bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing social determinants of noncommunicable diseases in primary care: a scoping review
Authors: Allen L N , Smith R W , Simmons-Jones F , Roberts N , Honney R , Currie J 
Published: October 2020

Abstract

Background
Noncommunicable diseases (NCDs) are the leading cause of global mortality, and their risk factors largely manifest at the community level. In collaboration with public health, primary care is well placed to assess and address the local social determinants of NCDs (SDONCDs). Post-Astana, many countries are reorienting their primary care systems to incorporate these traditional public health functions, but there is little evidence to guide reform. We aimed to collate examples of primary care organisations that already engage in this activity.

Methods
Following Cochrane guidance, PubMed, MEDLINE, Embase & HMIC were searched from inception to 28/7/2019, along with hand-searching of references for any study designs that examined international primary care organisation(s) that addressed local SDONCDs. Independent dual review was used for screening, data extraction, and quality assessment - for which we used ROBINS-i.

Results
Searches identified 666 studies of which 17 studies from Canada, South Africa, UK, and USA were included. All used descriptive study designs. Individual-level surveys and interviews were the most common SDONCD data collection methods reported. Fewer studies collated population-level data held by external agencies. Actions ranged from individual-level interventions to novel representation of primary care organisations on system-level policy and planning committees. Several enablers and barriers to collecting and mobilising social determinant data within well- and under-resourced primary care settings were identified.

Conclusions
Several models of integrated public health and primary care already exist that fulfil the Astana mandate of developing place-based preventive services, tailored to local needs. Public health input at this granular level is required to support primary care services as they extend their scope of practice, and to assist with monitoring and evaluation of new initiatives to mitigate unmet health and social needs.

Key messages
Primary care organisations are increasingly being encouraged to assess and address local social determinants of noncommunicable diseases but there is weak evidence to guide reform. The different approaches described in our review can help policymakers tasked with integrating public health functions into primary care.
Managed care for reducing lower extremity amputations in Type 2 diabetes: a systematic review
Authors: Meza-Torres B , Carinci F , Heiss C , Joy M , de Lusignan S 
Published: October 2020

Abstract

Background
There is limited evidence on the effect of organizational arrangements on foot complications in diabetes. We evaluated the effectiveness of different organizational arrangements in the delivery of care for the reduction of lower extremity amputations (LEA) among people with Type 2 Diabetes (T2D) affected by foot ulcers.

Methods
We conducted a systematic review of the scientific literature published between 1999-2019 on Medline and Embase, using the following key terms as search criteria: people with T2D, diagnosed with diabetic foot ulcer, treated with specific processes and pathways of care, experiencing LEA as an outcome.

Results
A total of 57 studies were eligible for the study, investigating the following organizational aspects: dedicated teams; care pathways and protocols; multidisciplinary teams; and combined interventions. Among the retrieved papers, only 7 could be used for binary outcome meta-analysis. Overall, intervention groups showed a 29% reduced risk of any type of LEA (OR = 0.71, 0.52- 0.96). The effect was larger when focusing on major LEA alone, leading to a 48% risk reduction (OR = 0.52, 0.30-0.91).

Conclusions
Specific organizational arrangements may help reduce the burden of T2D among subjects affected by foot ulcers, particularly in terms of major amputations. Further studies should use standardized criteria for the investigation of care arrangements. Implications for practice are that organizational settings highlighted from the literature as potentially effective could be mapped to the local routine and continuously followed-up using data to verify their advantages in real world conditions.

Key messages
Specific organizational arrangements can have a positive impact on the reduction of LEA among people with T2D affected by foot ulcers. Continuous monitoring and benchmarking between different practices using routine observational data may identify sources of heterogeneity among services following the same set of clinical guidelines.
Lessons towards the roadmap on implementation and sustainability of cancer control actions
Authors: Albreht T 
Published: October 2020

