bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stenting of modified Blalock–Taussig shunt in adult with palliated pulmonary atresia and ventricular septal defect: a case report
Authors: Illner Julia , Reinecke Holger , Baumgartner Helmut , Kaleschke Gerrit 
Published: November 2019

Abstract

Background
Adults with complex congenital heart disease palliated with systemic-to-pulmonary artery shunts have become rare and represent a particularly challenging patient group for the cardiologist. One of the complications and causes of severe clinical deterioration during long-term follow-up are progressive obstruction or total occlusion of the shunt. The risk for surgical intervention is frequently high and catheter intervention may be complicated by complex anatomy and shunt calcification.

Case summary
We report the case of a 47-year-old man with uncorrected (palliated) pulmonary atresia and ventricular septal defect who presented with progressive cyanosis (oxygen saturation 69%) and decreasing exercise capacity. Computed tomography revealed a totally occluded modified left Blalock–Taussig (BT) shunt and a severely stenosed central shunt (Waterston–Cooley) in a patient with confluent but hypoplastic pulmonary arteries and multiple major aortic pulmonary collaterals. Due to a high operative risk, an interventional, percutaneous approach was preferred to re-do surgery. From a radial access the calcified BT shunt could be crossed with a hydrophilic guidewire. Then, a rotational thrombectomy, balloon dilatation, and bare-metal stenting at the proximal and distal anastomoses were performed. Post-interventionally, peripheral oxygen saturation increased from 69% to 82%. Clopidogrel was administered for 1 month after bare-metal stenting. At 1-year follow-up, the BT shunt was still patent on echocardiography and exercise tolerance markedly improved.

Discussion
This case highlights the benefit of percutaneous rotational thrombectomy followed by stenting of chronically occluded systemic-to-pulmonary artery shunts for further palliation in adult patients with complex congenital heart disease not suitable for surgical repair.
Bridging towards the future of public health in Europe (II). Can we and how do we ensure Health in All EU Policies?
Authors:   Moderators: Josep Figueras, European Observatory on Health Systems and Policies
Published: November 2019

Abstract

The plenary will continue the debate on The future of Public Health in Europe introduced in the previous plenary, tackling the role of the EU and its institutions in ensuring that health is addressed in all EU policies. The EU is firmly committed to implementing the 2030 Agenda and the Sustainable Development Goals through its range of institutional mechanisms. Incoming Commission President von der Leyen has pledged to refocus the European Semester ‘to make sure we stay on track with our SDGs’. These developments, together with the broad recognition of the central role of health in the SDGs and the momentum given by the new EU policy cycle presents a unique window of opportunity to critically reappraise the role of health in the EC, which, at least, on paper makes for an ideal Health in All Policies institution.
The first keynote by Director General Anne Bucher, DG SANTE, will draw on the ‘hot of the press’ results of the November 2019 State of Health in the EU exercise, including the EU Country Health Profiles and the Commission Staff Companion Report. She will highlight the main health and health system challenges faced by EU Member States—ranging from the burden posed by preventable mortality to the vaccination crisis and the resilience of the health workforce.
Prof. Scott Greer’s keynote will contend that to tackle these challenges we need to go beyond Public Health Article 168 and its subsidiarity corset. He will speak to the need to proactively employ the much stronger (health) policy tools within the large body of EU law underlying the internal market and to draw on the EU’s newfound role in fiscal governance such as through the European semester. Prof. Greer will draw on the innovative results of the new edition of the seminal study ‘Everything you always wanted to know about European Union health policies but were afraid to ask’ which will be distributed to participants.
The following panel will debate on the practical implementation and political economy questions arising from the plenary’s postulates. Prof. John Middleton, ASPHER’s president, will address the implications for the Public Health profession such as training in public health leadership, overhauling public health competencies or indeed the understanding of the public health profession itself. The second panellist will address the political economy implications of bringing health across EU policies and how to bypass the complexities of working across policy sectors in the EU institutions. The panel will actively interact with the participating audience through a range of innovative ways.

