bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information and communication technology-based interventions to support healthcare in migrants
Authors: Vaccaro F G , Alecreu A Oradini , Scardoni A , Frascella B , Vigezzi G P , Odone A , Signorelli C 
Published: November 2019

Abstract

Background
Advances in the field of Information and Communication Technology (ICT) are revolutionizing healthcare, while massive migration flows and cross-border populations’ transit impose the planning, implementation, and evaluation of new integrated healthcare services and programmes. Nevertheless, no conclusive evidence exists on the vast potential offered by ICT to promote healthcare in migrant populations.

Methods
We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool and critically appraise all the available evidence on the effectiveness of ICT-based interventions to support the healthcare provision to migrant and in-transit populations in Europe. We searched the electronic databases Medline and Embase, relevant grey literature and consulted with experts in the field. We restricted the area of interest to EU/EEA countries and included studies providing original quantitative data.

Results
Out of 127 retrieved records, 53 (42%) met the inclusion criteria. Included studies were classified in the following four interventions: implementation of healthcare services (47%), patients’ education (26%), healthcare services’ monitoring (17%), and interventions on providers (10%). The most relevant data refer to telemedicine, prevention interventions, and healthcare data sharing and the most represented specific health-topic is that of mental health (26%). We present available data qualitatively and quantitatively pooled by country, type of ICT, target population and health topic.

Conclusions
Selected ICT-based interventions have been implemented in Europe to promote healthcare in migrant populations; however, in most cases, no monitoring and evaluation exist on their impact, effectiveness, and cost-effectiveness. Strengthened efforts are needed to identify, plan, implement and evaluate effective interventions and share best practices to protect in-transit populations’ health.

Key messages
Information and Communication Technology (ICT) offer great potential to promote health-care in migrant populations. Effective ICT interventions and best practices should be shared across Europe.
Migrants and access to healthcare: the Italian public health residents action plan
Authors: Mammana L , Milani C , Bordin P , Del Riccio M , Sisti L G , Salvia C , Raguzzoni G 
Published: November 2019

Abstract

Background
Fighting health inequalities have been included in the WHO Sustainable Development Goals as a priority. Migrants are between the most vulnerable individuals and healthcare interventions, also during the post-migration period, should be oriented, context-specific and aimed at identifying reasons underlying inequalities, as suggested by the recent WHO report ’No public health without migrant health’. The “Inequality Working Group” of the Italian network of public health (PH) residents of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) aims at identifying an interdisciplinary approach suitable to detect barriers to healthcare access for migrants in different Italian regions. Secondly, we aspire to develop some strategies to overcome unequal healthcare access.

Methods
Focus group methodology was applied to set working group educational needs, priorities of action and working plan. Moreover, we implemented a network between various professionals involved in migrant healthcare, particularly with the Regional Groups of the Italian Society of Migration Medicine (SIMM).

Results
After a period of peer-to-peer education about social determinants of health and migration, we reviewed Italian policies about migrants’ healthcare and considered potential discrepancies from WHO recommendations. Furthermore, we mapped practices regarding access to care for migrant population and we focused on causes underlying unequal healthcare access.

Conclusions
Although with regional differences, migrants have limited access to healthcare services and therefore represent a vulnerable subpopulation.

Key messages
Fighting against the barriers that limit access to care for migrants is a priority for health systems. PH residents have a relevant role in identifying and defining critical issues, designing enforcement measures and implementing advocacy actions.
A first assessment of the electronic health insurance card for asylum seekers in Berlin
Authors: Gottlieb N , Ohm V , Knörnschild M 
Published: November 2019

Abstract

Background
Healthcare provision for asylum seekers differs across Germany. Most states use treatment vouchers as proof of eligibility; i.e., asylum seekers must first obtain a voucher from the welfare office to access healthcare. Since 2016 several states have introduced an electronic health insurance card (EHIC) for asylum seekers that enables access to care akin to statutory insurance. The EHIC has reanimated an old debate about asylum seekers’ health benefits. Opponents claim that medical costs will rise if control over healthcare access is eased. Proponents argue that the EHIC reduces costs through the cutback of administrative workloads and improves access to care. Evidence for either position is scarce.

