bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shaping Baby Buddy Cyprus: eHealth literacy for the transition to parenthood
Authors: Middleton N , Christodoulides V , Hadjigeorgiou E , Nicolaou C , Gourounti C , Leiweiber J , Gouni O , Baum A , Kolokotroni O 
Published: October 2020

Abstract

Issue
The transition to parenthood presents opportunities to promote mother-child health. Though of varying quality, internet information-seeking is prevalent while attendance in antenatal classes is low. Digital innovation can support access to timely and valid information for all, key component of WHO's Respectful Maternity Care.

Description of the problem
”Baby Buddy Forward” assessed the cross-national transferability of the innovative Baby Buddy (UK) healthy pregnancy and early parenthood app to the medicalized and decentralized birth environment in Cyprus. Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to engage with the professional and mums-to-be community and deliver a locally relevant resource to enhance user-provider communication and shared decision-making.

Results
We (a) assessed available resources in a structured quantitative and qualitative rating exercise, (b) identified gaps and priorities in an eDelphi survey (N = 275 mums and 193 professionals, re-rated at annual Midwifery conference), (c) gained in-depth understanding of information-seeking behaviours in a series of focus groups with a diverse set of mums-to-be (N = 100) and (d) explored perceptions about the use of internet for information in pregnancy and the quality of communication with professionals in a questionnaire survey (N = 200). New health communication material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework.

Lessons
In a “changing landscape” of antenatal education, Baby Buddy functions as “proof of concept” for cross-national innovation exchange. Beyond a learning experience, the use of PAR provided ground for building transdisciplinary alliances and creating a public health digital resource to enhance the health literacy of new parents and support the educational role of maternal and child health professionals.

Key messages
Digital resources can reduce social disparities, enrich the user-provider exchange and support the educational role of professionals. PAR provides a framework for co-creation and sense of common purpose.
Privileged access to drugs in Russia and differential inflation of its monetary substitute
Authors: Vlassov V , Kornilov M 
Published: October 2020

Abstract

Background and Objectives
One of the most acute problems of current healthcare in Russia is the absence of drug provision in ambulatory care. Only invalids and war veterans are eligible for the free drugs. In 2005 this and other natural privileges were monetized - eligible people were offered to opt out for the money equivalent. The aim of this study was to evaluate the effectiveness of the monetary substitution of the social services, specifically the inflation of the money substitution of drugs.

Materials and Methods
We use the official state statistics and evaluate the inflation using the official inflation rate and using the BigMac Index from 2005 to 2019.

Results
Over the past 10 years, the nominal value of the monetary equivalent of the set of social services has grown by 149% in nominal prices (from 450 to 1121 roubles, years 2005-2018). Official inflation over these years was 197%. Measured by BigMac Index the set of social services depreciated from 10.7 to 8.3. The cost of the drug provision subset had depreciated even more - from 9.52 to 6.39 units. The pensions during this period had increased in nominal, inflation-adjusted monetary size, and as measured by BigMac index. A set of social services in the natural equivalent decreased by 22.4%. The drug subset had depreciated even more - by 67.1%.

Conclusions
During the period from 2005 to 2019, the cost of a set of social services provided to the eligible citizens in monetary terms grew, while inflation-adjusted value and in physical terms it depreciated. Especially significant was the decrease of the value of the drug provision due to incomplete indexation for inflation. The decrease in the real value of the set of social services provided to vulnerable groups of citizens is an alarming trend. It is long lasting, and reflect the low priority of the drug provision for the decision makers.

Key messages
The value of the drug provision package is insufficiently corrected for inflation. The depreciation of the drug provision is long term and different from the other components of social support.
Regular consumption of red meat and health behaviors in the Brazilian population
Authors: de Assumpção D , Álvares Domene S M , Pita Ruiz A M , Stolses Bergamo Francisco P M 
Published: October 2020

Abstract

Background
The consumption of red meat should not surpass 500 g of cooked weight per week. Regular consumption can exceed this recommendation, increasing the risk of chronic diseases.

Objective
Estimate the prevalence of the regular consumption of red meat according to health behaviors in Brazilian adults (≥18 years).

Methods
A cross-sectional study was conducted with data from the 2013 National Health Survey, which is a household inquiry with a representative sample of the population ≥18 years of age. The regular consumption of red meat (beef, pork, goat) was defined as ≥ 5 days/week. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated according to health behaviors (healthy and unhealthy eating patterns, smoking, practice of physical activity during leisure and alcohol intake).

