bluuebunny/crossref_metadata_2025_split huggingface dataset:
The risk of emergency department visits in adults living in rural France
Authors: Mercier G , Rodwin Victor , Quantin Catherine , Chernew Michael , Gusmano Michael 
Published: November 2019

Abstract

Background
Individuals living in rural areas have poorer health outcomes due to complex causal pathways related to socio-economic status, health behaviors and lower use of primary care. Emergency department visits without inpatient admission (hereafter ED visits) are an indirect measure of access to primary care.

Objective
To analyze the determinants of ED visits among French adults living in rural areas.

Methods
We analyze survey data from the CONSTANCES cohort study, a representative sample of French adults aged 18-69 years. These data on individuals’ demographics, self-reported and physician-reported clinical indicators, and individual socio-economic status, are linked to France’s claims database (SNIIRAM). We analyze the risk of having at least one ED visit, in 2016, using a multivariate logistic regression model.

Results
Among 12,834 adults included in the study, 1,412 (11%) had at least one ED visit in 2016. After adjustment, the ED visit risk was associated negatively with female gender (OR = 0.87; p &lt; 0.01), age (OR = 0.97; p &lt; 0.01), secondary education (OR = 0.85; p = 0.03), higher use of GPs (OR = 0.99; p = 0.02); and positively associated with the number of comorbidities (OR = 1.1; p &lt; 0.01), poorer self-reported health status (OR = 1.01; p = 0.02), a higher self-reported depression score (OR = 1.01; p = 0.02), and acute care inpatient admissions (OR = 2.4; p &lt; 0.01).

Conclusions
These results suggest that, among adults living in rural France, those with a lower educational level are at higher risk of ED visits.
Policy implications: To reduce health disparities among rural and urban areas, policymakers and primary care professionals should focus on targeted outreach strategies to identify high-needs individuals.

Key messages
The risk of emergency department visit varies significantly among adult living in rural France. Among adults living in rural France, those with a lower educational level are at higher risk of ED visit.
Accessibility of early diagnostics for children with a developmental disorder in Flanders, Belgium
Authors: Cloet E , Leys M 
Published: November 2019

Abstract

Background
20% of all children suffer a neurodevelopmental delay or disorder (NDDD) worldwide. Early multidisciplinary diagnostics, early intervention and timely diagnostics along the rehabilitation trajectory are needed to improve the child’s functioning and participation. In Flanders, Belgium, 6 types of public organizations (164 service points in the region) offer multidisciplinary diagnostics of NDDD for children. However the objective of timely diagnostics for the population is not realized.

Methods
A qualitative thematic analysis identifies the criteria of Federal and Flanders’ regulations for publicly accredited and funded organizations providing multidisciplinary diagnostics for children with (suspected) NDDD. A survey was sent in different settings on waiting periods and perceived determinants hampering early diagnostics These results were discussed and validated by experts in focus groups.

Results
Average waiting times for diagnostics run up to 1 year before a diagnostic trajectory can be started. Regional differences occur in the availability of diagnostic services. Formal regulations hamper the development of collaborative networks and an integrated health services model offering accessible diagnostics along NDDD trajectories. The field lacks public health services strategies to provide accessible, efficient and effective diagnostics for a complex range of NDDD target groups

Conclusions
Coordination of services providing multidisciplinary diagnostics for children with (suspected) NDDD is needed. A health services approach supporting mandated regional networks will improve the accessibility of early and timely diagnostics.

Key messages
Development of collaborative networks of different types of services offering diagnostics will improve the accessibility of early and timely multidisciplinary diagnostics for children with NDDD. Better accessibility to multidisciplinary diagnostics will improve long term outcome for children with NDDD.
Individual Versus Area Level Social Risk Measurement in the General French Population
Authors: Mercier G , Quantin C , McWilliams M 
Published: November 2019

Abstract

Background
Ongoing health policy changes include a move towards alternative delivery and payment models. In addition, the emphasis is put on social determinants as part of performance measurement and payment calibration. Most payers and policy makers rely on area-level socio-economic data, which can lead to sub-optimal. However, little is known about the agreement between individual and area-level variables. The objective was to assess the agreement between individual and area-level social risk variables in the general French population.

Methods
We used data from the CONSTANCES general-purpose cohort, a randomly selected representative sample of French adults aged 18-69 years. Data collected include socioeconomic and demographic characteristics, behaviors, and health data. We assessed the correlation or agreement between individual and area-level variables for 4 dimensions: household annual pretax income, secondary education completion, occupational group (workers), and unemployment.

