancy and healthy life years between people with and without diabetes. Specific intervention and prevention activities should be implemented to tackle disability in persons with diabetes.
Type 2 Diabetes Mellitus in urban and rural districts in the area of Wolisso Hospital, Ethiopia
Authors: Madia A , Soprana M , Mele A , Kadhim C , Binello N , Lanzafame A , Cori M S , Battistella C , Azzimonti G , Putoto G 
Published: October 2020

Abstract
The prevalence of Diabetes Mellitus has been rapidly growing in developing countries, both in urban and rural contexts. Ethiopia has the largest diabetes population in sub-Saharan Africa (2.6 million adult people). At Wolisso Hospital, a collaboration is underway between Doctors with Africa CUAMM and the local Association of Diabetic Patients, with the aim of guaranteeing the correct monitoring and treatment of the disease.
Between December 2018 and May 2019, 244 diabetic patients were visited in a dedicated outpatient room in Wolisso Hospital; in 55 selected patients (type 2 Diabetes Mellitus, ≥ 2 visits in the 6 months, on insulin therapy), a further set of variables was measured, including: modality of insulin storage, monthly glycemic measurements, compliance with prescribed therapy, glycemic control, knowledge of glycemic target.
Based on their urban or rural provenience, patients were split in two groups (27 urban, 28 rural). The χ2-test was used to determine significance. P ≤ 0.05 was considered statistically significant. A statistically significant difference was reported for the following variables: availability of a fridge for insulin storage (51.9% urban vs 21.4% rural, p = 0.039), compliance with prescribed therapy (63.0% urban vs 35.7% rural, p = 0.043), prevalence of hypertension (55.6% urban vs 28.6% rural, p = 0.043), alcohol consumption (32.1% rural vs 11.1% urban, p = 0.018). 13/27 urban patients and 21/28 rural patients reported that they stored insulin in the sand. No substantial variation between the groups is observed for BMI, glycemic control, number of monthly glycemic measurements and knowledge of glycemic target.
The differences highlighted between type 2 diabetic patients from urban and rural districts of the area of Wolisso suggest that these populations probably have different features and risk factors; this consideration may be useful in the organization of specific public health interventions aimed at addressing the issue in the different settings.

Key messages
The prevalence of Diabetes Mellitus has been rapidly growing in developing countries, both in urban and rural contexts. The differences highlighted between type 2 diabetic patients from urban and rural districts of the area of Wolisso suggest that these populations probably have different features and risk factors.
Overview of equity in maternal health care coverage by ethnicity
Authors: Armenta-Paulino N , Sandín Vázquez M , Bolúmar F 
Published: October 2020

Abstract

Background
Indigenous women are one of the most vulnerable groups in Latin America. They experience substantially worse maternal health outcomes than most of the population and less likely to benefit from services. Therefore, inequities in maternal health care between different ethnic groups should be monitored to identify critical factors that could limit health care coverage.

Methods
Cross-sectional analysis of the continuum of maternal health care, the indicators covering the continuum of women's care from pregnancy to the puerperium were estimated. We used nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008-2016) to explore the coverage gaps across maternal health care by ethnicity. Women were classified as indigenous through self-identification, and we measured a relative inequality by ethnicity through the estimation of adjusted coverage ratios (CR), CR = 1 means that the coverage is equal between indigenous and non-indigenous. We estimated the CR with Poisson regression models adjusted for sociodemographic variables.

Results
Indigenous women in all four countries had less coverage than non-indigenous in the continuum of maternal healthcare. The most relevant inequalities occur in the coverage of skilled-birth-attendant and in the use of contraceptives, mainly for Bolivia [CR = 0.64, p &lt; 0.001; CR = 0.91, p &lt; 0.001] and Guatemala [CR = 0.78, p &lt; 0.001; 0.77 (0.73;0.80), p &lt; 0.001]. Peru and Mexico are the countries with the smallest gaps throughout the continuum care and Guatemala with the largest.

Conclusions
The differences observed reflect the inequities that indigenous women face in the coverage of maternal health care. Therefore, it is useful and necessary to monitor ethnicity inequalities to identify the factors that limit the coverage of care that indigenous women receive to design culturally appropriate programs and policies to reduce the risks of maternal mortality and the inequities in care that indigenous women face.