Results
A total of 60,202 adults were interviewed, 52.9% of whom were women and mean age was 42.9 years (95%CI: 42.6-43.2). The prevalence of regular red meat consumption was 36.7% (95%CI: 36.0-37.5) and was higher among those who ingested soft drinks/artificial juice (PR = 1.08) and sweets (PR = 1.05) ≥3 days/week, ingested beans (PR = 1.07) and raw vegetables (PR = 1.03) ≥5 days/week, ingested fatty meat (PR = 1.09), smokers (PR = 1.05), individuals who were inactive during leisure (PR = 1.04) and those who consumed alcohol ≥2 times/week (PR = 1.06). The prevalence was lower among those who ate fruit (PR = 0.99) and chicken (PR = 0.95) ≥5 days/week, those who ate fish (PR = 0.90) at least 1 day/week and those who drank no fat/low fat milk rather than whole milk.

Conclusions
The regular consumption of red meat was higher among individuals who ingested unhealthy foods more often, those who ingested fatty meat, smokers, those who ingested alcoholic beverages and those who did not practice physical activity. Actions are needed to reduce the frequency of red meat consumption.

Key messages
Regular consumption of red meat can exceed the recommendation of 500 g of cooked weight per week. The regular consumption of red meat was associated with the more frequent ingestion of unhealthy foods and fatty meat.
Life expectancy in the Emilia-Romagna region: an analysis of social and geographical variability
Authors: Di Girolamo C , Rosaia E M , Miglio R , Bartolini L , Caranci N 
Published: October 2020

Abstract
Italy and the Emilia-Romagna region record among the highest life expectancy worldwide. However, differences among geographical areas, social strata and genders have been reported at regional level. The aim of this work is to measure both geographic (among provinces) and social (among education levels) inequalities in life expectancy and to evaluate the association between education and cause-specific mortality, in the Emilia-Romagna region during the period 2012-2016.
The data source is an integrated dataset based on the linkage at individual level of the regional health population register, the mortality register, and the 2011 census; this system of microdata, which is the base of the Emilia-Romagna Longitudinal Study, allows a precise calculation of the person-time at risk. The study population consisted of all individuals who were residents in the Emilia-Romagna region at the 1/1/2012 and took part to the 2011 census.
Life expectancy was estimated through mortality tables reconstructed with a mixed cohort-period approach and combined with the Kannisto's method. Inequalities in mortality were estimated using a longitudinal approach and Poisson models.
Educational disparities were evident even in the Emilia-Romagna region in the early 2010s; life expectancy was shorter among low-educated subjects and the gap varied: 3 years among men and approximately 1.5 years among women. Life expectancy varied also among provinces, although the gaps were smaller and men and women were closer, and there was an indication of an interaction between education and geographical areas. The risk of dying revealed social pattern and disparities were greater for respiratory diseases and for some cancers, particularly among men.
This study is the first attempt to describe, through the Emilia-Romagna Longitudinal Study, educational and geographical disparities in life expectancy in the region and to suggest entry points for actions to tackle these differences.

Key messages
Geographical and social inequalities in life expectancy have been reported at regional level. Those inequalities and the mortality relative risks within Emilia-Romagna during 2012-2016 were estimated. The estimates by the Emilia-Romagna Longitudinal Study highlighted disparities in life expectancy in the Emilia-Romagna region and suggest entry points for actions to tackle these differences.
Do patients value similar hospital characteristics and quality metrics for different treatments?
Authors: Kuklinski D , Vogel J , Geissler A 
Published: October 2020

Abstract
Quality competition among hospitals, induced by patients freely choosing their hospital in a price regulated market, can only be realized if quality differences between hospitals are transparent, understandable, and thus influence patients' hospital choice. We use data from ∼145,000 German patients and ∼900 hospitals for colorectal resections and knee replacements to investigate whether patients value quality and specialization when choosing their hospital. Using a random utility choice model, we estimate patients' marginal utilities, willingness to travel and change in hospital demand for quality improvements. Patients respond to service quality and specialization and thus, quality competition seems to work. Colorectal resection patients are willing to travel longer for more specialized hospitals (+9% for procedure volume, +9% for certification). Knee replacement patients travel longer for hospitals with better service quality (+6%) and higher procedure volume (+12%). However, clinical quality indicators, often difficult to access and interpret, barely play a role in patients' hospital choice. Furthermore, we find that competition on quality for colorectal resection is rather local, whereas for knee replacement we observe regional competition patterns. Consequently, future quality transparency initiatives need to entail the development and publication of understandable outcome quality indicators (e.g. patient reported outcome measures). Moreover, clinical quality indicators need to be explained and presented more intuitively.

