bluuebunny/crossref_metadata_2025_split huggingface dataset:
The practicality of telemedicine and telehealth during the COVID-19 global outbreak
Authors: Ohannessian R , Yaghobian S 
Published: October 2020

Abstract
On 30 January 2020, the WHO declared a Public Health Emergency of International Concern (PHEIC) for the COVID-19 outbreak. On 7 March 2020, there were more than 100,000 confirmed cases in 88 countries. Telemedicine, otherwise known as telehealth, has been used at small scale in past outbreaks, including previous coronavirus outbreaks (SARS; MERS) and other PHEICs (Ebola; Zika). The objective was to describe the global larger scale use and practicality of telehealth in the COVID-19 outbreak.
The 2015 conceptual framework of telemedicine during an outbreak for epidemiological assessment and clinical management (Ohannessian R.) was used to describe the use cases. A multi-country analysis from China, France, USA and UK was performed with a literature review using official institution websites, grey literature, media/business reports, as scientific articles were not yet published.
Video and chat consultations were used for symptomatic patient assessments through private telehealth providers in all countries. In the USA, the Telehealth Services During Certain Emergency Periods Act of 2020 was voted by the Congress on 4 March 2020 to suspend restrictive rules of Medicare funding for telehealth home consultations. Triage via online auto-questionnaires were created by private providers and public authorities. In the UK, from 26 February to 2 March, 70,000 enquiries were made to a dedicated NHS111 online service. In China, teleradiology networks were also used for diagnostic of COVID-19 cases. Video consultation was used in France to monitor home isolated patients and non COVID-19 patients, to avoid risks of exposure.
Telehealth has been useful to the COVID-19 outbreak but efforts to better describe cases and evaluate impact on the public health response should be promoted. National and international health authorities should be aware of the opportunities offered by telehealth during outbreaks, and may consider its integration in public health emergencies preparedness plans.

Key messages
Telehealth was useful for the public health response to COVID19 outbreak. Telehealth should be integrated into public health preparedness plans.
Instagramming our way through public health communication: why and who is using it?
Authors: Vareda R , Garcia T , Rachadell J 
Published: October 2020

Abstract

Background
From disease prevention to health promotion, communication is key for Public Health (PH) practice and, according to the 9th Essential Public Health Operation its goal is to improve populations health literacy and capacity to access, understand and use information. Though social media is frequently presented as a potentially useful tool for PH communication, there is a lack of evidence about its effectiveness and impact on PH outcomes. This study researches Instagram® as a PH tool and aims to know who is using it, what content is shared on the platform and how much engagement there is.

Methods
This cross-sectional study regards information on 1000 Instagram® posts with the hashtags publichealth, publichealthpromotion, healthpromotion, publichealthmatters and publichealtheducation. Authors categorized post content and creators, and reviewed the number of likes and comments per post to determine engagement. Data analysis was performed on IBM SPSS® Statistics.

Results
The most common content categories were communicable diseases (n = 383), non-communicable diseases (n = 258) and healthy lifestyles (n = 143). Health professionals post more about communicable diseases (43,6%) and non-professionals about healthy lifestyles (36,1%). Non-professionals (n = 191) post about PH issues almost as much as health professionals (n = 220) and PH associations (n = 201). Most don't reference their sources (n = 821). Posts on communicable diseases have the most likes and comments per post (mean of 172 likes and 3,1 comments).

Conclusions
Half the Instagram® posts analysed in this study were made by health professionals or organizations. Communicable diseases, non-communicable diseases and healthy lifestyles were the most frequent content categories and had the most engagement. The majority of posts didn't reference their sources. Though Instagram® seems to be a potential PH communication tool, further research is needed to confirm its benefits for PH.

Key messages
Social media platforms like Instagram® are potentially powerful tools for PH communication. There is a need to understand the efficacy of social media as health promotion tools.
Labour market trajectories and health in Catalan youth
Authors: Gutiérrez-Zamora Navarro M , Belvis Costes F X , Bolíbar Planas M , Benach de Rovira J 
Published: October 2020

Abstract

Background
Difficulties with integration and job insecurity are currently a characteristic of youth labour market trajectories (YLMT), which have been associated with negative health impacts. This study sheds light on the relationship between YLMT and current health outcomes.

Methods
The study has a mixed methods sequential exploratory design, focusing on young people aged 25-34 in Catalonia, Spain. In the quantitative phase, longitudinal retrospective data from the Survey to the Catalan Youth 2017 SYC-2017 (n = 1247) was used to obtain a typology of YLMT by clustering techniques. Then, the association between such career paths and health outcomes was tested. In the qualitative phase, semi-structured individual interviews were conducted to a sample (n = 12) of SCY-2017 participants, structured according to the typology, sex and rural/urban criteria. Transcriptions were analyzed by mixed generation of categories.