Results
115,263 individuals were included in the study, 53% female and aged 48 years on average. The median annual household income was 42,000 Euros (USD 50,400), 73% had completed secondary education, 7% were unemployed, and 9.3% were workers. The correlation between income measured at the individual and area level was positive but moderate (Rho=0.20; p &lt; 0.01). Individuals having completed secondary education had a higher area-level median completion rate compared to those having a lower education level (48% versus 41%; p &lt; 0.01). Unemployed individuals had a slightly higher area-level median unemployment rate compared to employed ones (11% versus 10%; p &lt; 0.01). Lastly, workers had a higher area-level median probability to be a worker rate compared to other individuals ones (25% versus 18%; p &lt; 0.01).

Conclusions
In the general French population, area-level socio-economic variables are poor proxies for individual-level social risk.

Key messages
Area-level socio-economic data is a poor proxy for individual data. Researchers and policy makers should move towards individual data.
The economic burden of NCDs due to low fruit and vegetables consumption in the Russia in 2016
Authors: Mukaneeva D , Kontsevaya A , Balanova Y , Myrzamatova A , Khudyakov M 
Published: November 2019

Abstract

Introduction
A significant risk factor for NCDs is low fruit and vegetables (F/V) consumption, which leads to economic and social costs in all countries, regardless of income level.

Aim
To evaluate the economic burden of NCDs associated with low F/V consumption in the RF in 2016, including the direct costs and the economic losses caused by reduced productivity.

Materials and Methods
An analytical review of the literature on the search for relative risks (RR) of morbility and mortality from NCDs associated with low F/V consumption was carried out. Based on data on the prevalence of low F/V consumption in the RF (41.9%) and RR, the attributive risk for the population (PAR) was calculated for CVD, diabetes and several types of cancer. To assess the economic burden, the proportion of risk factor in morbidity and mortality from NCDs included in the analysis based on PAR was determined. Direct costs were calculated on the basis of tariffs for the provision of medical care in the RF in 2016 and the amount of disability benefits. Indirect costs included the loss of gross domestic product due to premature mortality and disability.

Results
PAR of low F/V consumption in the RF in 2016 in mortality for all CVD was 5%, in morbility about 7%, in morbility of stroke - 10%. PAR of low F/V consumption in morbility of diabetes was 6%, COPD - about 5%. PAR of low F/V consumption in mortality for ovarian cancer was 27%, for kidney cancer - 20%, in morbility from 3% for stomach cancer to 40% for pancreatic cancer. The economic burden associated with low F/V consumption in the RF in 2016 amounted to about 162 billion rubles (0.19% of GDP). A significant contribution to the economic burden was made by cancer: pancreatic cancer (38.2%), colorectal cancer (21.3%), ovarian cancer (26.3%), kidney cancer (26.4%).

Conclusions
An assessment of the economic burden will be an argument for justifying the feasibility of investing in the prevention of NCDs associated with low F/V consumption.

Key messages
To evaluate the economic burden of NCDs associated with low F/V consumption in the RF in 2016, including the direct costs and the economic losses caused by reduced productivity. The economic burden associated with low F/V consumption in the RF in 2016 amounted to about 162 billion rubles (0.19% of GDP).
Midwifery in Germany – The necessity of developing a workforce and service planning approach
Authors: Raddatz M , Hellmers C , zu Sayn-Wittgenstein F , Stelzig S 
Published: November 2019

Abstract

Background
Midwifery care in Germany is a legal right for every woman (SGB V). Midwives work employed or freelance in hospitals or in community services, providing maternal care from pregnancy until the end of breastfeeding (Sayn-Wittgenstein 2007). Increasingly, a shortage of midwifery care has been observed, forcing hospitals to understaff or to close their birth units, leaving women and their families without care (Sander et al. 2018). At the same time, birth rates are rising, thus leading to an increasing demand of midwifery care (Destatis 2019). As off today there is no central register for midwives across Germany’s 16 states. Therefor the exact number of registered midwives as well as the scope of services provided by midwives are not known (Niedersächsisches Landesgesundheitsamt 2019). Given the present situation, it seems to be imperative to establish effective midwifery workforce planning.
The aim of this poster is to identify already existing health workforce planning approaches and to determine the extent to which those can be transferred to the German system of midwifery care.

Methods
Health workforce planning approaches, already being used on a national and international level, have been analysed, focusing their applicability to midwifery services in Germany.

Results
Particular elements of the workforce planning approaches already being used in Germany for registered physicians seem to be adoptable. However, they need to be adjusted and enhanced to ensure the characteristics of midwifery in the German public health services. Internationally used approaches are not readily transferable due to systemic differences in health care systems.

Conclusions
The development of new specific workforce and service planning approaches for midwifery care in Germany is crucial to meet present and future needs of women and their families during the childbirth period.

