bluuebunny/crossref_metadata_2025_split huggingface dataset:
Success of reformulation and health education in reducing sodium intakes across socioeconomic groups
Authors: Gressier M , Frost G , Sassi F 
Published: October 2020

Abstract

Background
The UK salt reduction programme started in 2005, consisting of education campaigns and a reformulation strategy. This programme is often cited as an example of a successful public health programme, and used as a model for other programmes. This study aims at assessing how the programme succeeded in reducing sodium intakes, and whether success was even across socioeconomic (SES) groups.

Methods
Food intakes for the UK adult population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (Y1) and 2016/17 (Y9). Year-specific sodium densities of foods were used to calculate the quantity-weighted average sodium density of all food and beverage consumed by the population. Using a decomposition approach (Griffith et al., Economica, 2017), changes in sodium density were attributed to either changes in food composition (change in sodium density), or changes in behaviour (type and quantity of food products consumed), stratifying by SES.

Results
The programme was linked to a 16% decrease in sodium intakes between Y1 and Y9, while sodium density decreased by 15%. This decrease was largely driven by reformulation (-12mg/100g), while changes in food choices had a smaller impact (-2mg/100g). This finding was consistent across SES groups, whether stratified by education or income, with no significant differences between SES groups in behavioural responses to the programme (changes in food choices).

Conclusions
Changing people's food environment, through reformulation to reduce the sodium density of foods, had a larger impact on sodium intakes in the UK population than efforts to change food choices, and produced consistent impacts across SES groups.

Key messages
Reformulation led to a consistent reduction of the sodium density of food consumed across SES. There was no evidence of adverse equity impact from changes in behaviour.
Information about organ donation: the perspective of people with limited health literacy
Authors: Rademakers J , Rolink M , Heijmans M 
Published: October 2020

Abstract

Background
In 2020, a new law on organ donation will come into force in the Netherlands. This law requires people to actively register their choice whether or not to be an organ donor after death. In this opt-out system, people who do not register themselves are automatically considered to be a donor. To inform the general public, the Dutch ministry of Health launched a communication campaign to inform the general audience. However, people with limited health literacy - 1 in three Dutch adults - have difficulties understanding health related information. Therefore, a study was performed to determine the appropriate information content and communication channels to better address the knowledge needs of this specific target group.

Methods
The study was done through (a) desk research and (b) 6 individual interviews and 4 focus groups with people with limited health literacy (total 30 people). The respondents were recruited through organisations that focus on specific populations with limited health literacy (limited reading and writing skills, minor intellectual disabilities, migrants).

Results
Most respondents had not heard about the new law on organ donation. Those who were aware of the law did not know what the law entails and what was required of them. The content of the information currently used were generally considered too difficult and abstract and did not give the respondents enough input on which to base a decision whether or not to be an organ donor. People with limited health literacy can mention specific topics on which they want information. Furthermore, they want practical help in registering their choice through the website. As information channels they prefer simple films and narratives of other people.

Conclusions
People with limited health literacy need more specific information on organ donation and what the new law entails. They have a preference for films and narratives. Furthermore, they need practical help in registering their choice.

Key messages
Current information on the new Dutch law on organ donation is too difficult and does not address the knowledge needs of people with limited health literacy. Films and narratives are preferred information channels of people with limited health literacy.
Evolution of Health literacy measurement tools
Authors: Corvo E , De Caro W 
Published: October 2020

Abstract

Introduction
This study aimed to provide a review of the tool characteristics and dimensions of health literacy measurement tools. Indeed, it is crucial to establish a clear correlation between what the tools detect and the definition of health literacy. The research question is therefore to what extent health literacy measurement tools are able to detect the ability and levels to make judgment and take decisions in everyday life concerning health.

Methods
A systematic review was conducted. PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases on Health literacy tools and instruments from 1990 through 2020. An environmental scan was conducted to identify other health literacy measurement tools. For each tool, researchers evaluated validation, items and conceptual dimensions, and psychometric properties.

Results
198 tools were identified, 96 measured general health literacy, 38 measuring comprehension, the others were aimed to assess health literacy for specific diseases or populations. Most tools are performance-based, require in-person administration, and are exclusively available in a pencil and paper testing mode. Reported administration times vary, from less than 1 to 30 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups.

