bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic sleep deprivation and adolescent health: Two longitudinal studies of youth in Western Canada
Authors: Conklin A I , Yao C A , Richardson C G 
Published: November 2019

Abstract

Background
Chronic exposure to insufficient sleep may increase depression and poor health in adolescents who are particularly vulnerable to changes in sleep and neuro-cognitive development. The cumulative effects of persistent sleep deprivation on adolescent physical and mental health, and potential gender differences, are unknown. We investigated whether cumulative sleep deprivation is linked to sub-optimal health or depression in youth (13-18 y).

Methods
Longitudinal self-reported data (2011-2012) included three measures of sleep times and two of self-rated health (SRH) and depression (CESD). Missing data were multiply imputed using variables related to primary and secondary analyses for SRH (n = 3104) and CESD (n = 3071). Multivariable regression models with interaction terms estimated gender-specific associations; post-estimation calculated adjusted mean depression scores across levels of cumulative sleep deprivation.

Results
We found 11% of youth (56% females) in BC were chronically sleep deprived. Cumulative exposure to sleep deprivation was not associated with SRH in adolescents (all P-values ≥ 0.097), but was associated with increased risk of depression in young women only. Young women reporting chronic sleep deprivation had higher mean CESD scores (19.48 [17.59-21.38]), compared to counterparts reporting no history of sleep deprivation (16.59 [15.72-17.45]). No associations were seen in young men. Findings were robust to changes in model re-specification.

Conclusions
Results indicated that chronic sleep deprivation may be an important determinant of mental health outcomes in adolescents, particularly young women, although there was little support for effects on overall health status. Chronically impaired quality of sleep should be considered in future longitudinal work. Public health efforts to promote mental health for young people may require relevant strategies to support young women in achieving recommended amounts of sleep.

Key messages
Chronic sleep deprivation showed no association with adolescents’ self-rated health. Chronic sleep deprivation was linked to a higher risk of depression in young women only.
Economic evaluation of the Austrian telephone-based triage system
Authors: Ostermann H , Bachner F , Zuba M , Rainer L , Halla M 
Published: November 2019

Abstract

Background
In order to reduce avoidable consultations but also avoidable self-referrals to hospital outpatient departments, the Austrian authorities agreed to establish a voluntary telephone-based triage system in the course of the health reform 2013. Three regions piloted the system in early 2017.

Methods
An economic evaluation aimed to assess the impact on health service demand after having consulted the telephone-based system. For analysing the impact, we used the conceptual model of “shift cases” from one particular service setting such as outpatient clinic to another (e.g. GP office) and calculated savings realised through patient shifts. Based on potential savings in private and public costs and running costs of the service, we identified threshold values for cost-effective operation.

Results
In total, approximately 45,000 completed telephone consultations were registered in the pilot phase. 2,500 persons were advised to conduct self-care whereas more than 40,000 were recommended to contact a health service provider with differing levels of priority. Adherence to the initial recommendation of the provider setting was 70%, the level of priority was met in 90%. With regard to the economic impact, public savings of shift cases range from €31 (self-care instead of GP consultation) to €198 (GP/specialist instead of hospital outpatient clinic). Public costs ranged between €10 and €50 depending on the degree of capacity utilisation, contingency costs and duration of calls. Therefore, economic net gains can be realized if approximately 15% to 25% of callers choose a lower care setting due to the consultation service.

Conclusions
The tele-triage service has shown to be a potentially cost effective tool but largely depends on user uptake, patient adherence and local maintaining costs. In order to exploit the full potential of the system, policy makers are advised to promote the use of the system in general and to evaluate the used algorithm.

Key messages
Telephone-based triage systems are a potentially cost-effective strategy in order to reduce avoidable encounters both on a primary care level but also at hospital outpatient clinics. The public savings of a shift in the provider setting vary substantially depending on the level of service delivery with diminishing savings for shifts in lower levels.
Diagnosis and Treatment of Malignant Pleural Mesothelioma (MPM) Care Pathway and its cost analysis
Authors: Giusti M , Battisti F , Kundisova L , Persiani N , Chellini E 
Published: November 2019

