bluuebunny/crossref_metadata_2025_split huggingface dataset:
Learning between European health systems: the nature of the challenge
Authors: Fahy N 
Published: November 2019

Abstract
Given their shared values and challenges, European health systems should be able to learn from each other about what works best. In practice, though, turning good practice in one place into more universal practice is stubbornly difficult even within single health systems, and has proved particularly challenging between European health systems. This session will explore the nature of the challenge to implementing innovation; the nature of what implementing innovation involves, why it proves to be so challenging in practice, and the particular challenges of learning between countries, and outline what can be done in research, policy and practice to help learning across European health systems more effectively in future.
Recent European Union (EU) initiatives to support national vaccination efforts
Authors: de La Mata I 
Published: November 2019

Abstract

Background
Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defence we have against serious, preventable, and sometimes deadly, contagious diseases. Thanks to widespread vaccination, smallpox has been eradicated, Europe made polio-free, and many other diseases almost eliminated.

Methods
This presentation provides an overview of recent European Union (EU) initiatives to support national vaccination efforts.

Results
The EU has launched a number of initiatives to strengthen national vaccination efforts. In December 2018 the European Council adopted a Recommendation to strengthen the EU cooperation on vaccine-preventable diseases. The initiative aims to tackle vaccine hesitancy, improve coordination on vaccine procurement, support research and innovation, and strengthen EU cooperation on vaccine-preventable diseases. EU countries are encouraged to develop and implement national vaccination plans with initiatives to improve coverage, and to introduce routine vaccination status checks.
The European Commission is also reinforcing its support to national vaccination efforts to increase coverage, including through the preparation of a Joint Action on vaccination co-funded by the Health Programme. Launching in 2018, the Joint Action will address vaccine hesitancy and seek to increase vaccination coverage in the EU. It is coordinated by INSERM (France) and involves 23 countries (among them 20 EU countries).

Conclusions
Vaccination policy is a competence of national authorities, but the European Commission assists EU countries in coordinating their policies and programmes.
The organization and delivery of vaccination services in the European Union
Authors: Rechel B , Priaulx J , Richardson E , McKee M 
Published: November 2019

Abstract

Background
The design and operation of health systems can influence vaccine uptake, including through the way that vaccination programmes are governed, financed and delivered. This study examined the organization and delivery of vaccination programmes in the 28 EU member states and key barriers and facilitators to improved vaccination coverage.

Methods
We undertook an umbrella review of systematic reviews on health system related factors influencing vaccine uptake and commissioned country fiches that describe the organization and delivery of vaccination programmes in each of the EU member states, followed by a comparative analysis. The focus was on measles vaccination for children and seasonal influenza vaccination for adults.

Results
In all countries covered, there is a dedicated agency in charge of developing and overseeing implementation of national vaccination plans and programmes. In 9 EU member states (Bulgaria, Croatia, Czech Republic, France, Hungary, Italy, Poland, Slovakia and Slovenia), vaccinations against measles are mandatory for children, while in the remaining 19 countries they are voluntary, but recommended by the relevant authorities. However, the distinction between voluntary and mandatory immunization is not always clear-cut. In contrast, vaccinations for adults against influenza are voluntary in almost all EU member states, with the exception of Slovakia. Vaccinations are provided in most countries through primary care physicians or nurses.

Conclusions
There are many actions that health systems can take to improve vaccination coverage. These include a mix of incentives and sanctions, targeted measures and outreach services for vulnerable population groups, and an expansion of public financing for vaccinations against influenza, as well as the removal of administrative barriers.
Academic performance in mathematics and reading and self-reported mental health problems in children across Europe
Authors: Husky M 
Published: November 2019

Abstract

Background
The School Children Mental Health Europe was a EU funded project designed to set up a kit of instruments enabling cross EU comparisons.

Methods
A literature review allows to select the SDQ (Strengths and Difficulties questionnaire) to be administered to the parents and teachers after a validation process in each country and the Dominic Interactive (DI), a sort of video game designed to evaluate DSM more commune diagnoses on children 6 to 11 years old.

