bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the effectiveness of a screening program for cardiovascular diseases in Kazakhstan
Authors: Bekbergenova Z , Derbissalina G , Umbetzhanova A , Koikov V , Bedelbayeva G 
Published: November 2019

Abstract

Background
Cardiovascular diseases (CVD) occupy leading positions in the mortality of the Republic of Kazakhstan (RK). In RK CVD screening is performed with 40-years of age. Objectives: to evaluate the effectiveness of screening over time.

Methods
We conducted a survey of 121 patients with CVD, identified on screening.

Results
The average age patients in survey-54.3 [95% CI: 52.64;55.96], of which 38% are men and 62%-women. Fact smoking mark 64 persons (52±8), alcohol-(37.2±11.6), family history-66 (54.5±8.1) daily physical activity-34 person (28.1±14.3). Middle systolic blood pressure (BP) is 144.3 [95% CI: 141.61;146.99] and diastolic BP 90.2 [95% CI: 89.02;91.38] mm.Hg. Most of the respondents have different degrees of obesity. The average BMI is 31.8 [95% CI: 30.93;32.67]. The average waist size is 89.1 [95% CI: 86.88;91.52], with the waist size of women over 80 cm (91.9 [89.03;94.77] and the waist size of men 86.1 [82.31; 89.89]. Mean values for total cholesterol of 5.9 [95% CI: 5.85;5.95]. To evaluate the effect of various factors on the increase in BP, we calculated the analysis of variance. According to our calculations, gender does not affect BP, however, age, BMI and waist size affect.
We interviewed patients for complaints, analyzed outpatient cards, a check-up journal: chest pains or interruptions in the heart during exercise are noted by 25 people (20.7±17.5), improvement of the subjective state-29 (24±15.9), regularly receive basic therapy-59 (48.8±9.1), call the ambulance team-43 (35.5±12), are urgently hospitalized for a year-31 (25.6±15.2) and 7 person participate in the school of CVD. There is a statistically significant relationship between gender and smoking, gender and alcohol, gender and regular intake of basic therapy at a significance level of p &lt; 0.05.

Conclusions
Identifying the low effectiveness of CVD screening over time requires the revision of a comprehensive training program for doctors-nurses and the public.

Key messages
Patients in Kazakhstan generally do not change their lifestyle after screening for a disease. The effectiveness of the screening depends on the teamwork of the doctor, nurse and patient.
Citizens’ perceptions of the health-related neighbourhood environment in Limassol, Cyprus
Authors: Kleopa D , Panayiotou A , Kouta C , Middleton N 
Published: November 2019

Abstract

Background
“Place” can impact on health and quality of life. There is a growing interest in neighbourhood audits. In the context of developing the CyNOTes audit tool, a residents’ perception of the neighbourhood environment survey was performed.

Methods
A systematic random sample of ten adult residents (N = 150) across a stratified sample of fifteen neighbourhoods according to educational attainment as per census data responded to the “Place Standard” tool which assesses 14 aspects of the physical, built and social neighbourhood environment. Neighbourhoods were also audited using the 126-item CyNOTes.

Results
Three in four participants were home owners and lived in the neighbourhood for over 10 years. With the exception of “identity and sense of belonging” (M = 5.8, SD = 2.0) and “opportunities for social interaction” (M = 5.3, SD = 2.1), physical and built aspects of the environment were rated close to the middle point on a scale 1: large to 7: little room for improvement. “Parks, playgrounds and green space” and “garbage, animal droppings and other physical disorder” were the most commonly mentioned priorities for action in the free text by one in three participants. The lowest score was recorded for “influence and sense of control” (M = 3.4, SD = 2.4). While on a 1-10 subjective perception of neighbourhood position, residents in lower education neighbourhoods gave a rating of 6.6 on average compared to 8.1 in the higher group, they tended to rate aspects of their neighbourhood more favourably. Even though the audit revealed a systematic pattern of less favourable conditions along the socio-economic continuum, the perception survey revealed a U-pattern with residents in the middle category more likely to give less favourable ratings.

