bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic Inequalities in Health Behaviors among Jordanian Adolescents
Authors: Alshammari A , Piko B 
Published: October 2020

Abstract

Background
Health inequalities as a global problem concerns both developed and developing countries. However, levels of inequalities are not the same in different age groups, e.g., during adolescence there are fewer inequalities in morbidity and mortality, while they are more likely to appear in health behaviors. This study aims to test inequality (gender, parental education, and family affluence) in students' health behaviors (dietary habits, hygienic behavior and smoking).

Methods
Using a sample of students (N = 2741, aged 13 - 18 years) from public and private schools in Irbid governorate, Jordan, in the year of 2020, measurements included SES indicators), the Global School-based Student Health Survey and health behaviors (tobacco use, personal hygiene, dietary behavior).

Results
There was a relationship between paternal education and not having enough food at home (p = 0.000), adolescents' brushing their teeth (p = 0.000), eating fruits (p = 0.000), drinking milk (p = 0.000), having fast food (p = 0.000). Results were similar with maternal education, in addition, it was also related to eating vegetables (p = 0.027) and washing their hands before eating (p = 0.005). Smoking was also associated with maternal education (p = 0.009). In terms of family affluence, significant associations can be found between the student's health behavior variables and the self-assessed financial situation in all cases. Finally, females engaged in more healthy dietary and hygienic behaviors and less smoking, while males were more physically active.

Conclusions
Our findings give important evidence for the association between socioeconomic inequalities and health behaviors among Jordanian adolescents. The strongest associations were found with family affluence, while parents' education may have different roles in various types of health behaviors. These findings strengthen the need for policymakers and researchers to pay greater attention to these inequalities.

Key messages
In Jordan, health care should face many challenges in terms of inequalities between different groups of the population according to socioeconomic status. Adolescence is a critical life period when besides biological modifications, there are also psychosocial changes which needs severe adjustment.
No change in life expectancy: the devil is in the detail
Authors: Karanikolos M , Rajan S , Murphy A , McKee M 
Published: October 2020

Abstract

Background
The rate of improvement in life expectancy in high income countries has slowed down over the past few years, and instances where life expectancy is lower than a year before are increasingly common. This paper aims to analyse changes in life expectancy over the last decade to better understand what causes and age groups contribute to the slowdown.

Methods
We use WHO mortality data by age and cause to construct life tables, and we use Arriaga decomposition method to analyse the contribution of specific causes and age groups to changes in life expectancy in Australia, Canada, France, Germany, Netherlands, United Kingdom and the United States of America. We look at the change between 2007-2012 and 2012-2017 (or latest available).

Results
All countries experienced a slowdown in life expectancy in the past 5 years (2012-2017), in comparison to the preceding period. Slowdown in under 65s was particularly pronounced, with younger age groups only contributing minimally (between 0.4 years for males in Germany and -0.4 years for males in the United States) to changes in life expectancy. Among people aged 65 and over, gains ranged between 0.05 years for females in France and 0.6 years for males in the Netherlands. Certain causes of death contributed negatively to change in life expectancy between 2012 and 2017, with notable increases in deaths from accidental poisonings in males (up to -0.09 year in the UK and Canada, and -0.34 in the US) and suicides (up to -0.08 year in Australia and -0.07 in the US).

Conclusions
While recent slowdown in life expectancy gains in high income countries is often attributed to lack of improvement in people of older ages, we show that, beyond this, there are increases in mortality in younger age groups from external causes, that contribute negatively to change in life expectancy in some countries. This pattern is of a particular concern, as deterioration in preventable mortality points to broader worsening of socio-economic climate.

Key messages
Improvements in life expectancy in high income countries slowed down markedly over the past few years, but contributing mortality patterns differ for age groups and causes of death across countries. Persistent increases in preventable mortality from certain external causes in younger age groups in Australia, Canada, US and UK point to broader deterioration of socio-economic climate.
Measuring efficiency of the German health care system from the population perspective
Authors: Köppen J , Achstetter K , Blümel M , Busse R 
Published: October 2020

Abstract

Background
Human and financial resources in health care systems are limited and require efficient use. Efficiency is one of the final goals of the WHO Health Systems Framework but measuring efficiency and finding room for improvement is complex; a rarely used approach is the assessment from the population perspective. This study aims to analyse, if inefficiencies in the German health care system are present and can be identified by the population.

Methods
In 2018, a survey was conducted with a random sample of 20,000 insured persons of a German private health insurance (PHI) company. Three aspects of efficiency were operationalized in the questionnaire: self-reported duplicate tests, prescription of unnecessary health services, and adequacy of insurance premiums. Results are based on descriptive analyses.