Results
Data were collected on 7682 children randomly selected in a two stages selection: schools by country and children within the schools for whom 1) either parent- or teacher SDQ were completed: Overall, 12.8 % of children have any probable disorder with significant inter-country differences, 8.4 % probable conduct disorder, and 2.0 % probable hyperactivity/inattention. Adjusting for socio-demographic variables and parental psychological distress, country of residence did not predict the odds of having any disorder. 2) Overall, 22.0% of children were identified per their own evaluation as having at least one mental disorder, ranging from 16.4% in the Netherlands to 27.9% in Bulgaria. The prevalence of internalizing disorders was 18.4% across countries and ranged from 11.8% in the Netherlands to 24.3% in Turkey. The prevalence of externalizing disorders was lower with an average of 7.8%, ranging from 3.5% in Turkey to 10.5% in Bulgaria. Combining samples across European countries, 1 in 5 children reported internalizing problems and 1 in 12 children externalizing problems.

Conclusions
This lecture aims to present and discuss child mental health measure instruments from different informants perspectives, comparisons across countries and the challenges for interpreting the difference.
Children’s food intake in relation to preschool-level facilitators and barriers of healthy nutrition
Authors: Lehto R , Ray C , Vepsäläinen H , Korkalo L , Nissinen K , Koivusilta L , Roos E , Erkkola M 
Published: November 2019

Abstract

Background
Childcare is an important setting for young children’s food consumption as, in Finland, most children eat three meals a day in childcare. Thus, it is important to recognize determinants of children’s dietary intake in childcare. The aim of this study was to examine food-related factors at preschool and manager-level and their association with children’s fruit, vegetable and fibre intake at preschool.

Methods
The study was a part of the cross-sectional DAGIS survey conducted in 2015-2016. It aimed to examine 3-6-year-old preschoolers’ energy balance-related behaviors in Finland. Preschool managers from 58 preschools filled in a questionnaire on food and nutrition related factors at preschool such as kitchen type, food policies, food education, the manager’s possibilities to impact fruit and vegetable supply and cooperation challenges with the catering service. Preschool personnel kept food record for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender and municipality as confounders, preschool-level factors as independent variables and children’s vegetable (g/day) and fruit (yes vs. no) consumption, and fibre intake (g/MJ) as outcome variables.

Results
Having many written food policies in the preschool was associated with higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least 2 out of 3 different cooperation challenges with the catering service was associated with higher intake of fibre (0.03) and lower odds of eating fruits (p = 0.01).

Conclusions
Written food policies and manager-reported challenges with the catering service were associated with children’s vegetable, fruit and fiber intake at preschool. Factors that are relatively distal from the meal situations may impact children’s food intake at preschool and should be taken into account when promoting healthy food intake at preschool, but more studies are needed.

Key messages
Written food policies and good cooperation between the preschool and catering services may be of benefit to children’s healthy food intake at preschool. The relation between preschool and manager-level factors and children’s food intake are very little studied, and thus more studies are needed before conclusions can be made.
Ultra-processed food intake and risk of type 2 diabetes in a French cohort of middle-aged adults
Authors: Srour B , Fezeu L K , Kesse-Guyot E , Allès B , Chazelas E , Deschasaux M , Hercberg S , Monteiro C A , Julia C , Touvier M 
Published: November 2019

Abstract

Objective
The consumption of ultra-processed foods has been increasing during the last decades, and has been previously associated with increased risks of mortality and several chronic diseases. The objective of this study is to assess for the first time the prospective associations between consumption of ultra-processed foods and the risk of type 2 diabetes (T2D).

Methods
104707 participants aged at least 18 years (median age 41.5 years) from the French NutriNet-Santé cohort (2009-2019). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items, categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risk of T2D were assessed using multi-adjusted Cox proportional hazard models.

Results
Ultra-processed sugary products, fruits and vegetables, and beverages were the highest contributors of the ultra-processed category (respectively 27.9, 18.5 and 15.6%). Ultra-processed food intake was associated with a higher risk of T2D (n = 821 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.15 (1.06-1.25); P = 0.0009, 582252 person-years). These results remained statistically significant after adjustment for other metabolic comorbidities, for several markers of the nutritional quality of the diet (red meat and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.

Conclusions
In this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of T2D. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.

