bluuebunny/crossref_metadata_2025_split huggingface dataset:
In the search of solutions to improve healthcare access for migrants and refugees in Athens, Greece
Authors: Gionakis N , Ntetsika M 
Published: November 2019

Abstract

Background
Migrants and refugees face many challenges in their effort to access the health services. The Metaplan© methodology was applied to generate and prioritize solutions and tools for pilot interventions to improve migrants’ healthcare access in Athens. Methods. The Metaplan sessions included three groups: professionals working with refugees and migrants, mixed gender French-speaking migrants and refugees, and unaccompanied minors (11-16yrs).

Results
Professionals prioritized the communication issue, particularly a proper delivery of the language courses, and the enhancement of cultural competence in professionals. Besides, the instrumentalization of ‘vulnerability’ was focused on the relocation assessment. They suggested trainings to improve the collaboration between interpreters and professionals and build cultural competence, along with creation of migrant-friendly hospitals. The migrants underscored a gap between their needs and the current efforts to support their integration, such as language courses, job consultancy, and general information. Their access to health services was hindered by the lack of language skills and intercultural competences of providers. The migrants prioritized initiatives to overcome the challenges of everyday life, raise awareness and sensitize the local community on their realities, and tackle racism. The unaccompanied minors underlined the lack of shelters and a long bureaucratic procedure for the placement in a shelter as some experienced homelessness. They also pointed out the inefficiency of emergency health services. The solutions as perceived by this group included a proper assignment of homeless minors to shelters, better emergency units and more information about the health services.

Conclusions
The trainings for both health professionals and interpreters for the interdisciplinary cooperation and enhanced cultural competence are needed, along with informative workshops and flyers on health rights and services.
Research Implications for future telemedicine studies and innovations
Authors: Timpel P , Harst L 
Published: November 2019

Abstract

Despite the increasing application of information and communication technologies (ICT) in health care, robust data on the effectiveness and implementation of digital health solutions is lacking. Therefore, the objective of this analysis is to identify and categorise implications for future research in order to inform policy and practice decisions.
Systematic reviews and meta-analyses of RCTs evaluating the effectiveness of telemedicine in chronic diseases, all identified via a recent umbrella review, were used as primary sources of information. Qualitative content analysis following Mayring (2000) was used to categorize future research topics mentioned in the discussion sections and conclusions of included research published after 2015. Parallel, independent data extraction and coding using inductive category development was performed by two researchers with previous coding experience. Any disagreements were solved by discussion.
Of the 25 included systematic reviews and meta analyses, 23 reported on future research implications. They were categorised as follows: (1) Need for high quality studies including specific outcome measures; (2) Need for comprehensive technology assessment; (3) Need for in-depth considerations of patients’ characteristics & more diverse study populations; (4) Ethics & Safety; and (5) Translation & implementation strategies. A codebook comprising descriptions and examples of those categories and sub-categories was developed.
Results show a need for larger and more rigorous studies with longer intervention durations, mid- to long-term follow-ups as well as more heterogeneous study populations. More pragmatic study designs to evaluate multimodal and tailored interventions like telemedicine solutions are needed to develop an improved understanding on mechanisms and target-group specific effectiveness.

Key messages
We need a stronger focus on relevant and well-designed studies to improve the impact of telemedicine trials. Identified needs have the potential to inform future guidelines for the use of telemedicine.
Workshop: Quantifying burden of disease to support public health policy: exchange of views and experiences
Authors:   Organised by: University of Bordeaux Chair persons: François Alla - France, Jean-Claude Désenclos - France
Published: November 2019

Abstract

Information on disease burden, risk factors, related healthcare costs and their variations over time represents a major concern for public health decision makers. These data could contribute to define priorities and strategies, to allocate resources and to evaluate health policies and interventions at regional and national levels. In this context, the use and synthesis of all available data is essential, whether these data were collected for the purpose of epidemiological surveillance, healthcare, research, and/or reimbursement. This process raises conceptual and methodological issues. The question of the use of these data by decision-makers is also essential and depends not only on their validity, but also on their credibility, their usability, and their capacity to respond to needs in the context of decision. There are now national experiences of production and use of these data. There are also international collaborations. In particular, the Global Burden of Disease (GBD) Study is an extremely structured process with extensive global collaboration.
The aim of this workshop is to exchange and share experiences on the different approaches, indicators, methods used in order to quantify the burden of disease; the use of health insurance databases as a source of data for quantifying burden of disease; the use of burden of disease information by public health decision-makers at national and local levels.

