bluuebunny/crossref_metadata_2025_split huggingface dataset:
Speedy, predictable and secure cancer care? Introducing cancer patient pathways in Norway
Authors: Melby L , Håland E 
Published: November 2019

Abstract

Norway introduced cancer patient pathways (CPPs) in 2015. CPPs are standardised patient pathways, based on current guidelines for cancer diagnostics and treatment. The aim is to speed up patient assessments and start of treatment and minimise waiting times, in order to make the assessment period as predictable as possible. Each CPP are divided into phases, and each phase should be completed within a defined time period. The aim of this paper is to describe and discuss how healthcare professionals work to realise the objectives of the CPPs and how they reflect upon them as tools for achieving predictable and secure cancer care.
The paper departs from an ongoing study (2017-2020) investigating the introduction of CPPs in Norway. The study has a qualitative cross-sectional design and focuses on four CPPs: breast-, prostate, and lung cancer, and malign melanoma. Data are mainly collected through interviews. The study setting is four hospitals, and study participants are hospital staff, including physicians, nurses, clerical workers and managers (N = 60).
Preliminary results show that keeping the waiting times has become a major concern, and national statistics are published showing if the hospitals keep the defined time limits. From the perspective of healthcare workers, CPPs may contribute to a predictable assessment period for patients, and thereby creating a more secure experience. However, predictability and security rest on patients being informed about receiving care organised through a CPP. We found that in many instances this was not the case.
Our study indicates that most effort in hospitals is directed towards reducing waiting times, and we argue that publishing of statistics may be an incentive for hospitals to reorganise their resources and prioritize cancer patients before other (elective) patients. Further development of the CPPs should encourage informing and supporting patients so they can have the most predictable and secure experience as possible.

Key messages
Patient pathways is an incentive to reorganise resources to reach defined time limits in cancer diagnostics. Short waiting times are positive for patients, even if survival rate is not necessarily affected.
Estimation of the epidemiological impact of the organized screening program for colorectal cancer
Authors: Barre S , Leleu H , Taleb S , Vimont A 
Published: November 2019

Abstract

Introduction
Colorectal cancer (CRC) is the third most common cancer and the second most deadly in France. A CRC national organized screening (OS) program was set up in France in 2009. It targets asymptomatic people aged 50 to 74 year with medium risk of CRC. OS program is based on fecal immunochemical test (FIT) followed by colonoscopy. Participation rate over the last period showed a participation rate of 34%, far from the European standards and the 45% target objective of the French cancer plan.

Methods
The epidemiological impact of the DO-CCR was estimated from the results of an individual simulation model adapted from the MISCAN-Colon model, calibrated and transposed to the French context. The model simulates the natural history of CRC in a cohort of 5,000,000 individuals from birth to death. The simulated population reproduced the age and sex structure of the French population. Current screening strategy was simulated for the entire population. A first analysis was conducted to estimate the individual impact of screening by sex and by age of screening initiation and cessation. A second analysis was carried out to estimate the global impact of the based on various participation rates.

Results
FIT every 2 years, from the age of 50, is associated with a reduction in the CRC incidence of 21% for women and 24% for men and a reduction in CRC mortality of 43% for women and 51% for men. At the current level of participation, the OS reduces incidence by 5% and mortality by 14% (2,200 CCR and 2,600 deaths per year) compared to no OS. The impact would be reduced by an additional 3% and 8% for participation rates of 45% and 65% respectively, a decrease of 1,300 and 3,500 cases per additional year. Similarly, mortality would decrease by an additional 8% and 22% for participation rates of 45% and 65%, respectively additional decreases of 1,400 and 4,000 deaths per year.

Key messages
These results confirm that in a population at medium risk for CRC, the OS is an effective strategy for reducing incidence of CRC. Increasing participation rate to reach the Cancer Plan’s objectives remains a key issue in France.
Barriers and facilitators on cervical cancer screening among HIV women in Cote d’Ivoire
Authors: Mensah K , Pourette D , Duschene V , DeBeaudrap P , Dumont A 
Published: November 2019

Abstract

Background
With 50,000 death every year, cervical cancer is the fourth most common cause of death by cancer in sub-Saharan countries. Due to high risk human papilloma virus (hr-HPV) persistence on the cervix, leading to pre-malignous lesions, the disease is more frequent among HIV-positive women. In low- and middle-income countries, cervical cancer screening strategy relies on visual inspection with acetic acid, an operator-associated technic. As an alternative, HPV-based detection and its better performances are considered as it could lead to a potential screening uptake and women empowerment through self-sampling. Côte d’Ivoire, with a high HIV prevalence, is considering this innovative strategy. Yet, few studies analyzed the potential socio-cultural factors associated with cervical cancer screening in this context. Our study aims to assess beliefs and perceptions toward cervical cancer among HIV positive women in Abidjan, Côte d’Ivoire.

