bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity prevention - is school an effective place? A systematic review
Authors: Kula A , Liersch S , Krüger K , Walter U , Hagen A 
Published: November 2019

Abstract

Background
Juvenile and childhood obesity or overweight are associated with various secondary diseases and physical limitations, as well as with the effects of discrimination and social exclusion. The early prevention of obesity remains a key area of action worldwide. Schools are considered as a classical setting. The analysis focuses on the effectiveness of interventions, the identification of effective components and conditions as well as barriers. The aim is to provide a differentiated presentation of the current study situation.

Methods
The systematic literature search in eleven databases included studies in English and German published in 1990 to 2015. A control group and posttest data were obligatory. Evaluated outcome measures must map effects on the prevalence of obesity (e.g., BMI, body fat percentage, waist-to-hip ratio). Included full texts were evaluated with the instrument ROBINS-I. Due to the heterogeneity of studies (especially in terms of design, intervention and outcomes) results were analysed qualitatively.

Results
48 primary studies were included of which most studies report data on changes in mean BMI over time, and show predominantly (small) effects in favour of the intervention. Almost all identified interventions include behavioral measures, most of them combine the fields of nutrition and physical activity, with behavioral prevention being overrepresented in particular in activities addressing nutrition.

Conclusions
The results allow the conclusion, that school-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. There is clear evidence that the effects achieved tend to be maintained beyond the intervention. There are also clear indications for the cost-effectiveness of school-based obesity prevention. The studies from this field of research have clearly gained in quality over the years and are now flanked by health economic analyses.
Funded by DIMDI

Key messages
School-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. In order to fully realize its potential, school-based measures to prevent obesity should be accompanied by interventions at other levels, like the health-promoting design of living environments.
Satisfaction with health and oneself and the Unplugged program among Slovak Schoolchildren
Authors: Orosova O , Gajdosova B , Benka J 
Published: November 2019

Abstract

Background
The investigation of protective factors and intervention effects on health are important issues of prospective studies. The aims of this study were to explore the changes in schoolchildren’s satisfaction with their health and themselves (SH) following their participation in the Unplugged program (PU).

Methods
This study was carried out as a cluster randomized controlled trial (1195 participating schoolchildren, Mean age=11.52; 47.4% boys) with data collection conducted immediately before PU implementationT1, immediately after the implementationT2 then 3 monthsT3, 12 monthsT4, and 18 months after the implementationT5. The schools were randomly assigned to either an experimental (EG, n = 540) or control group (CG, n = 655). EG was exposed to PU consisting of 12 lessons (http://www.eudap.net/). The effect of participating in PU, gender, and self-efficacy (SET1) were explored in relation to changes in SH in both EG and CG. GLM Repeated Measures were used for the data analyses.

Results
There was a significant main effect of time on SH, F(4, 1096)=6.685, p &lt; 0.001. The contrast analysis revealed that SH was significantly lower at every follow-up when compared to SH at T1. There was a significant interaction effect SHxSE, F(4, 1096)=2.868, p &lt; 0.05. The contrast analysis revealed that SH was significantly lower at T2 than at T1 among the schoolchildren with a lower level of SE. Finally, the SHxSExPU interaction was significant F(4, 1096)=2.779, p &lt; 0.05 and the contrast analysis revealed that SH was significantly higher at T5 than at T1 among those participants of PU with a higher level of SE.

Conclusions
The findings generally suggest that while there was a decrease of SH among schoolchildren between T1 and T5 a long-term effectT5 of PU was found among the program participants with higher levels of SE who were able to maintain higher level of SH.

Key messages
Schoolchildren’s satisfaction with their health and themselves was found to generally decrease in time during the 22 months when Unplugged was implemented and evaluated. A long-term effect of Unplugged was detected among program participants with higher levels of self-efficacy who were able to maintain higher level of satisfaction with their health and themselves.
Perception of Social Gender Roles in Medical Faculty Students
Authors: Aygar H , Atalay B Isıktekin , Zencirci S Akbulut , Unsal A , Arslantas D 
Published: November 2019

Abstract

Background
“Gender equality’’ is the fifth of the Sustainable Development Goals put forward in order to ensure the development in all areas. Medical faculty students, who will be a doctor, should practice with a gender equality perspective and shape their views and attitudes with equality in mind which will have an important part in the adoption of equality by society. The aim of the study was to evaluate the perception of social gender roles in medical students.

Methods
This cross - sectional study was performed with all students in Eskisehir Osmangazi University Faculty of Medicine. The questionnaire includes sociodemographic characteristics and Gender of Perception Scale(PCS) to measure perception of social gender roles. The scores that can be taken from the scale are ranged from 25 to 125, and high scores indicate that perception of gender is positive and equality. Mann Whitney U, Kruskal Wallis were used in univariate analysis; multivariate linear regression was used in multivariate analysis.

