bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Swedish study on improved contraceptive counselling for immigrant women postpartum
Authors: Larsson E , Kilander H , Weinryb M , Vikström M , Petersson K 
Published: October 2020

Abstract
Contraceptive choices postpartum have not previously been studied in Sweden. Being foreign born is a risk factor for induced abortion. Improving postpartum contraceptive counseling could potentially fulfill unmet needs for contraception.
This is an organizational case study using a Quality Improvement Collaborative (QIC) within the regular healthcare setting at 3 maternal health clinics in Stockholm. The active phase of the study was Sep2018-Sep2019. Quantitative and qualitative methods were combined. Routine registration of choice of postpartum contraception was introduced at the clinics and analyzed focusing on Swedish born and foreign-born women. Midwives and researchers met continuously, and during the active phase every 2-3 months in learning seminars with around 20 participants. During the learning seminars PDSA-cycles were used and areas of improvements for continuous performance measures were chosen. The midwives decided on and tested multiple evidence-based changes in contraceptive counselling and services during action periods. Goals were set and competency building in areas chosen by the midwifes were held. In addition, both foreign- and Swedish born women gave their input to the improvement areas. Qualitative data was analyzed through content analysis from field notes and verbatim transcripts.
Preliminary results show that the proportion of women choosing an effective contraceptive method (SARC or LARC) among immigrant women increased from 40% to 55% when comparing the start and the end of the project. The midwives reported how they had changed their approach when counselling women who were skeptical about contraception and tried to find a new way to meet women's needs.
As much as the QIC showed positive results, it was a small-scale study in 3 clinics in one geographical area. A larger study to determine and explain the effectiveness of QIC on the proportion of immigrant women choosing an effective contraceptive method postpartum is planned for 2021-2024.
Applying translational behavioural science to improve people’s health
Authors: Nagyova I 
Published: October 2020

Abstract

Background
The rising burden of chronic diseases poses a challenge for the whole public health system, and to deal with this we need to address the socioeconomic, cultural, and behavioural aspects of health and its determinants. While a change in individual 'lifestyle' factors, such as diet, exercise, smoking, and alcohol are often the target of intervention design, there needs to be an acknowledgement that behavioural science is much more than just 'lifestyle choice' on the individual level.
Governments worldwide are increasingly incorporating the behavioural insights approach into policymaking. There has been an increasing interest in 'choice architecture' and 'nudging' to facilitate behaviour (change), often by manipulating elements of the environment. Designing interventions that target the most important determinants of behaviour, based on research evidence in the field of behavioural science, provide the best chance of changing behaviour and demonstrating a positive impact in terms of health outcomes and cost-effectiveness. However, knowing what works and how to apply it presents an ongoing challenge.

Results
The COM-B, EAST, and MOST are behaviour change models that were built on an impressive effort to synthesize available evidence regarding intervention development frameworks, behaviour change theories, and behaviour change techniques. They tackle determinants of behaviour in terms of capability, opportunity, and motivation on the level of the individual (micro level), alongside ways in which to intervene, at mezzo level (intervention functions) and macro level (policy categories).

Conclusions
These approaches take a holistic view of interventions and can contribute to the development of new scientific knowledge regarding mechanisms underlying effective knowledge mobilization in behaviour change. They are also expected to further support the adoption of the evidence-based practices within the field of public health.
The geriatric workforce: is there anybody out there to care in Romania?
Authors: Ungureanu M I , Paina L , Brînzac M G , Forray A , Donca V , Avram L , Crișan D 
Published: October 2020

Abstract

Background
Demographic changes - such as population ageing - pose great challenges to health systems around the world. For the Romanian health system, challenges might be particularly difficult to address. Facing a severe under-funding and significant workforce maldistribution, the health system in Romania is called to care about both the ageing population and the workforce taking care of the elderly. The aim of this paper is to apply the health labour market framework to the geriatric workforce in Romania.

Methods
The paper describes the composition and distribution of the geriatrics workforce in Romania based on data in the Healthcare Facility Activity report, policy documents and available reports.

