bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strengthening local impact on maternal health for the most vulnerable populations
Authors: Faillat V , Mortiz A , Vouiger S , Liska J 
Published: October 2020

Abstract
Sanofi Espoir Foundation evaluated impact of its decade long investments, in the amount of over 5 million Euros, on addressing health inequalities globally. Focusing on Saint-Louis department in Senegal, they have mapped specific profiles' experience like pregnant teenager suffering from community stigma, and finally linked each key moment with the health determinants, actors and initiatives. This study puts into perspective the impact the health system, including healthcare practitioners, can have on the pregnancy experience in regards of the influence of other determinants such as religion, culture, education, transportation, labor conditions, physical environment, health habits as well as local actors and initiatives. Each social determinant is highly and quite equally influencing the ante- and post-natal experience of the women, whereas the health system is the key factor during childbirth experience. If social determinants in health are well known, they are not reflected as such into health programs and funding processes. Maternal and newborn health in vulnerable situations is not simply a technical concern but a complex social issue that needs to be managed with an integrated, specifically “local” approach, transforming the objective 17 of the Sustainable Development Goals about partnering and breaking down silos, from an abstract paradigm into a daily process, thanks to community engagement and global accompaniment.
Migration, adolescents and health
Authors: Devakumar D 
Published: October 2020

Abstract
In low- and middle-income countries, migration for work is common but the health consequences on adolescents is poorly understood. Particularly in low-resource settings, when children enter their adolescent years, their lives change dramatically as they take on adult roles. Young girls may get married and forced to move to their husband's home where they conduct domestic work and are exposed to high levels of air pollution from cooking. They are also more likely to become parents themselves. Many girls and boys drop out of school to work near their home or migrate within the country or abroad. They face risks throughout the journey and often work in precarious forms of labour. Among them, the unaccompanied adolescents face even greater risks than those who move with their parents. When parents migrate, despite increases in wealth from remittances, child and adolescent mental and physical health tends to worsen. With evidence mostly from the South Asian context, Dr Devakumar will explain detrimental impact of parental migration on left-adolescents and raise the importance of policy makers and health-care professionals on taking action to improve the health planning targeting of these young people.
Case-control study of risk factors for adolescent fertility and premature birth in Bulgaria
Authors: Kamburova M , Georgieva S L , Tsanova D K , Karadzhova P 
Published: October 2020

Abstract
The significant positive correlation between share of Roma population and adolescent live birth in EU member states (r = 0.804, with 2-tailed significance p = 0.000) was found. The highest level of proportion of live births to mothers aged less than 20 years was found in Romania (9.8%) and Bulgaria (9.5%). At the same tame proportion of Roma population in those countries is highest: Bulgaria (4.7%) and Romania (2.5%). The study found that two thirds (66%) of children born to mothers under the age of 19 are born prematurely OR = 2.10 95% CI (1.13-3.91). Among the newborns studied, the proportion of prematurely born children living in rural areas is significantly higher than those living in the city (p = 0.0001; r = 0.26). Later registration (after the first trimester) and monitoring of pregnancy is a significant risk factor and increases more than four times the risk of having a premature baby OR = 4.23 95% CI (1.41-12.69). A holistic approach is needed in which socio-economic development and education of Roma girls leads to further reduction of adolescent childbirth and premature delivery in Bulgaria.
Early years pathways to inequalities in childhood asthma? A causal mediation analysis
Authors: Creese H , Mason K , Schlüter D K , Taylor-Robinson D , Saxena S 
Published: October 2020

Abstract

Background
Asthma affects one in five children in the United Kingdom (UK). Children in deprived areas have twice as many unplanned admissions for wheeze but mediating pathways between socioeconomic circumstances and asthma remain unclear. We aimed to quantify which early years pathways explain inequalities in childhood asthma in the UK.

Methods
We analysed data on 10650 children from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life socioeconomic circumstance (SEC) was measured by maternal education at birth. Our outcome was parent-reported asthma at 5 years of age categorised as none, diagnosed asthma and diagnosed asthma with wheeze symptoms in the preceding year. Mediators were grouped into perinatal characteristics (maternal BMI, breastfeeding duration, birthweight, gestation, maternal smoking and alcohol use during pregnancy), neighbourhood features (pollution, grime and environment issues, traffic volume, housing quality) and the home environment (damp/condensation, tenure, pets, tobacco smoke). We used multinomial regression to examine the total effect of SEC on childhood asthma, then adjusted for all potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators.