Key messages
The consumption of ultra-processed food is associated with an increased risk of type 2 diabetes. As the French Public Helath agency recommends, their consumption should be limited. Nutritional composition, food additives, contact materials, or neoformed contaminants might play a role in these associations and further studies are needed to understand their relative contribution.
Dietary pesticide exposure profiles in the NutriNet-Santé cohort
Authors: Rebouillat P , Vidal R , Cravedi J-P , Debrauwer L , Gamet-Payrastre L , Touvier M , Hercberg S , Lairon D , Baudry J , Kesse-Guyot E 
Published: November 2019

Abstract

Pesticides are commonly used in current agriculture and some negative effects are suspected for human health but evidence from dietary exposure in the general population is lacking. This study aimed to describe dietary pesticide exposure among French cohort participants. Organic and conventional food consumption was assessed using a self-administered semi-quantitative food frequency questionnaire in 2014 in the NutriNet-Santé cohort. Exposure to 25 commonly used pesticides was estimated using contamination data (CVUA Stuttgart) accounting for farming system. Dietary pesticide exposure profiles were identified using Non-negative Matrix Factorization, adapted for non-negative sparse data and then introduced in a hierarchical clustering process. The 6 identified clusters (n = 34,193) seemed to be exposed to the same molecules with gradual intensity. Cluster 1 was characterized by the lowest energy-intake and dietary pesticide exposure, and high consumption of organic food groups (23.3%). Proportion of male participants was higher than in other groups. Clusters 2 and 5 were characterized by intermediate energy intake, lower organic food consumption and intermediate pesticide exposure. High conventional fruits and vegetables intake and high pesticide exposure were observed in cluster 3, composed of a lower smokers’ proportion. Cluster 6 was characterized by the highest energy intake, lowest organic food consumption (9%), and highest pesticide exposure; high consumption levels of conventional fruits, vegetables and a higher proportion of vegans were observed. For cluster 4, pesticide exposure varied more across molecules than for other clusters. The highest exposures were observed for Acetamiprid, Azadirachtin, Cypermethrin, Pyrethrins, Spinosad pesticides. Proportion of organic food in the diet was the highest (31.5%).
Dietary pesticide exposures seem to vary across the clusters and related to the proportion of organic food in the diet.

Key messages
Dietary pesticide exposures seemed to vary gradually across the clusters and depending on the proportion of organic food in the diet. High consumers of conventional FV in this cohort seem to be more exposed to our selection of pesticides.
Health Literacy questionnaire development for 9 and 10 years old: a discussion of assessment tools!
Authors: Reis A , Barroso I , Saboga-Nunes L , Okan O , Bollweg T , Bittlingmayer U 
Published: November 2019

Abstract

Background
With Health literacy (HL) investments - to promote health and self-care during people’s life cycles (childhood, especially) - health professionals approach is multi-dimensional: within the family, school settings and community. The objective of this study is to explore the feasibility and usability of a questionnaire to characterize HL levels among 9 and 10 years old. It is expected that this will help health care personal to better focus health promotion initiatives in the school setting.

Methods
The CrAdLiSa project in conjunction with the HLCA German Consortium, implemented a field test for the newly developed HL assessment tool for children in the Portuguese context. This is a deductive-inductive, exploratory-descriptive study including 16 children, with 9 and 10 years old, from 2 different elementary schools in Santarém District (rural and urban areas). Semi-structured interviews aim at exploring the cognitive appraisal of concepts and indicators at the base of the questionnaire developed to assess HL levels. Data was subjected to content analysis, with a priori and a posteriori categorization.

Results
Preliminary results point to the cognitive comprehension by children of the feasibility of an instrument to assess their HL levels. It depicts discriminatory capabilities (to allow characterization of low, medium or high levels of HL). Children living in urban areas, having better financial resources are less likely to develop obesity, or low weight. Better self-perception of school performance, good relationship with family members, parents with higher education or higher levels of HL appear to have better quality of life.

Conclusions
Results suggest the need to invest in children’s and families’ HL, while taking into consideration personal, environmental and socioeconomic determinants. School settings should be considered as a natural arena to improve children’s (and, as a result, families’ and communities’) HL levels.
Healthy schools, healthy children – achieving climate-friendly and health promoting buildings for future generations
Authors: Stauffer A 
Published: November 2019

Abstract
Children spend a significant amount of their time in schools indoors, and the quality of this indoor environment influences their health and their ability to learn. Recent studies have demonstrated the specific vulnerability of children to air pollution, especially particulate matter (PM). However, awareness among the public, parents and policy-makers on indoor air quality in schools is low, and media reports are scarce. Therefore policy measures have largely focused on providing clean air outdoors. With the political drive to improve the climate footprint of buildings, including schools, there is an urgent need to consider air quality and health.
The presentation will present results from a project by the Health and Environment Alliance on citizens science monitoring of outdoor and indoor air quality in more than 40 schools in 6 European capitals, Berlin, Paris, Madrid, Warsaw, Sofia and London in the spring of 2019. Pollutants measured included PM and NO2; as well as CO2 concentrations. Strategies on how to achieve an energy efficient and health promoting school environment will also be discussed.
Socioeconomic Status, Health Inequalities, and Solidarity Trends in a Mass Vaccination Campaign
Authors: Tur-Sinai A , Gur-Arie R , Davidovitch N , Kopel E , Glazer Y , Anis E , Grotto I 
Published: November 2019

