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WORLD UNIVERSITY DIRECTORY is the one and only largest database of world educational institutions with geo data viz Longitude, Latitude, UTM, GPS, Lombard projection, map, etc, thereby enabling the browsers to know to distance between the searched University and the browsers.

CONFERENCE section lists the conferences that are to take place around the world.

WORLD UNIVERSITY DIRECTORY has the World's largest online database of universities, polytechnics, colleges, schools and online universities across globe. Discover the complete list of universities, and other educational institutions available in North America, South America, Europe, Asia, Australia, New Zealand, rest of the world and online.

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1Universidade Federal do Rio de Janeiro     
Universidade Federal do Rio de Janeiro
Category: University
Brazil
South America, America
2Kuwait University      
Kuwait University
Category: University
Kuwait
Middle East , Asia
3RMIT University     
RMIT University
Category: University
Australia
Australia and New Zealand, Oceanic
4Brock University     
Brock University
Category: University
Canada
North America, America
5Universite Bordeaux 1     
Universite Bordeaux 1
Category: University
France
Western Europe, Europe
6University of Cambridge     
University of Cambridge
Category: University
United Kingdom
Northern Europe, Europe
7University of Oxford     
University of Oxford
Category: University
United Kingdom
Northern Europe, Europe
8Massey University    
Massey University
Category: University
New Zealand
Australia and New Zealand, Oceanic
9Australian National University     
Australian National University
Category: University
Australia
Australia and New Zealand, Oceanic
10Harvard University    
Harvard University
Category: University
United States
North America, America
11University of Auckland    
University of Auckland
Category: University
New Zealand
Australia and New Zealand, Oceanic
12Stanford University    
Stanford University
Category: University
United States
North America, America

1.
Distance Learning Balancing Your Education and Busy Lifestyle
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2.
Homework Help
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3.
Accredited Online Universities Getting Good Grades
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4.
Why Do You Want a Degree
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College Tuition Costs are Spiralling
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Five Steps To Choosing A College
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How To Improve Your Study Habits and Remember Better
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College Study Tips: Work Smarter, Not Harder
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Exam Guides One: 5 Great Tips To Improve Your Strategy
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How to Save Money While at College
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What is the Cost of College Tuition
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Academic Research on the Internet : There Is a Better Way
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Secrets Of Successfully Sitting Exams
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14.
Online Education and Digital Divide
Online Education and Digital DivideDigital Education is really coming along thanks to the US Military and their expenditures in the IT Framework to make training ava
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15.
Dont Graduate - What Students Should Know About College, But No One Ever Tells Them
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16.
How Parents Can Help Allieviate The Stress of Getting Into College
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17.
The Distance Learning Explosion!
The Distance Learning Explosion!A generation ago few would have given much thought to educating themselves apart from a 'brick and mortar' educational inst
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18.
Too Much to Read and Too Little Time
Too Much to Read and Too Little TimeI spent the better part of 17 years in and out of higher education. Eleven of those years were invested in taking classes and purs
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19.
9 Lessons for Success in College - That Actually Make Sense
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20.
Online Education Has The Power To Transform Lives And Fulfill Dreams
Online Education Has The Power To Transform Lives And Fulfill DreamsOnline education is a dramatic development in the advancement of distance learning. A cent
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21.
Getting Into College No Longer A Numbers Game!
Getting Into College No Longer A Numbers Game!Sending your kids to college has never been more difficult or more expensive, and outstanding grades no longer guar
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22.
Business and Academia!
Business and Academia!The driving factor of any university is to make the students understand the business needs of today and equip them for a better tomorrow.
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23.
Choose the Delivery Mode for your e-Learning Course
Choose the Delivery Mode for your e-Learning CourseThere are so many ways to deliver instruction online that the topic warrants its own lesson. In fact, deciding how
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24.
College Entertainment for Less
College Entertainment for LessMost of these activities are free or very cheap:

* Campus music or dance recitals

* College theater
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25.
Scholarships not Working for You Neither, Huh?
Scholarships not Working for You Neither, Huh?We're going to college, and we need cash. We have tuition and food, housing, books... like I said, we need cash. We hear
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26.
Discover How Online College Classes Work
Discover How Online College Classes WorkIt's no secret that more and more people are looking to the internet for a convenient way to further their education. Online cla
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27.
Mind-Body Secrets for College Success - Six Key Secrets
Mind-Body Secrets for College Success - Six Key SecretsEmbrace the secrets of the body-mind connection and tap into an inexhaustible supply of power and energy leadi
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28.
Education - Let The Learning Begin!
Education - Let The Learning Begin!You've probably heard it since you were little, 'get a good education and you'll go far in life.' Maybe you used to wonder how truthful
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29.
Study More Effectively
Study More EffectivelyIf you are studying for an exam or if you need to learn some material for a presentation, you may be wondering how early you should start to
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1.
What Is the Free Application for Federal Student Aid (FAFSA)?
FAFSADefinition: Getting into graduate school is one thing. Paying for it is another. How will you pay for those 2-6 years of education? A graduate degree can easily cost $60,0
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2.
Finding a University if you want to Study Abroad
Finding a UniversityFinding a university abroad

Tempted to study abroad? Here are a few steps to start your study abroad process:
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3.
Student living in style
Student Living In StyleA new type of student living has come to London. QS Top Universities speaks with Emanuela Carbani of Nido to find out what all the fuss is about.
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4.
International student accommodation
International student accomodationSo you've decided to study abroad. You now need somewhere to stay. This will be your home for the next few years, where you will
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5.
Visa Applications for the UK
Visa Application For UKDo I need a Student Visa to study in the UK?