Results
Children whose mothers had no qualifications were more than twice as likely to have asthma by the age of 5 years with a wheeze episode in the preceding year compared with those whose mothers had degree-level qualifications (relative risk (RR) 2.21, 95% CI 1.44 to 3.40). After adjustment for all mediators, there was a 69% reduction to aRR 1.38 (95% CI 0.89 to 2.14).

Conclusions
Perinatal characteristics and early years neighbourhood features and measures of the home environment partially contribute to inequalities in childhood asthma.

Key messages
The antenatal period and early years of development are important for targeting interventions to reduce inequalities in asthma. About two-thirds of the social inequality in childhood asthma was explained by perinatal characteristics, early years neighbourhood features and the home environment.
How healthy is a ‘healthy economy’? Incompatibility between current pathways towards SDG3 and SDG8
Authors: Koutsoumpa M , Meurs M , Seidelmann L , Fienieg B , Kramer K , Bemelmans M 
Published: October 2020

Abstract

Background
The link between health and the economy is well known. However, economic growth as measured in SDG8, continues to leave people behind and the funding gap for realizing SDG3 for good health and well-being remains vast. International financial institutions, i.e. the IMF, influence national policies in ways that may undermine the SDGs. We examine incoherencies between economic growth and health goals in Malawi, Uganda, and Tanzania.

Methods
We conducted qualitative research based on policy analysis. To analyse IMF policy advice in the three countries we reviewed relevant program documents, article IV consultation reports (2016-18) and literature on structural adjustment. We accessed health information from WHO and World Bank databases, and national policies.

Results
In all three countries, some indicators, e.g. infant and child mortality, improved, but others lag behind. Underfunding is a major cause for poor health and inequities. GDP increases (as a measure of economic growth) do not automatically translate to increases in health spending. Health expenditure from domestic public resources remains much lower than international thresholds. To achieve this level of spending domestically, GDP in these countries would require an unrealistic manifold increase. IMF policy advice and loan conditionality that focus on GDP growth and tight monetary and fiscal targets impair social spending, while suggested taxation measures are generally regressive.

Conclusions
The GDP-focused SDG8 can delay efforts towards the SDG3 if governments opt to focus on GDP growth without measures to equally distribute wealth and invest in social sectors, often under IMF's influence. Although the IMF has acknowledged the importance of social development, its policy advice still adheres to austerity, harming population health. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective, strive for equitable economic development and emphasise global co-operation.

Key messages
GDP increases do not automatically translate to an increase of health spending, partly a result of IMF structural adjustment programs and policy advice. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective and place more emphasis on SDG17 on global co-operation.
The frequent user’s decision-making process when contacting urgent and/or emergency services
Authors: Worrillow N , South J , Cole A , Collin S , Briggs M 
Published: October 2020

Abstract

Background
There is a lack of qualitative research that has been undertaken which has captured the perspective of frequent users to urgent and emergency healthcare services. Previous research has viewed and studied this population largely by using retrospective routine data, which focuses on the patient's demographic, presenting symptom or demand implication. Current research now advocates that these vulnerable and complex individuals are using these services due to their unmet needs or multiple comorbidities. The aim of this research was to explore the patient's decision-making process and their motivations for repeatedly contacting urgent and emergency services.

Methods
Semi-structured interviews were undertaken with a small cohort of six previously identified frequent users to urgent and emergency healthcare services. These participants were recruited into the study by a third sector organisation, due to the vulnerabilities and complexities of these individuals' lifestyles. A framework analysis was used to code and extract relevant themes and concepts from the interviews.

Results
Social prescribing through a named support worker enables navigation and re-engagement into a range of services that benefits this population and reduces their demand upon other services. The support given through social prescribing organisations can counteract the lack of personal support networks and resilience factors that these individuals experience. In addition, individuals who have been re-referred into substance misuse services should be offered alternative engagement programmes, which differ from their initial programme.

Conclusions
Current inequities of outcomes and access to services should be examined, in relation to vulnerable and complex individuals who have reduced support networks and limited resilience factors. Future research should be undertaken regarding the benefits for frequent users of social prescribing to support patient outcomes and re-integration into services.

Key messages
Social prescribing is the link that enables complex and vulnerable frequent users to navigate and re-engage into a range of health and social care services. Examining the inequities faced by frequent users to urgent and emergency healthcare services.
Minimizing health inequalities in rural population through pilot integrated medico-social centres
Authors: Furtunescu F L , Dragoescu A , Pana B C , Minca D G 
Published: October 2020

Abstract

Problem
In Romania about 45% of the population (about 9 million people) still live in rural settings, having more detrimental health indicators and a poorer access to medical and social services compared to population living in urban.

