bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Equilibrium Methodology (HEM), a digital tool in public health work for health equity
Authors: Hallmyr M , Wretlind K , Magnusson M 
Published: November 2019

Abstract
HEM draws on theories for health behavior and power relations. The methodology contains a structured documentation for formative and summative purposes. Strive for a high level of participation, control and influence from individuals and community members is a foundation pillar. Systematic use of theories allows for answering the fundamental question “in what way do we anticipate the planned intervention to contribute to closing the health gap?” Social Cognitive Theory (SCT) considers social and physical environment. HEM currently involve several SCT determinants in planning and evaluation; self- efficacy, observational learning, facilitating, expectations of outcome, reciprocal determination. The qualitative procedure is described below. Numeric data are also collected.
Step one (before action, e.g. a dialogue-meeting): Consider which determinant(s) may be affected by the planned action, and by what mechanisms.
Step two: Carry out the action.
Step three: Describe what happened, based on input from the participants and the anticipated determinants and mechanisms.
Step four: Systematic self-critical review based on common grounds for discrimination. Examples: Was it difficult to engage or include participants because of language, gender, function variation, national background or other factor? In retrospect, can you identify stereotypes in the examples you used? Did anybody else at the event act to maintain prejudice or exclusion?
Step five: consider implications for methodological development.
Step six: Formative collective evaluation based on reflections from step four and implications from step five.
Stakeholders using HEM gather regularly for workshops based on their HEM-reports, aiming at developing tools for increasing health equity. HEM is implemented in public health work of Angered Hospital and the Dental Public Health, Region Västra Götaland, and is used by 20 different stakeholders. A web-application has been developed to facilitate documentation and spread.
The migrant health workforce in European countries: does anybody care?
Authors: Kuhlmann E , Greer S L , Burau V , Falkenbach M , Jarman H , Pavolini E 
Published: November 2019

Abstract

Background
Data and knowledge on the migrant health workforce are poorly developed, and we do not understand which institutional contexts may foster responsible governance. This introduction seeks to set the scene for critical debate by placing the structure and composition of the migrant health workforce in the context of health systems and policy. The aim is to confront growing nationalism and populism with the important contribution of migrant carers to health system performance and the health of the population.

Methods
A comparative approach was applied and a rapid review of available data and research undertaken. Five EU countries were selected which represent different healthcare systems, health workforce patterns and political contexts in high-income countries, comprising Austria, Denmark, Germany, Italy, UK.

Results
The migrant workforce pattern show high variation. The number of physicians is highest (around 28%) in the UK, and low in Austria, Denmark and Italy (below 5%) while Germany is in a middle position (around 10%). The picture turns when looking at nurses and carers, where Italy and Germany for instance are placed in higher ranks. The results suggest three things: no coherent patterns of health system types and composition of the migrant care workforce can be identified. There is also no clear connection between the size of the migrant health workforce and the relevance of populist movements. And finally, the migrant carers remain largely absent in the policy debates; none of the health systems has develop a comprehensive governance model that ‘cares’ for the migrant carers and that could help to highlight their contribution against the threats of growing nationalism and populism.

Conclusions
There is a need for comprehensive European monitoring and research to develop more inclusive health workforce governance and to identify institutional conditions that improve capacity and capability for ‘care’ ‘of the migrant health workforce.
“People expect you to work like you don’t have a child but be a mum like you don’t have a job’
Authors: Rush L , Hilton S , McDaid L 
Published: November 2019

Abstract

Background
Recent UK campaigns that aim to increase awareness of sepsis have been accompanied by high profile media reporting about deaths in children resulting from misdiagnosis. Parents have been urged by the Sepsis Trust to have a low threshold for suspecting sepsis when their child is unwell and to follow ‘gut instincts’, challenging health professionals if necessary. This study aims to explore how parents enact this advice in the context of everyday life.

Methods
Thematic analysis of 16 focus groups comprised of parents and carers of pre-school children and 4 groups with individuals affected by sepsis.

Findings
Participants encountered various barriers and conflicts of interest when endeavouring to do the ‘right’ thing in managing acute childhood illness. Gaining access to healthcare was often challenging, with parents weighing up the need for reassurance against fears of over using scarce health care resources. Despite knowledge of recent sepsis awareness campaigns, parents frequently reported that the diverse symptoms described were too non-specific to be of practical use. ‘Knowing your child’ and being able to detect subtle deviations from normal was seen as key to decision-making about the need to escalate care. However, for parents in paid employment, the obligation to be present with their sick child to monitor symptoms closely was often in conflict with their duty to employers. The capacity to work flexibly, while highly valued, was inconsistent and frequently based on discretion of line managers rather than supported by official workplace policies.

