bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the long-term impact of an antenatal healthy lifestyle service: retrospective cohort study
Authors: Fair F , Soltani H 
Published: October 2020

Abstract

Introduction
Maternal obesity is associated with increased odds of obesity in the offspring. The antenatal period is considered a good opportunity to promote lifestyle improvements. The long-term impact of maternal characteristics and attending a maternal healthy lifestyle service (MHLS) on childhood risk of overweight was evaluated.

Methods
Women with a body mass index (BMI) ≥35kg/m² referred to one MHLS in England from 2009 were included in a retrospective cohort study. Pseudo-anonymised data from the National Child Measurement Programme were matched to data from women referred to this service. Children were classified as 'overweight' if their weight centile was ≥95th centile at 6-8 weeks or 9-12 months or their BMI was ≥95th centile at school entry (4-5 years). Univariate logistic regression determined the odds ratios (OR) and 95% confidence intervals (CI) of childhood overweight according to uptake of the MHLS, gestational weight gain (GWG) and other characteristics.

Results
The proportion of infants classified as overweight increased over time [2.8% at 6-8 weeks (20/713), 13.8% at 9-12 months (89/647) and 30.4% at school entry (206/677)]. The odds of overweight increased with each unit increase in birthweight (OR 39.9 95%CI 13.4-119.1 at 6-8 weeks, OR 3.7 95%CI 2.4-5.7 at 9-12 months and OR 1.9 95%CI 1.4-2.5 at school entry). GWG above Institute of Medicine recommendations increased the odds of overweight at 6-8 weeks (OR 2.9 95%CI 1.1-7.4). Women living in the most deprived quartile (OR 1.6 95%CI 1.1-2.2) or who smoked when booking for antenatal care (OR 1.5 95%CI 1.0-2.2) had increased odds of infant with BMI ≥95th centile at school entry. Attendance at a MHLS and maternal BMI did not significantly impact on child overweight at any time; however the sample only included women with a raised BMI.

Conclusions
Lifestyle during pregnancy, GWG and other wider health determinants such as deprivation have long lasting effects on infant health and childhood obesity.

Key messages
Overweight at school entry is high (&gt;30%) for women with a raised BMI when booking for antenatal care. Addressing maternal socioeconomic conditions, gestational weight gain and smoking during pregnancy are key priorities for the long-term health of children.
Promoting Antenatal Care: Identifying Policy Levers in Indian Context
Authors: Singh V 
Published: October 2020

Abstract

Background
The growing body of literature associates Antenatal Care (ANC) with early detection and prevention of maternal complications which in turn reduce the likelihood of maternal and infant death. Studies report that only about 40% of pregnant women in developing countries have attended four ANC visits. This situation mandates identifying policy levers for promoting ANC visits.

Methods
The study uses data from the Demographic and Health Survey (DHS) India (2015-16). We analyze a sample of about 100,000 women in the age group of 15-49 years who gave birth in three years preceding the survey. Using the theory of health seeking behaviour we propose a conceptual model to understand the a) Predisposing factors; b) Enabling factors and c) Need factors affecting the ANC visits in Indian context.

Results
17 % women in our sample never went for ANC. 46 % women in our sample went for at least four ANC visits. SEM analysis suggests that our structural model fits well with the sample data (RMSEA: 0.05; TFI: 0.93; SRMR: 0.038). Higher age, lower parity, higher awareness and higher levels of education significantly predisposes women to go for ANC visits. The significant (95% CI) enablers include higher socio-economic status, meeting with Community Health Worker (CHW) and enrolment in government sponsored nutrition support program. While health system barriers and personal barriers act as disablers. Bad obstetric history and health issues during pregnancy are significant need factors. Our analysis suggests that meeting CHWs increases ANC visits by 1.8 units and enrolment in nutrition support programme increases ANC visits by 1.4 units.

Conclusions
CHW and nutrition support programme are significant policy levers to promote ANC care and reduce maternal and child morbidity and mortality. Antenatal care services must be included under universal health coverage domain to reduce financial barriers for women of low socio-economic strata

Key messages
Involvement of Community Health workers in the promotion of maternal and child health care is a cost-effective strategy. Nutrition support programmes through Anganwadi centres help advance maternal and child health care by promoting ANC care.
Innovative methods in teaching public health ethics. The need to adapt to the new times: from challenge to opportunity
Authors: Buron Pust A , Segura A 
Published: October 2020

Abstract

Background
Public Health Ethics (PHE) has been taught first as optional and later as a mandatory subject in the Master of Public Health in Barcelona for about 6 years. During these years, professors have adapted the methodology to make it more attractive and to maximize students' participation and time spent debating and practicing moral reasoning.

