bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of maternity waiting homes on perinatal deaths in an Ethiopian hospital. A case-control study
Authors: Dalla Zuanna T , Fonzo M , Sperotto M , Resti C , Tsegaye A , Azzimonti G , Manenti F , Putoto G , Bertoncello C , Zanovello S 
Published: November 2019

Abstract

Background
A Maternity Waiting Home (MWH) is a residential facility located near a medical facility, where women with high risk pregnancies can await and be transferred to the medical facility shortly before delivery or earlier if a complication arise. MWH are widespread in the developing countries, to reduce the long distances to reach health facilities. The aim of this study was to investigate whether MWH was an effective strategy in reducing perinatal deaths at Wolisso Hospital in Ethiopia, from 2014 to 2017. This hospital is supported by the Italian NGO Doctors With Africa CUAMM, with a strong commitment to reduce maternal and child mortality.

Methods
Through a case-control study, we compared perinatal mortality among women admitted via MWH and women admitted directly to the hospital. Cases were mothers who experienced at least a perinatal death before discharge. For each case, two mothers who gave birth to one or more babies alive until discharge were selected as controls. 3 groups of confounding variables were considered: maternal conditions or related to the current pregnancy, variables related to the delivery and neonatal characteristics. A regression model was built adjusting for each group. Statistically significant variables were combined in a final model.

Results
1175 cases and 2350 controls were included. Women admitted through MWH showed a OR 0.49 (95%CI:0.33-0.71; p &lt; 0.000) for perinatal mortality when adjusted for the maternal/current pregnancy conditions, and a OR 0.60 (95%CI:0.40-0.90, p = 0.013) when adjusted for the delivery variables. In the final model the risk of perinatal mortality for women admitted to MWH was 54% less than those admitted directly to the hospital (OR = 0.46, 95%CI:0.30-0.70; p &lt; 0.000).

Conclusions
Our results show a more than halved risk of perinatal death cases for women admitted to the hospital through a MWH in rural Ethiopia, and support the policy implemented by the government in building such structures nearby each hospital.

Key messages
Maternity Waiting Home is a structure near a health facility, where pregnant women at risk wait for their delivery. MWH is an easy and effective tool to reduce perinatal deaths in rural Ethiopia.
Tobacco smoking in pregnant women: fifty years of evolution in France
Authors: Demiguel V , Blondel B , Bonnet C , Andler R , Saurel-Cubizolles M J , Regnault N 
Published: November 2019

Abstract

Background
Smoking during pregnancy is a major modifiable risk factor for maternal and foetal morbidity. We aimed to describe 1/smoking trends in France between 1972 and 2016, 2/ the factors associated with smoking cessation and reduction during pregnancy in 2016.

Methods
French National Perinatal Surveys are routine surveys based on a representative sample of births (N = 11,733 in 2016). Data were collected in face-to-face interviews in postnatal wards and from the mother’s medical record. Smoking rates before pregnancy and during 3rd trimester were estimated for each study year and characteristics associated with smoking reduction (relative percent change in number of cigarettes smoked before and during pregnancy &lt;50% or ≥ 50%) compared with smoking cessation were analysed using multinomial logistic regression.

Results
After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester (30.1% and 16.2%, respectively in 2016). In 2016, 45.8% ceased smoking during pregnancy, 37.2% reduced by ≥ 50% their consumption and 16.9% reduced by &lt; 50% or did not reduce at all. The more cigarettes women smoked before pregnancy, the greater this reduction was (p &lt; 0,001). Moderate reduction (&lt;50%) vs stopping was more frequent in multiparae compared to nulliparae (aOR=2,47 [IC95%:1,93-3,15]) and in women with low education (aOR(&lt;High school vs university graduates)=7,20 [4,78-10,82]) and low income (aOR(&lt;1500€per month/&gt;3000€)=2,30 [1,51-3,50]).

Conclusions
Smoking rates were high before and during pregnancy in France in 2016. Socio-demographic factors should be considered when targeting women most at risk of continuing smoking during pregnancy.

Key messages
After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester in France. Supporting female smokers of childbearing age in their attempts to quit and remain non-smokers even after pregnancy is crucial, especially in multiparae and women in poor social condition.
Regulation of health care professionals as a quality strategy
Authors: Panteli D , Kreutzberg A , Reichebner C , Maier C , Destrebecq F 
Published: November 2019