Conclusions
The extent to which perceptions surveys may be affected by differential expectations across social groups is not clear. Neighborhood audits provide supplementary profiles of “place” independent of the perceptions of residents.

Key messages
Based on the Place Standard tool, Limassol residents’ rate social aspects of their neighbourhood environment more favourably than aspects of the built and physical environment. Neighbourhood observed-based audits, independent of residents’ perceptions surveys can supplement each other in city health profiling.
Evaluating implementation of an Heat-health action plan during 2018 heatwave in Amadora, Portugal
Authors: Leite A , Cabral M , Rodrigues E , Vaz D , Calé E , Silva A C 
Published: November 2019

Abstract

Issue
Heatwave-health effects are preventable. Heat-health action plans (HHAPs) include preventive measures aimed at protecting population. In Portugal, HHAPs exist since 2004 and have been operationalized at local level. Heatwaves occur infrequently, thus experience with HHAPs is relevant to countries implementing their own HHAPs.

Description
In the summer of 2018, Amadora (Lisbon, Portugal) issued a warning from the 2nd-6th August (highest level:4th-6th). Before/during the warning we implemented: 1.climatized shelter opened available upon request;2.text messages with recommendations and information on the walk-in clinic services available;3.information to nursing homes regarding available services (walk-in services/shelter);4.contact with individuals receiving home support and identified as vulnerable. Nationwide media publicity of individual protection measures was also ongoing. We aimed at evaluating these HHAP measures. We compared demand of walk-in clinic (primary care) and emergency department with existing capacity, updated during the heatwave. Mortality was analysed using an observed-expected ratio (O/E) of week 32 (following the heatwave) and 95% confidence interval (95%CI) under a Poisson distribution. Expected deaths were the average deaths in week 32 of the previous 4 years (2014-17).

Results
In the primary care walk-in clinic the demand was ½ of capacity; hospital emergency services demand did not increase. We had no requests for the shelter unit. Regarding mortality, O/E was 1.57 (95%CI:1.12-2.14). These results are preliminary; we are producing more detailed analyses of mortality data.

Lessons
We have no counterfactual to assess the effect of our HHAP but our results indicate the possibility to reduce heatwaves-mortality further and thus the need for additional measures. We did not observed the expected surge in service demand; the adequacy of supply-based measures is currently under debate. More detailed mortality analysis will provide further insights.

Key messages
We implemented several measures during a heatwave in Amadora, Portugal with no increased demand in available health services in the area. We detected an increased mortality following the heatwave, suggesting the need to implement further measures.
Occupational exposure assessment to per and trichloroethylene in dry cleaning in Sfax city (Tunisia)
Authors: Omrane F , Khadhraoui M , Abid A , Mitigui M , Elleuch B , Gargouri I 
Published: November 2019

Abstract

The use of chlorinated solvents in dry cleaning poses risks to human health. The current study is the first in Tunisia and Sfax city that aims to assess the occupational exposure and health risks of perchloroethylene (PCE) and trichloroethylene (TCE) in the dry cleaning industry. TCE was suspected to be used as it is not explicitly banned by law.
We identified dry cleaning facilities by door-to-door canvassing within a 5 Km radius from the city center of Sfax. We found 47 facilities, but only 33 accepted to join our study. Then, we randomly selected 16 facilities where the exposure assessment to these solvents was conducted by indoor air measurements. The exposure levels were compared to occupational exposure limit values (OELV) and toxicological reference values. Then, cancer risks were evaluated.
TCE was detected in all workplaces and their levels are close to the OELV (95% CI of the mean value [40.4-46 mg/m3]). The mean value of PCE concentrations is lower than the fifth of the OELV, but they are quite variable (95% CI of the mean value [5.1-43.4 mg/m3]). The overall results showed that inhalation exposure levels may induce many adverse effects that are probably threatening the occupationally exposed population and even the general one, because of the location of all facilities in residential settings. Among threshold effects, we noted high risks of neurological, renal, developmental and immune effects. As for carcinogenic effects, greatly high cancer risks were noticed if the lifetime exposure would have these average levels; 17 additional cases of kidney, hematologic or liver cancers are expected to occur in populations of 100.
This study is significant for better understanding of the dry cleaning industrial sector in Tunisia and for the progress of future risk assessment studies. Indeed, it responded to many interrogations and suspicions about the qualitative and quantitative exposure conditions and thus the health status of dry cleaning workers in Sfax.

