bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urbanization and greenness in HBSC survey: association with overweight and obesity in adolescents
Authors: Bellisario V , Bono R , Squillacioti G , Caputo M , Gintoli I , Borracino A , Lemma P , Dalmasso P 
Published: October 2020

Abstract

Background
Childhood obesity is an important public health issue worldwide and includes different risk factors, such as environmental pollutants exposure or physical activity. Neighborhood composition and green spaces availability could contrast obesogenic lifestyles and promote healthy habits, whereas, urbanization and traffic volume exposure are inversely associated with physical activity and worsen effects on childhood health.

Methods
This project analyzed students involved in the HBSC survey from the Piedmont Region. Data were collected in 2018, following the protocol. All the subjects were georeferenced within buffers around schools. Green-spaces availability was measured by Normalised Difference Vegetation Index (NDVI-satellite images) while urbanization was calculated by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations).

Results
Overall, the sample included 3022 subjects, with amount 50% male/female and 30% for each age group (11-13-15 years old). Concerning weight status, above 14% of the all sample is obese or overweight, with, respectively, 20% among boys and 11% among girls. Preliminary analyses showed an association between weight status and population density (rural vs urbanized areas). Currently, we are analyzing the association with greenness and the other measures of urbanization.

Conclusions
Our preliminary findings suggest that high urbanization levels impact health implementing weight in children. We are testing the hypothesis that greenness positively influences weight status and reduce negative effects of urbanization and air pollution. The managing of these risk factors must be deepened and corroborated by active preventive Public Health strategies for improving children health.

Key messages
Urbanization and greenness may influence weight status in children. Public Health strategies must be improved for children health.
What is the role of community fridges in the UK? An exploratory mixed methods study
Authors: Visram S , Brown E 
Published: October 2020

Abstract

Background
More than one-quarter of the world's population is experiencing severe or moderate food insecurity, yet one-third of all food produced is lost or wasted. In response to this paradox, countries such as Spain, Germany and the UK have introduced community fridges: 'a public space where organisations and households can make perishable foods that would have been wasted available to the community'. The UK is home to the world's first national community fridge network, comprising 90 operational fridges that have so far redistributed 780 tonnes of surplus food. Other fridges exist outside of this network but little is known about what they do or who they serve. The objective of this study was to explore the role of community fridges in the UK.

Methods
A mixed methods approach was used, involving an online survey of community fridge organisers and telephone interviews with a purposively selected sample of respondents. The survey was piloted before being distributed via email and social media. Forty-seven responses were received from individuals representing 42 community fridges, and in-depth interviews were conducted with eight respondents. Data were analysed using thematic analysis.

Results
Three main roles fulfilled by community fridges were identified: reducing food waste; helping those in need; and building a sense of community. Some participants were reluctant to describe their work as being linked to food insecurity, citing the potential for stigmatisation. Others indicated that their primary goal was to tackle hunger in a non-stigmatising way, by providing free access to nutritious foods. A minor theme involved creating opportunities to build community cohesion.

Conclusions
Community fridges may form part of efforts to reduce food waste and tackle growing levels of food insecurity in the UK. This is an area ripe further for research, given the potential to promote sharing and social cohesion but also the risks in terms of stigma, hygiene and food safety.

Key messages
The UK is home to the world's first national community fridge network, but little is currently known about what these fridges do or who they serve. Community fridges have a role in reducing food waste, addressing food insecurity and building community cohesion, although stigma remains a concern.
14.G. Workshop: Teaching ethics in public health and medicine – International experiences, concepts, challenges
Authors:   Organised by: UK Faculty of Public Health, EUPHA Ethics in public health section, DGPH WG Public-Health-Ethik (Germany), SESPAS WG Ethics in Public Health (Spain),   Chair persons: Ilona Koupil - Sweden, Els Maeckelberghe – EUPHA-ETH
Published: October 2020