Abstract
The speaker will present the Innovative Partnership for Action Against Cancer (iPAAC) Joint Action (JA), which is aiming to develop innovative approaches to advances in cancer control and a Roadmap on Implementation and Sustainability of Cancer Control Actions, identifying areas of relevance to AMR. The issue of AMR is an important issue in view of cancer management. It pertains both to the control of one of the pathogens clearly identified as conducive to cancer - Helicobacter pylori as well as to the issues arising from the vulnerability of the cancer patients in the course of oncological treatment. In the previous JA on Cancer Joint Action on Cancer Control (CanCon), an expert consensus process led to the conclusion that population-based screening for Helicobacter pylori, followed by antibiotic treatment at large scale could trigger AMR, even if it could offset some morbidity due to stomach cancer. It is clear that further research activity is necessary to explore this issue since stomach cancer remains a public health challenge. This is important because of late stage detection, resulting in poor survival. The other important issue is the need to protect cancer patients in treatment and beyond by securing effective antibiotic treatment for infections arising from their condition and/or following their treatment.
From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care
Authors: Petelos E , Lionis C 
Published: October 2020

Abstract
The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.
Adolescents’ stress - a challenge for adults in charge - The Improve the Youth project
Authors: Kleszczewska D , Mazur J , Dzielska A , Gaspar T , Gaspar de Matos M 
Published: October 2020

Abstract

Background
The project was an answer to the results of the HBSC (Health Behaviour of School-aged Children) study 2013/2014 which indicated an alarming situation regarding the adolescents' mental health. The aim was to investigate mental health problems of Polish and Portuguese youth and to create tools and materials which can be a professional help in this matter. Improve the youth project consisted of two main elements: research and implementation phase. The mixed-method approach was applied in the project. Quantitative and qualitative research methods were used. 2004 pupils (aged 13-19) were surveyed in 89 schools in 2017/ 2018 in Poland. Findings form qualitative study were guidelines for quantitative research. Perception of stress among young people was selected as the leading subject. Short Form Perceived Stress Scale (PSS-4) in a shorter version of 4-statement were used. There were two advisory boards: first - practitioners (psychologists, pedagogists, teachers, social workers) and second - adolescents. Both were consulted to prepare all materials.

Results
Stress levels are higher in girls than in boys, and they increase with age: between 13 and 19 year of age the increase in the prevalence of high stress level was 5,3% in boys and 12.5% in girls. Family affluence, school achievements and school burden were identified as stress determinants of adolescents.
Materials presenting the data and giving practical information and tools on how to support adolescents in coping with stress: guide for adults, guide for youth created by youth and scenario of workshops.
20 workshops for young people run by young people were organised in both countries for about 200 adolescents
Results and materials were presented to youth organizations, social institutions and decision makers responsible for youth policy during two 'Improve the Youth' conferences in Poland and in Portugal.
Comparing trends of perinatal mortality in two rural areas of Matlab, Bangladesh
Authors: Rahman A , Anwar I , Austin A 
Published: October 2020

Abstract
The study conducted in a rural sub-district, Matlab, Bangladesh among adolescent motherhood (10-19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh included total of 4,996 adolescent mothers in the analysis. Chi-square tests and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death. The fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 year of study period. The adjusted odds of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69 (95% CI: 0.52 - 0.91, p-value&lt;0.05). Significant determinants of perinatal death among adolescent mothers were: maternal education, paternal education, mothers' age at first birth, asset score and distance from nearest facility. Dr. Rahman will raise the importance of addressing these determinants in designing health policy interventions targeting this specifically vulnerable group.
A new public health agenda for Europe: health under a sustainable development framework
Authors: Nogales Crespo K A , Abrantes A , Dias S 
Published: October 2020

Abstract

Background
As a science and normative framework, sustainable development attempts to comprehend and regulate the interaction between the global economy, society, and environment. The connection between health and sustainable development is widely recognized by the Sustainable Development Goals (SDGs), challenging the way we understand and do public health. In the absence of operationalizing tools, the SDGs would have limited value. Using policy documents (PDs), this study aims to diagram a new public health agenda for sustainable development in the WHO European Region.

Methods
32 PDs ranging from 2010 to 2018 were identified and selected using the contents of the 2015-2018 Sessions of the Regional Committee for Europe. Based on the alignment of PDs and health-related SDG targets, a content analysis was used to characterize a new public health agenda.

Results
Preliminary results show several pathways of bidirectional contribution between heath, the environment, and economy. Closing the health inequity gap demands upstream measures to combat behavioral risk factors using a life-course and gender approach and a mix of cost-effective universal and target interventions. A transformative process of health and health delivery systems to provide people-centered, demand drive interventions are necessary. Addressing the determinants of health requires strong leadership in the health sector and partnerships for policy coherence. Preparedness to human and environmental induced emergencies requires tackling the root causes of climate change and violence and investing in systems and individual's resilience.