Panellists
Anne Bucher
DG SANTE, European Commission
Scott L. Greer
Health Management and Policy, University of Michigan
John Middleton
The Association of Schools of Public Health (ASPHER)
Equality of Opportunity and Mortality in Europe
Authors: Gugushvili A 
Published: November 2019

Abstract

Background
This study investigates if intergenerational equality of opportunity is linked to mortality in 30 European countries. Equality of opportunity may lead to greater returns on health investments, and, consequently, improvement of health outcomes. In turn, a perceived lack of fairness in the distribution of life chances and limited possibilities for upward intergenerational mobility can cause anxiety among individuals and gradually compromise their health.

Methods
We used information on parents’ and their 163,467 children’s Socio-Economic Index of Occupational Status from a large survey data-set to generate three complementary measures of equality of opportunity and linked them to administrative data on total, gender- and cause-specific mortality rates derived from the national statistical offices.

Results
We found that lower equality of opportunity, measured by the attainment of individuals from the lowest and highest quartiles of socio-economic status and by the overall intergenerational correlation in socio-economic status, was related to higher mortality rates, particularly in relation to diseases of the nervous system and the sense organs, diseases of the respiratory system, and external causes of mortality. Our measures of equality of opportunity were more consistently linked with mortality of men than women.

Conclusions
Equality of opportunity may be an important explanation of mortality that warrants further research. Measures that aim at facilitating intergenerational social mobility can be justified, not only due to normative considerations of equality of opportunity, but also in terms of individuals’ chances to enjoy healthy lives.

Key messages
Intergenerational equality of opportunity was more consistently linked to mortality of men than that of women. Our key message is that equality of opportunity is not only fair but it is also good for health.
Food insecurity and social determinants of students’ low adherence to the Mediterranean diet
Authors: Tsiampalis T , Petralias A , Linos A 
Published: November 2019

Abstract

Background
Despite the fact that the Meditteranean diet is highly beneficiary for people’s health, there are many factors which cause disparities in the level of adherence. The aim of the present work was to investigate the effect of household food insecurity (FI) on adherence to the Mediterranean diet (AMD), to explore the participants’ characteristics modifying the studied relationship and find the social determinants of students’ low adherence to the specific dietary pattern.

Methods
A cross-sectional study with 140 schools and 4,242 students was conducted in Greece (2017-2018). Especially designed and validated instruments were used to record students’ sociodemographic characteristics, household’s FI status and students’ AMD. Analysis of Variance (ANOVA) and Covariance (ANCOVA) was used to investigate the effect of FI and to identify the significant social determinants of students’ AMD, according to students’ school grade.

Results
After adjusting for other characteristics, students whose both parents are born in other countries, spend at most 4 hours/week on TV/electronic games, live in the regions of Peloponnese, Central Macedonia or Attica and attend primary schools adhere more to the Mediterranean diet, while higher level of physical activity and lower FI are significantly associated with better AMD. Parents’ educational level in nursery schools (p = 0.002) and employment status in nursery schools (p = 0.012) and in high schools/ lyceums (p = 0.008) were found to modify significantly the studied relationship in the univariate analysis, while school grade (p = 0.013) and physical activity (p = 0.088) were found to modify the studied relationship in the multivariable analysis.

Conclusions
Several demographic, socioeconomic and lifestyle characteristics were significantly associated with students’ AMD. Thus, emphasis should be given on the design of special programs to reduce household FI and intervene in the rest characteristics.

Key messages
Researchers and policymakers should consider food insecurity as important risk factor for school-aged children, particularly for those who live in poverty. Emphasis should be given on the design of special low-cost programs aiming to reduce food insecurity.
Metabolic syndrome among Ghanaian migrants and their homeland counterparts: the RODAM study
Authors: van der Linden E L , Agyemang C 
Published: November 2019

Abstract

Background
Metabolic syndrome (MetSyn) is a major risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). T2D and CVD are a major burden among African populations both in Africa and in high-income countries. However, it is unknown whether the prevalence of MetSyn shows geographical differences between a homogenous population residing in different settings in Africa and Europe.

