bluuebunny/crossref_metadata_2025_split huggingface dataset:
The wider consequences of obesity: estimated social and economic costs from Mendelian Randomization
Authors: Hughes A , Harrison S , Dixon P , Dickson M , Davies A , Rice F , Davies N , Howe L 
Published: October 2020

Abstract

Background
Obesity is a key public health issue worldwide. Accurate estimates of its full impacts on health, social, and economic outcomes are required, but are difficult to obtain due to bias from confounding and reverse causality (the impact of social and economic factors on obesity).

Methods
Using data from the UK Biobank and ALSPAC, we applied a genetic causal inference approach (Mendelian Randomization, MR) to estimate the impact of body mass index (BMI) on key social and economic outcomes. Because genetic variants are assigned before birth and cannot change, estimates from MR studies are less liable to confounding and reverse causation.

Results
Effects of higher BMI were often larger in MR than conventional (non-genetic) models, suggesting previous studies may have underestimated the impact of BMI. For example, in adolescents, MR models implied a standard deviation increase in BMI led to exam scores around 1/3 of a grade lower in all subjects at age 16, and 8.7% (CI: 1.8% to 16.1%) more school absence. In adults a 5kg/m2 increase in BMI corresponded, among other negative outcomes, to £2,778 less annual household income (CI: £1,864 to £3,693), less chance of owning one's home (-1.6%, CI: -2.4% to -0.8%), and higher chance of being lonely (2.4%, CI: 1.4% to 3.5%). At £21.22 (CI: £14.35 to £28.07) per person per marginal kg/m2 per year, MR estimates for inpatient hospital costs were around 40% higher than conventional estimates.

Conclusions
Findings from causal inference based on genetic variation indicate that high BMI has negative impacts on social and economic outcomes that may be larger than previously estimated. This evidence highlights the potential social and economic value of preventing high BMI across the life course.

Key messages
High BMI has considerable negative impacts not only for health, but for individuals’ education and socioeconomic outcomes, and overall health care costs. Previous attempts to quantify these effects may have underestimated BMI’s full impact.
Mobile Medical Applications and Cloud Federation Challenges
Authors: Patias I , Georgiev V 
Published: October 2020

Abstract

Issue
Given the importance, of cloud environments for mobile telemedicine information systems, focus is given in this paper on the challenges rising. We discuss the pros of the access to computing services and resources on demand without having own infrastructures, and the need of advanced interoperability data formats and application program interfaces (APIs) to facilitate the usage of the infrastructure.

Description of the problem
Cloud-Oriented Architecture (COA) describes the architecture, where applications act as services and serve other applications in the cloud environment. The aim is IT infrastructure and software applications to be optimized for their use in cloud computing environments. But what happens in the specific field of health as data interoperability for mobile telemedicine information systems?

Results
Two architectures were presented using a patient's compliance and engagement solution. A simple Representational State Transfer (REST) based architectural style was implemented in a three-layered architecture first and then compared to a cloud federation model. In the second the interaction goes through the federation via a middleware layer. Internal operations of cloud providers in the federation are still transparent to the cloud users. The middleware layer aims to coordinate the interaction with cloud users and providers in the federation. But, to avoid delays in those interactions interoperability of data formats and APIs.

Lessons
A Fast Healthcare Interoperability Resources (FHIR) based application was developed. Mobile telemedicine information systems are a strong instrument in patients' compliance. Many systems have proved that the used resources combined can solve clinical and administrative problems in a secure environment.

Key messages
The use of cloud is wide spread in the health sector. The challenge is to combine this infrastructure into one federated platform and maximize the added value by using advanced interoperability data formats and APIs.
Evidencing value of public health programmes to enable sustainable investment for health & wellbeing
Authors: Dyakova M , Stielke A , Ashton-Brown K , Daniels P , Kadel R , Cotter-Roberts A 
Published: October 2020

Abstract

Issue
Global sustainability challenges related to health, inequity, the environment and the economy require urgent innovative action and focus on prevention. Fair evidence-informed prioritisation of scarce resources is pivotal to ensure sustainable investment policies and practices. It is key to capture the value and return on investment of public health (prevention) programmes in order to show their wider benefit to people, communities, society, economy and our planet.

Description
The Evidencing Value project builds on a global and national drive towards measuring the value of health services and interventions. The World Health Organization Collaborating Centre for Investment in Health and Well-being (WHO CC) is developing an innovative approach and digital solution to assess the holistic (economic, social and environmental) value and return on investment of public health programmes. It uses a Social Return on Investment (SROI) approach, which involves key stakeholders from the beginning and measures what matters most. This helps to identify the wider impact and outcomes of different health protection, disease prevention and health promotion programmes. The evidence is embedded in an interactive digital database to inform investment prioritisation and quality improvement.