Conclusions
Recent awareness campaigns have highlighted the need for parents to be alert to the possibility of sepsis when their child is acutely unwell. However current campaign materials do not enable parents to confidently identify when to seek help. Lack of access to primary care appointments and unsupportive employment policies may act as barriers to acting in accordance with sepsis awareness messages.

Key messages
Recent sepsis awareness campaigns focus on the importance of ‘parental instinct’ in managing risk. Parents often experience conflicting obligations towards their child and employer which can act as a barrier when monitoring risk during episodes of acute illness.
International, inter-university transferability of a student health surveillance system (SuSy) tool
Authors: Reintjes R , Holt M , Kalbus A , Powell S 
Published: November 2019

Abstract

Introduction
While university students are known to face major life transition challenges with the risk to engage in potentially undesirable health-related habits, there are very few attempts to monitor students’ health behaviour on a regular long-term basis. Even in cross-sectional designs, students from the field of Public Health and/or Health Sciences are rarely investigated. Here, a cross-university students’ health behaviour surveillance system is presented.

Methods
A students’ health and health behaviour surveillance system (SuSy) has been implemented in Hamburg University of Applied Sciences in 2014, collecting and analysing data of health sciences students twice a year since. After Manchester Metropolitan University joined the project and adapted SuSy to its specific context in 2016, data of both SuSy settings were compared using logistic regression models. In addition, focus groups were carried out in both universities in order to assess the perception and acceptance of the tool.

Results
After eight elicitations with total sample of 1366 responses, a decreasing trend of smoking and increasing trend of cannabis consumption can be observed among Hamburg students. In comparison, Manchester students tend to smoke significantly more (OR = 3.74, 95%CI 1.95-7.17), but consume less cannabis (OR = 0.51, 95%CI 0.14-0.9). Trends in physical activity and healthy food consumption complete the overview. Focus groups revealed that SuSy is perceived as an appealing, useful and recognisable tool among students from both universities.

Discussion
While being easily adapted in content and delivery, SuSy allows for the provision helpful, comparable information about students’ health behaviours as well as for the observation of time trends. These findings underline SuSy’s potential in promoting university students’ health.

Key messages
The student health surveillance system (SuSy) tool allows comparable information about students’ health behaviours as well as the observation of time trends. SuSy is perceived as an appealing, useful and recognisable tool among students from both universities.
Surveillance of dengue: evolution of surveillance strategies during a large outbreak, Réunion, France
Authors: Menudier L , Vilain P , Robinson E , Balleydier E , Daoudi J , Thébault H , Jaffar-Bandjee M C , Muriel V 
Published: November 2019

Abstract

Issue
After a period of low-level circulation of a few cases per week during 2017, La Réunion experienced an outbreak of dengue in 2018 followed by a second and ongoing larger epidemic wave in 2019. Various surveillance systems have been progressively implemented to monitor and characterize the outbreak.

Methods
All laboratory diagnoses of dengue are routinely notified to the regional health authority (RHA) for investigation. With the outbreak onset additional programmes were implemented including the monitoring of presentations to emergency departments (EDs) and hospitalisations of dengue cases. In addition, all death notifications to the RHA which cite dengue are reviewed by an expert committee and the cause of death classified as directly, indirectly or unrelated to dengue. Finally, weekly data from a sentinel network of general practitioners is used to estimate the number of community consultations with dengue-like illness across the island.

Results
In 2017, 97 dengue cases were notified, with low level circulation continuing through the austral winter. In 2018, 6,679 cases (exclusively serotype 2) were notified. Western and southern regions of the island were most affected. The supplementary surveillance identified over 500 ED presentations for dengue-like illness and 160 hospitalisations. Three deaths were determined to be directly due to dengue, while 3 were indirectly related. Finally, there was an estimated 26,000 consultations for dengue-like illness in the community. After a second winter of persistent circulation, a second epidemic wave commenced in December 2018, and is still ongoing.

Lessons
The implementation of additional surveillance systems enabled a better understanding of the magnitude and impact of the outbreak. The use of sentinel network allowed the estimation of the number of people affected in the community without a laboratory diagnosis. The ongoing viral circulation since 2017 suggests a high risk of endemisation of dengue on the island.

Key messages
The outbreak has had a significant impact of health and community health services, and on the wider population. The second consecutive austral winter with interrupted transmission suggest a high risk of endemisation.
Influenza-associated morbidity and mortality in Tunisia
Authors: Bouguerra H , Hechaichi A , Bouabid L , Yazidi R , Abdeddaiem N , Maazaoui L , Moussi A , Ben Khelil J , Ben Salah A , Ben Alaya N 
Published: November 2019

Abstract

Background
Influenza is a highly contagious viral infection representing a public health problem worldwide with more than 10% of the population affected each year. In addition, severe complications and deaths may occur especially among high-risk groups. Our objectives was to assess the severity of influenza in Tunisia from 2015 to 2017 and to identify the isolated circulating viruses.