Key messages
As long as the inequalities persist, identifying them will be the first step in their elimination. If not reduce the differences in care, it will be difficult to reduce maternal mortality that indigenous women face.
The FOODia-Net Protocol
Authors: Graps E A , Giuliani R , Graffigna G , Bosio C , Damiani G , Francesconi P , Chiaramonte F , Lattanzio F , Franchetti M , Castelli N 
Published: October 2020

Abstract
The increasing of chronic diseases represents a worldwide issue and conceiving effective operating models of preventive care looks mandatory to satisfy new health and social needs. It is known from Evidence-Based Medicine that to combine a multidisciplinary/multiprofessional care approach with the promotion of patients’ health literacy and correct lifestyle can improve chronic diseases management at global level.
Five Italian Regions are currently collaborating in the framework of the National Centre for Diseases Prevention and Control Research Call funded by the Italian Ministry of Health. The Project ultimate goal is the implementation of an innovative skill-mix-change operating Protocol aimed to promote patient engagement and food literacy about diabetes and its complications. To pursuit this objective and to conduct the Project dissemination activities, the creation of a dedicated web-based platform is scheduled. The assessment of the effectiveness and sustainability of the whole Project is foreseen.
A non-systematic review of available publications about existing skill-mix-change approaches designed to promote food literacy and patient engagement has been performed and a cross-sectional study to investigate food literacy of diabetic patients has been drawn up. It was approved by Local Review Board in February 2020. Meanwhile a requirements audit among Partners has been carried out to outline the ICT framework for commissioning the creation of the web-based platform to support dissemination activities.
The Project is ongoing. With the aim to preliminary map existing educational initiatives on diabetes an initial scenario analysis shows that: counselling initiatives are performed in 89% of GPs groups; patient engagement initiatives in 52% and training initiatives in 58%. Training initiatives for professionals take place in 27% of clinics; at least 1 initiative, on diabetes prevention or food literacy promotion, is carried out in each of the 9 Associations registered.
17.D. Workshop: Healthier populations through addressing environmental health topics and the SDGs
Authors:   Organised by: EUPHA Environment and health section, Regional Health Network of WHO Europe,   Chair persons: Julia Nowacki - Germany, Marija Jevtic - EUPHA-ENV
Published: October 2020

Abstract
The strategic priority of promoting healthier populations with 1 billion more people enjoying better health and well-being as expressed in the General Programme of Work (GPW) 13 by the World Health Organization (WHO) emphasizes the need of multisectoral action to address the social and environmental determinants of health including climate change. WHO data from 2016 show that approximately one quarter of the global burden of disease are caused by known avoidable environmental risks to health, with at least 12.6 million premature deaths every year. Out of this total, 7 million deaths a year are attributable to both ambient and household air pollution, placing it among the top global preventable health risks. As human influence on the environment continues to grow, global environmental challenges will escalate, including climate change and rapid urbanization. Many of the resulting risks exacerbate disease and injuries, while impacting our quality of life, reducing our productivity, and weighing on our health systems. The global endorsement of the sustainable development agenda with its Sustainable Development Goals (SDGs) provides a clear signal that the world expects greater cohesion between people and the planet, with benefits for health and health equity. More sustainable ways of functioning go hand in hand with creating healthier and more sustainable environments, with enhanced focus on prevention through action on the root causes of disease.
The SDGs set a broad agenda to advance health and equity by 2030. Health is centrally positioned within the SDGs, with SDG 3 - Ensure healthy lives and promote well-being for all ages. However, achieving this goal means more than just improving health care. It involves action in key economic development sectors, like housing and transport, as well as in the settings where people live and work in cities and rural areas. These areas are covered by SDGs such as: Achieving Affordable and Clean Energy (SDG 7), Sustainable Cities and Communities (SDG 11), and Climate action (SDG 13). Progress on these SDGs will not only significantly reduce but also support primary prevention of some of the world's most serious disease threats - including heart and lung diseases, cancers, stroke, injuries, and more. At the workshop different topics and tools that support the achievement of WHOs one billion goal of achieving healthier populations and through this the SDGs will be discussed.

