bluuebunny/crossref_metadata_2025_split huggingface dataset:
The kids are not alright: Lessons from the advocacy pursuit of restrictions on food marketing
Authors: James L , Arango M , Lawrence S 
Published: October 2020

Abstract

Issue
Poor nutrition is a leading contributor to ill health worldwide. WHO recommends restrictions on the marketing of unhealthy food to children to reduce intakes of energy-dense, nutrient-poor foods. In Canada, the government made this a mandate commitment. This provides an opportunity for other countries pursuing public health nutrition policy to better understand and overcome commercial interests when trying to advance public health.

Background
Heart & Stroke Foundation (H&S) advocated for over a decade (2008-2019) to secure government policies to restrict food marketing to youth in Canada. The inclusion of such policy in the government's 2015 mandate was promising and the associated bill was one of the strongest in the world - well received by public health advocates worldwide, positioning Canada as global leader. However, the commercial interests of various stakeholders including food and marketing industries created concerns among policy makers. Public health advocates underestimated the influence, power and opposition of industry.

Results
In order to counter industry opposition, the public health community worked in coalitions and employed a range of innovative tactics to mitigate policy concerns. This included public engagement on social media, evidence generation, celebrity endorsement, as well as calling out industry practices and political blockers. Despite the innovative and collaborative approach of public health, the policy failed to be adopted.

Lessons
Food industry will use a range of concerns including economic, environmental, and health issues to generate skepticism among policy makers. Public health advocates working in nutrition need to be proactive and prepared with insightful counter arguments and evidence to dispel myths and re-frame the issue.

Key messages
Public health progress on nutrition policy is at an early stage and we need to learn lessons from successes and failures. There is a strong amount of food industry opposition to public health nutrition policy.
National level wealth inequality and socioeconomic inequality in adolescent mental wellbeing
Authors: Dierckens M , Weinberg D , Huang Y , Elgar F , Moor I , Augustine L , Lyyra N , De Clercq B , Stevens G W J M , Currie C 
Published: October 2020

Abstract

Background
Previous research established a positive association between national income inequality and socioeconomic inequalities in adolescent health, but little is known about the extent to which national level inequalities in accumulated financial resources (i.e. wealth) are associated with these health inequalities. Therefore, we examined the association between national wealth inequality and income inequality and socioeconomic inequalities in adolescent mental wellbeing.

Methods
Data were from 17 countries participating in three successive waves (2010, 2014 and 2018) of the cross-sectional Health Behaviour in School-aged Children (HBSC) study. We combined individual-level data on adolescents' life satisfaction, psychological and somatic symptoms and socioeconomic status (SES) with country-level data on income and wealth inequality (n = 244771). We performed time-series analysis on a pooled sample of 48 country/year groups.

Results
Higher levels of national wealth inequality were associated with fewer average psychological and somatic symptoms, while higher levels of national income inequality were associated with more psychological and somatic symptoms. No associations between either national wealth inequality or income inequality and life satisfaction were found. Smaller differences in somatic symptoms between higher and lower SES groups were found in countries with higher levels of national wealth inequality. In contrast, larger differences in psychological symptoms and life satisfaction (but not somatic symptoms) between higher and lower SES groups were found in countries with higher levels of national income inequality.

Conclusions
Although both national wealth and income inequality are associated with (socioeconomic inequalities in) adolescent mental wellbeing, associations are in opposite directions. Further research is warranted to gain better understanding in the role of national wealth inequality on (socioeconomic inequalities in) adolescent health.

Key messages
This is one of the first studies to examine if socioeconomic inequalities in adolescent mental wellbeing are associated with national wealth inequality independently from national income inequality. Opposing effects of national wealth inequality and income inequality on socioeconomic inequalities in adolescents’ mental wellbeing warrant further research before policy recommendations can be made.
Undocumented migrants’ right to health care: Physicians’ rejection of law in their gatekeeper roles
Authors: Greenbrook J T V 
Published: October 2020

Abstract

Background
Legal consciousness theory acknowledges the known gap between law in writing and law in its everyday practical application in society. Limited research has explored legal consciousness in medical contexts, and limited knowledge exists surrounding how the intrusion of law in medical authority impacts applied medical ethics. Conflicts between law and medical ethics can be saliently observed in Sweden, where current law forcibly places physicians in a gatekeeper role in satisfying undocumented migrants' right to health care access, relying on physicians' assessments of whether patients without legal residency status should be provided 'care that cannot be deferred'.