Conclusions
The health literacy measurement tools currently available represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools are lacking key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. Furthermore, from a more practical point of view doubts emerged about the actual suitability of these tools in the day to day health care/promotion settings. Work is needed to develop more rapid and straightforward tools for practice.

Key messages
Measure health literacy save lives. Health literacy is a vital sign.
Forecasting emergency admissions in the city of Milan to predict overflow: a 2-day warning system
Authors: Murtas R , Decarli A , Russo A G 
Published: October 2020

Abstract

Background
The emergency department (ED) is one of the most critical area in any hospitals. In Italy, the mean waiting time is increasing causing potentially ED overflow and a detrimental effect on quality of care.

Methods
We collected total daily ED visits between 2014 and 2019 in the five major hospitals of Milan. To predict daily volumes, we used a regression model with ARIMA errors. Predictors included were weekly and yearly periodicity, meteorological and environmental variables, information on influenza epidemics and festivities. Parameters have been calibrated on training datasets (2014-2018) and successively validated on 2019, accuracy of prediction have been evaluated with the Mean Absolute Percentage Error (MAPE). Finally, we evaluated the impact of the COVID-19 outbreak calculating the proportion of ED accesses by triage levels, before and after the outbreak.

Results
Between 2014 and 2019 there have been 2 million of ED visits in the hospitals of Milan. We found different patterns of ED visits across age and days: children (0-14 years) tended to visit ED more likely on weekends while adults and senior people on Mondays. Results confirmed the role of meteorological and environmental variables, and the presence of yearly and weekly pattern. We found high correlation between observed and predicted value with a MAPE globally smaller than 8.1%. During the COVID-19 outbreak, the number of white triage ED accesses was reduced up to 71%.

Conclusions
Results permitted to develop a 2-day ED warning system combining forecast data provided by ARPA Lombardia. This is crucial in a system where inappropriate emergency admissions are still high where the analysis conducted during the COVID-19 pandemic period suggested a dramatic reduction in the number of daily ED access of lower triages.

Key messages
The ability to forecast future demands would be a valuable support in a system of limited resources, which must therefore be used in the best way. Environmental and meteorological variable have a moderate effect on emergency admissions.
Using Structural Equation Modelling to Untangle Pathways of Factors Associated with Type 2 Diabetes
Authors: Duan M , Dekker L H , Carrero J J , Navis G J 
Published: October 2020

Abstract

Background
Risk factors for type 2 diabetes (T2D) are multi-facet and interrelated. We aimed to apply structural equation modelling to examine and quantify pathways of modifiable risk factors related to incident type 2 diabetes.

Methods
Analysis was based on 68 649 participants (35-80 years, without diabetes at baseline) from the Lifelines cohort study. We proposed a conceptual model that illustrates the pathways of risk factors related to incident type 2 diabetes: socio-economic status (income and education) → lifestyle behaviors (diet quality, physical activity, TV watching, and smoking) → clinical markers (blood lipids and obesity status) → incident type 2 diabetes. Structural equation modeling was performed to test this proposed model.

Results
After a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified. The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (β: 0.213 ), followed by HDL-cholesterol (β: -0.141). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest direct effects on all lifestyle behaviors.

Conclusions
Using this innovative approach, our analysis provides a more nuanced assessment of the interplay of type 2 diabetes risk factors, compared to traditional risk estimates. Our results indicated that reducing large waist circumference may be prioritized as the main target for the prevention of type 2 diabetes, and lifestyle interventions are urgently warranted with additional support for those with a low education.

Key messages
Our study elucidated the multiple causal pathways to type 2 diabetes in a prospective setting. Our results identified the most critical targets for future prevention strategies for type 2 diabetes.
The effect of COPD on length of stay and in-hospital mortality of diabetic patients
Authors: Di Martino G , Di Giovanni P , Cedrone F , D'Addezio M , Masciarelli M , Meo F , Scampoli P , Staniscia T 
Published: October 2020

Abstract

Background
Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. It is currently one of the leading cause of death worldwide. Metabolic syndrome has been recognized as one of the most relevant clinical comorbidities associated with COPD. Diabetes is more prevalent in COPD than in the general population, ranging between 10.1-23.0%. However, the link between COPD and diabetes is much less clear. The aim of this study was to investigate the effect of COPD on diabetic patients, focusing on length of stay and in-hospital mortality.