Key messages
By addressing environmental health risks through progress on SDGs supports also the 1 billion goal to achieve healthier populations. Multisectoral action and turning this action into everyday practice is needed to support achieving the SDGs and the 1 billion goal of WHO.
Conversion of industrial contaminated sites into residential areas –safeguarding health and wellbeing
Authors: Nowacki J , Braubach M , Baranyi G 
Published: October 2020

Abstract
Across Europe, urban settlements are changing and expanding. Due to lack of land resources, urban development often relies on the re-use and conversion of former industrial areas - land which has had special functions before but now is being used for urban, public, recreational and residential functions. This challenge is often referred to as land recycling or brownfield conversion, and is associated with urban processes labelled e.g. urban sprawl, renewal, revitalization, regeneration or redevelopment.
Urban revitalization and the use of former non-residential land for urban functions raise potential challenges related to health, wellbeing and equity. The use of former industrial areas can be associated with contamination which, if not fully remediated, can pose health risks to new residents. With increasing urbanization in many countries there is a need for cities to provide new residential areas.
The WHO Regional Office for Europe is developing a compilation of health impacts of such urban land-take processes - including a review of lessons learned and a collection of practical experiences - that can provide better understanding of the scope of the problem, related health challenges and guidance for action for countries and cities where such conversion projects take place. The work will contribute to achieving SDG 11 by discussion practical processes for multi-stakeholder engagement in all stages of urban development that build consensus, inclusion, resilience and sustainability when converting former industrial areas into residential areas.
The presentation will focus on environmental, social and health implications and experiences of urban and residential use of land resources with formerly different functions. The presentation will include lessons learned regarding the assessment of risk associated with land contamination etc.
Health care’s climate footprint: the health sector contribution and opportunities for action
Authors: Karliner J , Slotterback S , Boyd R , Ashby B , Steele K , Wang J 
Published: October 2020

Abstract
While vastly differing in scale, each nation's health sector directly and indirectly releases greenhouse gases (GHG) through energy consumption, transport, and product manufacture, use, and disposal. Until recently, however, the health sector has not been measured as a coherent segment of the world's climate footprint. A 2019 report by Health Care Without Harm, in collaboration with Arup, provides the most comprehensive global analysis of health care's contribution to climate change to date, based on full global coverage of spending data together with detailed information from 43 countries. It identifies key sources of health care emissions while allowing for comparison between nations and among many regions of the world. Among the report's key findings are that health care's climate footprint is equivalent to 4.4% of global net emissions; that the top three health care emitters-the United States, China, and the European Union-comprise more than half of the global footprint; and that 71% of emissions are derived from the health care supply chain. The findings inform a series of international, national, and subnational policy recommendations for health care climate action, and it identifies opportunities for further research and methodological development to support the health sector in its efforts to understand and address its climate footprint. Additional findings from 2020 will also be presented. Ultimately, these estimates of health care's climate footprint provide the baseline information needed to devise pathways and track progress toward health care de-carbonization across the sector.
Regions for health case study: Turning Welsh legislation for sustainable development into everyday practice
Authors: Weatherup C , Zambon F 
Published: October 2020

Abstract
In 1998, Wales became one of the first nations in the world to have a legal requirement in relation to sustainable development. The introduction of the Well-being of Future Generations (Wales) Act 2015 bolstered previous schemes, by providing an enabling framework for thinking and working differently, and embedding a Health in All Policies approach. With seven well-being goals which aim to make Wales a healthier place, where the social, economic, environmental and cultural well-being of Wales is improved, the Act impacts on public bodies, including local authorities, to make sure that when making their decisions they take into account the impact they could have on people's well-being, that they involve citizens, and they look to the future as well as focusing on the now. Wales also became one of the first nations in the world to establish a legislative link to the international SDGs.
A new report gives practical examples and case studies demonstrating how organizations can respond to the legislation. Informed by a review of the international evidence, the report makes five key recommendations for practical implementation of sustainable development principles.
Although the report reflects the Welsh public sector context, the findings can act as a go-to guide for any organization seeking to address global issues such as climate change, biodiversity and de-carbonization, as well as to implement the globally agreed Sustainable Development Goals (SDG). The report is positive about the Welsh legislative approach; suggesting it could make a significant and long-lasting difference to the people living in Wales, with the potential to set an example globally.
The presentation will provide examples on how this is translating into practical action for the Welsh NHS system change including collective action on a de-carbonization pathway and how staff and the wider public are being motivated and engaged to 'Be The Change'. to create a network of champions will be given.