bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation research to evaluate an educational intervention for people who inject drugs
Authors: Roux P , Magen C , Stranz R , Schatz E , Verdes L , Curado A , Tsiakou T , Roy E , Carrieri P 
Published: November 2019

Abstract

Objective
In the context of disseminating harm reduction (HR) programmes in Europe, the Eurosider project aims to study the transferability of an effective educational intervention for people who inject drugs (PWID) to four European countries (Bulgaria, Greece, Portugal and Romania). This intervention, entitled Individually-Tailored Support and Education for Safer Injection (ITSESI), has been shown to reduce HIV-Hepatitis C Virus (HCV) risk practices by offering educational supervision during all phases of the injection sequence, from pre- to post-injection.

Methods
The project employs mixed methods and implementation science. The exploratory first step used qualitative interviews and other available data in each country. The second step consists in implementing and evaluating the intervention using a 6-month study conducted among 300 PWID enrolled in the 4 countries. They are interviewed at baseline and at 6 months. The third step will consist in designing, promoting and disseminating all the tools necessary to transfer ITSESI at the European level.

Results
Results from the exploratory phase highlighted two main determining factors for the feasibility of implementing ITSESI: funding and a repressive legal context. Preliminary results from a quantitative analysis of data from the second step will provide a baseline description of the 300 PWID.

Discussion
Findings to date indicate that an exploratory phase is crucial to adapt and transfer the intervention to local contexts and to evaluate it. More globally, the Eurosider project will 1) help understand each local context to adapt the intervention accordingly; 2) assess the feasibility and effectiveness of ITSESI in different contexts; 3) promote and disseminate tools and training to implement the intervention at the European level.

Key messages
People who inject drugs in European countries report HIV-HCV risk practices and adequate prevention should be provided. The implementation of an innovative educational intervention for people who inject drugs may be one response but requires to take into account contextual factors: funding and repressive drug policy.
Screenings for children: international programmes & recommendations from evidence-based guidelines
Authors: Winkler R , Reinsperger I 
Published: November 2019

Abstract

Background
Children and adolescents are in general a healthy population group. However, they are exposed to a number of morbidities (physical illnesses and mental disorders) and social burdens (e.g. poverty, violence). In Austria, there are currently no routine screenings for children older than 6 years. The project aimed at providing an overview of international screening programmes and of recommendations from evidence-based guidelines for 6 to 14 years old children.

Methods
The overview of screening practices in nine selected (mostly European) countries is based on an (Internet) hand search and expert contacts. For the guideline overview, we conducted a search in guideline databases and on websites of institutions.

Results
We identified four main screenings that were predominantly offered in the analysed countries: screenings of body weight & height, hearing & vision disorders, dental disease and mental disorders. The services are provided in school and/or in doctors’ practices, involving physicians and/or nurses. 50 evidence-based guidelines from 16 institutions met our pre-defined inclusion criteria. We identified recommendations for 24 diseases or risk factors. We found most recommendations on screening for overweight and dental disease. Further guidelines addressed infectious diseases, mental disorders, health and risk behaviour, and counselling.

Conclusions
The results are now used as a basis for discussion for the development of a new screening programme in Austria. The overview provides an international and evidence-based view. However, social determinants of health, such as education and living conditions, were hardly considered in the identified screenings, but should be increasingly addressed in a comprehensive programme.

Key messages
Screenings for overweight and dental disease were central in both the selected countries’ programmes and the guideline recommendations. Comprehensive programmes should not only focus on physical parameters, but should also take into account the social determinants of health.
Collaboration between midwives and dietitians in improving dietary intake of low SES women
Authors: Super S , Beulen Y , Wagemakers A 
Published: November 2019

Abstract

Background
A healthy dietary intake during pregnancy is important for maternal and child health. However, pregnant women with a low socioeconomic status (SES) are less likely to adhere to nutrition guidelines as compared to high SES groups. Midwives in the Netherlands experience limited opportunities to provide nutrition advice. Dietitians could play a role in providing nutrition advice to pregnant women, but collaborations between midwives and dietitians are limited. Therefore, this study aimed to investigate the opportunities and barriers for collaboration between midwives and dietitians in antenatal care for low SES women.

Methods
Questionnaires were administered amongst 134 dietitians to examine experiences of providing nutritional advice to pregnant women. Four focus groups were organised with midwives (2x) and dietitians (2x) to explore opportunities and barriers for collaboration.

Results
Questionnaire results indicated that 73% of the dietitians like to see pregnant women more often in their practices and 78% feels the necessity to strengthen the collaboration with midwives. The focus groups showed that dietitians and midwives wish to strengthen the collaboration, but they also experience barriers: a focus on food risks rather than healthy nutrition in antenatal care, lack of referral procedures for women without medical necessity to see a dietitian, negative connotations with referring women to dietitians, and lack of time to discuss nutrition in consults by midwives.