Abstract
To conduct good public health practice and research, ethical standards and reflection are essential. Therefore, ethics education rightly plays an increasing role in the training of the public health workforce. The organizers of this workshop all have the theme of ethics education for the public health profession as a priority in their activities. In this workshop, we present recent research findings, lessons learned and challenges in a European and global perspective. The aim of this workshop is to present and discuss these to help public health organizations and institutions of higher education to improving their public health ethics education. The added value of this workshop is to engage - personally - during the conference in Rome with senior public health professionals and researchers and to continue the dialogue on this important issue - a key mission of the EUPHA Ethics in Public Health section.
Four presentations in different formats are planned, a mixture of “Research Abstract” and “Training and Education Abstracts” and presentations respectively are foreseen. The first presentation gives an assessment of how ethics is (or is not) taught in schools of public health and to the public health workforce in Europe. It shows, for the first time, the results of two surveys, among EUPHA and ASPHER members on ethics education. The second presentation gives examples of a university in Barcelona (Spain) on innovative teaching methods at master level and thus gives impulses on how education can be integrated and improved in public health education. The third presentation reflects on the competencies in public health ethics that are aimed at with innovative and traditional teaching methods. Finally, a presentation from Nigeria contrasts educational experiences of low- and middle-income countries with high income countries and shows challenges and collaborative solutions to improved ethics education in the health field. This perspective is especially suitable to be integrated in this workshop given the global character of this year's “World Conference on Public Health”. Mutual learning and support within Europe and globally is key to develop and promote the field of public health ethics education further. A fifth timeslot for a presentation would be possible in this workshop but is not filled on purpose to have sufficient time for a structured debate on challenges and opportunities with the audience and speakers.

Key messages
Public Health Ethics education remains key for professional education; more awareness of ethical competences has to be raised. The diversity of experienced ethics trainings offers a challenging but also promising context to develop and integrate better ethics education.
Creating healthy places with the Place Standard Tool – An introduction
Authors: Hasler K , Howie J 
Published: October 2020

Abstract
This presentation will give an overview of the evidence around 'place' - the social AND physical environment - and how it impacts on lifelong health and wellbeing and health inequalities.
It will provide a comprehensive introduction to the innovative Place Standard tool (PST) developed in partnership in Scotland - and how it translates complex health and place-making relationships into a simple set of questions. The resulting tool allows participants to identify strengths and weaknesses and begin to develop a shared understanding of place from which to take collaborative action to improve places and the lives of the people that use them.
It will give a practical guide to how, when and where the PST can be deployed to support the delivery of healthy and equitable places, illustrated by real-life examples of use in a range of scales and contexts by the public sector and by communities across Scotland (and beyond) since its launch in 2015.
It will also draw out the lessons learned during the first phase deployment and showcase the resultant versions that have been developed by the Scottish team to address identified gaps in a changing climate. These new versions, which will be launched in 2020, are: improvements to the main PST intended amongst other things to better enable place-based conversations to address health impacts of climate change; versions for children to support children's rights and participation; and a Design version aimed at architects and planners to support the design process to deliver healthier places.

Key messages
The Place Standard tool is adaptable, easy-to-use and distils complex health evidence into simple questions relevant to a range of scales and types of real-life 'place'. As a practical, accessible framework for place-based conversations to support communities and agencies to together identify priorities for action to deliver high quality, sustainable places, it has proved highly transferable to a variety of contexts and countries.
The US health system: on the brink of major change?
Authors: Rice T , Rosenau P , Barnes A , Unruh L 
Published: October 2020

Abstract
The US system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program, and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditures levels per person far exceeding all other countries, poor objective and subjective indicators of quality and outcomes, and an unequal distribution of resources and outcomes across the country and among different population groups. Because of the adoption of the Affordable Care Act in 2010, and subsequent revisions to it, the US is facing a period of enormous change. There is a great need to improve coverage and improve equity, better ensure quality outcomes, and find ways to better control expenditures.
Factors related to tuberculosis delays: Evidence from nationwide retrospective study in Portugal
Authors: Lutfor Rahman M , Nunes C , Aguiar P 
Published: October 2020

Abstract

Background
Globally, tuberculosis (TB) remains one of the top 10 causes of deaths and the leading cause from a single infectious agent. Delayed TB diagnosis and/or treatment may result in the transmission of bacilli, increasing infectivity, the risk of severe disease states, morbidity and mortality. It is essential to identify the factors that prolong delays in TB services so that health planners can initiate necessary measures to control TB infections.