Objectives
To showcase 3 different teaching strategies or methods, presenting for each of them: resources required, outcomes so far in terms of satisfaction and exam performance, as well as the pros and cons from the teacher's perspective.

Results
Flipped-classroom strategy: theoretical content is delivered outside the classroom, and the practice into the classroom. Works well but needs incentives for compliance in reading. Versatile debating Methods: from parliamentary debate, to role-playing, online debate, etc. Depending on the Case-study, some work better than others; in the online they practice written deliberation skills, but it is important to set rules. MOOC: Massive Online Open Courses in PHE. Can be used as independent teaching material, it is a great tool to introduce PHE into other PH areas and non-teaching environments.

Conclusions
So far, these methods have proven to increase students' motivation and engagement in Public Health Ethics.

Key messages
Practising reflection and debating skills is an essential part of PHE. Modern teaching strategies, more interactive and online-based, can help maximising the time spent in these activities. Although challenging and time-consuming at first, these methods also increase students' interest in PHE.
Extrapulmonary tuberculosis among migrants in the EU/EFTA: Implications for policy and practice
Authors: Hayward S E , van der Werf M J , Noori T , Nellums L B , Boccia D , Friedland J S , Hargreaves S 
Published: October 2020

Abstract

Background
The proportion of tuberculosis (TB) cases in the European Union/European Free Trade Association (EU/EFTA) that occur in migrants is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality. To date, there has been no in-depth exploration of extrapulmonary TB in migrants across Europe.

Methods
We analysed 22 years of data from the European Centre for Disease Prevention and Control's European Surveillance System (TESSy) for 32 EU/EFTA countries between 1995 and 2017. We investigated whether the proportion of TB cases that were extrapulmonary varied between migrants and non-migrants, and whether this varied by a) country/region of origin, b) reporting country/region, and c) site of disease.

Results
1,270,896 TB cases were included in the analysis, comprising 326,987 (25.7%) migrants, and 943,909 (74.3%) non-migrants. The proportion of TB that is extrapulmonary is significantly higher in migrants than in non-migrants: 45.2% (n = 147,814) of cases in migrants were extrapulmonary, compared to 21.7% (n = 204,613) in non-migrants (χ2=6.7x104, p &lt; 0.001). A relatively low proportion of extrapulmonary TB was seen in Eastern (17.4%) and Southern (29.6%) Europe compared with Western (35.7%) and Northern (41.8%) Europe, with migrants having a greater proportion of extrapulmonary TB only in Northern/Western Europe. Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary TB, with over half of all cases being extrapulmonary (62.0% and 54.5% respectively).

Conclusions
Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than non-migrants, which has clinical and policy implications for patient detection and management. There is a need to improve clinical awareness of extrapulmonary TB, integrate detection of extrapulmonary TB into latent TB infection screening programmes, and harmonise data collection on migrant status in health systems.

Key messages
Migrants in the EU/EFTA are disproportionately affected by extrapulmonary TB compared to non-migrants. This has clinical and policy implications for diagnosis, screening, and data collection.
Co-design of data collection with participants of the Aberdeen Children of the 1950s cohort study
Authors: Johnston M , Butler J , Clark H , Locock L , Murray A D , Robertson L , Hannaford P , Iversen L , Skea Z , Black C 
Published: October 2020

Abstract

Background
The Aberdeen Children of the 1950s (ACONF) cohort comprises 12,150 people born in Scotland in the 50s. It contains rich early life data, questionnaire data from mid-life and linked electronic health records. Involving participants in designing future data collection is key to ensure research is acceptable and reflects public priorities.

Aim
Gather ACONF members views to inform how to: research healthy ageing, optimise recruitment and maximise participation.

Methods
3 co-design workshops with 30 ACONF members. A discussion was led by a facilitator using guidance questions developed by the study team. Workshops were recorded and transcribed.

Results
Participants viewed healthy ageing as keeping socially and physically active, taking responsibility for oneself and having a positive attitude to ageing. Research priorities were dementia, improvements in the social care system and engaging hard-to-reach groups. Members were keen for future research involvement. Recruitment may be maximised by: more information online, involving participants in recruiting other study members and clarity about potential benefits to themselves or others. It was acceptable to ask their offspring to participate. There were high levels of trust in researchers, but ongoing data protection is vital. Participation may be improved by regular contact (informing members of results, engagement events, phone “apps”). Participants viewed various data collection methods (questionnaires, applications, wearable devices, in-person tests, DNA collection and electronic record linkage) as acceptable.