Results
Three types of YLMT were obtained: permanent (PT), temporary (TT) and discontinuous (DT). Compared to PT, TT(p &lt; 0.01) and DT (p &lt; 0.001) were found to be a significant risk factor for self-perceived poor health. Similarly, DT were found to be a risk factor for life dissatisfaction (p &lt; 0.05). Trajectory type is not associated with smoking, however, alcohol (p &lt; 0.05), cannabis(p &lt; 0.05), cocaine (p &lt; 0.05) and overall consumption (p &lt; 0.05) are associated with DT. In the qualitative phase, material deprivation, hazardous working conditions, future unpredictability and the prolonged experience of unemployment, powerlessness and insecurity were identified as key explanatory mechanisms of the YLMT health relation.

Conclusions
YLMT has an impact on different health outcomes and quality of life through numerous causal paths and mechanisms related to the objective and subjective experience of insecurity. The precarisation of the labour market and the lack of decent employment opportunities for the young should be addressed as a primary public health concern.

Key messages
This study highlights the impact of labor market precariousness on the mental and physical health of Catalan youth as a public health concern. Three broad causal pathways have been identified: material deprivation, the ability to act as an organization in the construction of horizons and exposure to physical and psychosocial risks at work.
The cost of diets according to nutritional quality and sociodemographic characteristics in Belgium
Authors: Pedroni C , Vandevijvere S , Seck M , Desbouys L , Castetbon K 
Published: October 2020

Abstract

Introduction
Prices of foods may influence purchases and therefore, the overall quality of diets. Our objective was to estimate cost variations according to the nutritional quality of diets and to identify sociodemographic characteristics associated with the cost differences in adults' diets.

Methods
Data from adults (N = 1,158; 18-64 years) included in the 2014-2015 Belgian National Food Consumption Survey were used. Dietary assessment was based on two 24-h dietary recalls and a food frequency questionnaire. The “Mediterranean Diet Score” (MDS) and the “Healthy Diet Indicator” (HDI) were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the 2014 GfK ConsumerScan panel food price data. Associations were estimated using linear regressions.

Results
The mean diet cost was 5.79€/day (SEM: 0.07). Adjusted for covariates and energy intake, it was significantly higher in the highest (T3) tercile of both scores than in the lowest tercile (T1) (MDS: T1=5.60€/d (0.09) vs. T3=6.03€/d (0.10); HDI: T1=5.42€/d (0.09) vs. T3=6.34€/d (0.10)). Higher intake of fruits, vegetables, fish, dairy products, vegetable oil, fibre and potassium and lower intake of free sugars were associated with higher diet cost. Both diet quality and cost were higher in 35-64-year-old (vs. 18-34 years), active (vs. students) and post-secondary education (vs. secondary education or lower) respondents. The association between quality and cost of diets was weaker in males and among individuals with higher education levels.

Conclusions
Healthier diets are more expensive than less healthy diets in Belgium. These findings contribute to a better understanding of social inequalities in diet in order to support public health policies and actions.

Key messages
Strategies need to be developed to improve the affordability to a healthy diet. In particular, messages promoting healthy diet targeted to the vulnerable populations should better consider the food cost.
Addressing low consumption of fruit and vegetables in England: a cost-effectiveness analysis
Authors: Pinho-Gomes A C , Knight A , Critchley J , Pennington M 
Published: October 2020

Abstract

Background
Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F&V) in England, but economic analyses of structural policies to change diet are sparse. This study aimed to estimate (1) the health and economic burden attributable to the low intake of fruit and vegetables (F&V) by English adults, and (2) the cost-effectiveness of three policies promoting consumption of F&V in England - a universal 10% subsidy, a targeted 30% subsidy for low-income households, and a nationwide social marketing campaign (SMC).

Methods
Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL), and the healthcare costs attributable to consumption of F&V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies.

Results
Low consumption of F&V accounted for 16,321 [10,091-23,516] deaths and 238,767 [170,350-311,651] YLL due to cardiovascular diseases, type 2 diabetes and cancer in England in 2017, alongside £705,951 [398,761-1,061,559] million in healthcare costs. From a societal perspective, the incremental cost-effectiveness ratios were £22,891 [22,300-25,079], £16,860 [15,589-19,763], and £25,683 [25,237-28,671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20,000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy was the only policy that would also reduce inequalities.

Conclusions
Both a SMC and subsidies can significantly increase consumption of F&V and reduce the attributable burden of disease and healthcare costs, but their cost-effectiveness varies substantially. A targeted subsidy to low-income households is most likely cost-effective and can additionally reduce inequalities.