Methods
Basedon the network of ILI (Influenza-like illness) and SARI (Severe acute respiratory infection) Sentinel Sites and the National Influenza Center, we conducted a descriptive analysis of all data collected from 2015 to 2017. The case definitions of ILI and SARI were those recommended by WHO. Data entry was using Epi-Data and data analysis using SPSS-20.

Results
The total number of SARI cases during 2016-17 season was 614. The hospitalization rate was 0.7% which was higher than the 2015-16 season (0.19%). The majority of these severe cases were males (60,3%) and the group aged more than 65 years was the most affected. Comorbidities were reported in 58,7% of the cases, especially cardiovascular diseases, obesity and asthma. In 2016-17, the viruses identified in SARI cases were type A(H3N2) (47,7%), type B (40,9%) and type A (H1N1) pmd09 (4%). The lethality rate was lower than in the previous season (0.32% vs 20%) with two deaths reported in February. These deaths were due to virus B and virus AH3N2, comparing to 77% of deaths due to virus A (H1N1) pmd09 the season before.

Conclusions
Influenza severity vary from a season to another. The 2016-17 season was marked by higher rates of hospitalization but a lower lethality rate. This may be due to a lower circulation of the type A (H1N1) pmd09 virus, which virulence is much discussed. Influenza surveillance remains essential to detect any emerging novel pathogen and to guide decision-makers for future strategies.

Key messages
Seasonal influenza epidemics continue to have significant morbidity and mortality. Epidemiological and virological surveillance are highly essential for an early detection of epidemics and novel strains.
The Public Health Implications of Brexit in Wales: A Health Impact Assessment (HIA) approach
Authors: Green L 
Published: November 2019

Abstract

On March 29th 2019, the United Kingdom was due to exit the European Union (EU) in a process known informally as ‘Brexit’. The 2 years before this time (and ongoing) experienced a period of unprecedented political and social upheaval with many unknowns and much uncertainty attached to the outcomes and future impact of withdrawal and transitionary period.
Public Health Wales commissioned the Wales Health Impact Assessment (HIA) Support Unit to carry out a HIA of Brexit in Wales to assess the potential impact, extent and nature of ‘Brexit’ on health and wellbeing in Wales which would to inform its planning, future work and support other bodies decision-making, planning and policymaking.
A comprehensive HIA was conducted over a 6 month period in 2018/19, steered by a Strategic Advisory Group. Methods included; a literature review; stakeholder workshop; interviews with policy leads, a community health profile, and report with evidence synthesis.
Trade agreements, economic impacts, changing relationships with EU agencies, uncertainty and loss of regulatory alignment were key pathways for health impacts to occur. Potential impacts included; food standards/safety; environmental regulations; working conditions; and health and social care. Many impacts will affect the whole population. Vulnerable populations included; children/young people; those at risk of unemployment;Welsh areas receiving significant EU funding. Potential indirect impacts were identified on mental well-being.
Brexit has the potential to impact significantly on the determinants of health.The HIA has informed and influenced cross-sector planning and policy in response to the short/long-term implications of Brexit to ensure that health and inequalities are considered at every juncture.This unique work demonstrates continued leadership by Wales in the field of impact assessment and ‘health in policies’ and has been positively received. It has transferable learnings for many nation states and health policy leads.

Key messages
Brexit is a major policy change with major health impacts. HIA is an informative and influencing process to support planning and future policy making.
The EU Health Promotion and Disease Prevention Knowledge Gateway
Authors: Bakogianni I 
Published: November 2019

Abstract

Issue/ problem
Unhealthy diets, physical inactivity, alcohol and tobacco use are leading risk factors for non-communicable diseases. They are all modifiable and health promotion policies can support that.

Description of the problem
However, information overload, controversies and uncertainties, budget constraints and difficulties in balancing disparate interests are common challenges that can hamper action by policy makers in the field of public health. To support them, the European Commission has created the Health Promotion and Disease Prevention Knowledge Gateway. It is a reference point for independent and reliable information to assist policy making; it summarises both the data and knowledge needed to support prioritisation of public health policies and justify investments in health promotion.

Results
The Knowledge Gateway currently covers the areas of nutrition, physical activity, alcohol, marketing of foods and beverages, and related societal impacts such as disease burden and health inequalities. These topics have been prioritised by Member States representatives and policy makers. The content is organised into concise, well-structured briefs which include definition of each issue, health related effects, and examples of policy recommendations and implemented policies. The high-quality source documents are selected in a tiered approach and are mainly authored or endorsed by authoritative public health organisations.