Key messages
Our study is the first health risk assessment study of the exposure to chlorinated solvents in dry cleaning in Sfax city. It revealed high levels of trichloroethylene that is a carcinogen to humans. The high exposure levels to per and tri-chloroethylene, in dry cleaning in Sfax city, may induce adverse health effects to workers and even the general population due to residential exposure.
Attitudes, norms and behaviors enhancing unhealthy food choices of high school students in Armenia
Authors: Aslanyan L A , Demirchyan A D 
Published: November 2019

Abstract

Background
Negative attitudes towards healthy eating behaviors are common among school-aged children. Given the scarcity of studies investigating eating behaviors among adolescents in Armenia, the current study sought to explore eating behaviors among high school students and assess the attitudes, norms and behaviors enhancing unhealthy food choices among them. Theory of Planned Behavior (TPB) was applied as a theoretical framework.

Methods
A qualitative study with focus group discussions and in-depth interviews was conducted using semi structured interview guides developed based on TPB framework. The study covered high school students aged 15-18 years old, their parents, teachers and school canteen staff, residing in cities and villages of Shirak province, Armenia. Direct content analysis with deductive approach was used for data analysis.

Results
The most preferred foods by the adolescents were fast foods, sweets, salads and sugar sweetened beverages. Taste was the most powerful attitudinal factor influencing their food choices. Friends and advertisements were the main role models affecting adolescents’ eating behaviors. Knowledge on unhealthy food choices and the consequences of unhealthy diet on one’s health were adequate among all participants, but unlike rural participants, this factor did not result in healthy eating behavior among urban participants. Lack of time, high cost of food, seasonal changes in food availability, limited food choices in school canteens and low coverage of schools with canteens, especially in the villages, had considerable impact on adolescent’s food choices.

Conclusions
According to the study results, most of the TPB constructs played role in shaping unhealthy eating behaviors among adolescents. Based on the findings, recommendations were made to conduct social advertising of healthy food choices and healthy eating behaviors among adolescents, empower school cafeterias and increase the coverage of schools with cafeterias.

Key messages
In Armenia, adolescents’ eating behaviors are mainly influenced by taste, availability, and affordability of food choices, eating behavior of peers and advertisements. Government needs to increase the coverage of schools with cafeterias and empower school cafeterias, so that they suggest healthy, tasty and affordable food choices.
Integrated guide for public procurement and private contracts of collective catering system and SDGs
Authors: Barocco G , Patussi V , Cella M , Germano D , Pernarcic A , Longo T , Occoni E , Steinbock D , Calabretti A 
Published: November 2019

Abstract

Surveys (2008-2018) carried out by the Local Health Agency of Trieste (ASUITS) in local collective catering (CC) services of schools, hospitals, nursing homes, and workplaces (25.000 daily meals) have shown some non - adherence to healthier food choices, food standards, procedures and green and social procurement as recommended by the WHO, FAO, UE, Ministry of Health and of Environment.
The purpose of this project is to support local public and private organizations in transforming the national and regional catering services food standards related to health, nutrition, environment and social criteria into food procurement and food contracts specifications. This has been done by compiling the major obstacles to improved standards observed during surveys, and by sharing critical and relevant examples with major public contractors across local, regional and national level.
The guidelines (GL) for public procurement of CC consist of five chapters: the elaboration of specifications; a response module to present the offer of services; selection and award criteria, an evaluation system of offers, and the technical specifications attached. Technical information fixes the constituent elements of the service in order to have similar and directly comparable offers. GL cover both the purchasing of food and the contracting of catering services. In this way public or private institutions are able to prepare tender documents suitable to respond to health, economic needs and Sustainable Development Goals (SDGs).
The development of the GL has increased the awareness and real potential that local organizations have in enhancing the strategic use of purchasers to boost food qualification, jobs, growth and investment. As well as to create a more innovative economy, to be resource and energy efficient, and to be socially-inclusive.
To meet population nutrient intake goals and SDGs it is necessary to increase co-operation and the sharing of the objectives of ’Health in All Policies’.