Abstract

MPM is one of the most serious professional cancer with a high frequency in subjects previously exposed to asbestos. Several trials have been made or are ongoing to define an effective therapy to allow a longer survival and to reduce its burdensome management by the health systems. The few MPM Care Pathways (CP), which have been suggested by groups of experts of scientific community, are only a list of practicable interventions without the structure of a pathway so the aims of this paper are the declination of possible cases of a MPM CP and the quantification of the costs using a regional consensus CP, verifying its application.
The diagnostic and therapeutic procedures of the regional CP were defined starting to a sample of 34 patients treated in public regional hospitals for MPM, diagnosed in 2015, and having.at least a one year follow up. The costs were attributed using the regional price list for outpatient health activities and the DRG for hospitalized activities. The formed cost accounting model was applied in order to calculate the cost for the public regional administration. Last, the obtained results were discussed with surgical thoracic surgeons of the three regional university hospitals.
The developed cost accounting model has identified three cases of a MPM CP. They present a common diagnostic phase (7.246,90€) following by three possible treatments, differently combinable between them: surgery (10.808,00€), chemotherapy (164,00€ + drug cost for access) and observation (41,00€). The cost will be due to the specific combination of the three treatments plus the diagnostic phase, predictable according to patient’s age and staging, which can afford each patient affected by MPM.
The contribution of the cost accounting model applied to the consensus regional CP for MPM allows to assess the care’s appropriateness of the cases actually treated. It could be used also for CPs of other diseases and as a method for institutional financing of the route.

Key messages
Relevance of a shared Care Pathway realisation for a rare, highly letal and complex professional disease. An accurate and scientific costs analysis model to a C is an innovation.
Association between fast-food outlet exposure and Body Mass Index in 124,286 Lifelines participants
Authors: van Erpecum C L , van Zon S K R , Bültmann U , Smidt N 
Published: November 2019

Abstract

Background
Elevated Body Mass Index (BMI) is a key risk factor for numerous non-communicable diseases, such as cardiovascular diseases, cancer, diabetes type II and dementia. Previous studies showed associations between fast-food outlet exposure and BMI, but contained methodological shortcomings. Particularly within the Netherlands, evidence is scarce. We aimed to examine the association between fast-food outlet exposure and BMI among the Dutch adult general population, and whether this association was mediated by daily caloric intake.

Methods
Cross-sectionally linking baseline adult data (N = 124,286) from the Lifelines cohort to fast-food outlet location (LISA: employer register) data, we regressed fast-food outlet density (within distances of 500 metre(m), and 1, 3, and 5 kilometre (km)) and fast-food outlet proximity around participants’ residential address on BMI. We used multilevel regression and multilevel mediation models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation and neighbourhood address density. We stratified analyses for urban and rural areas, as these involve different living environments and study populations.

Results
More than half (56%) of participants was overweight (BMI ≥ 25.0). The average BMI in urban and rural areas was 25.9 (SD 4.4) and 26.3 (SD 4.3), respectively. In rural areas, having at least three fast-food outlets within 500 m was associated with higher BMI (B = 0.17, 95% confidence interval (CI): 0.06, 0.28). In urban areas, having at least five fast-food outlets within 1 km was associated with higher BMI (B = 0.42, 95% CI: 0.20, 0.63). Having the nearest fast-food outlet within 100m was associated with higher BMI (B = 0.43, 95% CI: 0.19, 0.67). The associations were partly explained by daily caloric intake.

Conclusions
Fast-food outlet exposure may be an important environmental determinant of BMI. Policy-makers should consider intervening upon the fast-food environment.

Key messages
Fast-food outlets within 500 metres in rural areas and 1 kilometre in urban areas may play a fundamental role in the rise of BMI. Targeting fast-food outlets may be key to reduce BMI on a population level.
Evaluation of Education for Public Health: A Practical Foundation for Solidarity
Authors: Perkiö M , Harrison R , Grivna M , Tao D , Evashwich C 
Published: November 2019

Abstract

Education is a key to creating solidary among the professionals who advance public health’s interdisciplinary mission. Our assumption is that if all those who work in public health shared core knowledge and the skills for interdisciplinary interaction, collaboration across disciplines, venues, and countries would be facilitated. Evaluation of education is an essential element of pedagogy to ensure quality and consistency across boundaries, as articulated by the UNESCO education standards. Our study examined the evaluation studies done by programs that educate public health professionals.
We searched the peer reviewed literature published in English between 2000-2017 pertaining to the education of the public health workforce at a degree-granting level. The 2442 articles found covered ten health professions disciplines and had lead authors representing all continents.
Only 86 articles focused on evaluation. The majority of the papers examined either a single course, a discipline-specific curriculum or a teaching method. No consistent methodologies could be discerned. Methods ranged from sophisticated regression analyses and trends tracked over time to descriptions of focus groups and interviews of small samples. We found that evaluations were primarily discipline-specific, lacked rigorous methodology in many instances, and that relatively few examined competencies or career expectations.
The public health workforce enjoys a diversity of disciplines but must be able to come together to share diverse knowledge and skills. Evaluation is critical to achieving a workforce that is well trained in the competencies pertinent to collaboration. This study informs the pedagogical challenges that must be confronted going forward, starting with a commitment to shared core competencies and to consistent and rigorous evaluation of the education related to training public health professionals.