Most people need a student visa for the UK, except European Union countries. Always check yo
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6.
Student Visas for New Zealand
Student Visas for New ZealandNew Zealand welcomes people from all cultures and countries around the world, although you will probably need a visa. Luckily, New Zealand ha
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7.
International Student College Application Calendar
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8.
Life-Long Students Make More Money
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How to Survive First Year Engineering
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10.
Financial Aid for Online Education
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11.
Acing the SAT Exam
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12.
Prepping for the new SAT I
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MRCP and MRCPCH ? Preparation for the Examination
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14.
Most Colleges Require Letters Of Recommendation
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15.
The All-Important College Application
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College Admissions Essays that Take 1st Place -A Personal Statement Checklist
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Submitting The College Application
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Need Help Paying Back Student Loans?
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Online College Programs ? How to Apply
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20.
Five Questions To Ask A Computer Training School Before Signing Up
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Quality Schools
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Consolidate Student Loans and Shop Online
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All About Grants for College Students
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How to Find Money for College Education
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Online Education: 57 Leading Institutions
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Student Loans ? Ensuring a Brighter Future Ahead
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5 Leading Online Schools
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28.
Pre-Bachelor
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Federal PLUS Loans
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European Public Health News

In this European Public Health News, we continue to focus on collaboration to attain the best public health for Europe. Jakab presents the joint action for the protection of people from health emergencies, a clear field where European collaboration is essential. Bucher presents the work of the European Commission to tackle the spread of vaccine preventable diseases, again a clear field where European joint efforts are necessary. Azzopardi Muscat highlights the World Health Day theme of universal health coverage. It takes a joint effort to continue this as top priority to reach the ambitious target of one billion persons covered for care. Zeegers Paget discusses the need for the public health network to step out of its comfort zone and start working with all policies to reach the highest level of health and well being possible. Charpak highlights the ‘bridge’ theme of the upcoming Marseille 2019 conference. Bridging is necessary not just between regions (Southern Europe–Northern Africa), or between professions touching upon health, but also bridging between languages (the language of advocacy but also the different languages in Europe).

Posted on 22 May 2019 | 7:00 pm

Cannabis in Malta—big business or laxing restrictions?

A view of what has happened on the local scene in Malta regarding Marijuana (or Cannabis) use over recent years is rather confusing and rather unsettling. To state that the laws and restrictions regulating Cannabis use for recreational purposes have not worked is to state the obvious. The biggest problem created by this traditionally restrictive view was the arresting, indictment and even imprisonment of users over the years and their subsequent loss of a clean police record. We have not seen much evidence of major harm or long-term ill effects from its recreational use and clearly many have flouted the law and used it with impunity for many years.

Posted on 22 May 2019 | 7:00 pm

Cannabis: harmless recreation or dangerous drug?

‘It doesn’t work’. This is a consistent message in the series of Viewpoint contributions on cannabis policy published in this issue. They are based on a round table discussion held during the EPH conference in Ljubljana 2018, where we were updated on the situation regarding cannabis production, distribution and use in some European countries. Another message was that a balanced discussion is lacking in most countries. Strong ideological motives with political undertone is driving the debate, and public health considerations are missing.

Posted on 22 May 2019 | 7:00 pm

France and marijuana: an unbalanced debate where public health competence is missing

In France today, marijuana is an illegal drug, the possession and use of which are strictly prohibited. The law aims for zero tolerance, and there has been no legal evolution to allow certain uses, as in some other European countries.

Posted on 22 May 2019 | 7:00 pm

A new wave of marijuana legalization: country case study from Belgium

  • In Belgium, according to the law, voted with a public health rationale, marijuana is illegal. This also means medical marijuana is strictly circumscribed (only on prescription for one clinical indication and one pharmaceutical presentation). In practice, limited depenalization is possible, as there is a prosecutor’s guideline as to possible discretionary leeway in prosecuting adults when found in possession of small quantities (defined in a circular letter as maximum 3 g) and no aggravating circumstances (e.g. using in the close proximity of minors) or public disorder. This can lead to regional variation as well as arbitrary application of the guideline. By extension, cannabis social clubs are subject to prosecution.
  • This policy is not working: prohibition for public health reasons makes a public health approach difficult to a public health problem that is intensifying. Marijuana with high Tetrahydrocannabinol (THC) content is widely available and accessible, particularly to the young and an essential part of the party scene, mixed with other substances. Driving ‘under the influence’ is being reported more and more, as is an increasing number of hospital admissions as well as admissions to drug help centers as a consequence of recreational use of marijuana.
  • Regulation or control of these markets is not only impossible, as they are illegal; we have little or no information nor analysis on the public health impact (externalities) of this approach, as to violence in illegal markets, health in prisons or how the marijuana overload diverts attention from true priorities in criminal justice. In 2016 an intriguing suggestion was even made as to how the illegality of drug dynamics could turn small time criminals into mass murderers through radicalization in prisons.1
  • A new approach in Belgium is needed, whereby these markets are brought out in the open so we can regulate and control them, but we are at a policy and political standstill, not to forget the specific challenges of the Belgian federal system where public health policy and competences are decentralized differently from law and order. For a better public health approach, we need to observe and learn from other countries, and also analyze what we are learning from our efforts in regulating tobacco and alcohol. Unfortunately, in Belgium, these latter efforts are equally challenged.
  • We would therefore welcome progress at the European and international level, where we would like to see Public Health take the lead over security and justice, also get more involved in Schengen, as this has implications for legal approaches towards marijuana. We would also support a more proactive position of the EU at the United Nations, and also involve WHO, particularly as to the scientific basis why cannabis remains listed under the UN Conventions schedule 1 and 4.2

Posted on 22 May 2019 | 7:00 pm

Populist politics and vaccine hesitancy in Western Europe: an analysis of national-level data

Abstract
Background
Parents’ reluctance to vaccinate their children undermines the effectiveness of vaccination programmes in Western Europe. There is anecdotal evidence suggesting a connection between the rise of political populism and vaccine hesitancy.
Methods
This paper analyses national-level data to examine the link between political populism and vaccine hesitancy in Western Europe. Political populism is operationalised as the percentage of people in a country who voted for populist parties in the 2014 European Parliament elections. Vaccine hesitancy is operationalised as the percentage of people in a country who believe that vaccines are not important, safe and effective according to data from the Vaccine Confidence Project (2015).
Results
There is a highly significant positive association between the percentage of people in a country who voted for populist parties and who believe that vaccines are not important (R = 0.7923, P = 0.007) and effective (R = 0.7222, P = 0.0035). The percentage of people who think vaccines are unsafe just misses being significant at the 5% level (R = 0.5027, P = 0.0669).
Conclusions
Vaccine hesitancy and political populism are driven by similar dynamics: a profound distrust in elites and experts. It is necessary for public health scholars and actors to work to build trust with parents that are reluctant to vaccinate their children, but there are limits to this strategy. The more general popular distrust of elites and experts which informs vaccine hesitancy will be difficult to resolve unless its underlying causes—the political disenfranchisement and economic marginalisation of large parts of the Western European population—are also addressed.