Methods
In this context, the present phenomenological study sought to explore how legal terminology is experienced, understood, and applied by physicians, contextualising the perceived meaning ascribed to the imposed gatekeeper role. Qualitative interviews were conducted with 42 physicians from five major Swedish hospitals, and analysed through the lens of legal consciousness theory.

Results
Participants actively rejected law by taking a firm, and often collective, stance against its intrusion in their work. Rejection of law was constructed through: rejecting legal hegemony and government imposed non-medical responsibilities; perceiving professional authority and medical ethics as empowering; considering repercussions of legal non-compliance unthreatening; believing increased legal knowledge would not influence their professions' foundational role.

Conclusions
The study produced novel findings, contributing to the limited body of work exploring legal consciousness in medicine. Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.

Key messages
Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.
Characteristics of discharged patients from hospitals - Georgian descriptive study
Authors: Skhvitaridze N , Gamkrelidze A , Kereselidze M , Gambashidze K , Kandelaki L , Grdzelidze N , Manjavidze T 
Published: October 2020

Abstract
COVID-19, the disease caused by the novel coronavirus, started spreading rapidly across the world. Although, many aspects of disease is still under the observation. Therefore, in this study retrospectively was investigated the data on patients discharged from Georgian hospitals between February and June.
According to Georgian regulation, all patients with confirmed COVID-19 should be hospitalized. The data sources were hospitalization registry and the standardized case report forms. In this descriptive study, epidemiological characteristics of 500 COVID-19 cases confirmed with PCR tests were analyzed. Among variables were: gender, age and geographic distribution, disease characteristics, underlying health conditions, test-related features, etc.
Majority of patients (72.0%) were admitted to hospitals by the ambulance. The mean age of the patients was 43 years. The sex distribution was merely the same for both genders (49.4% male and 50.6% female). The most common symptoms were fever (82.4%, 95% CI 78.4-85.9), fatigue (49.6%, 95% CI 44.7-54.5), and cough (38.3%, 95% CI 33.6-43.1). The proportion of asymptomatic cases during the PCR testing were 16.6%. More than one symptom was observed in 57.6% of patients. Most common underlying health conditions were cardiovascular diseases (21.8%), diabetes (7.6%), kidney disease (3.6%), chronic lung disease (2.4%), cancer (2.2%), and chronic hepatitis (1.8%). Disease severity significantly differ among cases. Of those without comorbidity conditions, 94% had mild severity. However, among those with comorbidity conditions 35% were sever or critical. 50% of patients were reported as obese. The proportion of severe or critical patients was higher with BMI-18.5-24.9 and BMI ≥30. The case-fatality rate was 2.6%, with majority of deaths among aged ≥70.
The severity of illness was strongly associated with comorbidity conditions and BMI. These findings are important to contribute and improve evidence-based knowledge for the novel coronavirus.

Key messages
Hospitalization of all COVID-19 cases, despite their severity, improving positive outcome of patients. Follow-up for discharged patients is necessary to control medium and long-term impact of COVID-19.
Building intersectoral networks: the role of health brokers in a community health promotion program
Authors: de Jong M 
Published: October 2020

Abstract

Background
In community health promotion programs (HPP) aiming to improve health and reduce health inequities, health brokers can have a crucial role in building and sustaining intersectoral networks. These networks are pivotal for developing and implementing the HPP. However, the role of health brokers is new and there is little insight into the changes in the networks' size and composition over time and the processes that facilitate brokers' networks. The aim of this study was to map the brokers' network in detail and unravel the barriers and facilitators in network building.

Methods
To study the brokers' networks in a HPP in a Dutch socioeconomically deprived city district, in October 2017 and November 2019 the Composed Network Analysis (CNA) and the Coordinated Action Checklist (CAC) were used, as part of the action research accompanying the HPP. The CNA provides insight into the size and composition of the network and the CAC explores facilitators and barriers in network building and sustaining. Focus groups with the core network members (n = 6) were held to discuss and interpret results.

Results
The health brokers' network had expanded from an average of 100 contacts in 2017 to about 140 contacts in 2019. Existing contacts (e.g. social work, welfare work) had been strengthened and new partners, e.g. general practitioners and volunteers joined the network. This resulted in an increased attention for health on the agenda of these organizations and several joint activities as part of the HPP. Facilitators were working on a small scale, informal and formal, and frequent personal contacts. The most important barrier was change of partners.