Key messages
Rigorous evaluation is not sufficiently used to enhance the quality of public health education. More frequent use of rigorous evaluation in public health education would enhance the quality of public health workforce, and enable cross-disciplinary and international collaboration for solidarity.
Sense of belonging and its association with health among people of foreign background in Finland
Authors: Seppänen A , Lilja E , Rask S , Kuusio H 
Published: November 2019

Abstract

Background
Sense of belonging is recognized as an important determinant of health. There is little research on the association between sense of belonging and health of people of foreign background (PFB) in Finland. In this study we examined: 1) to which extent PFB feel they belong to the Finnish society and citizens of their country of origin (CCO) and 2) if sense of belonging is associated with self-perceived health.

Methods
Data from a cross-sectional survey FinMONIK conducted in Finland 2018 was used. The random sample consisted of PFB (N = 12 877, response rate 53%). Identity was assessed by using the question “Which of the following areas or groups you feel you belong to?” with response options “My local municipality”, “Finns”, “the citizens of my country of birth or origin”. Based on this, we constructed a variable to group respondents belonging 1) only to the Finnish society, 2) only to CCO and 3) to both Finnish society and CCO (bicultural identity). Self-perceived health was measured by using a 5-point-scale and merging good and fairly good as a good perceived health factor. Logistic regression was used to test the association between perceived health and sense of belonging, adjusted for age, sex and country of origin.

Results
Majority of the respondents (39%) reported a bicultural identity, whereas 21% felt they belonged only to the Finnish society and 23% only to CCO. Self-perceived health was significantly associated with sense of belonging (p &lt; 0.001). Good perceived health was more common among those with bicultural identity (73%) than among those who felt belonging only to the Finnish society (66%) and CCO (63%).

Conclusions
Bicultural identity was most common and also associated with better perceived health.

Key messages
Sense of belonging to both host country citizens and CCO is likely to benefit individual’s health. Identifying with host country citizens and maintaining sense of self as a member of CCO should be supported.
Community engagement towards the development of health promotion tools: Summary findings of Metaplan sessions in Barcelona
Authors: Evangelidou S 
Published: November 2019

Abstract

Background
Spain has been a popular destination for immigrants mainly because of its cultural proximity with Latin America and its geographical proximity with Africa. More than 70% of migrants in the Spanish autonomous region of Catalonia reside in its capital city, Barcelona. The community engagement in the development of tools, which facilitate access to health services while ensuring quality healthcare provision to Vulnerable Migrants and Refugees (VMRs), is pivotal in health promotion initiatives.

Methods
The participation of the target population in the decision-making process over strategies to increase healthcare access was assured by employing the Metaplan© methodology. Five Metaplan group sessions were conducted in Barcelona with VMR: One with professionals (N = 13), two with young adults (N = 4, N = 6), one with women (N = 6) and one with Latin Americans (N = 9). All sessions were conducted at the Community Medicine Unit of Vall d’Hebron University Hospital.

Results
Two main categories of solutions were found through a thematic analysis. Primarily, the solutions associated to initiatives that the host community needs to undertake included: promotion of socio-economic stability for VMRs, communication campaigns though informative leaflets and orientation sessions on immigrants’ rights and available health services, as well as community-based interventions such as empowering the work of community agents/“health champions”, establishing mobile clinics and setting-up (peer) support groups. The second category of solutions was related to the personal barriers VMRs may face: improvement/acquisition of language skills and the importance of addressing one’s mental health problems.

Conclusions
Both the host community and the immigrants themselves are co-authors of the design and implementation of efficient health promotion strategies towards healthcare access and improvement of healthcare quality provision for VMRs in the given socio-cultural context of Barcelona city.
Informing the development of a pilot intervention to improve migrants’ healthcare assess in Brno, Czech Republic
Authors: Movsisyan N K , Matuchova E 
Published: November 2019

Abstract

Background
Third-country nationals have the least access to healthcare in the Czech Republic yet representing the largest group of migrants. This study aimed to inform the development of a pilot intervention to improve migrants’ healthcare access in Brno, Czech Republic, within the existing health policy framework.

Methods
A Metaplan© qualitative technique was applied to ensure the community participation, through separate sessions with social integration professionals and third countries nationals. Each group first identified issues in migrants’ healthcare, then suggested solutions to address these issues and prioritized these solutions.