Key messages
Quality competition among hospitals is beneficial for all participants in the health care system. Our paper reveals the quality information that is decisive in the patient’s decision making process. Accessibility and comprehensibility of quality information plays a large role in its impact on patient hospital choice. Thus, policy makers need to raise quality transparency and patient emancipation.
18.L. Workshop: Public mental health policies - experiences and challenges
Authors:   Organised by: EUPHA Public mental health section,   Chair persons: Jutta Lindert – EUPHA-PMH, Marija Jakubauskiene – EUPHA-PMH
Published: October 2020

Abstract
The workshop has the aim to help developing and strengthening policies for Public Mental Health and support experience sharing platform for Public Mental Health policy development. Mental health policy defines the vision for the future mental health of the national population and internationally. The WHOs developed three recommendations for the development of mental health policy, strategic plans and for organizing services which are to deinstitutionalise mental health care; to integrate mental health into general health care; and to develop community mental health services. For each this aim a situational analysis and needs assessment is recommended as first step. Therefore, this workshop consists of four talks in the development of mental health policies at the regional and national level. First, the process of population consultations and participatory research is described (Felix Sisenop). Participatory research enables exchanging experiences, results and key challenges in Public Mental Health. Participatory research can contribute greatly in empowering people to discuss and deal with mental health issues and therefore is a step towards a more involved and active general public. Second, a policy development at the regional level is described (Elvira Mauz). On behalf of the federal ministry of health the Robert Koch Institute as the German public health institute is currently developing a concept for a national Mental Health Surveillance (MHS). In the talk objectives, framework model and work processes are presented. The MHS should systematically gather, process and analyze primary and secondary data, thus an integrating and monitoring system is working. Third, the Public Mental Health policy in Malta will be described (John Cachia) Over the last 7 years CMH Malta developed a strategic framework for the mental health with the input of patients, families, service providers, NGOs and civil society. The Maltese National Mental Health Strategy 2020-2030 was published in July 2019. This strategy will be described in the Talk. Fourth presenter (Ignas Rubikas) will introduce the national perspective on development of Lithuanian mental health policy addressing major public mental health challenges of suicide prevention, alcohol control policies and mental health promotion in a broader context of national mental health care.

Key messages
Participatory research in Public Mental Health is an approach to involve the population in policy development. Development of mental health policies can benefit from sharing experiences and lessons learned on a national and regional levels.
The service user voice in shaping mental health policy
Authors: Cachia J 
Published: October 2020

Abstract

Background
Over the last 7 years CMH Malta provided holistic evidence for a mental health strategic framework with the regular input of patients, families, NGOs and civil society.

Methods
This evidence featured in published Annual Reports, conference presentations, bilateral meetings, and media interventions. The National Mental Health Strategy 2020-2030 was published in July 2019. CMH proffered advice, experience and supporting documents to the Strategy Team. 80% of the action points in the strategy reflect CMH recommendations.

Results
The philosophy of care should emphasise person-centred multi-disciplinary care. The primary health care system must be an effective gatekeeper providing mental health promotion and care in the community thus preventing hospital admissions. Acute psychiatric care must be provided within the acute general hospital setting with active support of A&E and 24/7 intervention services that deal promptly with emergencies. Transition of youngsters to adult psychiatry and of adults to old age psychiatry should be flexible. Community-based rehabilitation is required for Adult Psychiatry, Child/Adolescent/Youth Psychiatry, Old Age Psychiatry, Forensic Psychiatry and Learning Disability. Policymakers must provide care options for older persons with chronic mental disorders, safe settings for youngsters with severely challenging behaviour, and shelters for persons suffering from substance misuse who resist treatment or rehabilitation.

Conclusions
Implementation of the Mental Health Strategy requires substantial capital investment and new resources. Service re-engineering and synergy are necessary to avoid duplication and waste. Better complements of professionals must be available to provide alternative therapies to the current medical pharmacological model.

Key messages
Patients, families, NGOs and civil society are critical partners in strategy development. Action points and implementation plans must reflect service user views and advice.
The roles of gender affirmation and discrimination in the resilience of transgender individuals
Authors: Lelutiu-Weinberger C , English D , Sandanapitchai P 
Published: October 2020

Abstract

Background
Transgender individuals face severe stigma-driven health inequities structurally, institutionally and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression and/or role, may be considered a manifestation of resilience.

Methods
To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey.

Results
Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation (p &lt; .001) and psychological distress (p &lt; .001), and higher odds of substance use (p &lt; .001), and past-year healthcare use and HIV-testing (p &lt; .001). Discrimination was associated with higher odds of suicidal ideation (p &lt; .001), psychological distress (p &lt; .001), substance use (p &lt; .001), and past-year HIV-testing (p &lt; .001). Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation (p &lt; .01), with affirmation having a significant moderating protective effect against discrimination.