Key messages
It seems sensible to consider the peculiarities of a healthcare system in midwifery workforce planning. Establishing workforce research still represents an important task for midwifery in Germany.
The Relationship between strength and academic performance: A new reason to promote physical activity
Authors: Peña J , Yanez C , Gomez C , Martin W , Castillo C , Granados J , Riveros M 
Published: November 2019

Abstract

Background
Experimental studies have determined that higher strength values are associated with more efficient cognitive function and better academic performance. In spite of this, the universities in Colombia are decreasing the time available for physical activity in favour of increasing the time devoted to theoretical subjects. This is one of the reasons why in Colombia, only 18% of young people complied with the world recommendations of physical activity. To examine this problem, the objective of this research was to establish the relationship between strength and academic performance in university students.

Methods
A cross-sectional study was developed in 135 (21.8 ± 4.5 yr; 78.69 ± 9.1kg) students of the fifth semester of the Areandina University in Bogota, Colombia. Each participant developed incremental protocols to determine the maximum weight that he or she could move in six different exercises: squat in smith machine, leg press, leg extension, bench press, pull down and military press. The average of the results of these tests was taken as the value of maximum strength. To determine academic performance, the average of the scores accumulated in the five semesters of their university studies was evaluated. Pearson correlation coefficient was used to find the linear relationship between strength and academic performance.

Results
Overall, 70.3 % of the participants were men and 29.7% were women. The results of the maximum strength tests were significantly higher in the male group than in the female group (P &lt; 0.05). Academic performance was similar in both genders (P &gt; 0.05). A positive correlation was established between maximum strength and academic performance. (r = 0.64 P &lt; 0.05).

Conclusions
The conclusion of this research was that there is a significant relationship between strength and academic performance. These results are fundamental to justify the inclusion of spaces for the promotion of physical activity in public and private universities.

Key messages
Universities are institutions that only focus on academic training and generate contexts in which sedentary behaviours are promoted. Sedentary lifestyles are a public health problem in Colombia.
Smoking behavior and exposure to tobacco smoke in Split-Dalmatia County
Authors: Marasovic Šušnjara I 
Published: November 2019

Abstract

Background
Tobacco use is the leading preventable cause of death, which is why a number of measures to reduce its use are carried out in the world. That’s why the aim of this study were to show the data on smoking behavior and the exposure to the tobacco smoke of the inhabitants of the Split-Dalmatia County, which represent the starting point in the creation of public health interventions

Methods
Via European Health Survey 2014/2015 (EHIS) the data on the smoking behavior and exposure to tobacco smoke in the Split-Dalmatia County were colected. The targeted population was aged 15 and over. The survey included 267 inhabitants (141 men and 126 women) of the Split-Dalmatia County.

Results
The overall sample shows that the daily smokers are 22.43% of the population, men 25.71%, and women 18.69%. Occasionally smokes 3.04% of the population (2.14% of men and 4.06% of women), while non-smokers are 74.52% of the population (77.23% of women and 72.1% of men). Tobacco products consumed are mostly cigarettes (97%). More than half (52.63 %) smokes more than 20 cigarettes a day. According to the survey results, more than half of the population (61.04%) has never or nearly never been exposed to indoor smoking, men rarely (56.03%) compared to women (66.1%). Less than one hour was exposed to 17.74% of the population (21.55% of men and 13.91% of women) and one hour and more 16.45% of the population (18.10 men and 15.65 women).

Conclusions
Indicators of smoking behavior and exposure to tobacco smoke are somewhat more favorable to residents of the Split-Dalmatia County than in the total population of Croatia. Despite the measures taken for years in Croatia, these indicators are still unsatisfactory. Existing measures need to be re-examined and strengthened to overcome this important public health problem as successfully as possible.

Key messages
In order to reduce the prevalence of smoking and improve the health of its population, Croatia needs to strengthen and adopt additional policies on tobacco control. One of the measures would certainly be a ban on smoking in public places, which could, among other things, have a significant impact on denormalising smoking in the community.
Barriers and facilitators of health behavior engagement in ultra-Orthodox Jewish women in Israel
Authors: Leiter E , Finkelstein A , Greenberg K , Keidar O , Donchin M , Zwas D R 
Published: November 2019

Abstract

Background
The ultra-Orthodox Jewish (UOJ) community is a primarily low socio-economic, culturally insular minority sub-sect in Israel. Compared with the general population, UOJ women report higher rates of diabetes and overweight, lower physical activity rates, and have lower breast cancer survival rates. Research in this sub-sect is limited. Identifying the facilitators and barriers to health behavior engagement would facilitate public health intervention design in this population.

Methods
This study describes UOJ women’s barriers and facilitators to engagement in targeted health behaviors (i.e. health nutrition, physical activity), identified through mixed methods analysis. Qualitative and quantitative analyses of interviews (N = 5), focus groups (5, including 35 women), and questionnaires (N = 239) identified barriers to engaging in preventive health behaviors and intervention preferences.