Results
The professionals’ group included five representatives of social integration service providers and administrators. The majority of migrants were female, with higher education, ages 35-55 years, arrived in two years mainly from Ukraine, and not employed.
The social integration professionals were more knowledgeable of healthcare policy and migrants’ rights and suggested a wider scope of solutions. The migrants underscored the role of reliable information as a critical tool in utilizing healthcare services. Both groups prioritized an open access to the information as a direct benefit to the users. Other suggestions included multilingual mobile applications, visual aids and translation services, bilingual doctors and universal access to public health insurance. The feasibility of these solutions varied and so their value as intervention models.

Conclusions
The future interventions should focus on health literacy in the migrant community. This would include the dissemination of multilingual information on health emergency, children vaccinations, health insurance and healthcare system, among other topics, and interactive trainings for migrants and social counselors, to improve self-efficacy in both groups.
Metabolic syndrome and renal cell cancer risk in Chinese males: a population-based prospective study
Authors: Li X , Wang G , Feng X , Lyu Z , Wei L , Chen S , Wu S , Dai M , Li N , He J 
Published: November 2019

Abstract

Background
Metabolic syndrome (MetS) is now a common public health problem. Few researches have reported the relationship between MetS and the risk of renal cell cancer (RCC). To investigate the association of metabolic syndrome and its components with the risk of RCC in Chinese males, the study was performed in the Kailuan male cohort, a large prospective cohort study.

Methods
A total of 104,333 eligible males enrolled in the every 2-year health checkup were involved in the Kailuan male cohort study (2006-2015). Information on demographic and socioeconomic characteristics, lifestyle, medical history and laboratory tests at baseline entry was obtained. Univariable and multivariable Cox proportional hazards regression models were used to estimate the association between MetS and the RCC risk.

Results
During a median follow-up of 8.9 years, 131 RCC cases were verified over a total of 824,211.96 person-years. Among the 5 single MetS components, hypertension (Systolic/diastolic blood pressure≥130/85 mm Hg or antihypertensive drug treatment of previously hypertension) (HR = 2.35, 95%CI:1.48-3.72) and elevated triglyceride (TG) (≥1.7mmol/L) (HR = 1.78, 95%CI:1.23-2.56) showed significant risk for RCC. Multivariate analysis showed that compared to those who did not meet MetS diagnostic criteria (number of abnormal MetS components&lt;3), HR of RCC risk for participants with MetS was 1.95 (95% CI 1.35-2.83). The number of abnormal MetS components was linearly associated with an increased risk of RCC (P trend&lt;0.001), and the HRs of RCC risk for males with 1, 2 and ≥3 MetS components were 1.27 (0.56-2.90), 2.42 (1.12-5.20) and 3.32 (1.56-7.07), respectively, compared with subjects without MetS components.

Conclusions
MetS was inversely associated with of RCC risk in males.

Key messages
MetS might be one of the scientific and important predictors of RCC. Controlling metabolic syndrome may potentially have key scientific and clinical significance for RCC prevention.
Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study
Authors: Irish M , Solmi F , Mars B , King M , Lewis G , Pearson R M , Pitman A , Rowe S , Srinivasan R , Lewis G 
Published: November 2019

Abstract

Background
There are few population-based cohort studies of the emergence, development, and persistence of mental health problems in sexual minorities compared with heterosexuals. We compared trajectories of depressive symptoms in sexual-minority adolescents and heterosexual adolescents from when they were aged 10 to 21 years, and examined self-harm at ages 16 and 21 years.

Methods
The study included 4828 adolescents born between April 1, 1991, and Dec 31, 1992, from the Avon Longitudinal Study of Parents and Children birth cohort (Bristol, UK) who reported their sexual orientation when aged 16 years. Depressive symptoms were assessed with the short Mood and Feelings Questionnaire at seven timepoints between ages 10 and 21 years. A self-harm questionnaire was completed at ages 16 and 21 years. Analyses were linear multilevel models with growth curves (depressive symptoms), logistic multilevel models (self-harm in the previous year at ages 16 and 21 years), and multinomial regression (lifetime self-harm with and without suicidal intent at age 21 years).

Findings
At age 10, depressive symptoms were higher in sexual minorities than in heterosexuals and increased with age to a larger extent. Depressive symptoms increased at each timepoint by 0·31 points in hetereosexuals, and by 0·49 points in sexual minorities. Sexual-minority adolescents were more likely than heterosexual adolescents to report self-harm in the previous year at ages 16 and 21 years, with no evidence that this estimate decreased with age. At aged 21, sexual minorities were more likely to report lifetime self-harm (ie, on at least one previous occasion) with suicidal intent than heterosexuals.

Interpretation
Mental health disparities between heterosexuals and sexual minorities are present early in adolescence and increase throughout the school years, persisting to young adulthood. Prevention of these mental health problems and early intervention must be a priority.