Conclusions
Midwives and dietitians recognise the importance of strengthening collaborations, but in order to do so, several challenges need to be overcome. In a follow-up of this study, pressure cooker sessions will be conducted to design an integral strategy in antenatal care to empower women to improve dietary intake.

Key messages
There is a great potential to strengthen collaborations between midwives and dietitians in antenatal care to empower low SES pregnant women to improve dietary intake. Several barriers need to be overcome to design in an integral strategy in antenatal care to improve the dietary intake of low SES prengant women.
Indications and practices of Cesarean Sections in a French region – The Robson classification
Authors: Laurent E , Lecuyer A I , Baron S , Diguisto C , Turpin D , Potin J , Grammatico-Guillon L 
Published: November 2019

Abstract

Background
Cesarian-section (CS) deliveries, although sometimes vital, are associated with increasing immediate- and long-term maternal and/or neonatal risks. The objective was to describe the indications of scheduled CS, measure the potentially avoidable CS and study the rate variations between maternities in one French region, Centre Val-de-Loire (CVL).

Methods
A cross-sectional study was conducted from September 2016 to February 2017. Information about all CS performed in the maternities of the region was collected: medical history, indication, schedule. Data collection was completed with the 2016 regional birth data repository (25,864 deliveries, including 19.2% of CS, among which 7.0% were scheduled). CS were classified according to the pre-existing risk high or low of CS as defined by the Robson classification.

Results
During the study period, 1,979 CS (18.6% of deliveries) were performed, of which 762 were scheduled (7.1% of deliveries). The main indications for planning a CS were: scarred uterus (60%, of which 56% with only one previous CS) or breech presentation (25%), considered at high risk of CS according to the Robson classification. For these two contexts, the regional birth repository showed decreasing scheduled CS rates from high to low level of maternities’ expertise. Remarkly, 22 nulliparous women with a single cephalic pregnancy in spontaneous labor before term (Robson’s low risk of CS) had a CS performed for unfavorable pelvimetry (0.2% of deliveries).

Conclusions
This study allowed identifying specific potential interventions: targeted CS on scarred uterus with only one previous CS or breech presentation, as recommended by national guidelines, and targeted use of radiologic pelvimetry. The Robson classification must be widely used to assess practices through cautious maternity comparisons to improve quality of care.

Key messages
Although potentially avoidable c-sections are rare, interventions were identified: targeted CS on uterus with one previous CS or breech presentation, targeted use of radiologic pelvimetry. The Robson classification must be widely used to assess practices, in order to improve healthcare quality.
Direct and the Indirect Determinants of Weight-Control Behaviours among Adolescents
Authors: Tur-Sinai A , Kolobov T , Tesler R , Baron-Epel O , Dvir K , Harel-Fisch Y 
Published: November 2019

Abstract

Background
Economic determinants such as socioeconomic inequalities and parents’ employment have a profound impact on the health of adolescents in terms of unhealthy weight-control behaviours (UWCB). In addition, various family factors may play a role in adolescents’ weight-control behaviours (WCB). This study examines the association among socioeconomic status, perceived family wealth, and number of employed parents and Israeli adolescents’ WCB and asks whether family variables (parental communication, monitoring, support, and family meals) mediate WCB.

Methods
Data from the cross-sectional questionnaire of the 2014 Israeli Health Behaviour in School-Aged Children study are analysed using structural equation modelling. The research population includes approximately 7,000 Israeli schoolchildren in grades 6, 8, and 10. The association among socioeconomic status (SES) factors (SES measures, parental employment), sociodemographic factors, and weight-control behaviours among adolescents is calculated.

Results
High family affluence and high perceived family wealth are negatively associated with unhealthy weight-control behaviour. Having two employed parents leads to lower levels of UWCB. Family-related variables like family communication and support and parental monitoring are found to mitigate unhealthy weight-control behaviours. Family meals have a significantly positive effect on healthy weight-control behaviour and a significantly negative impact on unhealthy weight-control activities.

Conclusions
The findings suggest that economic factors such as SES and number of employed parents are necessary strategies for long-term weight-control practice. The combination of WCB and family meals is the most effective method for adolescents’ healthy weight-control behaviour.