Posted on 24 February 2019 | 6:00 pm

Risk factors for subsequent work disability in patients with acute myocardial infarction

Abstract
Background
Scientific knowledge on risk factors for work disability in terms of long-term sickness absence (SA) and disability pension (DP) following acute myocardial infarction (AMI) is limited. The study aimed to investigate socio-demographic, work-related and medical characteristics as risk factors for long-term SA (>90 days) and DP in patients with a first AMI.
Methods
This is a population-based cohort study of 8199 individuals aged 19–60 years who had a first AMI during 2008–10 and were alive 30 days after AMI. Univariate and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with regard to long-term SA and DP with a 3-year follow-up were estimated by Cox regression.
Results
We found a higher risk of long-term SA and DP after AMI in women, those with lower education and previous SA (range of HRs: 1.29–7.34). Older age and being born in non-European countries were associated with a 2- to 3-fold higher risk of DP. Moreover, ST-elevation myocardial infarction (STEMI), musculoskeletal and common mental disorders (CMDs) were risk factors for long-term SA and DP, while diabetes mellitus and stroke were associated with a higher risk of DP (range of HRs: 1.12–2.98). Coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention was associated with a 2-fold higher risk of work disability.
Conclusions
Older women, those with lower education and non-European immigrants had a higher risk of work disability after AMI, particularly permanent work disability. STEMI, CABG, diabetes mellitus, stroke, musculoskeletal disorders and CMDs provide important clinical information for work disability after AMI.

Posted on 13 January 2019 | 6:00 pm

Cost-effectiveness and cost-benefit of worksite health promotion programs in Europe: a systematic review

Abstract
Background
The aim of this study was to assess the evidence regarding economic evaluations of worksite health promotion programs in Europe.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search, study selection, data extraction and quality appraisal were performed independently by two researchers. Full economic evaluations of worksite health promotion programs carried out in a European workplace were included.
Results
From 1728 search results, 39 articles describing 37 studies were included. Regarding methodological quality, 9 studies were rated as strong, 15 as moderate and 15 as weak. Six of the studies fulfilled the minimum standard for health economic evaluations. Worksite health promotion was applied in many different forms for a wide range of settings. Cost-effectiveness, cost-benefit and cost-utility analyses were performed from different perspectives. Effects on health outcomes tended to be small and uncertain. Only 9 out of 21 cost-benefit analyses reported a financial benefit and 10 out of 23 cost-effectiveness analyses concluded that the intervention was cost-effective. Two out of eight cost-utility analyses were found to be cost-effective. Productivity loss accounted for more than 85% of the total costs and thus, was the main cost driver in the analyses.
Conclusions
Due to considerable heterogeneity, no specific type of intervention could be identified to be particularly effective and the economic value of worksite health promotion remains uncertain. Further studies, investigating comprehensive worksite health promotion programs are needed to provide evidence on their efficiency. Guidelines to perform economic evaluations in the field of worksite health promotion, especially for valuation of productivity loss, are required.

Posted on 2 January 2019 | 6:00 pm

The HTQ-5: revision of the Harvard Trauma Questionnaire for measuring torture, trauma and DSM-5 PTSD symptoms in refugee populations

Abstract
Background
The Harvard Trauma Questionnaire (HTQ) was developed 25 years ago as a cross-cultural screening instrument to document trauma exposure, head trauma and trauma-related symptoms in refugees. This article aims to: (i) outline the process of revision of Part IV of the HTQ to (a) include the new DSM-5 diagnostic criteria for PTSD, and (b) separate out and more fully develop the refugee-specific functioning items; and (ii) promote a consistent approach to the validation of the HTQ-5 when adapted for use in other cultures and language groups.
Methods
Our process involved item mapping; expert consultations; generating items according to the new DSM-5 criteria; and drafting, refinement and finalization of the revised measure focusing closely on issues of meaning, future translation into multiple languages and comprehension amongst groups with low literacy and little or no exposure to Western trauma concepts. Validity and reliability testing of the new HTQ-5 is underway.
Results
The HTQ symptom checklist was modified consistent with current DSM-5 diagnostic criteria to identify those refugees at risk for mental health and other symptoms associated with traumatic life events, disability and dysfunction.
Conclusions
Accurate screening of post-traumatic distress and dysfunction enables those working with refugees to triage them more effectively to scarce health and mental health resources. When developing screening measures to inform public health policy and practice, it is vital that these measures can bridge the gap between western (etic) nosologies and indigenous (emic) understandings of traumatic stress.

Posted on 13 December 2018 | 6:00 pm

All-cause mortality among three generations of Moluccans in the Netherlands

Abstract
Background
Mortality variations have been reported for ethnic minority groups compared with their host populations. It is uncertain how this mortality variations change over time as younger generations become older and mix with the host population. This study aimed to examine all-cause mortality among three generations of Moluccans in the Netherlands, and to compare Moluccans with a mixed and non-mixed ethnic background.
Methods
We used data from the death and municipality registry for the years 2000 through 2013, including all registered Dutch inhabitants. A list of Moluccan surnames was used to select the Moluccan population. Mortality differences were calculated by Poisson regression, controlling for sex, age and district socio-economic status.
Results
High all-cause mortality rates were observed in all generations of Moluccans although the extent of the differences between Moluccans and the Dutch were smaller in second (1.15, 1.07–1.23) and third generation (1.14, 1.00–1.29) compared with the first generation (1.55, 1.49–1.60). Higher all-cause mortality is also reflected in the higher mortality from most causes of death except neoplasms and external causes. Both mixed and non-mixed Moluccans showed high all-cause mortality among the first (child) and second generation compared with the Dutch.
Conclusion
Our findings show a higher all-cause mortality in three generations of Moluccans compared with the Dutch. The results show that mortality inequalities may persist, though in an attenuated form, over generations among ethnic minorities.

Posted on 11 December 2018 | 6:00 pm

The impact of a comprehensive electronic patient portal on the health service use: an interrupted time-series analysis

Abstract
Background
There is little empirical research on the potential benefit that electronic patient portals (EPP) can have on the care quality and health outcomes of diverse multi-ethnic international populations. The purpose of this study is to determine the extent to which an EPP was associated with improvements in health service use.
Methods
Using a quasi-experimental interrupted time-series approach, we assessed health service use before (April 2012–September 2015) and after (October 2015–December 2016) the implementation of a comprehensive EPP at four hospitals in Madrid, Spain. Primary outcomes were number of outpatient visits, any hospital admission, any 30-day all-cause readmission and any emergency department visit.
Results
Implementation of the EPP was associated with a significant decline in readmissions. Among patients with chronic heart failure, EPP implementation was associated with a significant decline for all outcome measures, and among patients with COPD, a decline in all outcomes except readmissions. Among patients diagnosed with malignant hematological diseases, no significant changes were identified.
Conclusions
EPPs hold promise for reducing hospital readmissions. Certain patient populations with chronic conditions may differentially benefit from portal use depending on their needs for communication with their providers.