Goal
The study goal was to assess the 2016 EHIC introduction in Berlin to enable evidence-informed decision-making.

Methods
We analyzed claims data that were retrieved from the Berlin Senate Administration and ten semi-structured in-depth interviews with key informants. Interviews were recorded, transcribed and subjected to thematic analysis using ATLAS.ti software. Ethical clearance was obtained.

Results
Our study found an overall positive evaluation of the EHIC. Although the introduction implied extra efforts and total administrative workloads remained unaltered, the EHIC was said to have the following advantages as compared to treatment vouchers: 1) It simplifies certain work processes and 2) allows for unprecedented financial transparency and control. 3) It eases access to care with 4) no increase in medical costs. Finally 5) the EHIC signifies equality and integration for asylum seekers.

Conclusions
In light of our study results the common economic arguments against greater inclusion of asylum seekers into public healthcare systems appear unfounded. On the contrary, the example of the EHIC shows that inclusion can create win-win-situations by improving healthcare access, whilst keeping medical costs constant and advancing financial transparency.

Key messages
In Germany there is a long-standing debate whether easing access to care for asylum seekers will increase health costs. Our case study shows that, on the contrary, the introduction of an electronic health insurance card for asylum seekers can both improve access and have organizational and economic benefits.
Subjective status comparisons and depressive symptoms among migrants and refugees to Germany
Authors: Polizzi A , Santos-Hövener C , Mauz E , Lampert T , Hoebel J 
Published: November 2019

Abstract

Background
Prior research has identified perceptions of relative social status to affect mental health. We investigated whether migrants to Germany who perceive that they would have a higher relative social status if they were still in their country of origin experience more depressive symptoms than those who perceive no such status discrepancy.

Methods
Cross-sectional data were derived from a random sample of residents in the Berlin-Brandenburg region with a Croatian, Polish, Romanian, Syrian and/or Turkish citizenship (n = 728). Participants’ perception of their relative social status in Germany was measured using the MacArthur Scale of subjective social status (SSS). An adapted version of this scale was used to assess respondents’ hypothetical SSS in their country of origin if they had not migrated. Depressive symptoms were measured with the eight-item depression scale of the Patient Health Questionnaire. Diagonal reference models were used to examine whether discrepancies between the two status ratings were associated with depressive symptom severity.

Results
Most respondents reported a higher (35.6%) or similar (49.0%) hypothetical SSS in their country of origin compared to their SSS in Germany. Respondents whose SSS in Germany was lower than their hypothetical SSS in their country of origin experienced the most severe depressive symptoms. In the diagonal reference models, this association remained statistically significant (p &lt; 0.05), even after adjusting for objective socioeconomic position and other covariates. The pattern was similar for both refugees and non-refugees.

Conclusions
Our findings indicate that perceptions of having a lower social status in Germany than hypothetically in one’s country of origin are concomitant with poorer mental health among migrants. Prospective data are needed to address questions of causation and the direction of effects.

Key messages
Migrants who perceived that they would have a higher social status if they had not left their country of origin reported higher depressive symptoms than those with no such status discrepancy. This association persisted after adjusting for objective socioeconomic position in Germany.
Salt reduction in bread: Is it enough? Preliminary results of a HIA in Portugal
Authors: Santos J , Braz P , Costa A , Costa L , Santos M , Brazão R , Alves J , Lopes I , Guerreiro A , Almeida T 
Published: November 2019

Abstract

Issue
Health Impact Assessment (HIA) is a methodology that aims at assessing the impact of policies in health. A pilot HIA is in progress to kick off the implementation of this methodology in Portugal with the support of the World Health Organization (WHO). In this context, the impact of a nation-wide policy that intends to achieve a maximum of 1 g of salt/100 gr in bread is under assessment.