Key messages
Contractors need practical tools to apply sustainable development goals criteria in collective catering. The integrated collective catering guide is a key to improving capacity building in institutions.
Cost-effectiveness analysis of low-dose computed tomography screening for lung cancer in Hungary
Authors: Voko Z , Molnar A , Valay V , Moizs M , Kerpel-Fronius A , Bajzik G , Horvath I , Nagy B 
Published: November 2019

Abstract

Background
Hungary has the highest incidence of lung cancer in the world (GLOBOCAN, 2018). Since lung cancer is rarely treatable in its advanced stage, one possible way to reduce mortality is early diagnosis and subsequent treatment. The possibility and necessity of introducing low-dose computed tomography (LDCT) lung cancer screening as a public health programme is a current and relevant health policy issue.

Methods
A Markov cohort model was built to assess the cost-effectiveness of such a risk group screening programme in Hungary. The model was populated with transition probabilities and resource utilization data derived from the HUNCHEST Hungarian lung cancer screening trial. The model results are presented in incremental cost-effectiveness ratio.

Results
A closed cohort of 10,000 smokers with the average starting age of 59 years was followed over life-time horizon and screened for lung cancer annually until the age of 74. Compared to the current scenario of no organized lung cancer screening in Hungary, the model resulted in an additional 0.1614 life-year gained per individual and an additional 0.2924 disease-free life-year gained per individual with annual screening frequency. The incremental cost-effectiveness ratio was EUR 608 indicating that assessed intervention is cost-effective in the analyzed setting. Sensitivity analyses confirmed the robustness of the model results.

Conclusions
Results suggest that introducing low-dose computed tomography screening for lung cancer is a cost-effective intervention in Hungary. Considering the exceptionally high incidence and mortality of lung cancer in Hungary, the population could benefit from such a risk group screening programme.

Key messages
Low-dose computed tomography screening for lung cancer is cost-effectiveness in the Hungarian setting. Policy makers are encouraged to consider the introduction of a risk group screening programme.
Evaluation of the Health impact assessment (HIA) deployment process in a French region
Authors: Jabot F , Romagon J , Dardier G 
Published: November 2019

Abstract

Background
Health impact assessment is a method aimed at identifying the potential health impacts of policies and projects before their implementation and suggesting proposals in order to mitigate negative impacts and enhance positive ones. HIA is growing in France mainly at the local level. The Pays de la Loire Regional Health Agency (PDL-HRA) took an early interest in HIA and supported three experiments proposed by the town councils. An assessment was performed to judge its added value, identify success factors and draw lessons for the development of the practice.

Methods
An evaluation framework was built based on standards and literature. Using a qualitative multiple case study design, a cross-sectional analysis of the HIAs was carried out in order to compare the implementation process in their respective contexts, the governance arrangements and the changes introduced as a result of the HIA. Evaluation draws upon HIA reports, workshops, field observation and 40 interviews that were analysed with NVivo.

Results
While the conduct of HIAs is generally in line with standards of practice, the analysis of the relevance of HIA and impact characterization remain insufficiently documented. Implementation and success factors depend on the political context, the culture of institutions, actors and the purpose of HIA. Recommendations have been taken into account and changes are emerging. The stakeholders indicate their interest in HIA insofar as it is a meeting point between the concerns of institutions regarding health equity and democracy and it provides tools for action.

Conclusions
Although the approach is unanimously valued, it faces time, resource and competition with other activities. The continuation of the approach depends on the HRA policy specifying the aims, resources, fields of application and positioning with regard to the partners.These findings are consistent with other French work and literature data. French experience coulfd benefit from that of other countries.