Conclusions
The health brokers have been successful in and expanding their networks, putting health on the agenda of network partners and supporting activities. As such, the broker is essential in connecting a diverse range of partners and organizations in an intersectoral network in the city district.

Key messages
Working on a small scale, and with frequent personal, formal and informal contacts facilitated the health brokers network building and sustaining. A health brokers’ role, being initiator, facilitator and connector is essential for continuation of the community health promotion approach.
Real-time immunization trends in under-2 children in Pakistan: insights from big data analysis
Authors: Siddiqi D A , Mirza A , Abdullah S , Dharma V K , Shah M T , Akhter M A , Habib A , Khan A J , Chandir S 
Published: October 2020

Abstract

Background
Despite the provision of free-of-cost vaccines in Pakistan, fully immunized child (FIC) coverage in Sindh province remains low at 49%. In 2012, we developed and piloted the Zindagi Mehfooz (Safe Life; ZM) Digital Immunization Registry, an Android-based platform that enables vaccinators to enroll and track child level immunization data of children in the catchment population. In 2017, ZM was scaled-up across Sindh province and is currently being used by 2,284 vaccinators across 1,526 facilities serving &gt;48 million (m) population.

Methods
All children under-2 years of age visiting EPI centers are enrolled. At enrollment, caregiver and child bio-data and child immunization history are recorded, and the child is provided with a unique Quick Response (QR) code for identification. For follow-up immunization visits, 3 SMS reminders are sent to caregivers, and upon immunization, child history is retrieved by scanning the QR code and vaccination record updated. ZM allows real-time access to data and generation of monitoring reports. Data from ZM was used to calculate coverage rates, timeliness, and trends for immunization coverage in Sindh.

Results
From Oct'17 to Dec'19, more than 2.4m children and 0.8m women were enrolled in the Registry, while &gt;17m immunizations were administered. The FIC coverage in 12-23 months old children has increased from 49% (at baseline) to 57% for children enrolled in ZM. Additionally, pentavalent-3 coverage increased from 59% to 68%.

Discussion
ZM demonstrates the potential of DIRs to improve immunization outcomes within low-resource settings by enabling better child tracking and a higher retention rate. Additionally, the big dataset provides the opportunity to identify real-time trends and provides actionable data for evidence-based decision making.

Key messages
ZM Immunization Registry has strengthened the current EPI program through increased FIC coverage and timeliness through better tracking of children and increased retention. Big Data from ZM can be used to analyze immunization trends of global relevance, and guide strategic policy decisions for improving immunization coverage and equity, based on actionable data insights.
Participation in data generation and information sharing: are patients and carers willing to engage?
Authors: De Freitas C , Silva S , Leão Teles E , Maia T , Amorim M 
Published: October 2020

Abstract

Background
Health systems are moving towards a personalisation of care. Personalised care relies on data-intensive research, which depends on active participation by citizens in data generation and information sharing. Collecting and sharing one's data for research can deliver several benefits. However, it also comes at a cost in time and effort that may burden different population subsets to varying degrees. This study aimed to assess patients' and carers' willingness to generate and share health data, and its associated factors, to inform the design of inclusive engagement strategies.

Methods
A cross-sectional study was performed with 157 patients and 487 carers (participation rate=89.3%) followed at 2 rare diseases reference centres in Portugal (06/2019-01/2020). Participants were asked about willingness to collect their health data. Those who responded yes/maybe also reported, from 0 (not willing) to 4 (always willing), on willingness to share it for the following purposes: diagnosis/treatment, non-profit research and for-profit research related to their disease and to other diseases. Data were analysed using descriptive and inferential statistics.

Results
From 567 respondents, 42.7% are willing to collect their health data, 34.7% are unsure and 22.6% do not want to participate in data generation. More educated participants, with white-collar occupations, satisfied/very satisfied with their health and those with higher social trust levels are significantly more willing to engage in data collection (p &lt; 0.05). Participants are less prone to share information for for-profit research on their disease (Median[P25-P75]: 3.0[2.0-4.0]) or others (Median[P25-P75]: 2.0[1.0-3.0]), in particular carers (p &lt; 0.05).

Conclusions
Participants are more willing to share information for diagnosis/treatment and non-profit research. Efforts to engage people in data generation and sharing should be directed towards disadvantaged groups to reduce biases related to skewed populations.