Conclusions
A public health agenda under the SDGs invites stakeholders to re-think policymaking, understanding health as a pattern of relations intertwined with the environment and economy. Moving beyond the treatment of diseases, this agenda calls for upstream interventions to tackle the determinants of health and improve health delivery systems to close the gap on health equity.

Key messages
The SDGs challenge the way we understand and do public health. A public health agenda for the SDGs conceives health as a shared responsibility across governance levels and policy sectors.
Exploring the use of nudging in public health lifestyle interventions: A literature review
Authors: Ledderer L , Kjaer M , Madsen E , Busch J , Fage-Butler A 
Published: October 2020

Abstract

Background
The concept of nudging has been imported from behavioral economics into the public health context to correct 'unhealthy behaviours' and produce health-promoting behavior changes in individuals. However, there is lack of clarity as to what constitutes a nudge and whether nudging techniques in public health lifestyle interventions are effective. The aim of this literature review is to identify nudging techniques used in public health lifestyle interventions and to investigate whether nudging techniques induce expected healthy lifestyle changes in interventions that relate to diet, exercise, sleep, alcohol and smoking.

Methods
A systematic literature review on the concept “nudging” in public health lifestyle interventions was conducted, applying a free text search strategy on a set of search terms in three databases: PubMed, CINAHL and PsycINFO. Articles meeting the inclusion criteria were included in our data set, and we performed a meta-synthesis to construct interpretative explanations.

Results
66 original studies published in international peer-reviewed journals were identified. The findings showed that most nudging interventions involved diet/nutrition (n = 55), were carried out as single experiments, lasted for a short period of time and that the majority had the intended effects. Specific nudging techniques were identified and sorted into eight broader categories. The most commonly used nudging technique involved making healthier food items more apparent and accessible than less healthy foods.

Conclusions
The synthesis showed that these studies were limited with regard to their design, target groups, duration of the intervention, measures of effectiveness and critical reflection on ethical issues.

Key messages
Nudging may be effective in producing immediate behavioral changes; however, there is little evidence that nudging interventions result in lasting behavioral changes outside the setting of the studies. Further critical discussions about the implications of nudging in public health lifestyles intervention are required.
A diabetes focused inter-sectoral approach to a more equal and healthy living environment in Turin
Authors: Costa G , Pilutti S , Di Monaco R , Gnavi R 
Published: October 2020

Abstract
The purpose of the project is to pilot an innovative intervention aiming to enroll the local actors in the responsibility to reduce inequalities in the epidemic of diabetes in the city. In the next few years, all the actors of the diabetes pathway (mostly the health professionals but also the local non-health actors) should analyse and recalibrate their organization and functioning, revising primary care system in the light of the paradigm of pro-active medicine
At first, a community of practice of health professionals involved in diabetes is being convened with the mandate to revise the process of generation, recognition and treatment of diabetes in order to identify the mechanisms potentially able to create inequalities. At the same time a community of practice of local non-health actors is being convened to react to the analysis of mechanisms of the community of practices of health professionals, with the mandate to interpret the data and enrich the diagnosis on mechanisms, relevance and responsibility. The two communities of practice will elaborate a plan of innovation involving the responsibility of the institutions and actors that are playing a role in the mechanisms generating diabetes inequalities, setting targets, assigning responsibilities, orienting resources. The Turin Longitudinal Study will serve as a tool for monitoring the process and assessing results and impact of this innovation. The expected results concern two types of effects, which are monitored. Firstly, improving the care system and collaboration among different services should have an impact on the accessibility and quality of care. These improvements will be introduced concerning specific problems that emerge from the analysis. Secondly, social capital should increase thus increasing the resources available to people, especially the most fragile and isolated ones. The results of this pilot on diabetes will be replicated for the other chronic diseases of the National Plan for Chronic Disease.
“Nudge” in Lucca’s Hospital: separate waste collection improvement and cigarettes dumping reduction
Authors: Canale A , Giardi F , Gandolfo S , Lorenzi V , Corda V , Farneti S , Taddeucci M , Maielli M , Privitera G , Mencaroni S 
Published: October 2020

Abstract

Background
Positive behaviour and user's collaboration improved by using choices orientation techniques; in Lucca's Hospital (North-West Tuscany Sanitary Authority) this approach has improved separate waste collection execution and has decreased cigarettes dumping in commons areas.

