bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Roma people exposed to NCD? Modifiable risk factors in a rural Roma community from Romania
Authors: Mangaloiu D , Bratu E , Furtunescu F , Minca D 
Published: November 2019

Abstract

Background
Knowing the prevalence of modifiable risk factors for noncommunicable diseases is the first step to plan effective public health interventions. The study aims to identify the prevalence and distribution of risk factors of non-communicable diseases (NCD) among adult Roma population in a rural community.

Methods
Using a tool based on the WHO stepwise approach, a cross-sectional study was carried out among a sample 116 adults aged 18-85 years (52 male and 64 female), from a rural community with 800 Roma members. The study instrument included questions to record behavioral risk factors (smoking behavior, alcohol drinking, diet and physical activity and also data on anthropometry and value of blood pressure). Descriptive statistics methods were used to analyze the data.

Results
The smoking prevalence was 35,3% (95%CI, 27.0 to 44.3,) higher for men (49,9%, 95%CI, 36,6-63,4%) than for women (23,4%, 95%CI, 14.2-34,9), higher than the smoking prevalence recorded for Romanian population in 2017 Eurobarometer study. Prevalence of obesity (body mass index ≥30 kg/m[2]) was observed to be high among Roma respondents 34,48% (95% CI, 26,26 to 43,47) compared with self-reported obesity rates among adults in Romania (9%, Eurostat, EHIS 2014). The observed proportion of obesity is similar for both genders, but central obesity was lower for men compared to women (57,4% to 79.6%). There was observed a higher proportion of people declaring they eat fruits less than once on a week (25%, 95% CI, 17,7 to 37,4) and adding salt before tasting the dishes (58,6%). Most of interviewed people have a sedentary lifestyle with less than 30 minutes of physical activity per day.

Conclusions
The high prevalence of risk factors for NCD in this rural Roma community indicates the likelihood of a high future burden of illness.

Key messages
There is a need for both further research into the health of Roma people regarding NCD and prevention interventions to address behavioral risk factors for NCD. Knowing the prevalence of modifiable risk factors for noncommunicable diseases is the first step to plan effective public health interventions.
Effects of Private Health Insurance on Unmet Medical Experience in Chronic disease Patients
Authors: lee J H 
Published: November 2019

Abstract

Background
Chronic patients are called ’long-term disorders,’ as they last for more than a year. They need continuous care, so health care through easily accessible medical institutions such as primary care is needed for them. In South Korea, however, they are mostly managed through secondary medical service systems, such as hospitals that are difficult to access. This causes them to increase their own burden rate, limiting their ongoing management of the chronic disease. However, it is known that Korea’s private health insurance policy affects the use of medical services, their own burden rate and reduces the unmet medical experience. Therefore this study aims to analyze the impact of the Korean chronic disease on private insurance subscription and unmet medical experience.

Methods
Using the 2014 survey data of the Korea Welfare Panel, the final analysis of the study was 4,243 households with chronic diseases among 6,581 households. The independent variable of this study is whether private health insurance is subscribed or not, and the dependent variable is unmet medical experience due to economic factors. The analysis method used frequency analysis and logistic regression. [Use SPss 22 for analysis]

Results
1,417(33.4%) of households subscribed to private insurance. The figure is significantly lower than the country’s reported private health insurance subscription rate (72.6%). Based on the median income of 60 percent of household income, high-income households have lower unmet medical experience than low-income households. In the case of unsubscribed private health insurance among the people with chronic diseases, the unmet medical experience was 1.921 times higher than that of those who signed up.
Conclusions: In order to reduce the burden on chronic patients, the government needs to strengthen the primary medical care system.Reinforce connectivity with private insurance through public financial support of national health insurance.

Key messages
Chronic disease. Private health insurance.
Legal policy challenges in withdrawal of dialysis treatment in Japan
Authors: Tanaka M , Kodama S 
Published: November 2019

Abstract

Issue/problem
In 2017, Japanese dialysis patients and kidney transplant cases numbered roughly 330,000 and 1,700, respectively. In March 2019, a patient died after a physician terminated her kidney dialysis at a hospital in Tokyo. The Tokyo Metropolitan Government and the Japanese Society for Dialysis Therapy (JSDT) investigated the case, questioning the patient’s terminal status and desire to withdraw her request to terminate dialysis.

Description of the problem
No Japanese law addresses treatment withdrawal, but several court decisions and the Ministry of Health, Labor and Welfare’s process guidelines and JSDT guidelines address treatment withdrawal from terminal patients. We examined relevant court decisions and guidelines, identifying three legal policy issues that may impact legal policy discussions on treatment withdrawal in other countries, regardless of the enactment status of such laws.