Posted on 11 December 2018 | 6:00 pm

Who suffers from the cumulation of atypical employment? A longitudinal analysis based on Dutch data

Abstract
Our study examines the relationship between the cumulation of employment statuses such as temporary contracts, self-employed, work at home or participating in the business activity of the spouse, and the health of Dutch early career workers. We followed four cohorts of Dutch early career workers that entered the labour market in 2002, 2004, 2006 and 2008 for a period of six years. Based on our fixed effects models, we conclude that men but not women who during their first six years of labour market participation experienced more spells of atypical employment also reported worse self-rated health.

Posted on 10 December 2018 | 6:00 pm

Practical generic guidelines for paediatric-to-adult transition for adolescents with chronic disease

Abstract
Background
The last 20 years have seen many attempts to improve transition to adult healthcare for adolescents with chronic disease, but there is currently no established consensus on generic practices. Our goal was to identify relevant and pragmatic guidelines for transition practice for each step of this process (before, during and after transfer), applicable to a wide range of chronic illnesses and health services, via a participatory approach involving all the key stakeholders.
Methods
We conducted interviews and a literature review to elaborate a questionnaire for use in an online 2-round Delphi survey. The survey panel included 36 French health and social professionals from different care settings, and young adults and parents with an experience of healthcare transition related to all types of chronic disease.
Results
The survey consensus identified 19 items on feasibility and relevance criteria, which form the guidelines. It is composed of five practices to be adopted during preparation in paediatrics, seven practices in the active phase of transition and seven in adult care. Two guidelines achieved complete consensus: having a longer consultation for the first appointment with the adult doctor, and keeping the same adult doctor throughout follow-up. A further 36 items met the criterion of relevance, but were deemed unfeasible.
Conclusions
Taking into account all stakeholder views and the real-world applicability of care practices enabled us to elaborate consensual guidelines whose implementation requires no additional health service resources.

Posted on 5 December 2018 | 6:00 pm

Education and mortality in three Eastern European populations: findings from the PrivMort retrospective cohort study

Abstract
Background
The aim of the study is 2-fold. Firstly, it attempts to investigate the potential impact of major political and economic changes on inequalities in all-cause mortality among men and women with different levels of education in three Eastern European countries. Secondly, to identify changes in contribution of smoking and drinking to educational differences in all-cause mortality. Study covers the period from 1982 to 2013.
Methods
Data were collected in 2013–14 as a part of the PrivMort retrospective cohort study. Participants in Russia, Belarus and Hungary provided information on their educational attainment, health-related behaviors and vital statistics of their close relatives (N = 179 691). Odds ratios for mortality and relative indices of inequality (RII) were estimated for individuals aged 20–65 years, stratifying by three levels of educational attainment: higher, secondary and less than secondary education.
Results
Those in lower educational groups were significantly more likely to die, through most time periods and sub-groups. The RII increased over time in all countries and both genders, except for Hungarian men. Alcohol consumption and smoking have increasingly contributed to educational inequalities in mortality during this period.
Conclusion
Educational inequalities in mortality in these Eastern European countries have increased during recent decades. Smoking and alcohol consumption, two major health-related behaviors, made a significant contribution to these increases in inequality.

Posted on 4 December 2018 | 6:00 pm

Determinants of medication adherence among chronic patients from an urban area: a cross-sectional study

Abstract
Background
Medication adherence is a complex area of behaviour. Little is known about what influences chronic patients to take their medicines. This study has aimed to compare and contrast the health-related beliefs, experiences and types of behaviour typical among patients who have at least one chronic condition and are following a pharmacological treatment in accordance with their level of medication adherence.
Methods
A questionnaire-based cross-sectional study, consisting of socio-demographic data, the 4-item Morisky–Green scale and 37 statements about health beliefs, perceptions and experiences, was conducted at different levels of healthcare (primary and tertiary settings).
Results
A total of 577 questionnaires were analyzed. Respondents had a mean age of 64 and took an average of 4.6 drugs. Optimal adherence was reported by 58.6% of respondents. Bivariate analysis showed adherent subjects were older, took more medications, were in better spirits and had greater confidence and information regarding their treatment. Multivariate analysis found older age and the statements ‘My doctor periodically reviews my treatment’ and ‘I am motivated to continue with the treatment’ to be significantly related to medication adherence, while ‘I make variations when taking medication depending on how I feel’ was significant for medication non-adherence.
Conclusion
Medication non-adherence is common among chronic patients. Patient-centred approaches should be implemented in daily clinical practice as patient health beliefs, experiences and conduct influence medication-taking. Motivational interviewing might improve medication adherence in permitting emotional state managing and increasing educational skills, patient motivation and confidence between patients and healthcare providers.

Posted on 4 December 2018 | 6:00 pm

Is there a golden recipe? A scoping review of public health workforce development

Abstract
Background
This study intended to design a suitable and comprehensive approach for a public health workforce development plan with the ultimate goal of meeting the health objectives in different European Region countries.
Methods
We performed a scoping review, including an accurate and exhaustive country-specific hand-search process, mapping the key concepts and practices used in public health workforce development based on the available evidence worldwide.
Results
We identified nine comparative measures, based on common features from a scoping literature review, for the assessment of public health workforce development plans available in selected countries. This list of nine comparative measures includes: (i) Alignment between the 10 Essential Public Health Operations (EPHOs) or core public health functions and organizational resources and public health priority areas; (ii) Regulations and Norms; (iii) Capacity Assessment; (iv) Datasets and Databases; (v) Workforce Development Strategies, Planning and Management; (vi) Education, Training, Core Competencies and Models; (vii) Licensing, Accreditation and Credentialing; (viii) Forecasting Strategies for Enumerating and Quotas and (ix) Ethical and Professional Codes of Conduct. These measures are essential to develop, sustain and modernize the public health workforce effectively.
Conclusion
We propose a well-balanced set of measures for countries aiming to improve or develop their public health workforce based on instruments that are successfully used and applied in a wide range of countries with different public health systems. However, the implementation should be tailored and adopted according to the specific country context and available recourses.

Posted on 29 November 2018 | 6:00 pm

Effect of lifestyle counselling on health-related quality of life in women at high risk for gestational diabetes

Abstract
Background
The incidence of gestational diabetes (GDM) is increasing and interventions to curb the detrimental effects of GDM are needed. We have previously reported that a combined diet and physical activity intervention has the potential to reduce GDM among high-risk women. It is also important to know whether the intervention affects health-related quality of life (HRQoL).
Methods
A total of 378 women at high risk for GDM were randomized into an intervention (lifestyle counselling four times during pregnancy, n=192), or a control group (n=186) before 20 gestational weeks. HRQoL was assessed with the 15D-instrument six times: once during each trimester and at six weeks, six months and 12 months postpartum.
Results
In this study population, the cumulative incidence of GDM was similar in the intervention and the control group (45.7 vs. 44.5%). There was no difference between the 15D scores of the control and intervention groups at any of the time points.
Conclusions
Combined diet and physical activity intervention did not provide HRQoL benefits in the study. A high prevalence of GDM in both study groups may have confounded the effect of the intervention.