Description of the issue
In 2017, Portugal approved a protocol between the industry and other stakeholders to gradually decrease the amount of salt in bread, as this is the main source of salt intake. The purpose of this study was to assess the impact in blood pressure from current (1.4 gr) to 1 g (29% reduction) of salt in bread. Data from two different surveys regarding blood pressure and salt intake was gathered. We estimated the decrease in blood pressure with respect to current average values according to sex, age, education and region.

Results
It is expected that a reduction of 29% in salt intake through bread contributes to a general decrease in systolic pressure for normotensive people (from 120.4mmHg to 120.0mmHg, p = 0.85) and hypertensive people (from 151.0mmHg to 150.1mmHg, p = 0.68), although not statistically significant. Older hypertensive individuals (65 to 75 years) are the group with the largest benefit (152.8mmHg to 152.0mmHg) but no statistical difference was found. Disaggregation by sex, region and education also didn’t show any statistical difference.

Lessons
The impact in blood pressure from a 29% reduction in salt intake from bread seems very small. We found no statistical significance between the current and expected values in blood pressure either for total or group stratification. The absence of statistical effect might be due to sample size as our sources only allowed us to work with aggregated data.

Key messages
Quality and access to data is needed to assess impact of policies. to increase effects in blood pressure either salt reduction from bread must be larger or a wider range of products should be considered.
Joint associations of fruit and vegetable consumption and physical activity with mortality risk
Authors: Mauramo E , Salmela J , Kanerva N , Lahelma E , Lallukka T , Pietiläinen O , Rahkonen O , Salonsalmi A , Lahti J 
Published: November 2019

Abstract

Background
Fruit and vegetable consumption (FVC) and leisure-time physical activity (LTPA) are associated with better health outcomes but less is known about their joint associations with the risk of mortality. We examined the joint associations of FVC and LTPA with premature mortality among midlife and ageing municipal employees, adjusting for key covariates.

Methods
Survey data collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, were linked with complete register data on mortality from Statistics Finland (4961 women, 1373 men; response rate 67%; written consent for register linkages 74%). FVC was dichotomised into daily or non-daily, and LTPA into high (&gt;14 MET-hours/week including vigorous exercise) or low. Covariates included age, sex, marital status, socioeconomic position, binge drinking, smoking and self-rated health. Cox regression models were fitted. The follow-up continued until the event of death or the end of 2015.

Results
A total of 281 deaths occurred during the follow-up. The mortality rate was 7.1% in men and 3.7% in women. A gender interaction was found, showing differing associations for women and men. Men with both daily FVC and high LTPA had the lowest mortality risk (HR 0.19, 95% CI 0.06-0.63) after adjusting for covariates. Men with high LTPA and non-daily FVC also had a lower mortality risk (HR 0.51, 95% CI 0.29-0.90) compared to those with non-daily FVC and low LTPA. Women with daily FVC and high LTPA had a lower mortality risk initially, but after adjusting for covariates no statistically significant associations were observed.

Conclusions
The joint associations of FVC and LTPA with premature mortality differed between women and men. This could be related to gender differences in e.g. the causes of death, and further studies are needed to clarify this. Increasing FVC and LTPA might prevent premature mortality among men.

Key messages
Fruit and vegetable consumption jointly with physical activity decreased the risk of premature mortality among men only. Further studies are needed to clarify the gender difference which could be related to for example death causes.
Medical costs associated with childhood maltreatment history among Japanese older people
Authors: Isumi A , Fujiwara T , Kato H , Tsuji T , Takagi D , Kondo N , Kondo K 
Published: November 2019

Abstract

Background
Childhood maltreatment can have a significant impact on health across the life course, but its impact on health care costs in later life is unknown in Japan. This study aims to assess additional medical costs of Japanese older people with childhood maltreatment history.