Abstract

Background
In July 2013, Israel was swept with fear of a polio outbreak. In response to the importation of wild polio virus, the Ministry decided to take preventive action by administering oral poliovirus vaccine (OPV) to all children born after 1 January 2004 who had received at least one dose of inactivated poliovirus vaccine (IPV) in the past. This study analyzes the vaccination uptake rates resulting from the mass polio vaccination campaign on the basis of health inequality parameters of socioeconomic status (SES), principles of solidarity, and the Gini inequality index. The research explores understanding the value of the Gini inequality index within the context of SES and solidarity.

Methods
The study is based on data gathered from the Israeli Ministry of Health’s administrative records from mother-and-child clinics across Israel. The research population is comprised of resident infants and children whom the Ministry of Health defined as eligible for the OPV between August and December 2013.

Results
The higher the SES level of the area where the mother-and-child clinic is located, the lower the OPV vaccination uptake is. The greater the income inequality is in the municipality where the mother-and-child clinic is situated, the lower the vaccination uptake. As time passed in the vaccination campaign, vaccination uptake increased regardless of the location of the mother-and-child clinics. The highest vaccination uptake rate was found among populations of low SES and low Gini inequality index. The lowest vaccination uptake rate was found among populations of high SES/high Gini inequality index.

Conclusions
Public health professionals promoting vaccine programs need to make specially-designed efforts both in localities with high average income and in localities with a high level of income diversity/inequality. Such practice will better utilize funds, resources, and manpower dedicated to increasing vaccination uptake across varying populations and communities.

Key messages
The higher the SES in municipalities with mother-and-child clinics, the less likely children were to be vaccinated. The lower the Gini inequality index, there is a higher polio vaccination uptake among of children.
Impact of safety-engineered devices (SEDs) on the prevention of percutaneous injuries
Authors: Garlasco J , Ottino M C , Rainero E , Argentero A , Zotti C M 
Published: November 2019

Abstract

Background
Needlestick injuries represent a major occupational hazard for healthcare workers as they lead to exposure to biological fluids, with higher risk of bloodborne pathogen infections. In order to minimise this risk, safety-engineered devices (SEDs) have been developed and introduced into the daily hospital practice. An annual survey, conducted by the Department of Public Health Sciences of the University of Turin since 1999, has been evaluating the number of percutaneous accidents in the hospitals of Piedmont (Italy), assessing also the impact of the introduction of SEDs on the injury incidence rate. The aim of this study is therefore to evaluate the efficacy of SEDs in preventing needlestick injuries.

Methods
Data about percutaneous injuries and needle consumption were obtained from 42 hospitals of Piedmont for the years 2014-2017, concerning all the types of needles and sharps most commonly used in the departments. After considering the overall trend of percutaneous events, standardised rates for 100000 needles were computed for both SEDs and conventional devices. The same analysis was performed considering all sharps except standard needles, which are mainly used for procedures not involving contact with patients (e.g. drug dilution).

Results
The comparison between the incidence rates with SEDs and conventional devices showed a slightly protective effect of SEDs in 2014, 2016 and 2017, with an incidence rate ratio ranging from 0.78 to 0.97. However, by removing the confounding effect of standard needles, the analysis yielded strong statistical evidence of the protective effect of SEDs for all years (RR = 0.28-0.63). Moreover, the total number of percutaneous events shows a trend of general decrease.

Conclusions
Safety devices have proved to be significantly effective in the prevention of needlestick injuries, and their introduction into the daily practice is one of the factors who could contribute to a reduction of percutaneous events.

Key messages
Safety-engineered devices are a very important tool in the prevention of injuries in healthcare workers, and their introduction into hospital practice has reduced the number of percutaneous injuries. Safety-engineered devices are significantly protective against percutaneous injuries compared to conventional ones, especially for procedures involving contact with patients (therefore at high risk).