Conclusions
Participant involvement is a fundamental part of securing a social license for research. Participants were in favour of ongoing research, including recruitment of their children. The workshops highlighted key considerations for future research and data collection.

Key messages
Co-design is vital for highlighting research topics which are important and relevant to the general population. Co-design can highlight strategies for maximising research participation and securing a social license for research.
The fourth decade of life: the age for preventive strategies?
Authors: Cuschieri S 
Published: October 2020

Abstract

Background
Non-communicable diseases (NCDs) have been on the health agenda for decades. As the 2020's decade sets in, most of the set health strategies and targets are ending while new goals are expected. Investigating a European country hub known for its high prevalence of NCDs provides evidence-based data that can be used for these new strategies. The aim was to explore potential NCDs trends and associations that could provide evidence for new preventive strategies and goals.

Methods
Data was obtained from a national representative cross-sectional study through a health examination survey (2014-6). The self-reported data and the results of the examination were used to diagnose participants with type 2 diabetes, dyslipidaemia, hypertension, overweight and obesity. The study population was stratified by ten years and sex for both descriptive and analytic analyses.

Results
The male population was significantly more metabolically unhealthy that the female counterparts across all age groups (p = &lt;0.01). The females had the highest newly diagnosed diabetes prevalence across all age groups. It was observed that type 2 diabetes, dyslipidaemia and hypertension were present as of the 30-39 years group. Conversely, on binary multiple logistic regression analysis, this age group was negatively associated with NCDs even after adjusting for confounders (Diabetes OR:0.06 CI95%:0.02-0.21 p = &lt;0.01; hypertension OR: 0.16 CI 95%: 0.05-0.55 p = &lt;0.01; overweight OR: 0.21 CI 95%: 0.11 - 0.40 p = &lt;0.01).

Conclusions
The fourth decade of life might be the starting point for metabolic dysregulation. Hence, subject to long-term health and economic burdens, with a potential extension of the metabolic impact on their offspring. Although further research is recommended, this study sets the ball rolling whether preventive action including screening for dysglycaemia and dyslipidaemia should be implemented at a population level from a young age.

Key messages
Preventive action should start from fourth decade of life. Targeting the fourth decade of life would also ensure a healthier new generation.
Heart failure hospitalizations in persons with and without diabetes in an Italian region: 2008-2018
Authors: Scampoli P , Di Giovanni P , Cedrone F , D'Addezio M , Di Martino G , Masciarelli M , Meo F , Staniscia T 
Published: October 2020

Abstract

Background
Hospitalization rate for heart failure (HF) is considered a prevention quality indicator and it is used as a tool to evaluate health services quality. This study aims to assess time trends in HF hospitalizations in a region of Southern Italy, focusing on diabetes mellitus as comorbidity.

Methods
Data were collected from hospital discharge records. All patients aged 18 or over hospitalized for HF in Abruzzo between 2008 and 2018 were selected, either with or without a diagnostic code of diabetes. Admissions for cardiac procedures were excluded. For each year, gender- and age-adjusted standardized hospitalization rates were calculated. Predictors of HF admissions were estimated by a multivariable regression model.

Results
Over the study period, 60,737 HF admissions occurred, 34,518 of which among people aged more than 65 (56.8%). A total of 15,424 hospitalizations were performed among diabetic patients (25.4%). The overall age- and gender-adjusted HF hospitalization rate declined substantially from 2008 to 2018 (-12.1%). Diabetes (adjOR 2.48; 95%CI 2.41-2.55), myocardial infarction (adjOR 3.92; 95%CI 3.70-4.14), peripheral vascular disease (adjOR 2.30; 95%CI 2.16-2.44), chronic obstructive pulmonary disease (adjOR 3.97; 95%CI 3.86-4.09) and renal disease (adjOR 5.61; 95%CI 5.44-5.78) were factors associated to an increased risk of HF hospitalization. Although HF admission rates remained higher, a significant reduction was highlighted among diabetic patients (-34.7%). Instead, time trend was nearly stable among persons without diabetes (+2.7%).

Conclusions
This study has shown a decline in HF hospitalization rate over the period considered, particularly among diabetic patients. HF hospitalization may be potentially avoided with good outpatient care. As the causes for HF admissions may include poor quality of care or problems accessing care, it is worthwhile to identify the triggering factors and the potential targets for an early intervention.