Results
In total, 3,601 respondents (age 58.9 ± 14.5; 64.9% male) were included (18.0%) in the analyses. Efficiency was rated as follows: 20% of respondents experienced duplicate tests due to a lack of coordination between physicians. This rate was even higher (38%) among those who perceived (very) poor/fair coordination. Unnecessary services (self-assessed) were prescribed to 22% of all respondents and was 50% among patients who experienced that physicians' consultations and treatments were led by motives other than the patients' wellbeing. A total of 33% rated their premiums as (too) high, 63% as fair and 4% as (very) low with differences according to income, sex and health status.

Conclusions
From a population perspective, the German health care system has the potential to be more efficient e.g. by reducing duplicate tests. Patients with PHI experience unnecessary services and duplicate tests, which put a strain on both, the already limited financial and personnel resources on a macro level, and the level of the individual PHI premium.

Key messages
Patients perceived tests or services as unnecessary, and hence, can detect inefficiencies of a health care system. Efficiency can be improved e.g. by a better coordination of care between health care providers.
18.H. Workshop: Bringing evidence during public health emergencies: addressing the challenge through HTA
Authors:   Organised by: EUPHA Infectious diseases control section, EUPHA Health technology assessment section,   Chair persons: Elena Petelos - Greece, Carlo Favaretti - EUPHA-HTA
Published: October 2020

Abstract
Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking.
The process of including evidence in public health decision-making and for evidence-informed policy, in preparation, and during public health emergencies, is not systematic and is complicated by many barriers as the absences of shared tools and approaches for evidence-based preparedness and response planning. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability and to implement coordinated evidence-based response plans. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. As a multidisciplinary, standardized and evidence-based decision-making tool, Health Technology Assessment (HTA) represents and approach that can inform public health emergency preparedness and response planning processes; it can also provide meaningful insights on existing preparedness structures, working as bridge between scientists and decision-makers, easing knowledge transition and translation to ensure that evidence is effectively integrated into decision-making contexts. HTA can address the link between scientific evidence and decision-making in public health emergencies, and overcome the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines. It may allow a 360° perspective, providing a comprehensive view to decision-making in preparation and during public health emergencies. The objective of the workshop is to explore and present how HTA can be used as a shared and systematic evidence-based tool for Public Health Emergency Preparedness and Response, in order to enable stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent.

Key messages
There are many barriers and no shared mechanisms to bring evidence in decision-making during public health emergencies. HTA can represent the tool to bring evidence-informed actions in public health emergency preparedness and response.
18.I. Workshop: Opportunities for EU funding in health
Authors:   Organised by: EUPHA, CHAFEA, EC,   Chair persons: Anne-Marie Yazbeck - CHAFEA
Published: October 2020

Abstract
The session will outline the new stand-alone EU4Health Programme for 2021-27. The programme that will fill the gaps revealed by the COVID-19 crisis and ensure that EU's health systems are resilient enough to face future health threats through: more coordination between Member States,more capacity at EU level to prepare for and to fight health crises,more investment in health systems to face future challenges.
Links to other important areas of EU funding will be included, such as: social inclusionregional developmentresearch and innovation.
Presenters are European Commission staff covering areas: EU4 Health Programme, DG Health and Food SafetyEuropean Social Fund+; DG Employment, Social Affairs and InclusionHealth Research in Horizon Europe; DG Research and InnovationDigital Health in Horizon Europe; DG Communications Networks, Content and TechnologyEuropean Regional Development Fund; DG Regional and Urban Policy.

Key messages
Building on the lessons learned from COVID-19, EU4Health is an ambitious and dedicated funding programme for 2021-2027 to build resilient health systems in the EU to be better equip us for the future. Other important areas of EU funding for health include social inclusion, regional development, research and innovation.
Burden of foodborne disease in the Netherlands: from science to policy
Authors: Mughini Gras L 
Published: October 2020