Key messages
Willingness to participate in data generation and sharing is influenced by social indicators. Engagement by less advantaged groups should be promoted to avoid biases related to skewed populations.
Australia’s 2020 summer shows our changed climate future - a public health preparedness challenge
Authors: Hanna L 
Published: October 2020

Abstract

Background
Humans have wandered this planet for hundreds of thousands of years, yet in the last 160 years we have dramatically disrupted planetary systems upon which we depend. Humanity has polluted the oceans, rivers, air and soils. Our persistent burning of fossil fuels to power opulent lifestyles is now perilously close to permanently disrupting global climatic systems.

Problem
It is clear. The problem is us. Australia's summer of horrors provides a terrifying glimpse into our collective future. This rich and exquisitely advantaged nation has voted for governments that have ignored fragile ecosystems, dismantled environmental protection laws, ignored climate science and expanded its fossil fuel exploration, extraction, consumption and exportation. It has systematically silenced science, ignored its duty of care to protect its present and future citizenry.

Evidence
The 2019-2020 summer brought unprecedented disasters to a country familiar with disasters. After the hottest and driest year on record came the world's largest bushfire, which started in winter, and burned uncontainable for 7 months across 5 states. Billions of animals perished, thousands of homes & businesses destroyed, 33 people burned alive. Continental-wide temperatures of 42oC. Smoke levels exceeded hazardous levels by a factor of 25, lingered 6weeks in the national capital, circumnavigated the southern hemisphere. 80% of Australians were affected by the fires in some way, and the nation fell into a deep grief.

The public health challenge
As the world faces new climate regimes, the associated health challenges are elevating to unheralded and unforeseen levels. Public health preparedness for past situations will inevitably fail. Events are no longer singular, short lived or readily managed. Today's events are multifaceted, expansive and protracted. Their sheer magnitude and scale prevent response activities, interrupt transport and supply chains and shut down power and communications.

Key messages
Unfettered human development has degraded planetary systems upon which humanity depends for survival and flourishing. Climate change is disrupting all our key environmental determinants of health. Environmental degradation and climate change now present a rapidly intensifying health emergency. Australia’s summer of disasters demonstrates we need an explosion of public health preparedness.
Psychological impacts of the 2019 Quebec floods: findings from a large population-based study
Authors: Genereux M , Maltais D , Lansard A L , Gachon P 
Published: October 2020

Abstract

Background
During Spring 2019, many regions in Quebec (Canada) experienced severe floods. As much as 5,245 households were flooded and 7,452 persons were evacuated, causing extensive material and human damages. A large population-based study was therefore conducted to examine medium-term effects of this natural disaster on health and well-being.

Methods
Six to eight months post-floods, households located in the flooded zones (in one of the 6 Quebec regions the most severely affected) were randomly invited to participate to a telephone or a web-based survey (response rate=15.3%). Several psychological health outcomes were examined, including psychological distress (based on the 6-item Kessler Scale, score 0-24) and post-traumatic stress (based on the 15-item Impact of Event Scale, score 0-75). These outcomes were compared among 3 levels of exposure using Chi-square test: flooded (floodwater in ≥ 1 liveable room), disrupted (floodwater in non-liveable areas, loss of utilities, loss of access to services, or evacuation), and unaffected.

Results
Of the 3,437 participating households, 349 (10.2%) were flooded and 1230 (35.8%) were disrupted (but not flooded) during the 2019 floods. A steep gradient was observed for moderate/severe symptoms of post-traumatic stress (score ≥ 26) according to the level of exposure to flooding (unaffected: 3.0%; disrupted: 14.6%; flooded: 44.1%; p &lt; 0.0005). For psychological distress (score ≥ 7), the baseline level (i.e. unaffected group) was 7.3% while it reached 15.0% and 38.4% in the disrupted and the flooded groups, respectively (p &lt; 0.0005).

Conclusions
This study is among the largest to examine the psychological impacts of flooding. The magnitude of effects observed in flooded households is consistent with the literature and calls for stronger social and economic measures to support flood victims. Such support should help coping with initial stress, but also alleviating secondary stressors classically observed in post-flood settings.

Key messages
Psychological impacts of floods may persist for several months and may be observed in both flooded and disrupted people. Stronger social and economic measures are needed to better support flood victims, not only in the short but also in the longer term.