Methods
The study considered all hospital admissions of diabetic patients aged over 65 years performed between January 2006 and December 2015 in Abruzzo, a region of Italy. Data were collected from all hospital discharge records. A 1:1 propensity score-matching algorithm was used to match patients with and without COPD, according to their baseline characteristics. Logistic regression analysis was performed to evaluate the risk of in-hospital mortality and prolonged length of stay among diabetic patients with COPD.

Results
A total of 140,556 ?patients were included: 18,379 with COPD and 122,177 without COPD. After matching procedure, 36,758 patients were included into the analysis: 18,379 with COPD and 18,379 controls. After matching, all the baseline characteristics resulted well balanced, with a standardized mean difference less than 10% for all the variables considered. COPD patients showed a higher risk of in-hospital mortality (OR: 1.10; 95%CI 1.01-1.20; p = 0.036) and length of stay over 15 days (OR:1.18; 95%CI 1.06-1.31; p = 0.002).

Conclusions
In a cohort of Italian patients, diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD. Defining the causes of these differences would improve public health surveillance systems and policies.

Key messages
Diabetes is more prevalent in COPD than in the general population. Diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD.
Predicting difficult discharge from surgical wards: a cohort study in an Italian sample
Authors: Corradi A , Bert F , Corsi D , Kakaa O , Scarmozzino A , Siliquini R 
Published: October 2020

Abstract

Background
Poor discharge planning (DP) can increase costs for European hospitals and worsen patient's experience. Validated scores are used in internal medicine to identify clinical or social difficulties in discharges upon admission but there is a lack of such a tool in the surgical context. This study aims to detect early predictors of difficult discharge.

Methods
Socio-demographic and clinical data from 15,165 surgical Hospital Discharge Records (SDOs) of the Molinette hospital of Turin, including an additional pre-surgery evaluation of social vulnerabilites from a subgroup of 388 patients, were collected between 2017 and 2019. Outcomes were length of stay (LOS), discharge destination (home, Long Term Care - LTC). Descriptive analysis and multivariable regressions were performed.

Results
52.3% of patients were male and the median age was 61 (IQR 22). Median LOS was 6 days (IQR 6) but 15 (IQR 30) for patients discharged to LTC. 18.7% were admitted through the Emergency Department (ED) with a median LOS of 7 (IQR 10). 17.6% of the subsample declared living alone. Linear regression showed associations between discharge to LTC, admission through ED, diagnosis of neoplasia and a longer LOS (Bs 10.76, 5.21 and 2.57 respectively, p &lt; 0.001). Logistic regression showed associations between admission by ED, age and discharge to LTC (OR 1.77 and 1.02 respectively, p &lt; 0.001). Preliminary analysis of the subsample did not show any new association with social vulnerabilities, but 98.2% attended elective surgery and thus probably had time to prepare for discharge.

Conclusions
Surgery LOSs are extremely diversified among patients. This study identified several predictors of difficult discharge, mainly admission through ED, discharge to LTC and diagnosis of neoplasia, suggesting difficulties handling an unexpected event by patients' relatives. Further studies gathering patients' data at admission are required in order to develop a predictive tool useful for European hospitals.

Key messages
Clinical (cancer) and social (sudden event, no housing solutions) factors can determine a difficult discharge for European patients and should be investigated to anticipate discharge planning. Elective surgery patients seem less prone to social vulnerabilities (e.g. living alone), probably because relatives have time to prepare, while ED patients often need help in the discharge process.
Analysis of hospitalization trends for ambulatory care sensitive conditions in Piauí/Brazil, 2009-18
Authors: Sousa R , Silva F , Silva R , Santos R , Mouta J , Cardoso T , Cardoso O 
Published: October 2020

Abstract

Introduction
Hospitalizations for ambulatory care sensitive conditions (ACSC) are hospitalizations that can be potentially preventable through care at the first level of contact for health care. In fact, the actions offered in a timely and effective manner can reduce the risk of unnecessary hospitalizations by preventing diseases, controlling acute episodes and managing chronic diseases.

Aim
Analyze the trends in hospitalizations for ACSC in Piauí, Brazil, from 2009 to 2018.