Key messages
Disease burden statistics are a resource for data-informed policy-making. Health insurance databases are a complementary source for quantifying disease burden.
Participation of disadvantaged school age children (7-18) in health inequality projects
Authors: Jovanovic M 
Published: November 2019

Abstract

The descriptive research was conducted in the period from September until December 2018 involving projects tackling health inequalities of children 8-17 years old. The sample included 10 projects funded by the Directorate General for Health and Consumer Protection from its 3rd Health Programme (2014-2020) listed on the Consumers, Health, Agriculture and Food Executive Agency website. The study methods involved desk review of 10 selected projects, 6 semi-structured questioners and 6 interviews. Data were analyzed according to 4 participatory principles: relationship building, storytelling, strategizing action and supporting organizational structures to support execution of these actions, as outlined in the Leadership, Organizing and Action: Leading Change course thought by the Harvard School of Public Health.

Results
The preliminary finding is that none of the ten selected projects have identified children 7-18 years old as a primary target group. Majority of the projects (4 out of 6) involve sort of relationship building with children, while storytelling is used by a smaller number of projects (2 out of 10). All projects (6 out of 6) involve children just in the implementation phase focusing on educating children and none of them in the project design phase. Moreover, children covered by the implementation are mainly included through schools (8 out of 10) due to a missing parent consent for interacting with most disadvantaged children that are not in schools.

Conclusions
There is a serious lack of awareness on the importance of meaningfully engaging disadvantaged children in health programming processes for decreasing existing health inequalities. Due to a significant lack of meaningful participation of disadvantaged children in majority projects tackling health inequalities of school-age children in Europe there is a serious risk of having these inequalities increased rather than overcome, despite significant financial and human investments.

Key messages
The most disadvantaged children should be meaningfully engaged in design, implementation and evaluation of health inequality projects that are of their immediate concern. There is a need for more in depth research on health inequalities faced by school age children (7-18) that are out of educational system.
Use of e-cigarettes by young people in Great Britain before and after Tobacco Products Directive
Authors: Moore G , Brown R , Page N , Hallingberg B , Gray L , Maynard O , McKell J , Bauld L 
Published: November 2019

Abstract

Background
Young people’s experimentation with e-cigarettes has increased in recent years, although regular use remains rare. In May 2016, the EU Tobacco Products Directive (TPD) introduced regulations aimed in part at preventing use by young people. It imposed warnings on e-cigarette packets, banned many forms of advertising, and restricted nicotine strength. This paper examines change in young people’s e-cigarette use after TPD, as well as complementary and alternative causal explanations for change, from young people’s perspectives.

Methods
Quantitative data sources were 2013, 2015 and 2017 School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and 2014 and 2016 Smoking Drinking and Drug Use surveys in England. Data were analysed using segmented binary logistic regression in Wales, with simpler before and after analyses in England. Results were considered alongside qualitative interview data from young people aged 14-15 years in England, Wales and Scotland, collected in 2017 and 2018.

Results
Ever-use of e-cigarettes almost doubled from 2013-15, though subsequent increases were smaller. In Wales, where pre-legislation time series data were available, under a range of assumptions, prior growth in e-cigarette ever-use did not continue post-TPD. Change in trend post-TPD did not reach significance (OR = 0.96; 95%CI=0.91 to 1.01), but became significant after adjusting for change in smoking rates across the time-series (OR = 0.93; 95%CI=0.88 to 0.98). Regular use did not increase significantly from 2015 to 2017 in Wales, although ever and regular use in England both increased from 2014 to 2016. Young people described limited interactions with core components of TPD, while commonly describing e-cigarette use as a fad which was beginning to run its course.

Conclusions
Growth in youth experimentation with e-cigarettes may be slowing. Qualitative data from young people provide a range of explanations which appear largely unrelated to TPD itself.

Key messages
Survey data provide preliminary evidence that use of e-cigarettes may be plateauing among young people in the UK after a rapid initial increase in experimentation. Explanations position e-cigarettes as a passing fad which is beginning to lose its appeal in UK youth. Longer term monitoring of trends and perceptions remain vital.
Multimorbidity and quality of life: longitudinal analysis of the European SHARE database
Authors: Makovski T , Le Coroller G , Putrik P , Stranges S , Huiart L , Zeegers M , van den Akker M 
Published: November 2019