Description of the problem
Under the Swiss-Romanian Cooperation Programme, a public health intervention was implemented in seven rural remote communities from Romania, aiming to increase access to basic medical and social services for the people living in those communities, with focus on the most vulnerable ones and to facilitate integration between medical and social services at the community, county and national level. In the first phase a decentralized training in health projects has been provided for local teams coming from eighteen rural remote communities which expressed their interest to be involved in the intervention. after the training, each local team developed its own pilot project for building a local model of integrated medico-social services. In the second phase, best projects were selected for implementation and received financing. All local teams were supported in the implementation of the model by a central coaching team, which had the role to provide technical advice and to facilitate mediation with the county and central authorities from the medical and social protection sector. The third phase aimed to capitalize the experience from the field and the lessons learned on three layers: local community, county level and central authorities.

Results
Seven medico-social centres were founded in the rural communities and continued to operate after the project end, serving around 20000 inhabitants, among which around half have medical and/or social vulnerabilities.

Lessons
Using a bottom up strategy in building medico-social integrated models of care in rural and remote communities is a key premise for the success and sustainability of the model.

Key messages
Involvement of local actors is essential when trying to increase access to medical and social care for rural, underserved communities. Facilitating access to general health and social protection systems is a key element for sustainability, instead of building new or specific models of services.
Suicide Prevention Pathways: linking risk and behaviour within the Maltese context
Authors: Cachia J 
Published: October 2020

Abstract

Background
People engage in suicidal behaviour as a result of several risk factors, such as acute stress, severe depression, violence, sexual abuse, etc. Beyond such evidence from literature, a mental public health approach to suicide prevention needs also to take into account specific country characteristics and to look beyond the demographic characteristics of deaths by suicide. Available clinical information can help identify and quantify risk, analyse patterns of behaviour, explore links between risk and behaviour and provide possible suicide prevention pathways.

Methods
In this study, the 128 deaths by suicide for the period 2015-2019 in Malta are analysed against available clinical information. Major sources of detailed clinical information include obligatory notifications to the Commissioner for Mental Health of all cases involuntarily admitted to acute psychiatric services and other medical records held within the Maltese public mental health system.

Results
84% of 128 deaths by suicide for the period 2015-2019 were males, two-thirds of them between 25 and 54 years. The preliminary findings have confirmed that less than 50% of these deaths had previous contact with the public health system. The two main diagnostic criteria among deaths with recent psychiatric admission/s were acute stress reaction to personal life events and very severe mood disturbances, particularly depression. There seems to be increased risk among migrants and foreign workers residing and working in Malta. The frequency of prior admissions, age-related issues, the time-event relationships and relevance of elicited clinical findings are still being evaluated, and will be presented in more detail in the workshop.

Conclusions
Exploring risk factors within the history of cases of suicide and attempted suicide through available clinical information can contribute to the development of suicide prevention pathways, relevant to the specific context of local communities.
Comprehensive health literacy in general populations – An international comparison
Authors: Pelikan J , Link T , Berens E , Pettersen K , Le C , Sørensen K , Vogt D , Gibney S , Aringazina A , Vrbovsek S 
Published: October 2020

Abstract

Background
The HLS-EU study in 2011 demonstrated for 8 EU Member States that there exists limited comprehensive health literacy for considerable proportions of the general population, that there is a social gradient for health literacy and that limited health literacy has problematic consequences for healthy lifestyles, self-reported health and utilization of professional health services. It was also shown that distributions and associations of health literacy differ considerable between countries. WHO-Europe started the Acton Network on Measuring Population and Organizational Health Literacy (M-POHL) to measure health literacy regularly with the Health Literacy Survey 2019 (HLS19).

Methods
Based on the design and instrument of the HLS-EU study (to allow comparisons for countries participating in both surveys) a core questionnaire was developed for measuring comprehensive health literacy and its relevant correlates. Optional packages were created to measure, among others, digital health literacy and its most relevant correlates. Data were collected from probability samples of at least 1.000 respondents per country for the general population 18+ by personal interviews, telephone interviews or internet surveys in at least 15 member states of the WHO-Europe region.