Methods
We performed in-depth interviews with 21 HIV positive women randomly attending a health center or member of a women’s association, in November 2018. All interviews were recorded and transcribed. A theoretical framework with the Health Belief Model and the PEN-3 was used to categorize women’s perceptions, enablers, nurturers, perceived gravity and self-efficacy about cervical cancer, screening and self-sampling technique introduction.

Results
Positive findings were knowledge about cervical cancer, awareness about women’s vulnerability and HIV status role on it and relationship to caregivers. Fear appeared as a barrier to screening but also a facilitator among women with health awareness. Negative findings were reluctance for HIV-associated diseases, poor screening knowledge and lack of resources to get treated. Self-sampling introduction was disregarded due to lack of self-confidence.

Conclusions
This study provides useful information for counselling and opens the door to HPV-based screening implementation.

Key messages
Beliefs and perceptions about cervical cancer screening among HIV women need to be assess before implementing a new strategy. Cervical cancer screening uptake will need to address fear, self-confidence and stigma.
Employment two years after breast cancer diagnosis: role of household characteristics, CANTO cohort
Authors: Caumette E , Dumas A , Pinto S , El Mouhebb M , Bovagnet T , Meglio A Di , Lemonnier J , Everhard S , Vaz-Luis I , Menvielle G 
Published: November 2019

Abstract

Background
Breast cancer is associated with a high 5-year survival rate and more than half women are still of working age at diagnosis. Many studies evaluated the clinical determinants of return to work (RTW) but few investigated RTW in relation to family factors. Our objective was to study the role of household characteristics in non-RTW two years after breast cancerdiagnosis.

Methods
We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Patients had to be under 57 and have a job at diagnosis. We performed logistic regressions to model non-RTW two years after diagnosis in relation to household characteristics at diagnosis (marital status, children, support from partner), adjusting for tumor characteristics, health status at baseline and one year after diagnosis, and household income at diagnosis. In a second step, we conducted analyses stratified for household income at diagnosis.

Results
In total, 1874 women were eligible. Being in a relationship did not impact non-RTW (OR = 1.43 [95% CI 0.95-2.16]). Among the 1566 women in a relationship, being married was associated with elevated odds of non-RTW(OR = 1.37 [0.96-1.94]). Having children(OR = 1.17 [0.81-1.69]) or receiving support from their partner (OR = 1.17 [0.77-1.78]) was not associated with non-RTW. However, the situation differed in low-income households(&lt;2500€) among whom being married was associated with more elevated odds of non-RTW(OR = 1.94 [0.97-3.88]). No clear association was observed between having children (OR = 1.85 [0.85-4.03]) and non-RTW, but living with at least two children (OR = 2.76 [1.14-6.70]) and receiving support from their partner (OR = 2.28 [1.01-5.17]) was associated with increased odds of non-RTW.

Conclusions
The family environment is associated with non-RTW among the poorest women but not the others.

Key messages
Among the poorest women, the family environment is associated with non-RTW. Among all women, the family environment is not associated with non-RTW.
Traditional Eastern European diet and its relationship with mortality: results from the HAPIEE study
Authors: Stefler D , Brett D , Sarkadi Nagy E , Kopczynska E , Detchev S , Bati A , Malyutina S , Kubinova R , Pajak A , Bobak M 
Published: November 2019

Abstract

Background
Cardiovascular disease (CVD) and cancer mortality rates in Eastern European countries are among the highest in the world. Although unhealthy diet is an important risk factor for both of these chronic diseases, traditional eating habits and their health effects in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European population-based cohorts.

Methods
We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) multi-centre prospective cohort study based in Russia, Poland and the Czech Republic (age range at baseline: 45-70 years). Diet was assessed by food frequency questionnaire, and we constructed an Eastern European diet score (EEDS) from nine food groups considered as “traditional” in this region. The relationship between EEDS and all-cause, CVD and cancer mortality was calculated with Cox-regression models.

Results
From the 18,852 participants, 2,234 died during the average follow-up of 11.7 years. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.20; 95% CI 1.05-1.38) and CVD deaths (1.32; 1.05-1.64) compared to those with low adherence. The association with cancer mortality was not significant (1.12; 0.90-1.40). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while processed fruit or vegetable consumption showed consistent inverse associations.