Key messages
Low intake of fruit and vegetables accounts for a substantial number of deaths and years of life lost and represents a heavy burden for the healthcare system in England. From a societal perspective, a targeted subsidy to low-income households was most likely cost-effective and it would reduce inequalities.
Food insecurity among Finnish private sector service workers and food pantry clients
Authors: Erkkola M , Uusitalo L , Puputti K , Saari T , Jallinoja P , Rahkonen O , Nevalainen J , Walsh H 
Published: October 2020

Abstract

Background
There is a paucity of comparable quantitative data on the prevalence and predictors of food insecurity in high-income countries. We applied the Household Food Insecurity Access Scale (HFIAS) to assess food insecurity among i) the Service Union United members; female-dominated, low-income employees of the Finnish private service sector, and ii) a convenience sample of Finnish food pantry clients.

Methods
The HFIAS classification was based on 9 validated questions capturing respondents' perceptions on food scarcity and behavioural responses to food insecurity due to lack of resources during the past month. The resulting indicator categorized respondents as food secure, and mildly, moderately and severely food insecure. We performed cross-tabulations and regression models to assess if education, housing, self-perceived health, income, and resource scarcity associated with levels of food insecurity. In addition, gender, age, and self-perceived disadvantage were assessed among the food pantry clients.

Results
Among the service workers (n = 6 573, 6% of those invited), 35% were food secure, 29% mildly or moderately food insecure, and 36% severely food insecure. The respective proportions were 28%, 26%, and 46% among the 129 food pantry clients. All assessed variables were associated to food insecurity status in the service workers (p &lt; 0.01 for all). Among the food pantry clients, men (OR 1.60; 95% CI 1.09 − 4.80) and homeless/tenants in community rental units (OR 7.12; 95% CI 2.42 − 20.95) were most likely to experience severe food insecurity.

Conclusions
Alongside the food pantry clients the majority of the service workers demonstrated some degree of food insecurity, with a considerable proportion being severely food-insecure. This predominantly low-income group is subject to rapid changes in the labour market and social security systems. The data demonstrated that well-known SES indicators and self-perceived health are linked to food insecurity.

Key messages
Severe food insecurity was common among predominantly low-income private sector service workers and food pantry clients. Food insecurity is linked to SES indicators and wellbeing.
Co-designing mHealth technologies with youth: REACH Initiative in Turkey and Lebanon
Authors: Karadag Caman O , Karabey S , Sumbuloglu I , Yazbik-Dumit N , Ben Amor Y 
Published: October 2020

Abstract

Issue
Many young people face barriers in accessing youth-friendly health information and health care. Differing cultural norms, languages, laws, and stigma pose additional challenges for young refugees in host countries. There is a need to implement more innovative, youth-friendly and widely used solutions to address the health education and health care needs of young people.

Description of the practice
REACH (REfugees Act and Communicate for Health) is a regional initiative, which aims to bridge the gap in health literacy and health care access among refugee and local youth via digital technologies in Turkey and Lebanon. Using community based participatory action research (CBPAR) approach, REACH aims to assess the impact of information and communication technologies on accessing health information and services among youth in countries that host large refugee populations. The initiative is supported by TaiwanICDF, Blue Chip Foundation and Columbia University.

Results
With a strong youth-adult partnership, the initiative includes stakeholders’ meetings, a mixed-methods study (survey and photovoice study with youth, qualitative interviews with service providers and policy makers), photo exhibitions, panels, and production of policy reports and scientific publications. Based on local needs in each country, REACH works with refugee and local youth, software developers, academia, local health authorities, UN organizations and NGOs to develop a multilingual mHealth application to increase health literacy and improve health care access among young refugee and host communities, and aims to assess its effectiveness to contribute to the limited evidence base on using health technologies for youth health promotion in forced migration settings.

Lessons
Using CBPAR and co-design approaches and engaging both refugee and local youth in the process of assessing needs and developing mHealth technologies can help to mitigate risks and increase the success rate of interventions.

Key messages
Community involvement and empowerment as well as harmonization between refugee and host communities increases the success of health interventions and builds a shared environment in host countries. mHealth solutions can be used for youth health promotion in a cost-effective way, and help in reaching vulnerable or stigmatized youth that struggle with health information and health care access.
Development and validation of a social position measure in Greece
Authors: Lamnisos D , Dimou G , Giannakou K 
Published: October 2020

Abstract

Background
A valid measure of social position is important for investigating health inequalities. The registrar general classification is not theoretically based or validated and it is based only on occupation. On the other hand, the National Statistics Socio-economic Classification (NS-SeC) distinguishes between different social positions in terms of both their typical labour market and work situations. The aim of this study was to validate the NS-SeC in a Greek population.

Methods
A cross-sectional study was conducted in 2018 in Athens, Greece. Participants were classified in one of the seven social position classes of NS-SeC based on their responses to questions related to their occupation, employment status (employer, self-employed or employee), supervisor or manager and number of employees in the workplace. Participants were also asked to rate their general health over the previous 12 months in one of three categories: “good”, “fairly good”, or “not good”. The multivariable logistic regression model was used to investigate the predictive validity of NS-SeC.