Results
The study group consisted of 1023 (84.3%) students in the study group, 52.8% were females and their ages ranged from 17 to 30 and the mean was 21.36 ± 2.06. The PCS scores ranged from 32 to 125 and the mean was 108.07±16.58. Multivariate linear regression analyzes were performed to determine the factors associated with the PCS. According to the results of last model sex, living with grandparents until the age of 18, region of the majority of life and parental attitudes were found to be related to perception of social gender roles (F = 29.602, R2=0.170, p &lt; 0.001).

Conclusions
The perception of gender of medical students was found to be positive. Sex and the characteristics of the social environment were related to perception of gender. In order to raise awareness on gender equality, it might be useful to ensure integration in the medical education curriculum.

Key messages
Factors that can be changed, such as the social characteristics of the living environment, were found to be related to perception of social gender roles. Ensuring gender equality, one of the Sustainable Development Goals, is important for medical students who will be a role model for society.
Education and T2DM: the role of differential exposure and susceptibility to overweight and obesity
Authors: Mathisen J , Jensen A K G , Andersen I , Andersen G S , Hvidtfeldt U A , Rod N H 
Published: November 2019

Abstract

Background
There is a clear educational gradient in type 2 diabetes and differential exposure and susceptibility to overweight and obesity across educational groups may explain part of this gradient. Previous studies have mainly addressed differential exposure to overweight/obesity, even though the pathways are highly intertwined. We take advantage of novel methodological developments to assess the simultaneous contribution of both pathways. We further compare these analyses to more traditional approaches.

Methods
A prospective cohort of 53,159 Danish men and women, aged 50-64 years at enrollment in 1993-1997, were followed for a mean of 14.7 years. We used national register data to ascertain education and incident type 2 diabetes. Overweight/obesity was determined by BMI. Using a marginal structural approach and a three-way effect decomposition, we estimated rate differences of type 2 diabetes by education and decomposed these into direct, indirect and mediated interactive proportions. We compared this approach to traditional and separate approaches to mediation and interaction analysis.

Results
Compared with high education, medium education was associated with 316 (95% CI: 268-363) extra cases of type 2 diabetes per 100,000 person-years, and low education with 454 (95% CI: 398-510) extra cases. Differential exposure to overweight/obesity accounted for 29% (95% CI: 24-36) and 37% (95% CI: 31-45) of the cases in the medium and low educational levels, respectively, while differential susceptibility accounted for 6% (95% CI: 3-10) and 9% (95%CI 4-14). Traditional approaches suggested stronger effects of both pathways.

Conclusions
Differential exposure and susceptibility to overweight/obesity are both important pathways in the education-type 2 diabetes association, and the results emphasize the importance of addressing them simultaneously.

Key messages
Lower educated groups are more exposed and susceptible to the adverse effects of overweight/obesity with regard to type 2 diabetes, suggesting a large preventive potential. Future studies could benefit from estimating both differential exposure and differential susceptibility to better understand social inequality in type 2 diabetes and other health outcomes.
Standardization of the Cancer Health Literacy Test – 6 in a non-cancer populations
Authors: Dumenci L , Siminoff L A 
Published: November 2019

Abstract

Background
The Cancer Health Literacy Test-6 (CHLT-6) was originally developed in a cancer population to identify persons with limited cancer health literacy (LCHL). There is no instrument to identify individuals with LCHL in non-cancer populations such as caregivers and epidemiologic samples. This study aims to test if the CHLT-6 can be used to identify persons with LCHL in non-cancer patient populations. The CHLT-6 was administered using a hand-held touch-screen computer.

Methods
A patient sample of 512 persons was used to test the CHLT-6 measurement structure and externally validate the test. English speaking, aged 18 or higher, and no history of cancer diagnosis were used as eligibility criteria. Participants were recruited from health fair grounds, primary care clinics, and community centers in the Mid-Atlantic region of the U.S.A. Consistent with the analysis of the developmental sample, discrete latent variable modeling was used as the underlying measurement structure of the instrument.

Results
Two classes were clearly separated by the CHLT-6 items. Measurement invariance tests showed equivalence of conditional probabilities between gender, race/ethnicity, and educational groups. There were significant group differences in prevalence of LCHL. The CHLT-6 was externally validated using race/ethnicity, education, and income. Overall results were very similar to those reported in the cancer population.

Conclusions
The CHLT-6 is the first and only instrument to identify individuals with LCHL using a discrete latent variable framework. Measurement invariance tests provided empirical evidence that labels used to describe latent classes (i.e., limited and adequate cancer health literacy) have the same meaning between gender, race/ethnicity, and educational groups. Persons self-described as African Americans and low educational attainments have a high probability of belonging to the LCHL class.