Results
Geriatric care is provided in Romania mainly by geriatricians employed by public hospitals. The team around geriatricians is limited to nurses only, with other professions - such as psychologists, physiotherapists and social workers - almost absent. Even though the number of geriatricians has increased country-wide over recent years (from 149 to 242), there are significant differences in their distribution at a county level. Eleven counties out of the 41 reporting to have only 1 geriatrician for populations of hundreds of thousands. Training curricula for geriatrics residents fall short of addressing team work and inter-professional collaboration. Reports show growing concern over geriatrician burnout, caused in part by inadequate team work. Faced with burnout risk, many of them report considering changing specialties, which would further aggravate the lack of comprehensive elderly care.

Conclusions
The geriatrics workforce in Romania is poorly developed, and significant efforts are still needed to develop policies addressing geriatrics production, inflows and outflows, and maldistribution and inefficiencies. Moreover, addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation.
22.D. Workshop: The Food Environment Policy Index for the EU, Germany, the Netherlands, Norway and Poland
Authors:   Organised by: Pettenkofer School of Public Health (Germany),   Chair persons: Peter von Philipsborn - Germany, Karin Geffert - Germany
Published: October 2020

Abstract
Unhealthy diets are a key risk factor for disease and premature death in Europe and worldwide. Moreover, the food system is a key driver behind many processes of global environmental change, including climate change, biodiversity and habitat loss. Accordingly, calls have been made for a transformation of the global food system. This requires action in a variety of policy fields and on all political levels. The creation of healthy food environments through public sector action on a national and regional level is an essential aspect of this.
The Food Environment Policy Index (Food-EPI) is an established methodological framework for the assessment, analysis and benchmarking of public policies influencing food environments, developed by INFORMAS, a global network of public-interest organizations.
In this 90 min workshop, we will present the approach used by the Food-EPI and results from the implementation of the Food-EPI on the EU level and in Germany, the Netherlands, Norway and Poland, followed by a joint discussion of lessons learnt and key policy implications.
The Food-EPI has two components (policy and infrastructure support domains) covering a total of 13 domains and 47 indicators. For each indicator, policies and actions are compiled and benchmarked against international best practice by independent experts and stakeholders. Based on this assessment, priority actions for reform are identified. Policy makers and independent public health and nutrition experts are involved in key steps of the process to ensure policy relevance and impact.

Key messages
The systematic assessment and benchmarking of nutrition policies helps to identify priority actions to improve food environments and enhances government accountability for public health. Both on the EU level and in EU member states, governments have taken action to support healthy food environments, but considerable room for improvement remains.
Evaluating food-related policies in Germany using the Food Environment Policy Index (Food-EPI)
Authors: Geffert K , von Philipsborn P , Stratil J M , Rehfuess E A 
Published: October 2020

Abstract

Background
Germany has seen as rising burden of diet-related adverse health outcomes. Policies for improving food environments and related infrastructure are essential to reduce this burden. A growing awareness of the interlinkages between sustainability and nutrition underlines the need for healthy, sustainable food environments. Therefore, we applied the Food Environment Policy Index (Food-EPI) with an additional domain on sustainability to monitor German food policies and to formulate actions for improvement.

Methods
For the evidence analysis information on food environment and infrastructure was collected from various sources. Results were validated with an expert group consisting of representatives of government agencies, non-governmental organizations and academia. The level of implementation, compared to international best practice examples, was ranked by the expert group through an online survey. A one-day workshop was conducted to identify actions to fill the gaps identified in the online ranking and to prioritize these actions in terms of importance and achievability.

Results
The application of the Food-EPI to German policies and interventions shows a nuanced picture of strengths and weaknesses of the German food environment and infrastructure. Some domains such as monitoring and surveillance are in line with international best practice, however other domains show considerable room for improvement. The recommended actions to improve the shortcomings of the German food environment includes a list with priority actions.

Conclusions
The results from the Food-EPI provides an in-depth analysis of German food environment policies and infrastructure, as well as a list of prioritized actions to improve it.