Lessons
Judging by the positive feedback received, the Knowledge Gateway is being used widely across Member States and stakeholders. The content of the Knowledge Gateway will be further expanded to support other health priorities such as mental health promotion. Policy makers have a unique, trusted “one-stop-shop” with high quality information to support, justify and strengthen the development of public health policies and health promotion.

Key messages
The use of reliable authoritative information for the development of public health policies can support the prevention of major non-communicable disease risk factors. The EU Knowledge Gateway is a unique reference point of reliable, independent information to support policy making in the area of public health.
Impact of sleep and screen times on incidence of overweight in European children and adolescents
Authors: Guzman V , Arvidsson L , Lissner L , Hunsberger M 
Published: November 2019

Abstract

Background
A deeper understanding of the modifiable risk factors leading to excess weight in children and adolescents can provide unique opportunities for preventing the immediate and long-lasting health consequences of overweight. The aim of the study was to explore independent, prospective associations of screen time and sleep duration with incident overweight in a sample of European children.

Methods
Data from 4285 participants of the IDEFICS/I.Family cohort who were followed-up from 2009/2010 to 2013/2014 was analyzed. Hours per day of screen time and sleep duration were collected by parental report at baseline. Logistic regression analyses were carried in separate and mutually adjusted models controlled for sex, age, European country region, parental level of education and baseline BMI z-scores.

Results
At baseline screen time (hours/day) and sleep duration (hours/day) were inversely correlated behaviors (rs= -0.226, p&lt;.001), indicating the necessity of exploring their separate and joint effects on the weight trajectory. In the non-overweight/non-obese population at baseline (N = 3734), separate models suggest that every hour increase on screen time and every hour decrease on sleep duration were associated with higher odds of the child becoming overweight or obese at follow up (OR = 1.156, 95% CI 1.015-1.316 and OR = 1.226, 95% CI 1.053- 1.428 respectively). In the mutually adjusted model, the screen time association was attenuated to non-significance (OR = 1.125, 95% CI 0.986- 1.284), while the association with sleep duration was also attenuated but remained statistically significant (OR = 1.198, 95% CI 1.026-1.398).

Conclusions
Both screen time and sleep duration are significant predictors of incident overweight in children and adolescents. However, according to our results sleep duration plays a stronger role than screen time, suggesting an increased value of overweight prevention strategies that emphasize adequate sleep duration.

Key messages
A holistic and integrated approach is needed to prevent overweight from early age and with a life-course perspective. New strategies for overweight prevention could benefit from prioritizing interventions that promote adequate sleep duration and reduce excessive screen time.
Acute respiratory infection hospitalized in intensive care unit: long-term outcome in Elderly
Authors: Grammatico-Guillon L , Hermetet C , Gaborit C , Laporte L , Guillon A 
Published: November 2019

Abstract

Background
The consequences of the ageing population concerning ICU-hospitalization need to be adequately described, especially acute respiratory infections (ARI) strongly associated with Elderly. The study aimed to assess the long-term outcomes of ARI surviving ICU hospitalization in patients over 80 yo.

Methods
A retrospective multicentre cohort study was performed, based on hospital discharge databases in one French region (2.5 million inhabitants). Patients with ARI in ICU were selected according to specific ICD-10 diagnosis codes recorded and matched with a control population (patient undergoing a cataract surgery), using a propensity score (matching algorithm 1:1 ratio, caliper 0.002) with the matching variables (age, sex, frailty score, chronic heart disease, chronic pulmonary disease and cancer). Analyzes of this matched population were performed to determine their 2-year in-hospital mortality, healthcare utilization and evolution of the frailty score during the 2-year period before/after the inclusion stay.

Results
A total of 1,658 hospital stays for ARI after 80 yo were identified, with 438 dead (26%) during the initial stay. After matching with the cataract population, 988 patients were selected in each group without difference in the propensity score. ARI lead to an important increase of healthcare use during the 2 years after discharge. The patients that were discharged from hospital after ARI requiring ICU, had a 23-fold increase of death at 90 days and 4-fold at 2 years and the evolution of the frailty score was 1.6 fold higher than the cataract population.

Conclusions
Elderly patients with severe ARI survived from their ICU stay in 75%, but have a major risk of death in the following months, and an important increase in healthcare consumption. Our findings provide data for more informed goals-of-care discussions and may help target post-ICU discharge services for these high-risk groups.

Key messages
Elderly patients with severe acute respiratory infection survived ICU in 75%, but had a major risk of death in the following months, added to a substantial increase in healthcare consumption. These findings provide data for more informed goals-of-care discussions and may help target interventions for these high-risk groups.