Results
First, the patient was not “terminally ill” as defined by the court rulings and guidelines. Second, a clear decision based on appropriate informed consent from the patient seemed absent, violating the court rulings and guidelines. Third, the physician’s judgment of patient competency for decision-making may have been missing.

Lessons
We considered problems beyond the court rulings and guidelines by focusing on the patient’s right to self-determination and treatment refusal in other countries. The Patient Self-Determination Act and the Patient’s Bill of Rights (US) as well as court rulings and the NHS Charter (UK) guarantee such rights, and collectively enable competent patients in the US, UK, and elsewhere to refuse dialysis even if they are not terminal. Japanese legislation does not guarantee such patient rights or the explicit allowance/prohibition of treatment withdrawal, regardless of the patient’s terminal status; enactment of such laws should be considered.

Key messages
We identified legal ambiguity due to a lack of the patient’s right to both self-determination and treatment refusal. This could impact the international discussion on dialysis treatment withdrawal.
A discourse network analysis of the public media debate on the UK Soft Drinks Industry Levy
Authors: Buckton C H , Fergie G , Leifeld P , Hilton S 
Published: November 2019

Abstract

Background
On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a policy designed to reduce population level sugar consumption and related illnesses. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative.

Methods
Media content analysis was employed to build a data set of relevant articles from UK national newspapers. Articles were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the stakeholder network and coalitions evident in the debate, leading up to and following the announcement of the SDIL.

Results
We identified 3,883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Visualisations revealed a complex network of stakeholders with two discourse coalitions. Polarisation arose from 3 factors: (i) differences in political ideology; (ii) position on the specific policy option; (iii) interpretation of the evidence. Industry stakeholders appeared less united before the SDIL announcement. Some industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver was a dominant supportive stakeholder, suggestive of his role as a policy entrepreneur.

Conclusions
This study illustrates the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Public health advocates seeking to gain support for future upstream regulation to promote population health would benefit from tailoring their communication to take advantage of sources of polarisation. Vocal celebrity policy entrepreneurs may be instrumental to facilitate alignment of stakeholders around a clear ideology.

Key messages
This study provides a novel insight into the network of stakeholders involved in public debates on food policies. Public health advocates may benefit by identifying and aligning with a clear ideology.
Actions to improve chronic heart failure management in Paris and its suburbs, preliminary results
Authors: Marty M , Nicolle P , Bataille S , Roudier-Daval C 
Published: November 2019

Abstract

Background
Chronic Heart Failure treatment requires close collaboration between multiple health professionals (hospitals, general practitionners, cardiologists, nurses, pharmacists,...). Guidelines for management of chronic heart failure patients after hospitalization for heart failure were published in France in 2014.
In Paris and its suburbs (Ile de France) several indicators show that improvement of processes is required especially regarding linkage between hospital and ambulatory care (for example admission rate in emergency unit was 59,7% in 2014).

Actions
Since 2015 Regional Health Agency and Social Insurance have conducted several actions to improve patients care pathway: feed back to providers on their own results, support patients after hospital discharge, commitment of several hospitals to organize meetings with field professionals, setting up semi-urgent consultations in hospitals, bundled payment experience...

Preliminary Results
Indicators evolution from 2014 to 2017 is favorable for rate of admission in emergency unit (57,8% versus 59,7%), 6 months mortality (20,7% versus 23,1%), hospital readmission 6 months after index admission (24,4% versus 25,2%), but unfavorable for ambulatory clinical follow up rates (general practitionner consultation within fourteen days after hospital discharge (46,1% versus 52,5%), cardiologist consultation within sixty days after hospital discharge (47,1% versus 52,8%).

Conclusions
It is too early to assess the impact of each action and it will be difficult to conclude, because of interaction between actions. The evolution of outcome care indicators is satisfactory, which suggests the interest of acting on a whole care process. The worsening clinical follow up indicators leads to wonder about access to health care and requires an analysis by territory to adapt the actions.

Key messages
Actions to improve chronic heart failure management in Paris and its suburbs firsts outcomes are satisfactory. Acction adaptations are necessary and should be assessed in 2019/2020.
Colorectal Cancer Screening Programme: Algarve Preliminary data
Authors: Correia M , Cancela M , Caldeira P , Morera J , Cardoso C , Pereira R , Ferrinho D , Vale L 
Published: November 2019

Abstract

Problem
The burden of disease for oncological problems is significant in Portugal. Population-based screenings, such as colorectal cancer screening (CCS) with faecal occult blood tests (FIT) is a priority program to reduce the burden of disease and a cost-effectiveness measure.