Conclusions
Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

Key messages
This work indicates that traditional dietary habits in Eastern European countries may be one of the reasons for the poor health status of populations in this region. Public health nutritional interventions which target traditional but unhealthy foods, such as lard, have the potential to considerably improve population health in Eastern Europe.
Potentials of school nursing for strengthening health literacy: a 2017/18 German longitudinal survey
Authors: de Buhr E , Tannen A 
Published: November 2019

Abstract

Background
Health literacy (HL) plays a key role in explaining health disparities. School nurses provide health related expert knowledge and skills within the school setting. A positive effect on the HL of children but also their teachers and parents is assumed and supported by some research but gaps persist in the available data.

Methods
As part of a pilot school nursing project, which placed school nurses in 28 public schools in two German states, all teachers, parents and students (11+ years) attending the schools were invited to participate in a 2017 baseline (T0) and 2018 follow-up (T1) survey. Adult HL was measured using the HLS-EU-Q16 and child HL with the HLSAC. Bi- and multivariate analyses were carried out.

Results
Comparing T0 and T1, HL scores improved in all populations. In East Germany (Brandenburg), the percentage of teachers with problematic or inadequate HL decreased from 56.6 (N = 173) to 51.5 (N = 173) and among parents from 45.7 (N = 1719) to 43.2 (N = 1080). In West Germany (Hessen), the percentage of teachers with problematic or inadequate HL also decreased, from 43.7 (N = 201) to 42.2 (N = 263), and among parents from 42.2 (N = 2013) to 34.9 (N = 1251). The percentage of children that scored in the moderate or high HL brackets increased from 77.9 (N = 898) to 82.2 (N = 736) in Brandenburg and from 84.9 (N = 1379) to 86.5 (N = 1487) in Hessen. There were strong statistical relationships between child/parental HL and child health behaviors in all datasets. The T0 and T1 comparison showed some improvements over time.
The presence of school nurses in public schools seemed to increase health awareness, thus contributing to a “healthy school.” After a short period (18 months) and despite a rather nonspecific spectrum of interventions, the HL of all relevant target groups improved. Further research is needed to quantify the relative contribution of the school nurses to improvements in HL, for example, by implementing a HL curriculum in a controlled setting.

Key messages
The presence of a school nurse seemed to increase health awareness contributing to a “healthy school.” After 18 months of intervention, the health literacy of children, parents and teachers improved.
Association between occupational situation and health literacy: A Danish population-based survey
Authors: Wagner Svendsen I , Busk Damgaard M , Kronborg Bak C , Tang Svendsen M , Berg-Beckhoff G 
Published: November 2019

Abstract

Background
It is well known, that health literacy is associated with health, and that occupation and health is associated as well. But current knowledge on the relationship between occupation and health literacy is scarce. The aim of this study was to examine the association of occupation with health literacy.

Methods
Between 2016 and 2017 a random sample of the Danish population participated in a cross-sectional national representative survey using the short version of the European Health Literacy Survey Questionnaire. 15,682 adults aged 25 years or older was invited, and 8,997 residents participated. Data on occupational situation were obtained from nationwide administrative registries, which contains information on employment and public benefits. Logistic regression was conducted for the binary outcome of health literacy and the exposure variable of occupational situation. Model was adjusted for sex, age, immigration, education, cohabitation and income. Subsequently, a mediation analysis was conducted to analyze if health literacy was a causal pathway in the association between occupational situation and health.

Results
Respondents receiving unemployment benefits had a significantly higher risk of inadequate health literacy [OR = 1.66 (p &lt; 0.001)] compared to respondents who were employed. The associations were also significant for social assistance [OR = 1.63 (p &lt; 0.001)], employment and support allowance [OR = 1.59 (p &lt; 0.001)], and sickness benefit [OR = 1.55 (p &lt; 0.001)]. Mediation analysis showed, that the association between employment status and health were partly mediated by health literacy.

Conclusions
Results are important to understand the health disparities in connection to occupational situation, health literacy, and health. As a mean for health promotion, interventions to improve health literacy should be planned for groups receiving public benefits and when health information is delivered for these groups the level of health literacy should be considered.

Key messages
Association between employment status and health were partly mediated by health literacy. Interventions to improve health literacy should be planned for groups receiving public benefits.
Information seeking and knowledge on in-home care services in a representative sample in Switzerland
Authors: Mantwill S , Dawson-Townsend K 
Published: November 2019

Abstract

Background
In Switzerland the use of in-home care services has increased steadily in recent years. Contributing to this trend are a growing aging population and changing family structures. In-home care services are embedded in complex financing systems, which require considerable efforts and capacities to navigate, and if not well understood, can lead to inefficient usage of healthcare services. The aim of this study is to assess information seeking behavior and knowledge on in-home care services in the Swiss general population.

Methods
Data comes from a cross-sectional online survey, using a representative sample from Switzerland (N = 1050), conducted in September 2018. The survey included items on information seeking behavior (sources, difficulties seeking information), as well as general and financial knowledge on in-home care services.