Abstract
Health professionals are both a health system input and an active component of the functions that the health system performs. As such, the performance of the health workforce is directly linked to the quality of health services. Regulation is essential to define a clear framework within which health professionals acquire and maintain the competence needed to provide health services that are of high quality, i.e. that are safe, effective and patient-centered. This presentation discusses the evidence on a sequence of strategies that regulate health professionals, looking at how they are currently deployed in Europe, how (cost-)effective they are, and what can be done to optimize their implementation.
Adopting a comprehensive perspective ranging from the entry into training to life-long maintenance and demonstration of competence, the presentation brings together a) strategies to develop professional competence (including training structure and contents, curriculum development and the accreditation of institutions for health education); b) strategies that regulate the entry of physicians and nurses into their professions (e.g. licensing and registration); c) mechanisms to maintain competence (e.g. continuing professional development); and d) levers to address instances when fitness to practice comes into question.
“Pay for Quality” (P4Q) as a quality strategy
Authors: Quentin W , Eckhardt H , Smith P 
Published: November 2019

Abstract
P4Q can be implemented in various health care settings, targeting a range of health care providers or professionals. P4Q schemes can reward high quality measured in terms of structures, processes, and/or outcomes, and/or penalise low quality and are implementable in line with other quality improvement interventions. This presentation aims to clarify the concept of P4Q, highlight the use of P4Q schemes in different settings in European countries, and systematize the evidence on the effectiveness, cost-effectiveness and implementation of P4Q as a quality strategy.
We could identify fourteen primary care P4Q programmes and thirteen hospital P4Q programmes in a total of 16 European countries. P4Q schemes in primary care incentivise mostly process and structural quality with respect to prevention and chronic care. P4Q schemes in hospital care prioritize improvements in health outcomes and patient safety. Studies suggest small positive effects on process-of-care (POC) indicators in primary care but not in hospital care. Evidence on health outcomes and patient safety indicators is inconclusive. Cost-effectiveness is unlikely because of lacking effectiveness. P4Q schemes are more effective when the focus of a scheme is on areas of quality where change is needed and if the scheme embraces a more comprehensive approach, covering many different areas of care; however, such programmes are generally technically and politically difficult to implement. In this light, this presentation will conclude with a number of recommendations, both technical and policy-oriented.
Awareness of HPV and drivers of HPV vaccine uptake among university students in Italy
Authors: Baldovin T , Cocchio S , Fonzo M , Bennici S E , Buja A , Bertoncello C , Baldo V 
Published: November 2019

Abstract

HPV vaccination is a milestone in primary prevention. However in Italy, vaccine coverage is still nowhere near the target of 95%. We investigated drivers of vaccine uptake among university students, as they are likely to have just assumed a central role in their healthcare decision-making and potential barriers may differ from parents.
University students aged 18-25 were asked to fill in a questionnaire. The effect of socio-demographic and behavioural characteristics on HPV awareness was assessed with a logistic regression adjusting for age, gender, nationality, degree course, relationship, age at first intercourse, number of sexual partners, smoking, sexual orientation, past diagnosis of STDs and knowledge of people who had received HPV vaccine. A second regression adjusting also for information sources, awareness and knowledge investigated drivers of vaccine uptake.
9,988 questionnaires were included; awareness of HPV and vaccine was 83.3% and 69.9%, respectively. Awareness (adjOR: 3.3 95%CI 2.3-4.6) and a good knowledge positively affected acceptability, as well as a previous diagnosis of STDs and knowledge of vaccinated people. Healthcare workers (adjOR 1.6 95%CI 1.4-1.9) and family members (adjOR 1.7 95%CI 1.4-2.1) were the most influencing information sources, even if knowledge of vaccinated people was by far more persuasive (adjOR 2.7 95%CI 2.2-3.3). Only 12% of participants were acquainted with skin to skin HPV transmission, while 75% believed in a full effectiveness of condom; less than 22% associated HPV with cancer (other than cervical cancer).
Efforts to increase awareness are likely to be worth considering that: awareness is the main determinant of vaccine uptake; only 50% of individuals not interested in receiving vaccine were aware of it; males are much less aware (adjOR 0.09 95%CI 0.07-0.11). Moreover, this study spotlights some misconceptions and may provide suitable evidence in tailoring more efficacious communication strategies.

Key messages
There is room for improving the awareness of HPV. Efforts are likely to be worth since it remains the main determinant of vaccine uptake. Awareness has been growing but a gender gap still persists. Communication should focus more on HPV involvement in neoplasia other than cervical cancer; transmission via skin to skin contact; multiple sex partnership; partial protection of condom.
Measles outbreak at the Val Thorens ski station, France, 2019
Authors: Brottet E , Ronnaux-Baron A S , Grangeret N , Deher M , Andrivot B , Fougere E 
Published: November 2019