Conclusions
Gender affirmation is paramount in upholding transgender health, and these findings carry global significance, beyond the US. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.
Ecopsychosocial environments for health and mental health
Authors: Chrysikou E , Rehn J , Savvopoulou E , Petelos E 
Published: October 2020

Abstract

Theories of architectural morphology and society contributed to understanding the interconnections and synergies between society and space. Lack of knowledge of how space influences communities can foster social issues (Hillier & Hanson, 1984). This complements links between health and society identified by epidemiolohists (Marmot, 2015). Thus, theories connecting health and the environment unite all three disciplines by connecting health to the built environment. We characterise this holistic interconectedness of space, health and society as ecopsychosocial (Chrysikou, 2019) and we will use it as the underlying theory of the workshop. Spatial interventions could support prevention or disease-fighting mechanisms. We briefly mention anthropocentric examples related to space and vulnerability from the field of therapeutic architecture. The aim is to utilise those spatial features that could affect vulnerable people's physiology and perception. This approach does not replace medical intervention or treatment. Contrary, it aims to support healthcare professionals, carers and patients optimizing the healthcare delivery and recovery processes and subsequently reduce efforts required to overcome stressful situations through restaurative environment. This ecopsychosocial system would is more helpful for of low diagnostic and interventional accuracy such as mental illness (Christensen et al., 2009).

References
Christensen, CM., Grossman, JH. and Hwang, J. (2009) The innovator's prescription. New York USA: McGraw-Hill
Chrysikou, E. (2019) Psychiatric institutions and the physical environment: combining medical architecture methodologies and architectural morphology to increase our understanding. Journal of Healthcare Engineering, vol. 2019, Article ID 4076259, 16 pages
Hillier, B. & Hanson, J. (1984) The Social Logic of Space. Cambridge: Cambridge University Press
Marmot, M. (2015) The health Gap: the challenge of an unequal world. Bloomsbury Publishing, London
Moving forward: Cost-Effectiveness of PrEP in HIV prevention for Men Who Have Sex with Men in Italy
Authors: Nurchis M C , Riccardi M T , Sapienza M , Pascucci D , Damiani G 
Published: October 2020

Abstract
Globally, in 2018 1.7 million people contracted Human Immunodeficiency Virus (HIV) and 770,000 people died from AIDS-related illnesses. Men Who Have Sex with Men (MSM) have one of the highest probabilities of HIV transmission.
In Italy, in 2018 2,847 new HIV cases were diagnosed, of which 39% among MSM. The MSM population accounts for 16,690 individuals whereof 50% already underwent the Highly Active Antiretroviral Therapy (HAART). The aim of this study is to evaluate the cost-effectiveness of daily Pre-Exposure Prophylaxis (PrEP) in the Italian MSM susceptible population.
A Markov transition model was calibrated to the HIV epidemic among MSM in Italy, comparing PrEP to naïve patients (NP). Model parameters were retrieved by querying scientific databases. Transition probabilities were adjusted for incidence of HIV while costs and benefits were discounted at an annual rate of 3%. The impact on results of critical parameters was explored through a Monte Carlo-based sensitivity analysis. The cost-effectiveness analysis results were reported as Incremental Cost-Effectiveness Ratio (ICER) express as € per Quality Adjusted Life Year (QALY) gained.
The introduction of such a PrEP program would result in a total cost of €822,398,199 million and lead to a gain of 70,762 discounted QALYs over an 85-year time horizon.
Assuming a 92% efficacy of PrEP therapy, the ICER for the PrEP program is €4,346.16/QALY gained. This value is definitively lower than acceptability NICE threshold (£20,000).
PrEP can reduce the infection rate up to 60% in a five-year period. The Monte Carlo simulation confirmed the robustness of the model results.
This analysis showed PrEP to be cost-effective when used in a susceptible population. Even if PrEP doesn't protect from other sex-related infectious diseases, it could prevent HIV transmission, thus breaking down HIV-infection incidence rate. Each country should reflect on the real possibility to implement a robust Public Health program pondering the adoption of PrEP.

Key messages
PrEP is very effective at reducing HIV infection when taken correctly. It is the backbone in the “combination prevention”, necessary to reach the SDG of ending the AIDS epidemic by 2030. This preliminary analysis suggests that the introduction of a daily PrEP program for MSM in Italy is cost-effective and possibly cost saving in the long term.