Results
73 individuals with a mean age 43.2 (sd = 11.5) participated in the study. The 46.6% of the participants belonged to the class “managerial and professional occupations”, the 20.5% to the class “intermediate occupations”, while the 31.5% belonged to the class “routine and manual occupations”. The adjusted odds ratio (OR) for “fairly good” or “not good” general health was five times higher in the “routine and manual occupations” in comparison to the combine group of the other two classes (OR: 5.1; 95% Confidence Interval: 1.4-18.2).

Conclusions
The Greek version of NS-SeC has an excellent predictive validity and it is considered a valid measure of social position in a Greek population. Therefore, it can be used by public health authorities and public health researchers to investigate health inequalities attributed to socio-economic conditions.

Key messages
The Greek National Statistics Socio-economic Classification is a valid measure of socio-economic position. The Greek National Statistics Socio-economic Classification could be used by public health authorities and public health researchers to investigate health inequalities.
Implementation of a self-management programme: recruitment strategies in five European countries
Authors: Doñate-Martínez A , Pisano-González M , Boone A L , Vázquez R , Peñacoba D , Valsecchi V , Zora S , Tan S S , Baker G , Garcés J 
Published: October 2020

Abstract

Introduction
The Chronic Disease Self-Management Programme (CDSMP) has been successfully implemented in over 30 countries worldwide, demonstrating its effectiveness and cost savings to healthcare systems. The CDSMP aims at people with any chronic condition and caregivers, but it has not targeted specific vulnerable populations at different sites simultaneously. In this sense, this study presents the recruitment strategies to involve vulnerable populations in the CDSMP framed under the EU-funded project EFFICHRONIC (ref.: 738127).

Methods
The CDSMP was implemented in five countries (Spain, Italy, France, the Netherlands and the United Kinkdom) approaching several vulnerable target groups. The programme consists of strictly scripted group sessions during 6 weeks imparted by previously trained monitors. EFFICHRONIC recruitment was performed in 3 consecutive steps combining population-based and individual strategies: i) development of vulnerable maps to detect areas with higher vulnerability; ii) creation of alliances with different actors; and iii) identification of end-users.

Results
Over 234 leaders were trained distributed over the five sites and 237 workshops with end-users were organized following the recruitment strategies. The average number of engaged participants per workshop was 13. In total, 2,962 vulnerable persons were engaged and 2,177 finalized the programme, meaning a drop-out rate of 25%. The sample was composed of ethnic minorities, immigrants, refugees, older people living alone or in institutions, people with few economic resources or living in therapeutic communities, inmates and members of different kinds of associations.

Discussion
The strategic coordination at loco-regional level between multidisciplinary stakeholders has been a key success factor to obtain maximum recruitment. The activation of different strategies simultaneously optimized the project results approaching a wide variety of end-users and communities.

Key messages
Stakeholder engagement is crucial to identify and recruit vulnerable individuals in need of support for the management of their chronic conditions. Recruitment strategies must be adapted to each specific context and culture to achieve relevant adherence levels and benefits.
Influencing factors and determinants of health literacy
Authors: Grillich L , Kostial E 
Published: October 2020

Abstract
Health literacy has demonstrable effects on health status and quality of life and is a prerequisite for health-promoting behavior. Thus, health literacy is naturally an Austrian health target. Actions to strengthen health literacy should specifically address its determinants and influencing factors. To provide the best available knowledge for this goal, we developed an impact model of how influencing factors (indirect influence) and determinants (direct influence) will lead to increased health literacy based on the best available evidence
We conducted an umbrella review on systematic, narrative and scoping reviews that deal with concepts, models or definitions of health literacy. The systematic literature search in MEDLINE (Ovid/Epistemonikos) identified 256 relevant abstracts. Two authors checked the abstracts and included 32 in the full text assessment. Fourteen studies were ultimately included in the umbrella review. We extracted influencing factors, determinants, and outcomes and coded, summarized, and renamed them in an inductive approach to ensure uniform terminology. In total, we identified 10 specific influencing factors and 13 measurable determinants. A graphical impact model visualizes the causal relationships between influencing factors and determinants and how they affect the main dimensions of health literacy together: decision, appraisal, access & seek.
The impact model illustrates that health literacy is prevalent when decisions are made and implemented and that strengthening health literacy is best achieved through approaches that influence the determinants at the individual and situational level. With the list of specific influencing factors and measurable determinants, the impact model presented differs from all health literacy models available to date. The impact model gives clear recommendations on which concrete influencing factors and determinants programs for strengthening health literacy should be used to aim for positive changes.

Key messages
Interventions to strengthen health literacy should aim to improve both situational and individual determinants. A key situational determinant is the availability of accessible, understandable and reliable health information.