Abstract

During the 2019 winter season, a measles outbreak occurred at the Val Thorens ski station in France, in an area frequented by over 300,000 holiday-makers (70% foreigners) and 2,500 seasonal workers.
Between 24/01/2019 and 15/04/2019, 55 cases were reported (18 confirmed and 37 clinical). Apart from 5 infected children under 2 years old attending the same nursery, cases were mainly seasonal workers between 19 and 41 years old. Five cases were hospitalised, one with severe pneumonia. Of the 36 cases with known vaccination status, 25 (69%) had not completed 2-dose vaccination. Other confirmed cases in visitors to Val Thorens were reported in neighbouring valleys (n = 3), and in other French regions. One case was reported the French overseas territory Guadeloupe (WHO ‘Americas’ region where measles has been eradicated). British, Belgian, Danish, Dutch and Irish authorities reported 7 cases in people who had stayed in the area. The list of exported cases is non-exhaustive.
The regional health agency (ARS) provided increased information on epidemic risk and vaccination recommendations, particularly to health professionals and the town council. Identifying all contacts was difficult because many had occurred with seasonal workers. In addition to the approximately 150 vaccinations carried out by the Val Thorens medical centre from the start of the outbreak, only 41 other people were vaccinated in 5 free vaccination sessions organized in situ by the ARS, and the local medical and immunization centres.
The large attendance at the station favoured the outbreak and its extension in France and abroad. Due to low measles vaccine coverage in France (80.3% for 2-dose cover in 2 years in 2017), outbreaks in non-vaccinated and not fully vaccinated populations are increasing, as seen in Val Thorens.

Key messages
A major measles epidemic occurring in an undervaccinated population in frequent contact with tourists, led to the extension of cases in France and Europe. Despite 5 free in situ vaccination sessions, with the mobilisation of local health professionals, few seasonal workers came to be vaccinated.
The role of country-level structural stigma on sexual orientation disclosure and discrimination in health care settings among lesbian, gay, and bisexuals across Europe
Authors: Bränström R , Pachankis J E 
Published: November 2019

Abstract

Background
The national climate surrounding sexual minorities (i.e., those self-identifying as lesbian, gay, or bisexual [LGB]) varies greatly worldwide. Recent Cross-European studies have shown that country-level structural stigma is a strong determinant of sexual minority individuals health risk behaviors and mental health. The consequences of the significant country-level variation in structural stigma on sexual minorities’ experiences of health care discrimination and disclosure of sexual orientation to health care providers have not been previously investigated.

Methods
In 2012, 86 000 sexual minority individuals (aged 18 years and older) from all 28 European Union countries responded to questions concerning discrimination in health care settings and sexual orientation disclosure to health care providers (EU LGBT survey). Structural stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of sexual minority acceptance among citizens of each country.

Results
Disclosure of sexual orientation to health care providers were much more common in low stigma coutries (e.g., the Netherlands, Sweden, UK) compared to high stigma coutries (e.g., Lithuania, Latvia, Slovakia). Experiences of discrimination in health care settings were more common among LGB indiviudals who were open about their sexual orientaiton and increased by degree of country-level structural stigma.

Conclusions
Disclosure of sexual orientation and experiences of discrimination in health care settings varies greatly among LGB individuals in Europe largely due to structural stigma surrounding sexual minorities.

Main messages
These findings highlight the importance of eliminating legislation, policies, and national attitudes that promote the unequal treatment of sexual minorities in currently unsupportive European countries.
Smoking among immigrants in Norway, results from the Living Condition Survey among immigrants 2016
Authors: Kjøllesdal M , Øien-Ødegaard C , Grewal N K , Indseth T 
Published: November 2019

Abstract

Introduction
Smoking is one of the major risk factors for health and disease. Knowledge on smoking prevalence in groups of immigrants is needed to tailor interventions for smoking cessation.

Methods
Statistics Norway carried out a Living Condition Survey among immigrants in 2016. Participants were immigrants from twelve countries of origin with ≥2 years residency in Norway. They were interviewed in the main language of their country of origin, English or Norwegian as preferred. In this report 4339 immigrants aged 15-66 years were included. Participants were asked “Does it happen that you smoke?” and all participants answering yes to this question were classified as smokers.

Results
A smaller proportion immigrant women (14%) than other women (21%) smoked, whereas a larger proportion immigrant men (32%) smoked compared to other men (22%). Among immigrant women, the proportion of smokers varied greatly, from almost no smokers from Eritrea and Afghanistan (&lt;1%) to a high proportion among those from Turkey (32%) and Kosovo (29%). Among men, a low proportion of Eritreans (15%) and Sri Lankans (16%) smoked, but &gt;40% of men from Vietnam, Turkey, Poland and Kosovo smoked. Having moved to Norway in young age and long duration of residence increased the odds of smoking among women. Men without a close friend were more likely than other men to smoke.

Conclusions
Variation in smoking by country of origin and gender should taken into account in future smoking cessation initiatives and prevention among immigrants.