Key messages
There is a strong support for psychometric properties of the CHLT-6 in a cross-validation sample. This study provides empirical basis for using the CHLT-6 in non-cancer populations.
Economic burden of cardiovascular diseases from 2012 to 2017 based on French national claim database
Authors: Nicolas M , Pestel L , Rivière S , Rachas A , Gastaldi-Menager C 
Published: November 2019

Abstract

Background
The purpose of this study was to assess the economic burden of cardiovascular diseases (CVDs) in France by analysing the structure and the growth of expenditure attributed to these diseases between 2012 and 2017.

Methods
For each year, 11 CVDs were identified from SNDS data using algorithms based on long-term disease registry and hospitalization diagnoses, applied to the population of national health insurance general scheme beneficiaries. The individuals’ expenditure (26 different items) reimbursed for hospitalisations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to each considered groups of diseases based on the average expenditure by disease calculated for individuals with only one disease. To analyse trends, we applied the same methodology from 2012 to 2017.

Results
In 2017, of the €140.1 billion reimbursed, €14.0 billion (10.0%) were attributed to the care of 4.0 million people with a CVD (7.0% of the population). Short-stay hospitalisations accounted for 33% of this total expenditure. This proportion was higher for acute CVD (coronary syndrome: 64%, stroke: 56%, heart failure: 65%, pulmonary embolism: 69%) but also for valvular heart disease (50.0%). Medications represented almost 13% of the expenditure attributed to all CVDs, and up to 25% for chronic coronary heart disease. Disability pension essentially concerned sequelae of stroke (12% of the expenditure attributed to this disease). Between 2012 and 2017, the total expenditure attributed to CVDs increased by 3.3% per year, mainly due to the annual mean increase of the number of patients over the period (+3.1%).

Conclusions
These results demonstrate the high economic burden of CVDs in France with a detailed analysis of expenditures and their main drivers. The developed tool will help decision makers to monitor the burden of these diseases but also to provide stake holders with a better understanding of trends and regulating actions.

Key messages
Economic burden of CVD in France is high: 10% of healthcare expenditure. Implementation of public health policy to prevent CVD and control risk factors must be a priority.
Characteristics of hospitalizations with influenza diagnosis, France, 2012-2017
Authors: Pivette M , de Lauzun V , Nicolay N , Scanff A , Hubert B 
Published: November 2019

Abstract

Background
Seasonal influenza surveillance in France is based on several data sources (ambulatory data, emergency department and intensive care unit (ICU) admissions, laboratory data, mortality). However, the data do not provide a complete measure of the impact of the epidemics on the hospital system. The objective of the study was to describe the characteristics of influenza hospitalizations from the French national hospital discharge database (PMSI) between 2012 and 2017 and to precise the burden of influenza by age group and by season.

Methods
All hospitalizations in metropolitan France with at least one ICD-10 code related to influenza (J09, J10, J11) as a principal, related or associated diagnosis between 1 July 2012 to 30 June 2017 were extracted from the PMSI. For each season, the total number of hospitalizations, admissions to ICU, incidence and lethality rates, lengths of stay and classification in diagnosis-related groups were described by age group.

Results
During the 5 seasons, 91 255 hospitalizations with an influenza-diagnosis were identified. The incidence varied significantly between seasons, from 12.7/100 000 in 2013-2014 to 45.9/100 000 in 2016-2017. A high number of cases was observed in elderlies in 2014-2015 and 2016-2017, marked by the circulation of A (H3N2) virus. The proportion of hospitalizations with an admission in ICU was 10%, and was higher in the 40-79 age group (19%). Lethality increased steadily with age, from 0.5% under 20 years to 10% in 80 years and older. Length of stay also increased with age. Significant regional disparities were observed, with higher incidence rates in South-Eastern France each season.

Conclusions
The analysis of influenza hospitalizations from the PMSI provides important elements on influenza burden, not available in the current surveillance systems. An annual analysis, stratified by age group, would provide an indicator of the impact of the epidemics on hospital system at the end of each influenza season.

Key messages
Important influenza incidence variations were observed between seasons by age groups. Severity and impact of influenza (mortality, ICU, length of stay) varied significantly by age group.
Community use of antibiotics and development of bacterial resistance: a case-control study in Italy
Authors: Ferrante G , Massari M , Da Cas R , Pantosti A , Pezzotti P , Moser V , Pagani E , Aschbacher R , Traversa G 
Published: November 2019

Abstract

Background
Antibiotic resistance is now a global emergency. An increasing number of infections are becoming difficult to treat and lead to longer hospitalizations, higher medical costs and increased mortality. The aim of this study is to assess, in a population at low prevalence of use of antibiotics, whether a previous use of these drugs is associated with the occurrence of clinically relevant resistance of E.coli to fluoroquinolones (FQs), one of the most widespread and critical bacteria resistance in Italy.