Results
Project outputs include: (i) structured evidence repository detailing the value of public health services and interventions; (ii) interactive digital database for storage, manipulation and presentation of data; (iii) SROI pilots; and (iv) generalised framework for investing in public health/prevention to be used by other public bodies and countries.

Lessons
It is essential to understand the wider impact and value of public health programmes to facilitate Universal Health Coverage and sustainable investment for health and wellbeing. This project uses an innovative approach and digital solution to enable evidence informed resource allocation and decision-making focused on prevention.

Key messages
Evidencing value of public health supports the case for investing in prevention. Using innovative methods and digital solutions is essential to inform sustainable investment for health.
First results on the efficacy of a digital life-skills program for substance use prevention
Authors: Paz Castro R , Haug S 
Published: October 2020

Abstract

Background
Life-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones might represent a more economic and scalable approach.

Methods
The efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents is currently tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with follow-up assessments after 6 and 18 months. The fully automated program is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Participants of the intervention group receive up to 4 individually-tailored text messages per week for a period of 6 months. The study started in 2019 and aims for 1,312 study participants between the ages of 14 and 16 years from approx. 100 secondary school classes in Switzerland. Outcomes are 1) problem drinking, 2) cigarette smoking, 3) perceived stress and 4) interpersonal competences.

Results
So far, 1'611 students within 88 secondary school classes were invited to participate in the study. Of these, 1,450 (90.0%) consented to participate. To date, 24 out of 726 (3.3%) participants of the intervention group discontinued the program and 945 (65.2%) were invited for 6-month follow-up. Of these, 752 (79.6%) completed the assessment. Preliminary analyses showed a beneficial effect of the intervention for the subscale negative assertion, assessed by the brief version of the Interpersonal Competence Questionnaire.

Conclusions
A large proportion of adolescents participated in this first study testing the efficacy of a mobile phone-based life-skills training for substance use prevention and the majority of them participated at 6-month follow-up.

Key messages
A novel, mobile phone-based life-skills training seems widely accepted by secondary students. Given its effectiveness, it could be economically implemented within secondary schools.
mHealth for Pneumonia Prevention
Authors: Mahmood H , Sheraz S Y , Kiani H , Mckinstry B , Fairhust K , Luz S , Hazir T , Hamneed R 
Published: October 2020

Abstract

Introduction
Pneumonia contributes to 14% of under-five mortality in Pakistan. Delayed care seeking is one of the causes of death due to this disease. One of the most impactful strategies can be timely healthcare-seeking through CHW's. We, therefore propose to develop an intervention package for educating caregivers on pneumonia by Lady Health Workers (LHWs).

Methodology
This first phase of the feasibility study comprised of a systematic review (SR) on best mobile health-based approaches for CHWs on the management of childhood illness followed by formative research (FR). In the systematic review, 6 databases were searched, and 22 articles were included. Based on findings of SR and FR along with guidelines of WHO and UNICEF, a mobile application-based intervention package will be developed in the second phase. Recruited LHWs will use the mobile application in their monthly visits for 6 months. Text and voice messages will be sent to each caregiver. Pre and Post-intervention surveys will be conducted with the recruited caregivers to assess the impact of the intervention and FGDs with the recruited LHWs to get feedback on the intervention.

Findings
Findings of the systematic review suggest that the most common approaches of mobile health for community health workers is the use of a customized application for disease management and data collection. Findings of formative research suggest that the majority of the caregivers were not aware of the danger signs of pneumonia. Respondents agreed to the importance of an educational intervention package on pneumonia and its prevention by LHWs through mHealth.

Acknowledgment
This research was commissioned by the National Institute of Health Research using Official Development Assistance (ODA) funding. The views expressed in this publication are those of author(s) and not necessarily those of NHS, the National Institute of Health Research, or the development of Health.

Key messages
mHealth intervention employing community health workers can be a useful mode of improving healthcare services. Use of technology to raise awareness and delivered health-related information at community level can prove tremendously helpful for illness management.
Measuring Health Literacy in Tuscany through the Italian risk factor surveillance system (PASSI)
Authors: Zanobini P , Lorini C , Caini S , Lastrucci V , Masocco M , Minardi V , Contoli B , Bonaccorsi G 
Published: October 2020

Abstract

Background
Health literacy (HL) can be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. A module to measure HL has been implemented in Tuscany since 2017 within the Italian risk factor surveillance system (PASSI). Here, we aimed to assess HL levels and their relations with social determinants and health behaviours.

Methods
During 2017-2018, a representative sample (N &gt; 7000, aged 18 to 69 years) of the Tuscan population was interviewed in PASSI. HL was measured using the Italian version of the short-short form (HLS-EU-Q6) of the HLS-EU-Q47. Multivariate analysis was performed to investigate associations between HL, social determinants and selected health behaviours (diet and physical activity).