Key messages
The study highlights the importance of considering the quality of family communication and support as a health asset that may contribute to WCB among young people. Family affluence and perceived family wealth, which were two separate measurements, were perceived differently by adolescents.
The role of health literacy in explaining regional health differences among adolescents
Authors: Simonsen N , Wackström N , Roos E , Suominen S , Välimaa R , Tynjälä J , Paakkari L 
Published: November 2019

Abstract

Background
Health disparities in adolescence track forward to adulthood. In understanding disparities better, health literacy (HL) - as a broad range of health-related competencies - has been identified as a valuable construct. Higher HL has been associated with better health outcomes, also among adolescents. Not much is known about how language or region in a bilingual country is associated with HL, or how HL is associated with regional health disparities. The aim of this study, in a bilingual country, was a) to examine and compare HL and health levels among majority and minority language speaking adolescents in different regions of Finland, and b) to explore if HL explains possible regional health differences in these two language groups, taking into account other important structural stratifying factors.

Methods
The data of 13- and 15-year-olds were obtained from the Health Behaviour in School-aged Children study, conducted in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). HL was measured with the HLSAC-instrument. The data were analysed by logistic regression and interaction analyses.

Results
In the total sample, 23% rated their health as excellent; 33% had a high and 10% a low HL. The preliminary findings showed no differences in health or HL between the language groups. However, regional health differences were found in both language groups: in the Finnish-speaking sample among boys, and in the Swedish-speaking sample among girls. Findings also showed regional differences in HL levels in both language groups, especially among the Swedish-speaking minority group. Comprehensive HL was an independent factor in explaining these regional health differences.

Conclusions
This study adds to prior studies on the role of HL as a modifiable health resource by showing that in addition to other structural stratifying factors comprehensive HL explains regional health disparities among adolescents in a bilingual country.

Key messages
This study in a bilingual country found regional health disparities and regional differences in HL levels among both majority and minority language speaking adolescents. In both language groups, taking into account other important structural stratifying factors, comprehensive HL was an independent factor in explaining the regional health differences.
Weight Control Practices in Turkish Adolescents and Factors Related with Over- Weight and Obesity
Authors: Atintas Sert B , Ergun A 
Published: November 2019

Abstract

Backgrounds
Over-weight and negative body perception that may develop during adolescence period cause many slimming experiences, especially the diet and as the state of discontent increases, the methods used are more unhealthy and dangerous. This study was conducted to determine the weight control practices and the factors related to over-weight-obesity in Turkish adolescents.

Methods
This cross-sectional study was conducted with 900 high school students aged between 14-18. The data were collected by using an introductory form including questions about socio-demographic characteristics and weight control, eating attitude test (EAT-26), Bergen Insomnia Scale and height-weight.

Results
In this study, it was found that 9.1% of the adolescents were overweight, 8.2% of them were obese, and 32.9% of them had a risky eating behavior (EAT-26 score &gt; 20). It was found that 87.7% of adolescents who are overweight-obese and 40% of those with normal weight were wanted to lose weight. It was determined that 70.4% of adolescents exercise for weight control, 63.6% of them increased fluid consumption and 16.6% of them used weight loss dietary supplement. Adolescents who were overweight-obese had a higher proportion of those with a risk of eating behavior (EAT&gt; 20) and those with insomnia problems than those with normal weight (p &lt; 0.05). The factors related to overweight and obesity were found in female adolescents; standing snacking, angry negative moods and sometimes consuming irregular meals between meals, whereas in male students; watching TV, working while eating, standing snacking, late-night eating and insomnia (p &lt; 0.05).

Conclusions
It was determined that the majority of overweight-obese students wanted to lose weight and some of those had a risky eating habits and preferred unhealthy methods for weight control. These results indicate that was need programs of healthy weight control and prevention of obesity in the schools.

Key messages
Adolescents who were overweight-obese had a higher proportion of those with a risk of eating behavior (EAT&gt; 20). There is a need for public health programs on healthy weight control and weight regulation practices for adolescents.
Using ’White Flags’ to categorize socio-cultural aspects in chronic pain
Authors: Winkelmann C , Schreiber T U 
Published: November 2019

Abstract

Issue
Persistent chronic pain is a major medical and health economic problem. To assess the individual pain situation, the classification of various factors (flags) has been established.

Description of the problem
Structural biomechanical factors are classified as “red flags”. Psychological or behavioral factors are summarized as “yellow flags”, psychiatric and mental illness as “orange flags”. Both last flags are important for planning adequate therapies or rehabilitation, as well as for decisions to prognoses and tailored reintegration programs. An extension of the flag model was achieved by naming personal factors at workplace as “blue flags”, and “black flags”, if there is a restriction for returning to work. All these groups do not consider other important reasons for unsuccessful rehabilitation or failed reintegration.

Results
In these cases, often described as ’therapy-refractory’, clients often exhibit a special subjective understanding of illness that reacts neither to psychological interventions nor to behavioral therapies. These include individual beliefs based, for example, on cultural socialization, religious education, or spiritual experiences. Since such individual mental illnesses are culturally ideologically or religiously justified, they should be classified in a separate group called ’white flags’.