Methods
Through a data linkage of databases of the health information systems of the Province of Bolzano (Italy) a case-control study was carried out using 2016 data. All subjects for which the resistance of E. coli to FQs was tested by the regional microbiology reference laboratory were included in the study. Those with a positive FQs-resistant E.coli isolate were defined as cases (n = 409), while the others were considered controls (n = 933). For each subject the total number of prescriptions of any antibiotics and the total number of prescriptions of FQs in the previous year were detected through a record linkage with the drug prescription database. Information on potential confounding factors (age, gender, number of hospital admissions, days of hospitalization, number of surgeries, diagnosis of chronic diseases) were obtained from the database of hospital admissions. Multivariate logistic regression analysis was used to study the association between previous use of antibiotics (any and FQs only) and development of E.coli resistance to FQs.

Results
It was observed that for each unit increase in the number of prescriptions of any antibiotic, the probability for E.coli to develop FQs resistance significantly rises by 16%. This probability is much higher (45%) if the prescribed antibiotic is a FQ.

Conclusions
This study confirms the association between previous consumption of antibiotics and the onset of resistance even in an area with a low prevalence of use.

Key messages
The results of this study reiterate the need to prescribe and dispense antibiotics only when they are really needed. Health information systems allows to study the role of antibiotic use in the development of bacterial resistance, providing useful information for audit interventions among healthcare professionals.
Changes in mortality inequalities by marital status in Lithuania during 2001-2014
Authors: Sauliune S , Mesceriakova-Veliuliene O , Kalediene R 
Published: November 2019

Abstract

Introduction
Health inequalities have emerged as a big issue of public health in Lithuania. Recent studies have demonstrated increasing mortality differentials between marital status groups, occurring mainly due to a decline in mortality of the married populations.
The aim of the study - to determine changes in inequalities in mortality from major causes of death by marital status in Lithuania during 2001-2014.

Methods
Individual records from population censuses conducted in 2001 and 2011, National Mortality Register (period of 2001-2014), and Population Register (period of 2001-2014) have been linked using personal identification number. Study included those aged 30+. Mortality rates from cardiovascular diseases, cancer, external causes and digestion system diseases by the marital status (married and unmarried - never married, the widowed and the divorced) were calculated per 100 000 person years and standardized by age. Inequalities in mortality were assessed calculating rate ratio, while trends in it - conducting the Joinpoint regression analysis.

Results
Mortality from all analyzed causes of death among males and females in 2001 and 2014 was statistically significantly higher in unmarried compared to married. Inequalities in mortality by marital status increased statistically significantly in Lithuania throughout the period of 2001-2014 from cardiovascular diseases, cancer and external causes. The most significant increase in inequalities by 3.3% (p &lt; 0.05) on average per year was estimated from external causes among males. Inequalities in mortality from digestion system diseases did not change significantly throughout the study period.

Conclusions
Inequalities in mortality by marital status increased significantly in Lithuania throughout the period of 2001-2014 with the most significant increase from external causes.

Key messages
Mortality from all analyzed causes of death among Lithuanian males and females in 2001 and 2014 was statistically significantly higher in unmarried compared to married. Inequalities in mortality by marital status increased significantly in Lithuania throughout the period of 2001-2014 with the most significant increase from external causes.
Public health monitoring in Sweden focusing on inequality – a developmental work
Authors: Engström K , Makenzius M , Olsson G , Lindqvist N 
Published: November 2019

Abstract

Issue/problem
The overarching goal of the Swedish public health policy is to create the right societal conditions for good and equitable health throughout the population, and to reduce avoidable health inequalities within a generation. Relevant health topics and dimensions of inequalities in health should be monitored to enable effective interventions on the local, regional and national level. To achieve this a strong national health monitoring system (HMS) is central.

Description of the problem
The objective was to develop a high quality HMS to monitor a broad perspective of public health and its determinants, complemented by a more focused monitoring system of inequalities in health, with relevance on the local, regional and national level. A theoretical framework was developed and empirical mapping of relevant indicators conducted. An expert group was consulted and a country assessment of how to monitor health inequalities was carried out within the Joint action Health Equity Europe project. The developmental work started in 2018 and is not yet completed.

Results
A web-based monitoring system has been implemented to cover the broad perspective of public health and its determinants. All indicators are reported at the national level and, when possible, degradable at the local and regional level. In addition, a report with a focus on inequalities in health on a national level is published annually, and a longitudinal indicator-based comparative study, with results from Sweden’s 21 regions and 290 municipalities was published in 2019.

Lessons
General public health and inequalities in health may need to be monitored in different ways. To enable effective interventions, consideration must be given to at what level - local, regional or national - policy decisions are made.

Key messages
High quality health monitoring enables effective interventions. To reduce inequalities in health focused monitoring is required.