Methods
Data from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based cohort of independent people aged 65 years or older across Japan were used and linked uniquely with the database of health insurance claims for residents of a city with more than 1.5 million citizens, aged 75 years or younger (N = 978). Average annual medical costs for April 2012 and March 2013 and April 2013 and March 2014 were calculated and compared between those who experienced childhood maltreatment and those who did not, using generalized linear models.

Results
4.5% of our sample witnessed their father physically abusing their mother, 1.9% were physically abused, 10.6% were emotionally neglected, and 5.7% were emotionally abused in their childhood. Average medical costs of those with any childhood maltreatment (N = 176, 18.0% of the sample) were significantly higher than those without maltreatment (549,468JPY vs. 413,013JPY (1USD is equivalent to 110JPY); p = 0.007). When examining the effect of each type of maltreatment, average costs of those with emotional neglect were higher than the counterpart (573,481JPY vs. 412,082JPY; p = 0.008). Average costs of those who experienced physical abuse were also higher than those who did not (726,254JPY vs 431,106JPY; p = 0.035). The effect of any childhood maltreatment remained statistically significant after older adults’ age and gender were controlled (p = 0.03).

Conclusions
Our findings suggest that childhood maltreatment is strongly associated with additional medical costs among older Japanese. If it was truly causal, it can be estimated that additional medical costs associated with childhood maltreatment can be more than 333 billion JPY per year nationwide.

Key messages
Average annual medical costs of older adults with any childhood maltreatment history were significantly 116,098 JPY greater than those with no maltreatment history. As for each type of childhood maltreatment, emotional neglect tends to increase medical costs in late adulthood.
Body size, Mental health and Inequalities: The burden of obesity in South Africa
Authors: Koupil I , Mchiza J , Hossin M Z , Parker W 
Published: November 2019

Abstract

Background
Given the substantial burden of obesity in South Africa, it is important to understand how specific aspects of socioeconomic position influence the risk of unhealthy weight in different gender or ethnic groups.

Methods
We investigated body mass index distributions among subjects aged 15+ years from the South African National Health and Nutrition Examination Survey. Determinants of underweight, overweight and obesity were studied in 1655 (73%) men and 3104 (74%) women who had data available on social and mental health characteristics. Logistic and multinomial regressions were used to study associations with weight categories.

Results
Less than half of the subjects had healthy weight, 22% were overweight and 29% were obese. The proportion of healthy weight decreased and the risk of obesity increased with age up to 65 years. African women had a particularly high risk of overweight and obesity compared to men (age adjusted OR 4.65, 95% CI 3.94-5.50). The effect of gender was smaller in non-Africans (age adjusted OR 3.02, 95% CI 2.41-3.79; test for statistical interaction p = 0.004). Employment and higher education were associated with higher risk of overweight and obesity and a lower risk of underweight. Married subjects were at a higher risk of overweight and obesity. In men, higher income was associated with overweight and obesity. We found weak evidence of poor mental health being associated with unhealthy BMI.

Conclusions
There are social gradients and gender and ethnic differences in how underweight, overweight and obesity are distributed in the South African population. A high prevalence of obesity among women and positive associations of education, employment and income with overweight and obesity call for investments into health literacy. Action is also needed to prevent undernutrition among socially disadvantaged groups, and men in particular.

Key messages
There are strong social gradients and important gender and ethnic differences in how underweight, overweight and obesity are distributed in the South African population. High prevalence of obesity in women and positive associations of socioeconomic position with obesity indicate poor health literacy. Undernutrition needs to be reduced among socially disadvantaged.
Trends of sarcopenia and physical activity in elderly Koreans using KNHANES 2007-2017
Authors: Ahn H S , Kim B W , Park Y , Ki Moran 
Published: November 2019

Abstract

Background
Sarcopenia is one of risk factors for prevalence of chronic diseases which is associated with aging. Distribution of sarcopenia in Korea is important because Korea is one of the most rapid countries in population aging. This study aimed to understand trends in PA in elderly Koreans (≥65 years of age) and identify the proportion of sarcopenia in elderly Koreans based on a reference cutoff value of handgrip strength (28.6kg for men and 16.4kg for women).