Key messages
Skills of professionals have to be reinforced in order to make appropriate and quality HIAs. Evaluation is useful for understanding the development of an emerging practice and for supporting a decision-making in terms of scaling up, integration, role assigned to the health sector.
Different designs of additional payments for new technologies: The approach of Germany and the USA
Authors: Henschke C 
Published: November 2019

Abstract

Background
Health systems have to balance access to technologies, ensure safety and quality, and manage expenditures. As payment rates of prospective payments do not reflect higher costs of technologies, additional payments were implemented. The study aims at comparing the principles of Medicare’s New Technology Add-on Payments (NTAP) and payments for new diagnostic and treatments methods in Germany (NUB), and analyzing the development of additional payments over time.

Methods
A literature review was conducted using public domains of regulatory bodies and databases to compare payment approaches according to a) technologies’ eligibility criteria, b) their designs, c) implemented reforms, and d) conducted evaluations. Published data of responsible institutions was used to descriptively analyze the number of technologies authorized for additional payments in hospitals (2005-2018).

Results
Major differences between payment approaches were identified. The design differs regarding application and payment processes. While in Germany, a single hospital wishing to use the technology has to request for authorization, in the US the manufacturer starts the application process. The NUB-approach allows for payment negotiations per technology between insurers and a certain hospital, the amount of NTAP-payments is calculated per case using a calculation scheme based on real hospital costs. Hospitals, thus, may only be partially compensated for the higher costs of technologies. Only limited evidence exists on the effects of these payments.

Conclusions
Both approaches improve access to technologies compared to prospective payments. However, different designs indicate different incentive structures, which can affect patient’s access. Implicitly, both designs seem to limit excessive technology utilization. Further studies are necessary to evaluate the impact of additional payments on real utilization rates, outcomes and expenditures in order to optimize the design of those payments.

Key messages
Additional payments can improve access to technologies compared to prospective payments, but seem to limit excessive technology utilization at the same time. Different designs come along with different incentive structures to use technologies. Further empirical research is needed to analyze effects on real utilization rates, outcomes and expenditures.
Diurnal rhythms of cortisol and melatonin in night eating and non-night eating male police officers
Authors: Sørensen J K , Jensen M A , Hansen ÅM , Rugulies R , Garde A H 
Published: November 2019

Abstract

Background
Working during the night has in previous studies been associated with behavioural changes and diseases. Disturbance between behavioural and biological circadian rhythms have been suggested as a possible mechanism linking night work with cardiovascular diseases and pre-diabetic changes. The aim of this study was to investigate if night eating during two, four and seven consecutive night shifts is associated with differences in the diurnal rhythms of cortisol and melatonin in male police officers in Denmark.

Methods
We conducted an experimental study among 37 male police officers in Denmark who all collected data on the last night shift in three different work schedules with two, four and seven consecutive night shifts, respectively. Night eating was self-reported and defined as eating at least one main meal between midnight and early morning. Differences in the diurnal rhythms of concentrations of cortisol and melatonin in saliva were tested by phase changes and amplitude differences.

Results
Sixteen (43.2%) police officers ate a main meal during the last night shift in all three work schedules. The timing of the lowest cortisol concentration was on average delayed with 2:10 hours (95% CI 0:24-3:56 hours) and the level of the lowest cortisol concentration was on average supressed with 66% (95% CI 47-94%) for night eaters compared to non-night eaters. There was no association with number of consecutive night shifts. The phase and amplitude of melatonin were not statistically significantly different between night eaters and non-night eaters.

Conclusions
Night eating behaviour is associated with differences in the diurnal rhythm of cortisol in Danish male police officers working during the night. The difference in cortisol rhythm between night eaters and non-night eaters on night shifts is not affected by the number of consecutive night shifts.

Key messages
Night eating behaviour is associated with differences in the diurnal rhythm of cortisol. Future studies should focus on potential health outcomes of night eating behaviour among night workers.