Lessons
The advantages of categorizing sociocultural aspects separately from other flag classifications are avoidance of unnecessary therapies, including surgery,prevention of iatrogenisation,prevention of legal disputes.
It is important to realize that only health restrictions for insurance benefits can be taken into account and that individual socio-cultural circumstances or health convictions are not evaluated.
Main messages: A classification of ’white flags’ could contribute to a better classification of pain which are not accessible to various therapies and reduce reservations and misunderstandings by intercultural communication approaches.

Key messages
For medical professions it is important to recognize, that only health inabilities are taken into account for insurance compensation and not individual socio-cultural circumstances or health beliefs. In Future classifying ’white flags’ could help to properly assess persistent pain conditions.
Teaching Program for laymen and experts for neighborhood-based offers to elderly people living alone
Authors: Winkelmann C , Kasprick L 
Published: November 2019

Abstract

Background
For multimorbid very old people who are living alone, care networks are needed to ensure continuous and coordinated care across the sectors.

Objectives
The GeriNeTrainer (trainer in a geriatric network) is intended to preserve the day-to-day competences of elderly and to reduce the prevailing regional lack of help. Which content and structural aspects must include an educational concept that is aimed equally at laymen and experts (e g physiotherapists, nurses) and can be implemented sustainably? The competence profile was developed by an interprofessional staff of experts. According to the literature review, they rated the CanMeds role concept as the most relevant and suitable framework with regard to the holistic approach to care. Therefore, the teaching curriculum was developed based on this.

Results
Depending on the level of knowledge, interested laymen or experts enter the evident curriculum. The team of lecturers consists of physiotherapists, social workers, physicians, sports scientists, psychologists and speech therapists. As teaching and learning methods were defined: lectures, seminars, exercises, caseworks as well as compulsory homeworking in best practice facilities. The interprofessional imparting of knowledge as well as the exchange of experience between the individual occupational groups as well as the methodical inclusion of the perspective of laymen were evaluated as particularly beneficial and innovative. For sustainability, the certified graduates are supervised. Observation, a case study based on this, an electronic platform (Moodle) and annual conferences and symposia enable regular and practice-oriented communication and quality assurance in the sense of the continuous improvement process.

Conclusions
The graduates are connecting patient home with the health facilities. Increased professional, social and emotional competence in the quarter have positive effects of elderly people who are living alone.

Key messages
Valuable is the educational concept by conveying knowledge and exchange of experience of individual specialist groups as well as the lay perspective. Laymen and experts are learning together, their different perspectives are very helpful for the elderly.
Predicting musculoskeletal disorders risk using tree-based ensemble methods
Authors: Paraponaris A , Ba A , Gallic E , Liance Q , Michel P 
Published: November 2019

Abstract

Background
Musculoskeletal disorders (MSD) can cause short-term disorders and permanent disabilities which may all result in serious limitations in activities of daily living. According to the WHO, MSD are the second largest cause of disability worldwide. In France, preventing MSD became a challenge for both the sickness fund and the complementary health insurers as the MSD prevalence increased by more than 50% since 2003, the MSD representing more than 80% of the occupational diseases leading to sick-leaves or financial compensations in 2015.

Methods
Data from the IRDES 2012 health and social welfare survey (ESPS, enquête santé et protection sociale) was matched with individual care consumptions from the French health insurance. The ESPS survey is a national representative survey including 23,047 CATI/CAPI interviewed individuals (participation rate: 66%). Respondents self-assessed their health status, including MSD among other health troubles. Prediction of MSD risk was designed as a supervised binary classification problem, with the help of Random Forest (RF) and Gradient Boosting Machine (GBM) methods.

Results
Variable importance scores based on the squared error criterion over all trees were computed for the continuous and categorical variables supposed to be associated with MSD: the consumption of medicines, physiotherapists’ and GPs’ services, medical imaging, biomedical analyses, dental care, and sociodemographic features (occupation, age and income). Slightly better results were obtained with GBM compared to RF (overall test accuracy rate: 70% for both methods).

Conclusions
Machine learning methods with merged survey and registry data may help health insurers to better identify the individual MSD risk and prevent the occurrence and the disabling consequences of MSD with the help of individualized prevention strategies.
This research is financially supported by Malakoff Mederic Humanis, life & health French insurance for employees and individuals.

Key messages
The use of machine learning methods may be of interest to improve the ability to predict the MSD risk and help to identify insured people whom individualized prevention strategies can be offered to. Matching survey and health insurance liquidation data improves the ability to identify people at improved risk of MSD and gives the opportunity to provide them resources to prevent and to cope with.