Results
Distributions for indices, scales and levels of comprehensive health literacy will be presented as well as correlations and regressions for associations of health literacy with social determinants and with consequences for selected life style indicators, indicators for self-reported health and use of professional health care services.

Conclusions
Preliminary results show that the general trends of the HLS-EU study concerning health literacy hold true for HLS19 and that there are considerable differences between participating countries. Health literacy is relevant for health policy in all countries, but to understand the differences between countries a more detailed analysis is necessary.
26.B. Skills building seminar: Design thinking in public health
Authors:   Organised by: NOVA National School of Public Health (Portugal),   Chair persons: Juan Rachadell - Portugal, Nuno Do Amparo - Portugal
Published: October 2020

Abstract
Public Health (PH) is a multidisciplinary area that deals with complex problems. PH professionals from the global to the local level often find themselves faced with new challenges without an obvious solution. PH teams and organizations frequently try to find answers to problems with an experienced-based brainstorming methodology that can lead to solutions that might not be feasible, viable or desirable.
Commonly used in the context of innovation and entrepreneurship, Design Thinking (DT) is a problem-solving methodology that allows teams to arrive at the right questions, instead of just looking for immediate answers. It requires practice in order to be implemented and important changes in the usual workflow of PH teams when presented with a challenge.
This workshop intends to present DT as a valuable tool for problem solving in PH. It will provide an explanation of the concept of DT, its components and practical applications.
The workshop will be in a “Skills building seminar” format with 90 minutes total. It will begin with 2 presentations (25 minutes each, followed by 5 minutes Q&A) and a 30-minute exercise with the audience.
Presentation: Design Thinking and Public Health: importance and applications (Juan Rachadell)
Presentation: How to arrive at good questions and test them (Nuno Do Amparo)
Group exercise: Come up with a design challenge (Juan Rachadell, Nuno Do Amparo)
After the presentations, the audience will be asked to organize in groups of 5 or less people in order to train the DT methodology. Each group will be instructed to choose a theme in accordance with the Conference topics and arrive together at a corresponding design challenge. This process will be guided by both workshop presenters and will include debate between the groups.

Key messages
When tackling Public Health problems, asking the right question is often more important than trying to obtain answers immediately. Using Design Thinking as a process to arrive at the right question, the subsequent answers will be more effective at actually solving the problem.
26.D. Round table: Achieving healthy prosperous lives for all – from evidence to action
Authors:   Organised by: EUPHA, WHO/Europe Investment for Health and Development RHN, Public Health Wales (UK),   Chair persons: Natasha Azzopardi Muscat - EUPHA, Tatjana Buzeti - EUPHA-FN
Published: October 2020

Abstract
The adoption of the WHO Resolution on Health Equity (EUR/RC69/R5) put equity, gender equality, human rights and social determinants high on the agenda for policy action and priority for all 53 EURO Member States (MS) and partners. It gives new momentum in the European region to accelerate action in achieving healthy and prosperous lives for all, leaving no one behind. The European Health Equity Status Report initiative (HESRi) is connecting European policy makers with the solutions and best practices to accelerate progress towards this goal of healthy prosperous lives for all. The initiative was launched in 2018 by WHO European Office for Investment for Health and Development and uses an innovative five-step approach underpinned by a suite of tools and sophisticated data analyses to: (1) enable countries to identify who is being left behind and why; (2) build political and public support for action; (3) understand which policies and interventions work best; (4) measure and maintain progress; and (5) influence and sustain action. Key tools launched in 2019 include i) An online interactive Health Equity Dataset which provides country specific data on the status and trends of inequities in health, well-being, and five essential underlying conditions for the 53 member states of the WHO European Region, ii) A Health Equity Policy Tool to support countries in efforts to measure the coverage, uptake and effectiveness of policies for health equity, and iii) 30 case studies showing how countries are advancing real world solutions to improve equity in health.
Currently Italy, Slovenia and Wales are developing national and subnational health equity status reports in order to support action for health and well-being for all and measure policy progress. In the USA, practical action for health equity has been rooted in advocacy work reframing the public narrative to focus on social injustices and structural drivers of inequities, a key pillar of the HESRi work.
The round table aims to explore the country impact and uptake of the new innovative methods and tools and their potential for accelerating action on regional, national and global level.

Key messages
WHO Resolution on Health Equity put equity, gender equality, human rights and social determinants high on the agenda for policy action. The European Health Equity Status Report initiative (HESRi) is connecting European policy makers with the solutions and best practices to accelerate progress towards healthy prosperous lives for all.