Methods
We used data from the cross-sectional multi-centre Research on Obesity and Diabetes among African Migrants (RODAM) study that was conducted among Ghanaians aged 25-70 years residing in rural and urban Ghana and in Amsterdam, London and Berlin (n = 5659). MetSyn was defined according to the 2009 harmonized definition. Geographical locations were compared using age-standardised prevalence rates and prevalence ratios (PRs), adjusted for age, education, physical activity and smoking.

Results
In men, the age-standardised prevalence of MetSyn was 8.3% in rural Ghana and showed a positive gradient through urban Ghana (23.6%, PR = 1.85, 95% confidence interval 1.17-2.92) to Europe, with the highest prevalence in Amsterdam (31.4%; PR = 4.45, 2.94-6.75). In women, there was a rural to urban gradient in MetSyn prevalence (rural Ghana 25%, urban Ghana 34.4%, PR = 1.38, 1.13-1.68), but small differences in MetSyn prevalence between urban Ghanaian and European Ghanaian women (Amsterdam 38.4%). The prevalence rates of the individual MetSyn components showed a positive rural-urban-Europe gradient. However, compared to their urban and European counterparts, a low HDL-C level was significantly more prevalent among rural Ghanaians.

Conclusions
MetSyn and its components are highly prevalent in Ghana as well as in Ghanaian migrants in Europe. To understand the mechanisms driving the geographical differences in MetSyn, further research is needed, thereby aiming for the reduction of T2D and CVD prevalence in SSA populations.

Key messages
Metabolic syndrome is more prevalent in urban compared to rural Ghana, and even more prevalent in Ghanaian migrants in Europe. Its components show the same positive gradient, expect for low HDL-C, which shows a negative gradient.
Hyperuricemia And Estimated Cardiovascular Risk Among Migrant and non-migrant Africans
Authors: Agyemang C , Mannens M A M , Henneman P , Beune E , Meeks K , Requena-Mendez A 
Published: November 2019

Abstract

Objective
In the advent of rapid urbanization, migration and epidemiological transition, the extent to which serum uric acid (sUA) affects cardiovascular disease (CVD) risk among Africans is not well understood. We assessed differences in sUA levels and associations with estimated CVD risk among migrant Ghanaians in Europe, and non-migrant Ghanaians in rural and urban Ghana.

Methods
Baseline data from 633 rural, 916 urban and 2315 migrant RODAM study participants (40-70 years) were analyzed. Hyperuricemia was defined as sUA &gt;7mg/dl in males and &gt;6mg/dl in females. Elevated CVD risk was defined as pooled cohort equation estimates ≥ 7.5%. Logistic regressions were used to assess differences in hyperuricemia and associations with estimated CVD risk. Receiver operator curves were used to calculate sUA cut off values that maximised likelihood of elevated CVD risk.

Results
Prevalence for hyperuricemia in rural, urban and migrant participants were 17.4%, 19.1% and 31.7% for men, and 15.9%, 18.2% and 33.2% for women, respectively. Hyperuricemia was positively associated with elevated CVD risk among rural residents(adjusted OR for men 2.88, 95%CI, 1.20-6.88, 5.32, 95%CI, 2.86-9.95 for women), urban residents(1.26, 95%CI, 0.59-2.69 for men, 2.41, 95%CI, 1.56-3.73 for women) and migrants(2.39, 95%CI, 1.57-3.64) for men, 3.74, 95%CI, 2.78-5.02 for women). SUA cut-off values were 6.8mg/dl in men and 5.2mg/dl in women.