Abstract

Multimorbidity defined most commonly as co-existence of 2+ diseases is one of the major challenges of an ageing society. It is often accompanied with declining quality of life (QoL). The study aims to 1) assess the relationship between increasing number of diseases and QoL over time, 2) explore the differences between several European countries. Longitudinal data analysis performed on the relevant waves (2004 to 2017) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Data were collected every two years among participants aged 50+. Health conditions were identified through an open-end questionnaire containing 17 prelisted conditions. QoL was evaluated by Control, Autonomy, Self-Realization and Pleasure questionnaire (CASP-12v). Maximum QoL score, describing the best state was 48; minimum, 12 points. Association between increasing number of diseases and QoL is being assessed with multilevel analysis accounting for time and clustering within household and country. Minimum follow-up is 2 time points. Confounding variables include age, sex, socio-economic status, social support and health care parameters.
Preliminary findings show that 20 countries and 87,087 individuals participated in at least 2 waves; 80,041 answered CASP at least twice. Number of diseases when first reported was on average 1.65 (IQR=0,2) and increased to 1.88 (IQR=1,3) when last reported. Similarly, between first and last reported point QoL decreased on average by -0.32 (SD: ± 5.9); estimated by non-rescaled CASP scale. Greece showed the strongest decrease of -1.73 (SD: ± 6.36), while QoL increased in some countries, the most in Portugal for 0.76 (SD: ± 5.62).
Our preliminary findings suggest high geographic variations in QoL, possibly driven by differential clustering of multimorbidity across Europe, design issues and other factors. This may underline the need for country-specific analysis and initiatives to address the growing burden of multimorbidity in our ageing populations.

Key messages
First longitudinal study to address this research questions across wide range of European countries using SHARE. Study accounts for large number of confounding factors owing to the abundance of collected information.
Distribution of Cancer cases and survival analysis results: A retrospective cohort study
Authors: Pehlivan E , Mete B , Söyiler V 
Published: November 2019

Abstract

Background
Cancer was the second leading cause of death in Turkey. The aim of this study is to examine the changes in the incidence of cancer cases and survival analysis in a region.

Methods
This retrospective cohort study was carried out on data of 977 people had been diagnosed with cancer between the years 2013-2015 in Bingol province located in the east of Turkey. All cancer cases are included in the study. The data of the patients were obtained from the Ministry of Health Cancer Registry System and International Disease Classification Oncology (ICD-O) codes published by World Health Organization were used. Patients were evaluated topographically (tissue originating from the lesion) in 41 categories. Kruskal Wallis, Mann Whitney U test, Chi-square test and Cox regression analysis were used to analyze the data.

Results
The mean age of the patients was 58.73 ± 16.80 (min: 1-max: 107). It was observed that 28.7% of the patients died during the follow-up period and 71.3% of the patients were alive. 30% of the cancer cases digestive system, 11% respiratory system, 23% female breast- genitalia, 15% blood-lymph-thyroid, 11.8% muscle-bone, 15,4% other cancer species. In men, lung, stomach, colon, prostate; breast, thyroid and skin cancers are more common in women respectively. The incidence rate for all age groups was 97 per hundred thousand in 2013, 161 per hundred thousand in 2015. The increase trend did not differ by gender. The mean follow-up period of the patients who died was 388 days and 1541 days for the living patients. The risk of death is increased significantly in patients who cannot be operated (RR = 2.779, HR = 3.048). In patients not receiving chemotherapy, the risk of death is reduced significantly (RR = 0.656, HR = 0.340).

Conclusions
The incidence of cancer increases in the study area. Survival times vary according to treatment efficacy. Broad-based cohort studies evaluating the effects of treatment types on survival may be recommended.

Key messages
Cancer in the study area shows a significant increase from year to year. The average 5-year survival period of cancer patients was found is 71% as a good result.
Association between cancer and neurodegenerative disorders including dementias; a systematic review
Authors: Gagatsis L G , Ford E F , Bremner S B , Paudyal P P 
Published: November 2019

Abstract

Background
Several studies have examined associations between neurodegenerative disorders (ND) including dementia, and cancer. However, the associations and directions of these relationships vary by types of ND and cancer. In the current context of ageing populations and increased incidence of ND, dementia and cancer, and existing comorbidity between these disease groups, a better understanding of these relationships could, in future, inform prevention and therapeutics. This systematic review summarises the epidemiological evidence on these associations.

Methods
PubMed, MEDLINE, Embase, Scopus and Web of Science were searched to identify relevant studies published by 31/12/2018. The search strategy included a combination of search and MESH terms related to ND (e.g. Alzheimer’s, dementia), cancer and study design (case-control, cohort). The quality of included studies was assessed using the Newcastle-Ottawa scale (NOS).

Results
77 studies were eligible for inclusion. The majority of studies scored 6+ on the NOS scale and some reported significant associations between ND and cancer. The association with specific types of cancer was not as evident as with all cancers. An inverse relationship was found between NDs and particularly Alzheimer’s, Parkinson’s, and Dementia and Cancer. Only one study found no association between Vascular Dementia and Cancer.