Posted on 28 November 2018 | 6:00 pm

Gender differences in common mental disorders: a comparison of social risk factors across four European welfare regimes

Abstract
Background
Decreasing gender differences in mental health are found largely in countries in which the roles of men and women have improved in terms of opportunities for employment, education, child care and other indicators of increasing gender equality. In this study, we examine how European welfare regimes influence this association between mental health and the social roles that men and women occupy.
Methods
The EU-World Mental Health data are used, which covers the general population in 10 European countries (n = 37 289); Countries were grouped into four welfare regions: Liberal regime (Northern Ireland), Bismarckian regime (Belgium, Germany, the Netherlands and France), Southern regime (Spain, Italy, Portugal) and Central-Eastern regime (Romania and Bulgaria). The lifetime prevalence of mood, anxiety and alcohol disorders was determined by using the Composite International Diagnostic Interview 3.0. Overall prevalence rates along with odds ratios by means of bivariate logistic regression models are calculated to compare the presence of common mental disorders in women versus men per welfare regime.
Results
Overall prevalence of common mental disorders is highest in the Liberal regime and lowest in the Central/Eastern regime. The gender gap in mental disorders is largest in the Southern regime and smallest in the Liberal regime. Marital status and certain employment positions help to explain variation in mental disorders across and within welfare regimes.
Conclusion
Most prominent pathways linking gender to mental ill-health being are related to marital status and certain employment positions. However, these pathways also show substantial variation across welfare regimes.

Posted on 27 November 2018 | 6:00 pm

Optimizing decision-making among childcare staff on fever and common infections: cluster randomized controlled trial

Abstract
Background
Children 0–4 years attending childcare are more prone to acquire infections than home-cared children. Childcare illness absenteeism due to fever is mostly driven by fear towards fever in childcare staff and parents. This may cause high childcare absenteeism, healthcare service use, and work absenteeism in parents. This study evaluates a multicomponent intervention targeting determinants of decision-making among childcare staff on illness absenteeism due to fever and common infections.
Methods
The multicomponent intervention was developed based on the Intervention Mapping approach and consisted of (i) an educational session, (ii) a decision tool, (iii) an information booklet and (iv) an online video. The intervention was evaluated in a cluster randomized controlled trial in Southern Netherlands. Nine centres received the intervention and nine provided childcare-as-usual. Primary outcome measure was the percentage of illness absenteeism on cluster level, defined as number of childcare days absent due to illness on total of registered childcare contract days in a 12-week period. Secondary outcome measures included intended behaviour, attitude, risk perception, knowledge and self-efficacy of childcare staff. Outcomes were analyzed using linear mixed models accounting for clustering. Knowledge was descriptively analysed.
Results
Overall illness absenteeism was comparable in intervention (2.95%) and control group (2.52%). Secondary outcomes showed significant improvements in intervention group regarding intended behaviour, two of three attitude dimensions. Knowledge increased compared with control but no differences regarding self-efficacy.
Conclusion
The intervention was not effective in reducing illness absenteeism. However, the intervention improved determinants of decision-making such as intended behaviour, attitude, and knowledge on fever.
Trial registration
NTR6402 (registered on 21 April 2017).

Posted on 26 November 2018 | 6:00 pm

School experiences in relation to emotional and conduct problems in adolescence: a 3-year follow up study

Abstract
Background
Mental health in adolescents has become a major public health issue. This study examined school experiences in relation to mental health (emotional problems and conduct problems) from early to middle adolescence.
Methods
This longitudinal 3-year follow up study used data from the Swedish Study of Health in School Children in Umeå. Analyses were conducted in 1379 participants that were attending grade six in 2003 or 2006 (age 12 years). KIDSCREEN-52 was used to assess school experiences and the Strengths and Difficulties Questionnaire for emotional and conduct problems. Statistical analyses included repeated measures ANOVA and multiple linear regressions.
Results
Positive school experiences decreased while emotional and conduct problem scores increased from grades six to nine. Positive school experiences were negatively associated with emotional and conduct problem scores and contributed to the explanation of mental health scores in middle adolescence after controlling for background factors. When baseline mental health problem scores were taken into account the association with early school experiences disappeared (except for conduct problems in boys). However, incorporating concurrent school experiences in the analysis increased the levels of explanation for emotional and conduct problem scores further.
Conclusions
The results of this study confirm that school experiences are linked to emotional and conduct problems. That link may be stronger for conduct problems. In addition, the association of school experiences in early adolescence with later mental health may be overridden by concurrent school experiences in middle adolescence.

Posted on 26 November 2018 | 6:00 pm

Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories

Abstract
Background
Youth unemployment is a critical life event, which may trigger other labour market-related disadvantages and detrimental health implications. To better understand the processes causing unemployment, we study how socioeconomic circumstances of successive generations and familial and health factors in adolescence predict youth unemployment trajectories between ages 16 and 28 in Finland from 2000 to 2009.
Methods
We used survey data from 1979 to 1997 on 12- to 18-year-old Finns (n = 43 238) linked with 1970–2009 registry-based data of their grandparents, parents and themselves. Growth mixture modelling and multivariate logistic regression analyses were used.
Results
Three latent youth unemployment trajectories emerged; low (46%), decreasing (38%) and high (16%) risk groups. Of adolescent factors, low school achievement was the most important predictor of youth unemployment followed by smoking, stress symptoms and poor self-rated health. Grandparents’ education predicted their grandchildren’s unemployment but the effects of other grandparental socioeconomic circumstances mediated through parents’ socioeconomic status (SES). Parents’ low SES and education, and long-term unemployment increased the risk of the child’s unemployment. Youth unemployment was related to low education at the age of 29.
Conclusion
Grandparents’ education, family socioeconomic circumstances and adolescents’ health and school achievement predict the developmental trajectory of youth unemployment. Youth unemployment is also related to low education in early adulthood. Our findings suggest that the health selection of unemployment works already in adolescence.