Results
50.1% had sought information on in-home care services at least once. Logistic regression shows that age (β=.01, p&lt;.005) and gender are significant predictors for information seeking, with women being more likely to have sought information (β=.26, p&lt;.05). Those with highest education are less likely to have sought information (β=-.55, p&lt;.05). About 1/4 of participants indicate having had some difficulty when seeking information, including being worried about the quality of information. 84.8% indicate to have at least some knowledge about in-home care financing. Whereas the majority is relatively well informed on the financing of in-home care services, such as “acute and transitional care”, participants have overall relatively little knowledge on additional financing mechanisms, such as supplemental benefits. Multiple regression shows that age significantly predicts financial knowledge (β=.04, p&lt;.001).

Conclusions
The study shows that knowledge gaps exist, which may hinder effective and efficient use of in-home care services, as well as a potential lack of available and clear information to make appropriate decisions on services.

Key messages
Important knowledge gaps on in-home care services exist in Switzerland. The study indicates a potential lack of available and easy-to-understand information on in-home care services in Switzerland.
A life course analysis of income and incident AMI - a Danish register based cohort study
Authors: Lund R , Kriegbaum M , Andersen I , Hougaard C O , Brønnum-Hansen H 
Published: November 2019

Abstract

Background
Social inequality in ischemic heart disease has been related to socioeconomic position in childhood, early and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences has not been investigated.
The aim was to investigate the association between relative level of accumulated income across the life course and Acute myocardial infarction (AMI) from age 60+ and to study if the associations differ by gender and exposure in different age groups (30-39 years, 40-49 years and 50-59 years).

Methods
All Danes born 1935-54 N = 1,235,139 were followed-up in registers for incident AMI (ICD8: 410, ICD10: I20, I21) from age 60+, (42,669 cases). The The Accumulated Proportional Deviation from Median Equivalized Income = APDMEI for each gender/age /calendar year strata was constructed and divided in quartiles. The analyses stratified by birth cohort included all Danes born in 1955-70 (alive and reached age 40) N = 1,144,264, 1945-64 (alive and reached age 50), N = 1,434,769, 1935-1954 (alive and reached age 60) N = 1,235,139 including outcomes in the following 10 year period. Cox’s proportional hazard models adjusted for educational level, ethnic background and birth cohort.

Results
Among men, those in the lowest APDMEI quartile had a HR 1.40 (1.35-1.45) of AMI compared to the highest quartile, second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women the lowest quartile had a HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age-groups.

Conclusions
The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.

Key messages
Accumulated low income is associated with higher AMI risk in both men and women, but with larger relative differences between high and low accumulated income in women. This study adds a new approach to the study of inequalities in AMI by integrating duration and extent of low income into a relative measure of accumulated income.
Europeans’ willingness to pay for ending homelessness: a contingent valuation study
Authors: Loubiere S , Tinland A , Taylor O , Loundou A , Auquier P , Ornelas J 
Published: November 2019

Abstract

Objective
In Europe, 4 million people were homeless in 2009. The Staircase model of care targeted mental health, drug rehabilitation and housing readiness yields poor long-term housing results. Western countries are investing in a new model, Housing First (HF), which yields better clinical and social results. We aim to explore how much the European citizens are willing to pay for the HF model and what are the determinants of this valuation.

Methods
A nationally representative telephone survey conducted in 2017, targeted European adult citizens from France, Ireland, Italy, Netherlands, Portugal, Spain, Poland and Sweden. Respondent’s willingness-to-pay (WTP) (n = 5,631) for HF model was assessed through a contingent valuation method with bidding algorithm. Multivariate analyses using two-part models with a cluster and weighted design were conducted to predict: 1/ respondents’ refusal or incapacity to pay for the HF model; 2/ willingness-to-pay (continuum) for the HF model.

Results
42.3% of respondents were willing to pay more taxes to reduce homelessness through HF model; 30.3% were protest zero (don’t want to pay taxes (either contested the payment vehicle-taxes- or the survey instrument); huge differences being observed between countries (P&lt;.001). Respondents were willing to pay €57 (+/- 9) through annual taxes for the HF model. Respondents with higher educational attainment, paying taxes on income, reporting positive attitudes about homelessness or practices to reduce homelessness (donations, volunteering), and those residing in a country with higher share of social protection expenditures on family benefits or higher at-risk-of-poverty rate were more likely to value the HF model.

Perspective
These results provide key stakeholders with an understanding of the level of support from the general population for the Housing First model; especially since the determinants of this valuation were studied according to the social and environmental context of each country.

Key messages
More than 42% of European citizens reported to be willing to pay for reversing homelessness. More than a three quarter of European citizens thought that Government spending on Homelessness is too little.