Conclusions
The findings report an overall inverse association between NDs and all cancers but associations are less evident with specific cancer types. Results from this review can be helpful in recommending reporting standards for future research to reduce heterogeneity between studies.

Key messages
Exploring the intersection of neurodegenerative disorders/dementia and cancer might help redirect research to novel therapeutic approaches. A standardised approach in design and outcome measurement is necessary to reduce heterogeneity across the studies.
Impact of deprivation on hospital efficiency and financial balance in paediatrics
Authors: Michel M , Alberti C , Carel J C , Chevrel K 
Published: November 2019

Abstract

Background
In healthcare systems where hospital tariffs are based on average national length of stay (LOS), deprived patients may be a source of inefficiency for hospitals as deprivation has been shown to be associated with increased LOS. They may also negatively impact hospitals’ financial balance as few hospital payment methods include deprivation. Our objective was to study the impact of deprivation on hospital efficiency and financial balance.

Methods
A study was carried out using an exhaustive national hospital discharge database. All inpatient stays in mainland France between 2012 and 2014 by children over 28 days and under 18 in hospitals with a paediatric ward were included. Deprivation was estimated with an ecological deprivation index divided into national quintiles. Efficiency was assessed by variations in patients’ LOS compared to different mean national LOS (paediatric LOS, LOS of admissions for a similar condition...). Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level with the difference between all revenues and production costs for said hospital. Multivariate models assessed the association between those indicators and deprivation.

Results
4,124,510 inpatient stays were included. LOS was shorter than national means for less deprived patients and longer for the more deprived, and the difference was higher for diagnosis-related groups (DRGs) that included both adult and paediatric patients compared to paediatric-only DRGs. The multivariate model confirmed those significant associations. Deprivation also had a significant impact on hospitals’ financial balance, especially for hospitals with a percentage of paediatric patients in the two most deprived quintiles between 20% and 60%.

Conclusions
Measures to reform hospital payment methods must be encouraged to improve resource allocation efficiency and equity in access to good paediatric care.

Key messages
A reform of hospital funding to better account for deprivation is needed. A modulation of tariffs using an allocation key at the patient level must be considered to mitigate the effect of deprivation. DRGs specific to children should be encouraged to become the norm rather the exception to provide an adequate picture of resources used during admission and therefore an appropriate tariff.
The effect of an mhealth clinical decision-making support system on neonatal mortality in Ghana
Authors: Amoakoh H B , Klipstein-Grobusch K , Agyepong I A , Zuithoff P , Amoakoh-Coleman M , Kayode G A , Sarpong C , Reitsma J B , Grobbee D E , Ansah E K 
Published: November 2019

Abstract

Background
Mhealth interventions promise to bridge gaps in clinical care but documentation of their effectiveness is limited. We evaluated the utilization and effect of an mhealth clinical decision-making support intervention that aimed to improve neonatal mortality in Ghana by providing access to emergency neonatal protocols for frontline health workers.

Methods
In the Eastern Region of Ghana, sixteen districts were randomized into two study arms (8 intervention and 8 control clusters) in a cluster-randomized controlled trial. Institutional neonatal mortality data were extracted from the District Health Information System-2 during an 18-month intervention period. We performed an intention-to-treat analysis and estimated the effect of the intervention on institutional neonatal mortality (primary outcome measure) using grouped binomial logistic regression with a random intercept per cluster. This trial is registered at ClinicalTrials.gov (NCT02468310).

Results
There were 65,831 institutional deliveries and 348 institutional neonatal deaths during the study period. Overall, 47·3% of deliveries and 56·9% of neonatal deaths occurred in the intervention arm. During the intervention period, neonatal deaths increased from 4·5 to 6·4 deaths and, from 3·9 to 4·3 deaths per 1,000 deliveries in the intervention arm and control arm respectively. The odds of neonatal death was non-significantly higher in the intervention arm compared to the control arm (odds ratio 2·10; 95% CI (0·77;5·77); p = 0·15). The correlation between the number of protocol requests and the number of deliveries per intervention cluster was 0·71 (p = 0·05).

Conclusions
Non-significant higher risk of neonatal death observed in intervention clusters may be due to problems with birth and death registration, unmeasured and unadjusted confounding, and unintended use of the intervention. The findings underpin the need for careful and rigorous evaluation of mhealth intervention implementation and effects.

Key messages
Supposedly effective interventions must be evaluated in context before they are scaled-up. Mechanisms influencing outcomes in context must be considered in the design and evaluation of interventions.