Posted on 21 November 2018 | 6:00 pm

Choosing Wisely Italy: online survey on opinions and behaviors of 1006 people and 355 volunteers of healthcare advocacy associations

Abstract
Background
In the framework of ‘Doing more does not mean doing better - Choosing Wisely Italy’ health professionals, general population and healthcare advocacy associations are widely involved. PartecipaSalute-Mario Negri IRCCS and Altronconsumo organized a survey in order to assess the opinions and behaviors of people toward unnecessary tests and drugs.
Methods
An online survey was distributed by Altroconsumo to a voluntary panel of 6304 Italian citizens covering the whole of the country and by PartecipaSalute-Mario Negri IRCCS through the PartecipaSalute website, e-mail lists, website articles, lay journals and Facebook.
Results
In all 1006 people reached by Altroconsumo, and 355 volunteers of healthcare advocacy associations reached by PartecipaSalute responded. Respondents usually decides on their treatment together with the physician, respectively 50% for general population and 64% for volunteers of healthcare advocacy associations. The respondents are aware of the question of over-use of drugs and tests (80%), more often among the volunteers of healthcare advocacy associations (86%). Over-use is considered a problem mostly for economic reasons among the general population, while in the advocacy associations the risks for patients’ health is considered more important.
Conclusion
These findings suggest that patients do not always ask for more, especially if they receive an answer to their questions and clarifications about unnecessary treatments. There is a need for further understanding of the factors influencing decision-making aimed at achieving good care. Engaging the public and patients at all levels of healthcare is essential for a valuable use of health resources.

Posted on 18 November 2018 | 6:00 pm

Poor mothers, unhealthy children: the transmission of health inequalities in the INMA study, Spain

Abstract
Background
The health of pregnant women and their fetuses are especially sensitive to socioeconomic conditions. This study analyzes the impact of maternal socioeconomic status (SES), evaluated by occupation and maternal education level, in preterm births (PTBs) and in small for gestational age (SGA) fetuses, considering the effect of the potential mediating factors on the SES and birth outcomes.
Methods
A total of 2497 mother/newborn dyads from the INMA-Spain project were studied. We examined maternal occupation and education in relation to PTB and SGA along with covariate data, using logistic regression analysis. Adjusted models for each of the outcome variables in relation to SES indicators were estimated, considering potential mediating factors.
Results
About 4.7% of babies were PTB and 9.7% SGA. Full adjusted logistic regression models showed similar odds ratio (OR) for SGA in both SES indicators. Manual working women or without university studies had higher risk of SGA than their counterpart groups (OR = 1.39% CI = 1.03–1.88 and OR = 1.39% CI = 1.00–2.00, respectively). Likewise, mothers with a manual occupation were at more risk of PTB than those with a non-manual occupation (OR = 1.74 95% CI = 1.13–2.74), but there was no association between education and PTB. Smoking, pre-pregnancy BMI and underweight gain during pregnancy were significantly associated to SGA births. The mother’s age, presence of complications and overweight gain during pregnancy were related to PTB.
Conclusion
The mother’s socioeconomic disadvantage was consistently associated with birth outcomes giving rise to intergenerational transmission of health inequalities. Reducing inequalities requires eliminating the upstream causes of poverty itself.

Posted on 18 November 2018 | 6:00 pm

The effect of early-life and adult socioeconomic position on development of lifestyle-related diseases

Abstract
Background
Early-life socioeconomic position (SEP) is associated with lifestyle-related diseases in adulthood. However, evidence is lacking on the extent to which adult SEP mediates this association.
Methods
Time to either chronic obstructive pulmonary disease (COPD), cardiovascular disease or diabetes were assessed in the Danish population born between 1961 and 1971 (n = 793 674) from age 30 until 2015. Early-life position was assessed in 1981 (by parental) and again at age 30 (own) by four markers; income, occupation, education—divided into high, middle, low—and a combined score for all markers. Using a counterfactual approach, we estimated the total effect of early-life position on disease onset and the degree to which adult position mediated this effect.
Results
Results of the time-to-event analysis showed a gradient of all early-life markers on the risk of developing all lifestyle-related diseases. Notably, comparing those in the lowest to the highest educational position, the hazard of COPD was 130% higher for women [hazard ratio = 2.30(95% confidence interval = 2.20–2.41)] and 114% higher for men [2.14 (2.05–2.25)]. About 67%(63–70%) of the effect of educational position was mediated through adult position for COPD, 55% for cardiovascular disease and 50% for diabetes. For the combined score 44, 29 and 33%, respectively, was mediated.
Conclusion
About one-tenth to two-thirds of the effect of early-life position is mediated by the position attained in adulthood. The degree mediated depend on the outcome investigated, gender and the social position marker used indicating that alternative pathways may play a key role in developing effective policies targeting early-life behaviours.

Posted on 13 November 2018 | 6:00 pm

Does probiotic consumption reduce antibiotic utilization for common acute infections? A systematic review and meta-analysis

Abstract
Background
Overall reduction of antibiotic use is a widely adopted public health goal. Given evidence that consuming probiotics reduce the incidence, duration and/or severity of certain types of common acute infections, we hypothesized that probiotics are associated with reduced antibiotic use. This systematic review of randomized controlled trials (RCTs) assessed the impact of probiotic supplementation (any strain, dose or duration), compared to placebo, on antibiotic utilization for common, acute infections in otherwise healthy people of all ages.
Methods
We searched 13 electronic databases including MEDLINE, Embase and CENTRAL from inception to 17th January 2017. Backward and forward citation searches were also conducted. Two reviewers independently selected studies for inclusion and extracted study data. We assessed risk of bias for individual studies using criteria adapted from the Centre for Reviews and Dissemination, and the quality of evidence for each outcome was assessed using the GRADE system. Studies that evaluated similar outcomes were pooled statistically in meta-analyses using a random-effects model.
Results
We screened 1533 citations, and of these, 17 RCTs met our predefined inclusion criteria. All 17 were conducted in infants and/or children with a primary aim of preventing acute respiratory tract infections, acute lower digestive tract infections or acute otitis media. Included studies used 13 probiotic formulations, all comprising single or combination Lactobacillus and Bifidobacterium delivered in a range of food or supplement products. Mean duration of probiotic supplementation ranged from 4 days to 9 months. Trial quality was variable. Meta-analysis demonstrated that infants and children who received probiotics to prevent acute illnesses had a lower risk of being prescribed antibiotics, relative to those who received placebo (Pooled Relative Risk = 0.71, 95% CI: 0.54–0.94). When restricted to five studies with a low risk of bias, the pooled relative risk was 0.46 (95% CI: 0.23–0.97). Significant statistical heterogeneity was present in effect size estimates, which appeared to be due to one trial which could partly be considered as an outlier.
Conclusions
Probiotics, provided to reduce the risk for common acute infections, may be associated with reduced antibiotic use in infants and children. Additional well-designed studies are needed to substantiate these findings in children and explore similar findings in other population groups.