Conclusions
Our study shows variations of sUA levels in different African contexts. Hyperuricemia is associated with elevated estimated CVD risk in both migrants and non-migrants. Further studies should identify factors driving associations between SUA and CVD risk in Africans.

Key messages
Hyperuricemia is a risk factor for cardiovascular risk in both migrants and non-migrants. Cardiovascular risk is seen at low levels of serum uric acid levels in Africans.
Vaccination status of migrant populations in EU/EEA countries and implications for VPD control
Authors: Hargreaves S , Himmels J , Nellums L B , McGuire E , Friedland J S 
Published: November 2019

Abstract

Background
Migrant populations in the EU/EEA are increasingly being associated with outbreaks of vaccine-preventable diseases (VPDs), including the large-scale measles outbreak currently ongoing across Europe; however, it is unclear to what extent migrants represent an under-immunised group in the European context and implications for VPD control. Ensuring high levels of vaccination coverage is a key priority for all countries through the European Vaccine Action Plan, with EU/EEA Member States committed to eliminating measles and rubella, sustaining polio-free status, and controlling hepatitis B infection. We synthesised existing EU/EEA data to assess under-immunisation in migrants (defined as foreign born) residing in EU/EEA countries.

Methods
We did a systematic review and meta-analysis (PROSPERO CRD42018103666) in accordance with PRISMA guidelines. Inclusion criteria were primary research studies pertaining to vaccination status (measles, mumps, rubella, diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b [Hib]) in migrants residing in all EU/EEA countries. Pooled prevalence (95% CIs) were calculated for the meta-analysis using a random effects model.

Results
56 studies met our criteria (14 EU/EEA countries); 36 studies, which included data from 80,432 migrants, were included in the meta-analysis. Vaccination status of migrants for key VPDs varied substantially, with pooled immunisation coverage well below the herd immunity threshold (HIT) targets for measles 80% (95% CI: 73-87%; HIT 92-95%), mumps 65% (95% CI: 48-82%; HIT 75-86%), and diphtheria 51% (95% CI: 29-73%; HIT 83-86%). Polio type 1 and 2 coverage was high (97% [95% CI: 95-98%]; 95 [95% CI: 92-97%], respectively).

Conclusions
Migrants represent an under-immunised group in Europe, thus a high priority group for catch-up vaccination. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and/or control of key VPDs.

Key messages
Migrants represent an under-immunised group in Europe and a high priority group for catch-up vaccination campaigns. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and control of vaccine-preventable diseases.
1.E. Workshop: Comparative Public Health: Politics, science, and professionalism
Authors:   Organised by: University of Michigan Chair persons: Marleen Bekker - EUPHA (PHPP), Karine Chevreul - France
Published: November 2019

Abstract

Look around EUPHA, or any other public health conference. Public health is difficult to define, in theory and in practice. Its boundaries are all blurred, whether with medicine, schools, environmental protection or workplace safety inspectorates. Too often, we overstate the similarities between public health systems among countries. Efforts to promote networks, good practice, and even basic coordination have been undermined for decades by misunderstandings born of different educational, organizational, financial and political systems. The lack of comparison, and comparative political analysis in particular, also means that countries can have very similar debates about the proper nature and scope of public health, an about who is to blame for deficiencies, without awareness of when they are distinctive and when they are actually part of larger trends.
This project aims to identify and explain variation in the scope and organization of public health systems in selected high-income countries. Based on a formalized comparative historical analysis of Austria, France, Germany, Poland, the United Kingdom and the United States, researchers in the study first mapped the various axes of divergence: workforce composition, organization, levels of government, relationship to medicine, and the extent to which public health encompassed adjacent areas such as environmental health and occupational health and safety. For each country we then followed both case studies (communicable disease control including vaccines, HIV/AIDS, tobacco control, diet and nutrition, occupational health and safety) as well as the legislative history of the public health field in order to identify its changing organization and scope. It then identifies the relative role of historical legacies, changing science, burden of disease and politics in explaining patterns of both divergence and convergence.
This workshop presents four country specific case studies (France, Germany, United Kingdom and the United States) that identify the most important forms of variation and the political, scientific and professional drivers of convergence and divergence.