Methods
This study was performed using data from Korea National Health and Nutrition Examination Survey (KNHANES) between 2007-2017. Physical activity on walking (2007-2017), aerobic exercise (2014-2017), and muscle strength (2007-2017) were analyzed to understand trends of physical activity participation in elderly Koreans. Furthermore, using handgrip strength data from KNHANES (2014-2017), the study examined how sarcopenia has distributed in elderly in Korea.

Results
The proportion of elderly Koreans engaged in walking decreased from 46.8% (age standardized) in 2007 to 35.7% in 2017, and the proportion of elderly Koreans engaged in aerobic exercise decreased 41.1% in 2014 to 29.4% in 2017. Even though, the proportion of elderly Koreans engaged in muscle strength increased from 11.6% in 2007 to 17.5% in 2017, the proportion of sarcopenia in elderly men increased from 22.6% in 2014 to 29.3% in 2017 and the proportion of sarcopenia in elderly women increased from 19.3% in 2014 to 30.1% in 2017.

Conclusions
During the past 10 years, the participation in muscle strength has increased, while the participation in walking and aerobic exercise has decreased in elderly Koreans. Nevertheless, the proportion of sarcopenia in elderly Koreans has increased. This analysis provides evidence of necessity of public health efforts to implement sarcopenia reduction interventions and examine the correlation between sarcopenia and physical activity pattern in elderly Koreans.

Key messages
Although the participation of physical activity has decreased, the participation of muscle strength has increased in elderly Koreans (≥65 years of age). The increased proportion of sarcopenia in elderly Koreans showed the necessity of new public health intervention to reduce sarcopenia in spite of growing trends of muscle strength in elderly Koreans.
Suicidal ideation among Tunisian adolescents and the association with adverse life experiences
Authors: Sahli J , Mannai J , Zedini C , Limam M , Merzougui L , Ajmi T , Mtiraoui A , Mellouli M , Ghardallou M El 
Published: November 2019

Abstract

Background
Youth suicidality is a significant public health problem. Understanding the factors leading to suicide is essential to implement effective preventive efforts. In this context, this study was conducted to assess the link between suicidal ideation and adverse life experiences among Tunisian school aged youth.

Methods
A cross-sectional survey was conducted among a sample of 2020 secondary school adolescents in 2016. An anonymous self-administered questionnaire was used to collect data. The adverse life events measured were: domestic violence, parental divorce, physical aggression, sexual abuse and a familial antecedent of suicide.

Results
Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months with no gender difference (16.3% among girls and 17.3% among boys, p = 0.62). Among the participants, 26.7% experienced at least one adverse life experience. Those who reported domestic violence (Odds Ratio = 8.93; 95% CI = 6.84–11.66), parental divorce (Odds Ratio = 3.02; 95% CI = 1.57–5.79), physical aggression (Odds Ratio = 6.97; 95% CI =5.14–9.46), sexual abuse (Odds Ratio = 8.69; 95% CI =3.94–19.15), familial antecedent of suicide (Odds Ratio = 8.17; 95% CI = 5.75–11.60) were associated with increased odds of suicide ideation.

Conclusions
The prevalence of suicidal ideation observed in the survey area was relatively high and associated with all the measured life adverse events. These factors should be included in a suicide screening tool to be integrated in a suicide prevention program.

Key messages
Suicidal ideation among adolescents was associated with all the measured life adverse events. Identifying adolescents at higher risk of suicide and help them to cope with their adverse experiences could be effective to prevent taking action to attempt suicide.