Key message
Integrating a sustainability domain into the Food-EPI offers opportunities to identify priority actions for the creation of healthy, sustainable food systems.
Economic growth, population health and Sustainable Development Goal 8
Authors: Brunner E , Cable N , Iso H 
Published: October 2020

Abstract
High-income countries (HICs), including UK, Germany and Japan, are reducing CO2 output relative to economic growth. SDG8 refers to 'sustainable growth' but does not differentiate between low, middle- and high-income countries. The United Nations target is for net-zero CO2 emissions by 2050, therefore there is a strong case for exploring the implications of low or zero economic growth among HICs as a mechanism for limiting climate change. A key consideration is whether progress in population health would stall if HIC economies stopped growing.
We examined headline health statistics among HIC countries for evidence of divergence in health trends. We looked for associations between trajectories of national economies and health trends over the past four decades. Age-standardised death rates were calculated from all-cause and cause-specific rates in the WHO mortality database. All-cause mortality (ACM) rates declined in parallel in UK, France and Japan, from about 700 to 400/100,000 in the period 1980-2010, with the lowest rates in Japan. Decline in the ACM rate in USA was shallower 1980-2010. In the decade of austerity following the banking crisis, the ACM rate in USA and UK stopped declining. The Japanese ACM rate continued its rapid post-war decline in the two decades of economic stagnation after 1990. Trends in Japanese coronary heart disease, stroke and cancer mortality rates, but not those for suicide, were consistently favourable in the recent period.
The natural before-and-after experiment in Japan, of high economic growth in the decades to 1990, and low growth after 1990, is an example of a HIC with continuing progress in population health in a long period of low growth. Repeat measures of subjective, self-rated health from a population-based Japanese survey series (1986-2013) add to the evidence from objective mortality rate trends. Progress in population health does not need to stall if HIC economies focus on combatting climate change instead of growth.
Team-based Care for Improving Hypertension Management Among Outpatients
Authors: Santschi V , Wuerzner G , Pais B , Chiolero A , Schaller P , Cloutier L , Paradis G , Burnier M 
Published: October 2020

Abstract

Background
Innovative models of care are needed to reduce poor blood pressure (BP) control in European countries. The TBC-HTA study evaluated the effects of an interprofessional team-based care (TBC) intervention, involving nurses, community pharmacists, and physicians, on BP control compared to usual care.

Methods
We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Lausanne and Geneva, Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC (N = 46) or usual care (UC: N = 43). The TBC intervention was led over 6 months. Nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle and medication adherence, and provide health education. After each visit, they wrote a report with recommendations to the physician who could adjust antihypertensive therapy accordingly. The outcome was ambulatory BP measured at 6 and 12 months.

Results
A total of 60 men and 29 women [mean (SD) age: 61(12) year; mean (SD) number of antihypertensive drugs: 2 (1)] were included. At baseline, mean (SD) BP was 144(10)/90(8) and 147(12)/87(11) mmHg in the TBC and UC care groups. 76 patients were followed up to 12 months. At 6 months, the between-group difference in mean BP was -3/+2 mmHg [95% CI: -10 to + 5 / -2 to + 5]; BP control was 38% in the TBC group and 33% in the UC group, respectively. At 12 months, the between-group difference in mean BP was -8/-3 mmHg [95% CI: -14 to -1/-7 to + 1]; BP control was 34% in the TBC group and 20% in the UC group, respectively.

Conclusions
This TBC intervention helped long-term BP control among hypertensive outpatients in Switzerland. In line with recent European guidelines (ESC/ESH), this type of care should be more widely implemented.

Key messages
A TBC of hypertension helped control BP in a Swiss healthcare setting. Policymakers should evaluate how to implement such intervention.
Associated factors with death among young women exposed to intimate partner violence in Brazil
Authors: Pinto I V , Marinho F , Malta D C 
Published: October 2020

Abstract

Objective
The objective of this study was to identify associated factors with death among young women exposed to intimate partner violence in Brazil.

Methods
Case-control study used a linked database containing nearly 800,000 violence against women notifications in Notifiable Diseases Information System over the period 2011 to 2016 and 16,200 deaths over the period 2011 and September/2017. Cases were women from 15 to 29 years old with notification of violence by an current or former intimate partner and death for any basic cause. Controls were women of the same age group, type of notification and living in the same municipalities as the cases, but without death record in that period. Odds ratios were estimated by multivariate logistic regression.

Results
790 cases and 50,870 controls were included in the study. Most of the young women died from aggression (58,2%), transport accidents (6,1%) and malignant neoplasms (3,8%). According to the bivariate analysis, age, pregnancy, race, education, area of residence, disability, place of violence, means of aggression, nature of violence and chronic violence were significant. The results of the multivariate analysis showed that the greatest odds of death were in women whose violence was perpetrated by a firearm, a sharp or blunt weapons and residents of rural areas. Young women with disabilities also had an increased chance of death. On the other hand, the higher educational level appeared as a protective factor against death. A big effort is necessary to develop strategies to prevent these announced deaths. These findings may contribute to the surveillance system for violence in health services and its performance with the serviceś network for women in situation of violence.