Posted on 13 November 2018 | 6:00 pm

Work-disability in low back pain patients with or without surgery, and the role of social insurance regulation changes in Sweden

Abstract
Background
The aims were to study the differences in work-disability in patients with low back pain (LBP) in relation to (i) treatment provided (non-surgical or lumber spine surgery (decompression or fusion), and (ii) two time points, i.e. before and after the social insurance regulation changes in the in 2008.
Methods
All non-pensioned individuals, aged 19–60 years, living in Sweden, diagnosed with LBP in 2004–06 or 2008–10 were included (n = 153739). Hazard ratios (HRs) with 95% confidence intervals for long-term sickness absence (>90 days, LTSA) and disability pension (DP) for LBP-patients (non-surgical, decompression, fusion, both surgeries) were estimated by Cox regression compared with the matched references from the general population without LBP (n = 566008).
Results
LBP-patients had a higher risk of subsequent work-disability compared with the references before and after insurance regulation changes. LBP-patients receiving decompression surgery had similar risk for later work-disability as those treated non-surgically. However, following regulation changes, LBP-patients undergoing fusion surgery had higher risk estimates of both LTSA (HR: 3.3) and DP (HR: 4.8) than patients treated non-surgically (HR: LTSA 2.1; DP 2.5) or with decompression (HR: LTSA 2.6; DP 2.1). In the adjusted models, risk estimates mainly attenuated after controlling for previous sickness absence.
Conclusion
Risk for subsequent work-disability among LBP-patients was higher compared with people without LBP and lumbar spine surgery. Discrepancies in risk were explained by the treatment provided previous sickness absence and changes in the social insurance regulations, specifically LBP-patients treated with fusion surgery had an increased risk of subsequent work-disability after changes in regulations.

Posted on 13 November 2018 | 6:00 pm

Stronger responders—uptake and decline of HPV-vaccination in Denmark

Abstract
Background
The purpose of this study was to identify the stronger responders behind the fluctuating coverage with the HPV-vaccine in Denmark in order to facilitate information campaigns targeted at specific subgroups.
Methods
Newspaper articles published from 2006 to 2009 with information about coverage with the HPV-vaccine in Denmark were identified from the database Infomedia.dk. Vaccination coverage of recent years was retrieved from the publically accessible statistics from the State’s Serum Institute. Data on average disposable income nationally and for each municipality was retrieved from Statistics Denmark.
Results
According to numbers published in newspapers, girls residing in municipalities with a high disposable income were the first ones to secure the HPV-vaccine in Denmark. Years later, at the start of the debate about possible side effects of the HPV-vaccine, the decline in vaccination coverage was slightly steeper for girls from high income municipalities than for girls from low income municipalities.
Conclusions
Girls from municipalities with a high disposable income seem to be the stronger responders of the fluctuating coverage with the HPV-vaccine in Denmark. This was the case both during the initial surge in coverage after the vaccine’s introduction on the market, and during the later decline following the debate on possible side effects. Identification of this dispersion pattern enables health authorities to initiate targeted information campaigns.

Posted on 7 November 2018 | 6:00 pm

The cross-national measurement invariance of the health literacy for school-aged children (HLSAC) instrument

Abstract
Background
Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries.
Methods
The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance.
Results
Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups.
Conclusions
HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents.

Posted on 7 November 2018 | 6:00 pm

The MIPEX Health strand: a longitudinal, mixed-methods survey of policies on migrant health in 38 countries

Abstract
Background
Within health systems, equity between migrants and native-born citizens is still a long way from being achieved. Benchmarking the equitability of policies on migrant health is essential for monitoring progress and identifying positive and negative aspects of national policies. For this purpose, the 2015 round of the Migrant Integration Policy Index (MIPEX) was expanded to include a strand on health, in a collaborative project carried out between 2013 and 2017 in 38 countries.
Methods
Indicators of policies to promote equity were derived from the 2011 Recommendations of the Council of Europe on ‘mobility, migration and access to health care’ and used to construct a questionnaire compatible with MIPEX methodology. This yielded scores for Entitlement, Accessibility, Responsiveness and Measures to achieve change.
Results
As a measuring instrument, the questionnaire has a high degree of internal consistency, while exploratory factor analysis showed a coherent relationship between its statistical structure and the four scales it comprises. Measures to achieve change were strongly associated with Responsiveness, but not at all with Entitlements and only slightly with Accessibility. Examining the results from the sub-sample of 34 ‘European’ countries, wide variations in the equitability of policies were found: these were mainly associated with a country’s wealth (GDP), but differences between EU13 and EU15 countries were too extreme to explain completely in such terms.
Conclusions
The MIPEX Health strand is a robust measurement tool that has already yielded a number of important results and is providing a valuable resource for both researchers and policy-makers.

Posted on 5 November 2018 | 6:00 pm

Migration-related changes in smoking among non-Western immigrants in France

Abstract
Background
Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey.
Methods
Analyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models.
Results
Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more).
Conclusion
The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.

Posted on 4 November 2018 | 6:00 pm

Socioeconomic and health-related childhood and adolescence predictors of entry into paid employment

Abstract
Background
Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations.
Methods
The Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28–29 (low/high).
Results
After adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome.
Conclusions
Socioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.

Posted on 21 October 2018 | 7:00 pm

Tuberculosis knowledge, attitudes and practices: a cross-sectional study in the Somali population living in Finland

Abstract
Background
In Finland, the epidemiology of tuberculosis is changing: incidence declined from 13/100 000 in 1995 to 4 in 2016 and the proportion of foreign-borns among all TB cases increased from 5% to 50%. The most common country of origin among foreign-born TB patients was Somalia. Knowledge, attitudes and practices (KAP) studies are used to collect information for planning and tailoring health care services. KAP studies in Finland have been used for other diseases but not to study Somalis in regards to TB.
Methods
The KAP were assessed by a piloted questionnaire. Convenience sampling was performed, and the questionnaire was administered in mosques, shops and Islamic events. Knowledge and attitudes were assessed by creating composite scores. Associations between sociodemographic characteristics and knowledge and attitudes were investigated using logistic regression to compute odds ratios (OR) and 95% confidence intervals (CI).
Results
A total of 407 participants took part; 49% were male. Low level of knowledge was held by 53% of participants, and favourable attitude regarding TB by 63%. Knowledge was not associated with gender or country of birth. Female participants were twice more likely to have a favourable attitude than males (adjusted OR, 2.37; 95%CI, 1.40–4.01). Those with high knowledge are twice more likely to have a favourable attitude towards TB (adjusted OR, 2.21; 95%CI, 1.32–3.69).
Conclusions
The population held a favourable attitude towards TB, but knowledge gaps and misconceptions regarding TB were found. The results of this study can be used for designing health communication and targeted preventive measures for the Somali population.