Description problem
Algarve CCS started in 2017,to early detect colorectal cancer reducing morbidity and mortality. Screening strategy to detect and remove cancer precursors (adenomas) and early cancer detection with less invasive treatment using a non-invasive stool test was selected. A quantitative faecal immunochemical test for haemoglobin (FIT) with higher sensitivity for adenoma and cancer, specific for human globin with no dietary restriction, with a single sample screening is considered a test with higher participation. Target population all gender from 50 to 75 are invited to participate in the CCS by letter. Screening interval is 2 years and FIT cut-off- 117 (ng Hb/mL). Software was used to manage all CCS. Health units distribute the test and a flyer. All FIT-positive were invited to do a full colonoscopy at University Hospital.

Results
A preliminary descriptive analysis (2017/2019) was made. After exclusions 25017 of target population participate 34,4%(n = 8594),27.5%(n = 6883) submitted it for analysis, 3.9% (n = 266) had positive FIT and were invited for a full colonoscopy with 57.5% (n = 153)participation rate. Cancer detection was 0.9‰ and adenomas detection rate was 9.9%. FIT positive with colonoscopy 3.9% (n = 6) had carcinoma and 44.4% (n = 68) had adenoma.

Lessons
Some operational changes were made to improve participants and professionals adherence to CCS. Pathology observed in the positive cases, reinforce the need to implement strategies to increase literacy, raise public awareness, keep the screening test and improve accessibility of health facilities.

Key messages
The importance of a colorectal cancer early diagnosis prevent aggressive interventions in a precancerous phase. The importance of a colorectal cancer early diagnosis improves survival and population quality of life.
Predictors of a high work participation in the flexi-job scheme: a regional Danish cohort study
Authors: Munkedal D , Weye N , Fonager K 
Published: November 2019

Abstract

Background
In Denmark, people with permanent and significant reduced work capacity can be assigned to a flexi-job (FJ) scheme. In 2013, the social security policy for FJ was reformed in order to improve the chances for employment for people with reduced work capacity. In a Danish cohort study from the North Denmark Region we aimed to describe work participation in the flexi-job scheme before and after the reform. Furthermore, we described the associations between employment in the flexi-job scheme and predictors such as sociodemographic factors, healthcare use, and work participation before assignment.

Methods
The study population included individuals assigned to the FJ scheme between 2010 and 2015 in the North Denmark Region. The study population was followed until leaving the FJ scheme or end of follow up (September 2017). Baseline information included data on sex, age, place of residence, number of contacts to specialized healthcare, and number of working weeks five years before. Work participation score (WPS) was defined as number of working weeks divided with the total number of weeks in the FJ scheme. High WPS was defined as above the median. We used a logistic regression model to study associations between baseline characteristics and high WPS.

Results
A total of 4,668 people were included in the study. The overall median WPS were 73% (interquartile range (IQR) 42% - 90%). Policy changes (OR 1.40, 95% confidence interval (CI ): 1.24 - 1.59), male sex (OR 1.16, CI:1.03 - 1.31), young age (OR 1.45, CI: 1.17 - 1.80), urban living (OR 1.22, CI:1.03 - 1.46), no contact to specialized healthcare (OR 1.54, CI: 1.21 - 1.99), and a strong association to the labor market before awarded FJ (OR 4.25, CI: 3.34 - 5.41) were all predictors of a high WPS during FJ-scheme.

Conclusions
Policy changes increased work participation in the FJ-scheme. However, the strongest predictor of a high WPS for people awarded FJ was the degree of work participation before the scheme.

Key messages
Several factors had impact on work participation in a flexi-job scheme. The flexi-job scheme might be insufficient to secure employment for people with prior weak affiliation to the labor market.
Regional variations of amenable mortality rate in Latvia
Authors: Skrule J , Lepiksone J 
Published: November 2019

Abstract

Background
Death can be considered as amenable if all or most deaths from that cause (at certain age group if appropriate) could be avoided through optimal quality of health care. Amenable mortality is one of indicators to use for assessing health system performance and outcome.

Methods
For amenable death causes using list of diseases and conditions from Office for National Statistics of United Kingdom (used by Eurostat). Calculation of amenable death rate (per 100000 population) for ages 0 to 74 years at regional level (six statistical regions) for time period 2015-2017, direct age-standardization to the overall national population. Results accompanied by confidence intervals (95%).