Key messages
A reduction of HF admissions was observed only among diabetics and not among people without diabetes. As the HF hospitalizations are potentially preventable, the knowledge of the epidemiology is crucial for management of preventive health care.
Subjective social mobility, quality of life and mental health of asylum seekers/refugees in Germany
Authors: Costa D , Biddle L , Mühling C , Bozorgmehr K 
Published: October 2020

Abstract

Background
Changes in the subjective social status (SSS) of migrants, specifically between the pre- and post-migratory movement, can be a relevant determinant of their mental health condition. This study analyzed the effect of downward subjective social mobility to the mental health of asylum seekers and refugees (ASR) in Germany.

Methods
Through a random sampling procedure, 560 adult ASR (18+ years) were recruited across 58 collective accommodation centers in Germanys' 3rd largest state (2018). SSS was assessed with the MacArthur social ladder (10-rungs), in reference to the participants' position in the country of origin and in Germany. Quality of Life (QoL, measured with EUROHIS-QOL), anxiety (General Anxiety Disorder-2) and depressive symptoms (Patient Health Questionnaire-2), were considered as mental health outcomes. Generalized linear regression models were fitted to measure associations between changes in SSS and each outcome.

Results
A loss of 3 or more steps in SSS from origin to Germany (compared to no-change) was significantly associated with poorer scores in QoL (B, standardized coefficient= -2.679, standard error, se = 1.351, p = 0.047), with more symptoms of depression (B = 1.156, se = 0.389, p = 0.003) and anxiety (B = 0.971, se = 0.432, p = 0.025), in models adjusted for SSS in the country of origin. The strength and direction of associations was unaltered after further adjusting for sex, age, educational level and time since arrival, although the coefficient for QoL was non-significant for those declaring a 3-step downward mobility (B= -2.494, se = 1.351, p = 0.066 for QoL; B = 1.048, se = 0.393, p = 0.008 for depression; and B = 1.006, se = 0.438, p = 0.022 for anxiety).

Discussion
The results suggest that interventions should focus on those experiencing social downward mobility and not only prioritize individuals with low social status. Early integration efforts and intersectoral measures to counter social downward mobility could prevent poor mental health among ASR.

Key messages
We analysed the impact to the quality of life and mental health of asylum seekers and refugees, of a change in subjective social status from country of origin to Germany. Asylum seekers and refugees residing in Germany, who perceived a downward social status mobility following their migration process, are at risk for poorer mental health.
Including public health considerations in trade and investment agreements
Authors: Thow A , Garde A , Mabhala M , Smith R , Kingston P , Manning P , Hunter D , Winters L A , Lincoln P , Parish R 
Published: October 2020

Abstract
There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising.
The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues.
The training of school-doctors in France: ways of improvement, lessons to share
Authors: Godeau E , Chenel S 
Published: October 2020

Abstract
In France protection & prevention of students' health in schools is taken care of by school-doctors, in partnership. They follow a specific training for a year before becoming civil servants in the Ministry of Education. Around 1000 school-doctors are currently in post; 20-30 new school-doctors are trained each year. The training alternates academic sessions & supervised medical work in schools, under the responsibility of experienced mentors. Since 15 years, this training has been revised to improve its relevance in a Public health perspective, mainly by adding a strong health promotion component.
The current organisation aims at (1) individualising the training, capitalising on the knowledge & competencies of trainees, leading to an individual scheme defined with the national coordinators (a school-doctor and a pedagogical engineer) between 8 & 16 weeks of academic sessions given at the French school of Public health; (2) articulating academic contents with pragmatic & professional skills; (3) integrating pedagogical innovations to maximise the development of the 10 competencies identified as core to school-doctors; (4) giving school-doctors a broad Public health perspective, with research and health promotion expertise, while fostering their specific and particular medical practice in the global context of schools.
Each year improvements are implemented to answer the feed-back from trainees and professionals involved in the training. A closer articulation between local heads of school-doctors and the national level of their training has been fostered to improve coherence between academic & technical content while meeting ministerial requirements. The overall involvement & satisfaction of trainees are monitored.
There is still space to improve the training of qualified school-doctors to promote the health of school-students in a Public heath perspective, in a time in France where health inequalities need to be better addressed and where the medical demography is critical.

Key messages
In a time of lack of medical doctors, school-doctors are important public-health actors for children and adolescent, with a very crucial position at the articulation of the health and school systems. The training of school-doctors must meet the challenge to accommodate pedagogical requirements & changes in their practice due to vacant posts while fulfilling ministerial expectations.