Results
61% of the interviewees had an adequate HL level, 30% problematic and 9% inadequate. In the multivariate analysis, the odds of inadequate HL level increased for all social determinants except gender and loneliness. The strongest association was observed for foreign citizenship (OR 3.38, 95% CI 2.63-4.34) followed by financial problems (OR 2.10, 95% CI 1.73-2.55), low education (OR 1.91, 95% CI 1.58-2.32), being aged 50-69 years (OR 1.51, 95% CI 1.18-1.94) and unemployment (OR 1.42, 95% CI 1.17-1.72). With regard to health behaviours, subjects with inadequate HL level had the lowest odds of engaging in regular physical activity (OR 0.59, 95% CI 0.49-0.71) and one of the lowest odds of eating at least three portions of fruit and vegetables (OR 0.79, 95% CI 0.65-0.95).

Conclusions
Our findings suggest that HL is strongly associated with social determinants and has major influence on health behaviours. Our study is still ongoing, with the next step being to build a conceptual model to depicting the effect of HL as a mediator of the association between social determinants and health behaviours.

Key messages
Health Literacy is strongly associated with social determinants. Health Literacy has major influence on health behaviours.
21.H. Workshop: Incentivising vaccination uptake in Europe
Authors:   Organised by: EUPHA, CHAFEA, DG SANTE,   Chair persons: Anne-Marie Yazbeck - CHAFEA
Published: October 2020

Abstract
Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defence we have against serious, preventable, and sometimes deadly, contagious diseases.
However, we have witnessed measles outbreaks in the last years that could have been avoided if vaccination rates had been sufficiently high. The vaccination rate against seasonal influenza for older people also remains much below the recommended level (75%) in most EU countries.
We have also seen countries taking policy measures, such as introducing mandatory vaccination against certain childhood diseases (France, Italy, Germany), while other countries retain high vaccination rates without establishing such measures (e.g. Sweden, Denmark, Portugal).
This session will bring together policy-makers at various levels (national, regional), experts and civil society (e.g. health care professional associations) to showcase recent policy initiatives, good practices and innovative collaborations aiming at increasing the vaccination rates for key vaccines and taking a life course approach.

Key messages
Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defense we have against serious, preventable, and sometimes deadly, contagious diseases.
On the time trends among school-aged children in the Nordic countries
Authors: Löfstedt P , Arnarsson A M , Corell M , Lyyra N , Madsen K R , Torsheim T , Thorstensson E B , Välimaa R , Damsgaard M T , Eriksson C 
Published: October 2020

Abstract
Long-term trends in mental health of school-aged children can be analysed in the HBSC study. In Sweden the proportion of the children that report at least two weekly health complaints during the last six months has increased from the first data collection 1985/1985 to the latest 2017/2018 among all age groups for both girls and boys. Among the 11-year-old it reached 41 % among girls and 30 % boys, and among 15-year-old girls 62 % and boys 35 %. Can we trust this?
The prevalence of two or more weekly health complaints showed large differences by country over time and especially in 2014, when Iceland and Sweden showed an almost 10%-point larger prevalence of multiple weekly symptoms (about 35%) than Denmark, Finland and Norway (about 25%). Norway was the only country to show a decline during 2002-2014.
The prevalence of sleep difficulties has increased over the 12-year period in Denmark, Iceland, and Finland. In Sweden the prevalence fell from 26% to 21% from 2002 to 2006 but rose by 10% points from 2010 to 2014. Only Norway showed a positive development over the 12-year period; the prevalence declined in 2014 to 17% the lowest prevalence of sleep difficulties in any of the five Nordic countries.
The trend of excellent self-rated health for Nordic adolescents indicates a small overall improvement between 2002 and 2006 but a stable trend in the following periods up until 2014. Finland and especially Sweden shows a decline in the prevalence of students having an excellent self-rated health. The only country to show a positive development in the prevalence of students having excellent self-rated health from 2002 to 2014, is Norway. The overall prevalence of adolescents having high life satisfaction has declined in most of the Nordic countries examined.
Brief interventions for NCDs risk factors
Authors: Breda J 
Published: October 2020

Abstract

Background
Brief interventions (BIs) are short, structured, nonconfrontational conversations to motivate and support individuals to consider and plan changes in unhealthy behaviours. Noncommunicable diseases (NCDs) are a huge global burden responsible for a large number of premature deaths and other economic and social challenges. The WHO “Best Buys” report highlights BIs as an effective tool to address NCD risk factors in the general population. BIs are not quick fixes, but part of a long-term behavior change strategy. An integrated BI package is needed to prevent unintended consequences, such as increased physical activity leading to increased consumption of unhealthy foods. BIs can be applied in a wide range of settings, including primary care in the general population, prisons and other settings for vulnerable groups.