Abstract
In the Netherlands, the Ministry of Health mandates the National Institute for Public Health and the Environment (RIVM) to provide annual updates of the number of illnesses, disease burden and cost-of-illness caused by an agreed-upon standard panel of 14 enteric pathogens. These pathogens are mainly transmitted by food, but also via direct contact with animals, environment-mediated and human-to-human transmission routes. The disease burden is expressed in DALYs (Disability Adjusted Life Years), a metric integrating morbidity and mortality into one unit. Furthermore, the cost-of-illness (COI) related to these 14 pathogens is estimated and expressed in euros. The COI estimates include healthcare costs, the costs for the patient and/or his family, such as travel expenses, as well as costs in other sectors, for example due to productivity losses. Moreover, using different approaches to source attribution, the estimated DALYs and associated COI estimates are attributed to five major transmission pathways (i.e. food, environment, direct animal contact, human-human transmission, and travel) and 11 food groups within the foodborne pathway itself. The most recent DALY and COI estimates referring to the year 2018 show that the 14 pathogens in question are cumulatively responsible for about 11,000 DALYs and €426 million costs for the Dutch population in 2018, with a share for foodborne transmission being estimated at 4,300 DALYs and €171 million costs, which is comparable to previous years. These estimates have been providing vital insights for policy making as to guide public health interventions and resource allocation for over two decades in the Netherlands. Herewith, the approach and outcomes of the burden of disease and COI estimates in the Netherlands will be presented, with a focus on how these estimates enable policy-makers and the scientific community to monitor trends, generate scientific hypotheses, and undertake public health actions.
Mental health policy issues and development in Lithuania
Authors: Rubikas I R 
Published: October 2020

Abstract

Background
Lithuanian has experienced rapid and relatively successful transition to capitalism and transatlantic-Western values and practices in recent decades. Suicide and legal alcohol consumption rates remain the highest in the EU and OECD, and Lithuania's Positive emotions index score has been consistently amongst the 10 lowest in the world in recent years. Emigration rate is the highest in the EU and OECD, social inequality is amongst the highest in the same groups. Despite a relatively strong economy these changes are not automatically transferred to better social and emotional well-being.

Methods
This unconventional situation calls for strong and unconventional policy responses in the area of mental health, amongst others. Health impact assessment using theory-based approach and desk research.

Results
Recent attempts include strategic reorientation towards social and emotional well-being, stronger focus on prevention and promotion and primary care, intensifying efforts to reduce suicide rates, and implementation of strong regulatory measures to reduce alcohol use. Suicide rates have been declining since 2013 but remain high. Effort is made to implement best practices in media reporting, recognition and providing appropriate help for those in suicide crisis, expanding prevention efforts.

Conclusions
Finally, WHOs “best buys” in alcohol control were implemented since 2017, including steep increases in excise taxes, ban on alcohol advertisement, increase of allowed age, reducing alcohol trading hours and others. This resulted in the steepest decline of legal alcohol consumption in decades. The chosen policy route may be called iterative policy-making, whereby improvements are made along the way, which allows for quicker policy decisions and results.

Key messages
Mental health policies need to be based on the socio-political context of the specific country. Smaller countries such as Lithuania might benefit form flexible approaches to mental health policies.
Opportunities and current challenges for the use of polygenic risk scores in risk prediction and prevention
Authors: Kroese M 
Published: October 2020

Abstract
The panellist Mark Kroese will discuss about the opportunities and current challenges for the use of polygenic risk scores in risk prediction and the prevention of common adult onset conditions. Considerable progress has been made in the scientific development of polygenic risk scores for use in estimating the risk of common chronic conditions. However, key challenges remain in developing practical applications for their use in the clinic and establishing the evidence of their clinical utility. Questions remain about how such approaches will improve current risk prediction tools and methods. In addition, there is much debate about the nature of the possible benefits of using such scores for clinical advice and decision making as well as the likely impact on individual behaviour and future outcomes. Do we need a different approach in developing future risk prediction tools?
Homo Salus: the master mind behind health tourism
Authors: Saboga-Nunes L 
Published: October 2020

Abstract

Background
Health tourism (HT) (e.g. wellness tourism, thermalism & spa, medical tourism based in the delocalization of disease curative segments) is pervasive today in different formats. Hubs of high tech and nature spots are the basis for this increment of services. HT although present in the course of human history, has conquered a new social dimension today. Mobility and easy access to travel, are ingredients that fueled this segment, while a culture of health promotion (of all human dimensions - physical, psyche, spiritual and social) diversified the marked offers and services. The focus on health (salus, in latin) is the basis for the HT industry, contributing to a new ethos: the homo salus. Implications of HT need to be dissected and basic concepts integrated, as a glossary of terms and references and a charter of HT, from the public health perspective, are introduced to participants.

Methods
Document and stakeholder analysis help explore the Health Impact Assessment (HIA) of HT towards a knowledgeable civic society.