Results
There is a slight decline in amenable mortality of Latvia at national level over the period 2015-2017. Amenable death rate of Latvia in 2017 was 309 per 100 000 (95% CI, 308.95 - 309.05). Death rates at regional level varies from 274.34 (274.23 - 274.44) in Pieriga region to 375.49 (375.37 - 375.62) per 100 000 in Latgale region. There are no significant changes in ranking of regions for three years period.

Conclusions
Results shows that there are differences of amenable mortality rates between regions of Latvia. There are health inequalities between regions: Pieriga region show the best health care services performance, while Latgale displays the worst performance. There is field for deeper analysis and find better interventions for improvements at national level and reducing variability between regions.

Key messages
There are regional variations of amenable mortality in Latvia. Regional variations show places to reduce health inequality.
Government-based financing strategies for public health in Ukraine: way of transforming
Authors: Kovalenko N , Duda M , Liashko V 
Published: November 2019

Abstract

Since 2016 Ukraine is going through health financing reform. National public health (PH) system functioned with focus only on control of epidemics and sanitary situations. Following EU recommendations, the Government established Center for Public Health (CPH) and adopted the Concept of PH System Development. As new Budget Code comes into force in 2020, PH system must be transformed on institutional and financing level.
We conducted policy analyses and developed PH financing options and found that existing budget programs (epidemiological surveillance and purchases of medicines) make up over 70% of the total government PH spending. Public spending was ineffective based on line budget approach without attention to quality and not linked to epidemiological situation. New PH mechanisms will be piloted in 2019 in several regions to calibrate approach and ensure evidence-based policy. Transformed financing model focuses on purchasing PH services rather than maintenance.
We selected a phased approach to launch new PH financing mechanism. Procurement system ProZorro allows to follow transparency and good governance principles while purchasing PH services. Using experience with GF’s procurements, the CPH will purchase services: HIV and hepatitis prevention among key population, supporting PLWHIV, epidemiological surveillance. Legal framework developed and agreed with stakeholders. This approach allows to shift focus from dealing with consequences to prevention and early revealing of potential PH risks. Provider’s staff and network will be optimized. Budget economy is up to 15% in 2019, and additional 5% in 2020.
The rebuilding PH system showed that 2019 is an opportunity to develop and pilot new financing approaches. Key step is to ensure that national policy equipped with legislation and recommendations to implement new PH approaches. Pilot results will become a strong base for further PH system development as well as evidence-based policy for effective response to PH needs.

Key messages
Public health system in Ukraine is going through reforming process to address existing challenges and introducing new financing approaches with a focus on regional level. Using transparent procurement system to transform the public health financing mechanisms due to existing limitations and overall health financing reform in Ukraine.
Perceptions of barriers and levers to health-enhancing physical activity policies in French cities
Authors: Noël Racine A , Garbarino J M , Corrion K , d’Arripe-Longueville F , Massiera B , Vuillemin A 
Published: November 2019

Abstract

Background
Policy is one of the levers to initiate structural change to foster the promotion of Health-Enhancing Physical Activity (HEPA). To this end, policymakers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been published on this topic at the local level. The purpose of this study was to identify the barriers and levers to develop HEPA policies from the point of view of municipals managers and elected officials in mid-size French cities.

Methods
This study was conducted following the concept mapping approach: a list of statements was submitted to 17 French mid-size cities. These statements completed the beginning of this sentence: “In a mid-size municipality context, to develop HEPA policies, it is necessary to...”. First, key informants in each city rated the importance of each statement without considering their local context according to a Likert scale, ranging from 1 (not at all important) to 6 (extremely important). Then, they had to rate the feasibility of each statement considering their local context according to a Likert scale ranging from 1 (not at all feasible) to 6 (extremely feasible).

Results
A total of 23 municipal managers and 10 elected officials from sport (n = 14), health (n = 10), and social (n = 9) sectors from 11 French mid-size cities participated in this study. Statements related to political commitment, shared governance and partnership appeared as potential levers to develop HEPA policies. Statements related to the economic model of the local HEPA promotion, mandate of the mayor, and land use planning appeared as potential barriers to develop HEPA policies. The results varied according to the position and the sector of the respondent.

Conclusions
The results suggest that some local contextual factors could affect the development of HEPA policies in mid-size French cities. This study contributes to a better understanding of the development of local HEPA policies in the French context.

Key messages
Local contextual factors should be considered when developing health-enhancing physical activity policies. The perceptions of these local contextual factors varied according to the position and the sector of the respondent.