Key messages
Smoking prevalence among immigrant vary substantially by country of origin and gender. Smoking is related to acculturation and social environment.
Towards quantifying CO2 emissions from EPH conference travel
Authors: Fehr R , Zeegers Paget D , Mekel O C L , Bos N 
Published: November 2019

Abstract

Background
Aviation is accountable for significant emissions of carbon dioxide (CO2). Factors determining emissions include, e.g., trip distance, aircraft fuel efficiency, cabin class, atmospheric conditions, and stopovers. Approaches to estimate the carbon footprint are available, e.g., as carbon emissions calculators, offered by carbon offset providers.
Goal: To estimate the amount of CO2 emissions associated with EPH conference air travel, for fostering awareness among EPH conference attendees.

Methods
Based on EPH attendees’ empirical distribution of countries of origin for the 2017 Stockholm and 2018 Ljubljana conference, rough estimates of travel distances, CO2 emissions, and potential carbon offset costs were produced. In the absence of attendees’ detailed travel information, simplifying assumptions had to be made, e.g. on air vs. ground travel, place of departure, and stopovers. In approach A, using two different offset calculators, we look at a given “sample” country which provided a large fraction of foreign participants in both 2017 and 2018, then try to extrapolate to participants at large. In approach B, we use a rough approximation of total distance travelled by all participants, and an average emission value per distance unit.

Results
In approach A, expectedly, the emission estimates provided by the two different calculators and the associated price tags for offsetting were rather similar, whereas the overall approach B created lower estimates of CO2 emissions. In summary, the conference air travel was estimated to emit 650-930 tons CO2, with the cost for setoff being roughly € 20.000. In a typical case, the conference air travel CO2 emission of a person (foreign to the conference country) was estimated as being 580 kg. For comparison: to bring climate change to a halt, the total annual CO2 emission per person needs to be below 600 kg.

Discussion
While estimates should be improved, a major task lies in promoting CO2 emission reduction and mitigation.
Capacity building process – medical curricula implications on the long term
Authors: Ben Rejeb M , Said-Latiri H , Zedini C h , Nabli-Ajmi T h , Dhidah L , Mtiraoui A 
Published: November 2019

Abstract

Introduction
Currently, the Tunisian medical schools are going through a transition period marked by the reform of medical studies. Their curricula must be adapted to globally recognized medical education guidelines. Aware of the importance of teaching scientific research and public health, they are making efforts to integrate this new approach of education within several levels (undergraduate, postgraduate and continuous professional development). In this perspective, the public health research centres (C4EHPs) created under the CONFIDE project provide an opportunity to support such integration.

The progress
The Faculty of Medicine of Sousse was founded in the 70s to open up to its local and regional community. So, the public health topic was one of the top priorities. With the reform started in 2011, the importance of this topic has been further developed by integrating many modules that cover different aspects of public health throughout the curriculum. In this context, the materials, modules and information developed within the CONFIDE project complement the existing modules and bring a fresh perspective on the teaching methods. The faculty of Medicine of Sousse will integrate this information in the curricula to promote scientific production by allowing students to build up their scientific research knowledge, develop higher research competencies such as critical-thinking, problem-solving and data interpretation and analysis and train public health specialists to be health policy makers in the future.

Conclusions
Integrating the new approach based on the achievements of the C4EHP is an essential step for our faculty to develop more training in public health, ensure good quality of its teaching process and participate in the development of health policies that will improve the health of the Tunisian population.
Innovative strategies for the implementation of best practices
Authors: Van Dale D , Leenaars K 
Published: November 2019

Abstract
The Netherlands’ best practice portal for health promotion interventions includes approximately 350 interventions. The aim of the portal is to support policy and practice with evidence based information. There are five different levels to indicate the strength of their evidence base. In 2014, a study on the implementation of the best practices included in the portal showed that health promotion practitioners often do not implement them. One of the arguments given to opt for other interventions than those listed in the portal was the assumption that the ‘standard interventions’ will not fit their particular local context, and that adjusting a best practice is not possible.
We will present the criteria and procedure of the assessment of the quality, effectiveness and the feasibility of health promotion interventions. There after we present two strategies to increase and improve the take up of best practice implementation. The first strategy is to describe and present the core elements of the interventions. This strategy facilitates the possibility for the sound adjustments of a best practice. The second strategy is to identify the common effective elements of a group of interventions, and present that information in an accessible way to policy-makers and practitioners. Effective elements were identified through systematic reviews in combination with focus group interviews with health promotion practitioners. The result is a What works document (What works, What probably works, What doesn’t work and What’s unclear).
An example of the second strategy is a synthesis of the effective elements of fall prevention interventions. These elements were translated into a practical user’s guide, and illustrated with best practice interventions from the portal. Policy-makers and health promotion practitioners appreciated the new way of presenting the best practices.