Objectives
Phase 1 (May 2019): amendment of choices architecture recyclable waste bins in commons areas and into the wards were boosted, with “islands” clearly visible from any point of common paths; in the transit areas were installed exclusively multi-material and paper bins, equipped with signs that clearly indicate which products deliver; residual waste bins were allowed exclusively in certain points.ashtrays at the hospital entrances were eliminated and replaced with signage indicating smoking cessation benefits and the presence of areas “put your cigarette out” along the structure approach routes.
Phase 2 (scheduled for May 2020): “nudge” action
Spreading in community (using press and social-media) and locally (using poster) of the slogan “In San Luca we are taking a step forward: don't lag behind!”. This message stimulate the perception of an ongoing change to join.

Results
A decrease in residual waste collection and in instances of non-compliance in separate waste collection was detected. Decorum in the outdoor environments improved, with a reduction of user's reports and extra-cleaning interventions.

Conclusions
The described actions have improved user's collaboration, management efficiency of waste disposal and cleaning service, perceived quality and cost.

Key messages
Imitating a social model appears to be successful motivator of virtuous behaviours. Choices architecture and “nudge” techniques may improve citizens’ care pathways governance.
25.G. Round table: Public health codes of ethical professional conduct for effective practice
Authors:   Organised by: UK Faculty of Public Health, EUPHA Ethics in public health section,   Chair persons: Maggie Rae - UK, Els Maeckelberghe – EUPHA-ETH
Published: October 2020

Abstract
One of the major outputs of the WHO Regional Office for Europe “Coalition of Partners” initiative has been the development of the “Road map for professionalization of the public health workforce in Europe.” Public health ethics was considered as one of the key pillars for practice for the workforce. The report highlighted the case and urgent need for development of Public Health Codes of ethics and professional conduct (CoC) as an essential part of workforce development strategies. The development of CoCs is considered essential to pursue the mission and moral mandate of public health and to clarify the purpose of professional activities in public health. Scotland has been working as an initial pilot site in Europe to consider developing a CoC for its workforce as part of its public health reform program. The purpose of this roundtable workshop is to share and reflect on the learning from the process, experience and findings from development of the Scottish CoC as the first pilot site in Europe and implications for development of such codes in other public health systems. The workshop will also share the evidence, rationale and background to CoC with research and learning from around the world on the issue. The Roundtable will include brief presentations by an experienced expert panel of senior public health leaders, ethicists and academics who have been working on development of public health Codes of professional conduct. This will be followed by reflection, consultation and debate with participants around the case, nature and options for development of codes of practice and distinguishing features for public health practice. There are issues to whether there is need for country specific, regional or global codes of ethics taking account core public health values and implications for practice. One of the key issues identified is fundamental importance of ensuring such work is linked to a strategy and activities to build competency and capacity around public health ethics and law and to ensure resources, systems and robust education and training activities are put in place for a sustainable development of the issue.

Key messages
The Development of CoCs is important in order to support the workforce, pursue the mission and moral mandate of public health and clarify the purpose of professional activities. There is need to develop activities and strategy for building competency and capacity in public health ethics alongside development of Code of ethics and professional conduct.
The role of vaccines in combating antimicrobial resistance
Authors: Jit M , Cooper B 
Published: October 2020

Abstract
Vaccination is one of the most effective measures to reduce antimicrobial resistance in both human and animal pathogens. This presentation reviews the multiple pathways by which vaccines may act to reduce resistance: they can prevent infections by focal pathogens, reducing the need to use antibiotics; they can selectively protect against resistant subtypes of a pathogen; they can reduce infections by other pathogen species which are routinely treated with antibiotics (not necessarily appropriately) thus reducing bystander selection; and they could selectively reduce transmission in settings such as hospitals which may have higher proportions of resistant strains. Because vaccines are highly specific to their targeted pathogens, they are much less likely to induce resistance compared to antibiotics. Hence, they can be delivered to large populations as a preventive measure to reduce transmission. The impact of vaccination on resistance has been demonstrated for vaccines against Streptococcus pneumoniae, Haemophilus influenzae type b and influenza. Current and pipeline vaccines against pathogens such as Vibrio cholerae, Escherichia coli, Salmonella typhi, RSV, diarrhoeal viruses and nosocomial bacteria may also have potential to reduce resistance. Economic evaluations of vaccines need to be expanded to capture their benefits in reducing resistance, in order to incentivize development and introduction of the right vaccines. Accurately doing so will require health systems, epidemiological and economic research.