Methods
Ecological time-series study based on data from the Hospital Information System (SIH) of the public health system (SUS), which comprised all hospitalizations of residents of Piauí, Brazil, in the period from 2009 to 2018. The explanatory variables were the hospitalizations for ACSC groups. For temporal trend analysis, the Prais-Winsten linear regression model was used in the Stata version 14 program.

Results
567,577 were recorded as ACSC, representing 35.3% of the total hospitalizations (1,608,263). Most hospitalizations for ACSC were caused by infectious gastroenteritis (33.5%). The risk of hospitalization for ACSC decreased 36.8%, showing a significant reduction in the trend of the hospitalization rate (Annual Percent Change - APC: -4.6%; 95%CI: -6.4; -2.8). There was a greater decrease in the risk of hospitalization for asthma (70.3%), hypertension (66.4%) and infectious gastroenteritis (61.8%). However, a significant increase was identified for skin infection (6.1 times) and diseases related to prenatal care and childbirth (3.2 times).

Conclusions
The reduction in hospitalizations due to ACSC is a result of the strengthening of Primary Health Care as the Brazilian health system organizer and the implementation of the Mais Médicos Program, which enabled the presence of doctors in family health teams, especially in places that had not previously been attended. It is also necessary to develop new studies to expand the discussions and debates on these findings.

Key messages
Hospitalizations reflect the living conditions of individuals, with social changes being perceived by changes in hospitalization patterns over time. The strengthening of primary care policies in Brazil was able to reduce hospitalizations for ACSC and it is necessary to further strengthen these practices to improve people's health care.
Public health competencies in global health education and demand of the global health labour market
Authors: Czabanowska K , Krasna H 
Published: October 2020

Abstract

Background
Many competencies frameworks exist worldwide and it is well known that competence-based education supports employability. However, little research exists regarding public health graduates' employment outcomes. This paper aims to stir the discussion about the expectations of the global health employment market and the competencies, which should be developed in graduates of public health programs with global orientation.

Methods
Material from in three different studies is used, including a systematic review of public health competency frameworks, scoping review of employment outcomes of students earning public health degrees, and analysis of 16 years' worth job postings with focus on competencies related to climate change.

Results
Employers currently value competencies, such as the knowledge of climate mitigation/adaptation, climate-health justice, direct/indirect and downstream effects of climate on health, health impact assessment, risk assessment, pollution-health consequences and causes, Geographic Information System (GIS) mapping, communication/writing, finance/economics, policy analysis, systems thinking, and interdisciplinarity.

Conclusions
The public health workforce needs to be equipped with the capabilities which trespass disciplines, professional silos and paradigms in order to be effective and able to address multiple challenges and global disruptions including climate change, as well as to lead through insecure contexts. More systematic research is needed on tracking the employment outcomes of the global health workforce, which may help to adapt public health competencies frameworks and education programs to the changing demands of the global health employment market.
Transnational collaboration for global health education: Romania as West-East hub
Authors: Ungureanu M , Paina L , Brînzac M G , Cherecheș R M 
Published: October 2020

Abstract

Background
Similar to many Eastern European countries, Romania has faced significant health professional outflow in the past decades. However, in the recent global context, this pattern is slightly changing and increasingly more complex. Although Romania is not yet experiencing significant inflows of already trained health professional, it has gradually become a preferred destination country for Western students pursuing a medical degree. Moreover, Romania has become attractive as a setting for students in high income countries with an interest in global health. The aim of this paper is to describe how Eastern European countries can provide global health training opportunities for Western students.

Methods
The paper describes a case study of global health education through a global health practicum program managed by the Department of Public Health at the Babeș-Bolyai University in Cluj-Napoca, Romania.

Results
The global health program is designed to provide a rich, hands-on practical approach to public health issues for students in health professions. The program has an internship format, with a minimum length of four weeks, organized as either a research project, medical shadowing, community practice, or rural health program. It builds on four key elements: customized placements in public health organisations; academic support and mentoring; instruction conducted in English; and additional cultural elements. For the past ten years, the program has included over 50 participants from the United States of America, UK and Denmark.

Conclusions
The program implemented by the Department of Public Health revealed the importance of a blended approach - academic-based, and practice-oriented - to providing global health training for health professionals. This approach is vital for preparing the future health workforce towards implementation of SDGs and could serve as a model for other collaborative initiatives.