Key messages
Young women exposed to intimate partner violence who lived in rural areas had an estimated odds to death higher than they who lived in urban areas. The higher educational level was a protective factor against death in young women exposed to intimate partner violence.
Quality of life and risk of feminicide in women victims of intimate partner violence in Campinas
Authors: Caicedo Roa M , Gabrielle Dalaqua L , Filizola P , Cordeiro R 
Published: October 2020

Abstract

Introduction
Violence against women is a public health problem with severe consequences. Most women in situations of domestic violence are emotionally involved and/or economically dependent of their intimate partners contributing to the perpetuation and acceptance of violence.

Objectives
1) To characterize the women who join the Reference and Support Center for Women (Ceamo) in Campinas, Southeast Brazil. 2) To measure the quality of life in women victims of intimate partner violence 3) To determine the risk of feminicide.

Methods
The Ceamo is a public specialized service from the mayor of Campinas, it provides psychological, social and legal guidance to women in situations of gender violence. Inclusion criteria: Women attending Ceamo services, speaking Portuguese, age ≥18 years old and having experienced intimate partner violence. Measure instruments: Danger assessment Scale and WHOQOL-BREF.

Results
During the 11 months of the study, 78 new users were recruited. Average age 38.3 years old, mostly married/stable union, most of them with children (88%). 64% of women do not work and 36% live with the abusive partner. Prevalent types of violence suffered during by the victims in the last year were psychological n = 76, physical n = 62, moral n = 54 and sexual n = 23. The domain most affected in the assessment of quality of life was the environment (average 42% /100%) and psychological domain (42%/100%). 49% of women were classified with increased risk, 22% with severe risk and 1% with extreme risk of femicide. The questions with the most positive answers were those related to believing that the partner can kill her (77%), jealous of the partner (76%) and controlling behavior (73%), being followed/spied by the partner (67%) and threat death (65%).

Conclusions
The service in general receive very vulnerable women with low perception of their own quality of life, precarious material conditions and high risk of femicide.

Key messages
The women in domestic violence situation attended by the Ceamo service are at high risk of femicide. Service users have very low perception of their quality of life and poor social conditions.
Burden of occupational injuries occurred in Italy, 1900-2017
Authors: Ariani F , Baldasseroni A , Rondinone B , Ferrante P , Levi M , Balzi D , Romeo G , Biffino M , Cipriani F 
Published: October 2020

Abstract

Background
The GBD study allows comparison of health conditions among different societies and cultures. This permits also to estimate health variations over a long time in a single nation, overcoming the difficulties deriving from social and economic changes. INAIL, the National Institute for Insurance against Accidents at Work, provides since 1884, detailed data about the number of events and their consequences, age and sex of injured workers, and the total number of insured workers. Such data allow us to estimate DALYs in terms of incidence and prevalence, and under different mortality models.

Methods
1.8 mln. individual injury records occurred in 1990-2015 were transcoded into GBD injury categories. YLLs and YLDs were calculated considering life expectancy, DWs and duration, then distributed by compensation category. The YLLs and YLDs of permanent disabilities have been assessed with reference both to the life expectancy of the GBD 2017 and, in a competitive mortality model, to mean values at the time of the accident. Estimated DALYs were assessed both in terms of incidence and prevalence.

Results
Around 1900, an industrial worker suffered on average 0.087 incident DALY/year for occupational injuries, or 0.058 in a competitive mortality model. These values remained almost stationary until WWII when they showed a peak around 0.11, then declined to about a third in the 1970s, and to about a twentieth in 2017. The YLL / DALY ratio was 0.82 around 1900, then slowly decreased to less than 0.5 in the late 1930s, rose to a new peak around 0.8 in WWII, then diminished again to 0.32 in 2017. Considering prevalence, variations are much slower, due to the expected average durations of permanent disabilities, between 32.5 and 52 years. Risk breakdown by main industry sectors is ongoing.

Conclusions
DALY rate and YLL/DALY injuries declined largely along time. Nevertheless, such events continue to leave a very long-term legacy of disabilities.

Key messages
INAIL data permit to estimate burden for occupational injuries occurred in Italy along over a century. Injury burden declined over time, but continues to leave a legacy of long-term disabilities.