Results
In the EU28, HT contributes 0.3% to the economy (2017). HT has hindrances but represent also a set of benefits since it may contribute to health (per see) and moreover decrease pharmaceutical consumption and reduce health costs through disease prevention. For this to take place a set of (competences) health literacy needs to empower the health tourist so that the benefits of HT become sustainable. Therefore, the concept of health needs to be clarified since the commonly used idea of WHO (1948) of what health is, do not fit into the overall social representation of HT.

Conclusions
The advent of the Homo Salus as a Prosumer, is aiming at the creation of health (salus+genesis) i.e. the quest is to become in a better condition moving towards the health end of the dis-ease continuum. Salutogenesis as a framework can contribute to better understand the public health dimension of HT going beyond the traditional curative dimension.
Does management integration improve cross-level clinical coordination? Experience of Catalonia
Authors: Esteve-Matalí L , Vargas I , Cots F , Ramon I , Sánchez E , Coderch J , Plaja P , Vázquez for Gaia M L 
Published: October 2020

Abstract

Background
Cross-level clinical coordination is a priority for health systems. Evidence suggests that management integration may improve clinical coordination. This study aims to evaluate clinical coordination according to the type of management integration of the area in the Catalan health system.

Methods
Cross-sectional study based on the online questionnaire COORDENA-CAT (October-December 2017). Study population: primary and secondary care (acute and long term) doctors of the public Catalan health system. Sample: 3.308 doctors. Outcome variables: experience and perception of clinical coordination across care levels, knowledge and use of coordination mechanisms and related factors. Explanatory variables: area according to type of management (integrated, semi-integrated and non-integrated), demographic, employment characteristics and attitude towards work. Descriptive and multivariate analysis by robust Poisson regression.

Results
Better clinical coordination was observed in integrated areas compared to those semi-integrated, mostly in information transfer (PR 0.80 (95%CI 0.74-0.87)) and adequate follow-up of the patient (PR 0.89 (95%IC 0.82-0.97)). No differences were observed between integrated and non-integrated areas. General perception of coordination was higher in integrated areas than in semi-integrated and non-integrated areas (PR 0.73 (95%CI 0.63-0.84) and PR 0.85 (95%CI 0.75-0.97) respectively). Some organizational and interactional factors and the knowledge and use of coordination mechanisms showed also better results in integrated areas. There were common fields for improvement like accessibility between care levels.

Conclusions
No differences between integrated and non-integrated areas reveal that management integration is not enough condition to improve clinical coordination. Differences with semi-integrated areas suggest that coordination efforts should be equitable among all the providers of the territory to avoid inequalities in quality of care.

Key messages
Management integration does not determine clinical coordination. Cooperation formulas are needed between all territory providers that allow to fix common strategies to improve clinical coordination.
Evaluating small conditional cash transfers to improve vaccine coverage and timeliness in Pakistan
Authors: Abdullah S , Siddiqi D A , Shah M T , Glennerster R , Khan A J , Chandir S 
Published: October 2020

Abstract

Background
Low immunization coverage rates have prompted the need to design effective demand-side interventions to improve uptake. Simple SMS reminders and large (≥USD 100) incentives have been demonstrated to effectively increase immunization coverage. However, research on small incentives (≤USD 15) for immunization is sparse and there is uncertainty regarding the optimal structure of incentives in terms of size, schedule, and design.

Methods
A 12-arm randomized controlled trial is being conducted in Karachi, Pakistan with 10 incentive arms of varying size (amount), schedules (progressivity) and design (certainty of payment), an exclusive SMS arm and control arm. The incentives are provided through two mechanisms: mobile air time and mobile-money through a mobile-money provider. Children were enrolled when they presented to the study sites for either BCG, Penta-1, or Penta-2 vaccine.

Results
A total of 11,197 children were enrolled between Nov 2017 and Oct 2018 with approximately 800 children in each incentive arm and 1600 and 1599 in SMS and Control arm, respectively. As of Jan 09, 2020, Penta-3 and Measles-1 coverage are lowest in the control arm (71% and 60% respectively) and highest in the high-flat-lottery arm (78% and 69% respectively) with uniformly progressing incentive amounts along the immunization schedule.

Discussion
Interim results suggest that small mobile-based incentives coupled with SMS reminders can significantly improve immunization coverage in children. The final analysis will provide robust evidence of this impact and provide policy implications for the most optimal incentive structure that can build caregiver demand for effectively increasing child immunization in an LMIC setting.

Key messages
Small incentives (USD&lt;15) coupled with simple SMS reminders can improve immunization coverage and timeliness in low resource settings in an inexpensive, logistically simple way. The study will provide experimental evidence on optimal incentive design, structure, and size of small incentives for a cost-effective approach to increase immunization coverage and timeliness.