Results
Most of the barriers identified (financial and time limitations, personal preferences, lack of education/awareness, and family-related obstacles) are similar to those reported by women from the general population. Cultural aspects such as women’s role in the home, religious restrictions, and modesty were also identified as barriers to health behavior engagement, comparable to women from other insular communities.

Conclusions
Utilizing a mixed methods approach in identifying barriers and facilitators informed intervention development and improved cultural tailoring, potentially serving as a model for intervention design with additional UOJ communities as well as other difficult to access, low socio-economic, culturally insular populations.

Key messages
This is the first study identifying facilitators and barriers to UOJ women’s health behavior engagement. Findings can inform intervention design in difficult to access, culturally insular populations.
Schoolchildren’s participation in health promotion process
Authors: Maceinaite R , Šurkienė G , Sketerskienė R 
Published: November 2019

Abstract

Background
Health promotion (HP) process enables people to increase control over their own health. Schools offers ideal setting for HP interventions as most children spend a large part of time there. The pupils should be involved in this process. Information about schoolchildren’s participation in HP process is a key when planning measures to improve the situation. The shortage of information about students’ participation in this process leads to the aim of study - to determine schoolchildren’s’ participation in HP process.

Methods
Cross-sectional study was conducted in 2018. 906 schoolchildren aged 14-19 from 29 schools in Lithuania were surveyed by anonymous questionnaire (response rate 80.5%). Logistic regression models with 95% of CI were used for the data analysis. Statistical significance level was p ≤ 0.05.

Results
More than half of respondents (51.4% (95% CI: 48.2; 54.7)) participated in HP process. Participation was significantly related to residence (OR = 2.47 (95% CI: 1.80; 3.39)) and grade (OR = 1.39 (95% CI: 1.06; 1.82)). Participation in health promoting events (57.7% (95% CI: 53.2; 62.1)), assistance in organizing events (33.5% (95% CI: 29.3; 37.9)) - were the most common ways of schoolchildren’s participation. 35.3% of pupils (95% CI: 32.3; 38.5) evaluated their participation as good or very good. 68.7% of schoolchildren (95% CI: 65.6; 71.6)) wanted to participate in HP process more actively. Girls were more likely to want to participate in HP process more actively than boys (OR = 2.08 (95% CI: 1.56; 2.78)), children who lived in countryside were more likely to want to participate in HP process more actively than pupils who lived in city (OR = 1.42 (95% CI: 1.02; 1.99)).

Conclusions
Only half of schoolchildren participated in HP process. The majority of pupils would like to participate in HP process more actively, so it is very important for the school to create the right conditions and encourage schoolchildren to participate in HP process.

Key messages
The participation of schoolchildren in health promotion process is insufficient. The majority of pupils would like to know more about health promotion process.
Analysing local public health action plans: development of a tool for the French CLoterreS Study
Authors: Le Bodo Y , Fonteneau R , Harpet C , Hudebine H , Jabot F , Sherlaw W , Breton E 
Published: November 2019

Abstract

Background
The potential contribution of local authorities to prevention and health promotion is well recognized. In France, since 2009, Local Health Contracts (LHCs) are mobilising Regional Health Agencies, local elected officials and stakeholders to intervene in 4 areas: health promotion, prevention, health care and social care. LHCs remain poorly documented policy instruments.

Methods
As part of the CLoterreS study, a multidimensional coding tool was developed and tested by two coders to explore the place of prevention and health promotion in LHCs. Its development was based on the WHO conceptual framework for action on the social determinants of health and the Self-assessment tool for the evaluation of essential public health operations in the WHO European Region. Preliminary results concern a random sample of 17 LHCs from as many French regions selected among the 165 LHCs signed between 2015 and March 2018.

Results
On average, the LHCs featured 26 action forms (AF) (min: 5; max: 56). In a LHC, the average proportion of AF addressing either the social determinants of health, living circumstances or other determinants targeted by health protection, promotion or primary prevention interventions (SDoH-HPP-P1) was 79% while 44% of the AF address secondary/tertiary prevention, social care or the organization of health care and services. Among the SDoH-HPP-P1 themes (double coding permitted): psychosocial life circumstances were addressed in the 17 LHCs and concerned, on average, 31% of their AF; material living circumstances were addressed to a lesser extent (16 LHCs, 13%); other key themes include environmental health (12, 14%), mental health (16, 12%), alcohol abuse (15, 11%), drug use (14, 11%), smoking (13, 9%), physical activity (13, 12%), healthy eating (12, 12%).

Conclusions
This work confirms that LHCs are instruments with prevention and health promotion at their core. Explanation of the differing investments in this area across our sample will be further explored.

Key messages
Local Health Contracts are promising instruments to address locally a broad range of health determinants. The CLoterreS analytical tool has proven effective in capturing multiple themes and shedding light on differences between Local Health Contracts’ action plans.