Results
BI deliver immediate and long-term health, economic and social benefits. For example, BIs for smoking cessation can help individuals increase their life expectancy by up to 10 years, as well as reducing the risk of NCDs including stroke, lung cancer and CHD. Economic benefits include increased personal income and higher productivity, whilst social benefits include improved relationships and children being less likely to take up smoking.

Conclusions
WHO have published reports and training packages focused on the 5As and 5Rs brief interventions model in four major NCD risk factors: smoking, alcohol, unhealthy nutrition and physical inactivity. However, BI implementation remains low. To address this, WHO are currently working on a Manual for Integrated BI for NCD risk factors to support countries to implement, establish and promote BIs in their primary health care setting. It will contain information on health systems organization, intervention delivery, training and capacity building for healthcare professionals, referrals and follow-up, health literacy, and monitoring and evaluation strategies.
What can lifespan variation tell us about trends in life expectancy in high income countries?
Authors: Hiam L , Minton J , McKee M 
Published: October 2020

Abstract
Building on the findings of presentations 1 and 2, we turn to two further measures of population health: life expectancy at birth and lifespan variation. Life expectancy at birth provides a single figure that captures the overall mortality experience of a nation, and, in the absence of data artefact, a wide-scale environmental event such as war or natural disaster, a disease epidemic or mass migration, life expectancy can be expected to continue to improve in HICs. Concurrently lifespan variation, which measures the average gap between the age at death of an individual and the remaining life expectancy at that age, should decrease as life expectancy increases.
Recent analysis of life expectancy improvements in HICs by the Office for National Statistics, using Human Mortality Database data, found that while Japan continues to see improvements, the UK and the USA fell to the bottom of the rankings. Economically, both the UK and Japan have experienced 'lost decades' of poor economic growth, in 1990s and 2010s respectively. Yet, while Japan continued to see life expectancy improvements, in the UK life expectancy stalled, and both countries saw an increase in lifespan variation.
In this presentation, we will present the analysis of lifespan variation of 5 HICs: the USA, where life expectancy has declined, the UK, where gains in life expectancy have trailed behind those in other industrialised countries, Japan, which has seen sustained progress, and France and Canada, neighbours of the UK and USA respectively, which lie in the middle. We will examine what can be determined from these measures over periods of poor economic growth, and the implications for achieving 'sustainable growth'.
Patterns of risky driving behaviors among Tuscan adolescent drivers: a cluster analysis
Authors: Lastrucci V , Innocenti F , Lorini C , Berti A , Silvestri C , Gnaulati L , Voller F , Bonaccorsi G 
Published: October 2020

Abstract

Background
Adolescents have a high risk of road traffic accident (RTA) because of their high engagement in risky driving behaviors (RDBs); to date, very few studies have investigated the patterns of RDBs. The aim of the study is to identify distinctive RDBs patterns and to examine their associations with RTAs in a sample of adolescent drivers

Methods
The EDIT project is a cross-sectional survey carried out in a representative sample (6.824) of Tuscany Region students aged 14-19 years. The study analyses a subsample of students who reported to drive/ride at least once a week (2764). Self-reported frequency in the last year of the following RDBs was determined: talking on phone; texting; using GPS; talking to passengers; smoking; eating; listening to loud music; fatigued driving; speeding; and driving under the influence (DUI) of alcohol or drugs. A cluster analysis was conducted to identify RDBs patterns. A multivariate model was used to evaluate the difference in the risk of RTA across clusters; ANOVA and post-hoc pairwise comparisons were used to further characterize cluster membership

Results
Four distinct RDBs clusters were identified: “safe”(45.6%), “average”(21.8%), “careless but not DUI”(21.5%) and “reckless and DUI”(11.2%) drivers. When compared with “safe” drivers, “careless but not DUI” and “reckless and DUI” drivers showed a significantly higher risk of RTA (respectively, OR 1.68, 95%CI 1.29-2.18, p &lt; 0.001; OR 2.88; 95%CI 2.10-3.95, p &lt; 0.001). Clusters were characterized by several significant differences in sociodemographic variables, cell-phone use, quality of the relationships with parents, school performances, mental health and well-being, health behaviors, gaming, bullying and risky sexual behaviors

Conclusions
RDBs evidently occur in typical patterns that are linked with different RTA risks. Several domains of adolescent life seem to be involved in cluster membership. An awareness of this clustering enables to better targeting adolescents at higher risk of RTA

Key messages
RDBs occur in patterns in adolescents, and indicators of risky behaviors and of mental and social well-being may help to identify RDBs clusters at high risk of road traffic accidents. Multimodal prevention approaches in risky driving behaviors are likely to be more successful than targeting a single behavior in adolescents.