Methods
A nationwide retrospective study was conducted from 2010 until 2013 to analyze tuberculosis delays under the setting of the Portuguese National Tuberculosis Control Programme. There were 16824 participants who were from 25 administrative districts under 7 regions and were originated from 70 countries in the world. The log-rank test, Cox's regression, and the Kaplan-Meier method have employed to analyze TB delay data.

Results
The median of patients` delay was 34 days with interquartile ranges (IQR) 50 days. Alcohol addicted people with TB infection were delayed by 40 days with 95% CI 37.73-42.28 whereas the non-addicted people took 33 days with 95% CI 32.35-33.65. The median diagnostic delay was 12 days with an IQR of 38 days. The female participants were delayed more than that of male (median delay for female 17 days with 95% CI 15.80-18.19) in TB diagnosis. Further, comorbidities e.g. lung cancer affected TB candidates were delayed more than their counterparts (median delay 37 days with 95% CI 23.29-50.70). The median of public health delays was 63 days with IQR 72 days. The females were delayed more than that of males (median delay 68 days with 95% CI 66.06-69.94). The adjusted Cox's regression identifies the features - older age, female, drug addiction, and community residence as potential factors that might affect TB delays.

Conclusions
It is essential to emphasize on the influencing dynamics - older age, female patients, HIV patients, alcohol addiction, and comorbidities to minimize TB delays.

Key messages
To minimize spreading risk of TB infections the dynamics of TB delays e.g. older age, female patients, drug, and alcohol addiction, comorbidities should be prioritized in the TB control programs. Special attention should be given to other lung diseases while diagnosing TB infections.
Legitimising a ‘Zombie idea’: childhood vaccines and autism
Authors: Rizzi M , Attwell K , Casigliani V , Taylor J , Quattrone F , Lopalco P 
Published: October 2020

Abstract

Background
In June 2017 the Italian government made childhood vaccination mandatory following a drop in immunization rates. In the years preceding, two court judgments affirmed a causal link between vaccines and autism. Studies have linked these decisions to internet searches about vaccine-autism, the popularity of 'no-vax' theories, and drops in immunization rates. This paper provides an in-depth case study of both decisions and their impact.

Methods
We use a synthetic research design reliant on: (i) a systematic collection of primary sources (publicly available and obtained via official access to information requests); (ii) interviews with key actors prominently involved in the two cases or privy to the Italian vaccine-injury compensation regime (iii) a systematic analysis of media coverage.

Results
Circumstantial and systemic flaws enabled these decisions. Poor trial strategies, insufficient resources and laborious communication practices between arms of government were facilitators. Lack of awareness of the social sensitivity of vaccine issues, underestimation of the phenomenon of vaccine hesitancy, and a tendency to 'think in silos' informed the lack of attention dedicated to the cases. The decisions created false expectations of economic benefits and vindication for families with autistic children, resulting in increased litigation. Systemic flaws exist in the process of appointment of expert consultants acting for the court leading to judicial reliance on false data.

Conclusions
Lessons learned include greater levels of attention to vaccine cases by the administration and a matured attitude of adjudicating bodies. Two issues remain: (i) the inability of government lawyers to disseminate positive results to counteract unfounded narratives; (ii) flaws in the process of appointing expert consultants advising courts, which remains focused on the fiduciary nature of the relationship, rather than scientific authority.

Key messages
The Milan and Rimini decisions that directly affected vaccine governance stemmed from a combination of circumstantial decision-making and systemic flaws that still lurk in public health governance. Strategic decision-making that overlooks lower levels of the adjudicative system can lead to significant public health consequences as courts of law and courts of public opinion obey different logics.
Dynamics of multimorbidity in England between 2004 and 2019: a descriptive epidemiology study
Authors: Head A , Fleming K , Kypridemos C , Schofield P , O'Flaherty M 
Published: October 2020

Abstract

Background
An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence.