Key messages
Political organization and scope as images of public health are grossly under-researched and nonexistent in a comparative nature. Understanding the scope and organization of public health in different countries will permit better lesson-drawing and identification of relevant and effective levers of change.
The United States: A system built on fragmentation
Authors: Jarman H. 
Published: November 2019

Abstract

Background
The United States is effectively a laboratory for ways to produce public goods, such as public health, on the cheap. Its c. 90,000 governments compete for residents, businesses, taxes, development, and jobs while also trying to compensate for the lack of universal health care coverage. They all have structural incentives to provide services as cheaply as possible. The effects are diverse and poorly mapped. They can mean innovation in organizational forms, a different and typically less expensive skill mix among the workers, poor quality, or simple under provision. The exact mix can often be hard to identify. It can also mean extreme responsiveness to funding from higher levels of government such as the states or federal government.

Methods
A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results
The distinctively expansive scope of US public health actions is largely due to the country’s failure to establish a universal health care system, and the diversity of US public health tasks reflects local adaptation of tens of thousands of governments. This means that public health in the United States retains much of the activity it had in, for example, the UK before the establishment of the US. In particular, and even in states that accepted the Medicaid expansion in the Affordable Care Act (ACA), local public health departments provide a substantial amount of direct care and fill in for gaps in health care provision.

Conclusions
The US public health system is highly fragmented like the governments that run it, and therefore diverse. Reflecting the failures of the US health care system, it carries out many more tasks that in other countries are seen as health, especially primary, care.
Higher Education Students’ Mental Health Problems: Results from the Norwegian SHOT study
Authors: Bøe T , Hysing M , Sivertsen B 
Published: November 2019

Abstract

Highly educated people have better health than those without education. The number of young adults pursuing higher education is increasing; In 2015 almost half the Norwegian adult population had completed higher education (1). Studies have investigated horizontal stratification (i.e. differentiation within higher education) effects on labor market outcomes, but few have studied health returns from education (2). Data stem from a recent national student health survey from 2018 for higher education in Norway (the SHoT2018-study; N = 50 054, response rate = 30.8%). We examined the associations between level of ongoing education (One-year program, Bachelor, Master, longer professional education) and mental health problems measured with Hopkins Symptoms Checklist (HSCL-25; 3. There was a pattern of decreasing symptoms of mental health problems with level of study program, F (5,49782) = 103,34, p &lt; .001. The results formed a monotonic relationship; each level of increased education was associated with significantly less mental health problems. There was no difference between the Masters and professional programs. We found evidence of horizontal stratification of mental health problems in this large sample of Norwegian college and university students. The observed association may have three explanations; causality may run from schooling to health (4), it may run from health to schooling (5), or both may be determined third factors. Further studies should investigate mechanisms such as stigma and social status in relation to the observed associations (6,7).
1 OECD. (OECD Publishing, 2015), 2 Conti, G. et al. Am. Econ. Rev. 100, 234-238 (2010), 3 Derogatis, L. et al. Behavioral science 19, 1-15 (1974), 4 Grossman, Michael et al. in Handbook of the Economics of Education (eds. Eric A Hanushek & F. Welch) 1, (Elsevier, 2006), 5 Currie, J. J Econ Lit 47, 87-122 (2009), 6 Marmot, M. (Bloomsbury, 2004), 7 Hagquist, C. E. I. Eur J Public Health 17, 21-26 (2007)

Key messages
Increasing numbers of young adults pursue higher education, it is therefore important to investigate educational inequalities within higher education. College students pursuing higher education (masters or professional programs) have fewer mental health problems relative to college students enrolled in higher education, but at lower levels.