Methods
We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time.

Results
Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430).

Conclusions
The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends.

Key messages
The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.
Access to healthcare and self-rated health among refugees in transit and after arrival in Norway
Authors: Haj-Younes J , Strømme E , Hasha W , Igland J , Abildsnes E , Kumar B , Diaz E 
Published: October 2020

Abstract

Background
Lack of basic infrastructure and poor provision of health services in conflict settings and during flight can have a negative impact on health. The overall health status of refugees seems to improve after arrival at a safe destination. This may be related to a safer environment and better access to health care services, but prior studies on this topic are limited. This study aims to assess self-perceived access to healthcare and its relationship with self-rated health (SRH) among refugees in transit and when settled in a host country.

Methods
We used data from the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), which includes a cohort of 353 Syrian refugees who were contacted in 2017-2018 in Lebanon while waiting for relocation, and one year after their arrival to Norway. Information on self-perceived access to healthcare and its association with SRH was analyzed separately at each time-point. Data analysis was performed with STATA using logistic regression adjusting for age, gender, ethnicity and years of education and presented as adjusted odds ratios (AOR) with 95% CI.

Results
Fifteen percent reported good access to healthcare and 62% reported good SRH in Lebanon vs. 91% and 77% respectively, in Norway. Measures in Lebanon showed no association between access to healthcare and good SRH (AOR: 1.2 (0.6-2.2)), and men reported worse access to healthcare than women (AOR: 0.5 (0.3-1.0). In Norway, access to healthcare was strongly associated with good SRH (AOR: 4.7 (2.1-10.7) and was negatively associated with belonging to one specific minority group (AOR: 0.1 (0.0-0.3)).

Conclusions
Both SRH and perceived access to care improved from being in transit to being settled in Norway, the latter substantially more. There was a significant association between access to healthcare and good SRH after the refugees' arrival to a safe host country but not in transit.

Key messages
Refugee’s self-reported health and access to healthcare seem to improve shortly after arrival to a host country. To ensure that the UN’S Sustainable Development Goals concerning health equity are reached, refugees’ access to healthcare in transit and its impact on overall health needs to be addressed.
Cross-border value-based innovation procurement in health systems: the Euriphi Project
Authors: Fera F , Di Ciano M , Gorgoni G 
Published: October 2020

Abstract
The EU Coordination and Support Action, under Horizon 2020 “Innovation in Healthcare”, aims at the adoption of innovation in health and care systems and advancing procurement of innovation practices. In response to this initiative, a consortium of 25 leading organizations in procurement and health care has been created. Among the project partners, AReSS Puglia, in collaboration with InnovaPuglia (public provider of Apulian system), analysed and exploited the best integrated solution to adopt in the Health and Care system.
The EURIPHI project has successfully contributed to address common unmet needs and shortcomings in the current care delivery by using value-based innovation procurement for Public Procurement of Innovation Solutions and Pre-Commercial Procurement in the field of rapid-diagnosis of infectious diseases and integrated care.
Regions, providers and procurers joined the effort to map the unmet needs and to have a broader view on demands for innovative solutions for rapid diagnosis for infectious disease and integrated care. After the definition of unmet needs and, therefore of procurement objectives, the EURIPHI consortium organized two Open Market Consultations with the industry, one in the field of rapid diagnosis and in integrated care.
Two ecosystems have been created to ensure the sustainability of the project's

results
the EURIPHI Health & Social Care Regions Network and Value Based Procurement Community of Practice. Puglia Region is at the forefront of the two, together with other relevant healthcare stakeholders across Europe.
The needed reform of health and care systems in Europe requires the adoption of innovation and integrated solutions. One way forward is to rethink procurement policies. A positive transformation in this area definitively is to elevate procurement practices towards an approach that awards the value offered by innovation or integrated solution.