Posted on 14 October 2018 | 7:00 pm

Reducing consequences of child maltreatment during adulthood by public health actions: a Delphi study

Abstract
Background
Child maltreatment (CM) is associated with long-lasting poor health outcomes, as well as increased levels of disability and health-services consumption across the life-span. However, less is known about how CM consequences can be reduced during adulthood. We investigated professional opinions on how to mitigate long-term consequences of CM in a public health (PH) perspective.
Methods
Using the Delphi method in three rounds, we inquired 91 professionals, mostly European researchers and clinicians about potential PH actions to mitigate CM consequences during adulthood.
Results
Most experts agreed that PH actions are needed. Increasing community awareness and training emotional regulation in affected adults were prioritized strategies. Enlarging curricular knowledge about CM for professionals and developing evidence-based interventions were considered preferred methods. Reducing the barriers for access to interventions for adults, such as those provided by trauma-informed services were also suggested. Participants highlighted the possibility to reduce CM consequences across generations as a significant benefit.
Conclusions
PH programmes to reduce the burden of CM can be enhanced by specific actions to facilitate the recognition of difficulties in affected adults and to expand the availability of helpful resources. The application of these programmes could be assisted by the use of modern information-technology.

Posted on 10 October 2018 | 7:00 pm

A microsimulation model projecting the health care costs for resistance to antibacterial drugs in Sweden

Abstract
Background
Previous studies have shown that increasing antibacterial resistance (ABR) globally will cause extensive morbidity, deaths and escalated health care costs.
Methods
To project economic consequences of resistance to antibacterial drugs for the Swedish health care sector, we used an individual-based microsimulation model, SESIM. Health care consumption was represented as increased numbers of hospital days, outpatient visits and contact tracing for individuals getting clinical infections or becoming asymptomatic carriers. The risk of contracting a resistant bacterium was calculated using the incidence of mandatorily notifiable ABR in Sweden.
Results
We estimate accumulated additional health care costs attributable to notifiable ABR from 2018 until 2030 to EUR 406 million and EUR 1, 503 million until 2050. Until 2030 the largest proportion, more than EUR 247 million (EUR 958 million until 2050), was due to ESBL, followed by methicillin resistant Staphylococcus aureus, carbapenemase-producing Enterobacteriaceae, vancomycin-resistant Enterococci and penicillin non-susceptible Pneumococci which incurred costs of EUR 128 million (EUR 453 million, 2050), EUR 15 million (EUR 58 million, 2050), EUR 13 million (EUR 28 million, 2050) and EUR 2 million (EUR 6 million, 2050), respectively.
Conclusions
Projections concerning the future costs of ABR can be used to guide priorities and distribution of limited health care resources. Our estimates imply that costs in Sweden will have doubled by 2030 and increased more than 4-fold by 2050 if present trends continue and infection control practices remain unchanged. Still, indirect societal costs and costs for non-notifiable resistance remain to be added.

Posted on 8 October 2018 | 7:00 pm

Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden: a 20-year follow-up

Abstract
Background
Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered.
Methods
Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession.
Results
After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation.
Conclusions
Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years.

Posted on 26 September 2018 | 7:00 pm

Impact of improved urban environment and coaching on physical condition and quality of life in elderly women: a controlled study

Abstract
Background
Physical activity can slow the ageing process and preserve autonomy in the elderly. The aim of this study was to assess the combined impact of an organized urban walking circuit and individual coaching on women senior citizens’ physical well-being and quality of life.
Methods
Insufficiently physically active women >65 years were included in a quasi-experimental trial. Active arm: District with improved urban environment (IUE). Control arm: District without improved urban environment (WIUE). In each district, subjects were randomly allocated to receive coaching (C+ vs. C−). The main outcome measures were endurance, physical activity score, flexibility, quality of life, physical self-esteem, ageing exercise stereotypes, functional health and perceived health at baseline, three (M3) and six (M6) months.
Results
Fifty-two insufficiently physically active women were included, 23 in IUE and 29 in WIUE. Groups were comparable at baseline. At M3, endurance and physical activity score significantly improved compared with baseline in the IUE group and in the C+ group while no statistically significant change was observed for the WIUE group and the C− group. Moreover, endurance score was higher in the IUE group, whether coupled with coaching or not. After the coaching was removed, the IUE group regresses to baseline overall and the WIUE shows a decrement in endurance.
Conclusion
Our study highlights the positive impact of an improved environment and of individual coaching on the level of physical activity and quality of life of insufficiently physically active elderly women.

Posted on 16 September 2018 | 7:00 pm

Mortality after the death of a parent in adulthood: a register-based comparison of two ethno-linguistic groups

Abstract
Background
Most research on parental bereavement and health have analysed health consequences of parental loss in childhood, while collateral health in adulthood has been less studied.
Methods
Using register-based population data from Finland, we analyse adult offspring aged 18–50 years with discrete-time hazard models that adjust for offspring and parental socioeconomic and demographic characteristics. In focus are adult children whose parents were alive and lived together at the beginning of the observation period. We compare two culturally distinct but otherwise similar ethno-linguistic groups, Finnish speakers and Swedish speakers.
Results
The results suggest that bereaved men have an approximately 30% higher death risk than non-bereaved men, while there is practically no difference in women. Associations between parental and child deaths are, as expected, stronger for concordant causes of death than for discordant causes of death. However, some associations for discordant causes of death remain, which may indicate causality. Among Swedish speakers, who have notably higher family stability than Finnish speakers, the death of one or both parents shows a stronger association with own mortality.
Conclusions
The estimated associations found are generally larger than in the neighbouring country Sweden, which may be due to a stronger obedience to traditional family values and patriarchal family roles in Finland. These findings suggest that the association between parental death and mortality in adult offspring may depend on the societal context as well as on cultural practices. These factors should be increasingly acknowledged in future studies on collateral health.

Posted on 9 September 2018 | 7:00 pm

The association between social exclusion or inclusion and health in EU and OECD countries: a systematic review

Abstract
Background
Social exclusion (SE), or the inability to participate fully in society, is considered one of the driving forces of health inequalities. Systematic evidence on this subject is pertinent but scarce. This review aims to systematically summarise peer reviewed studies examining the association between the multidimensional concepts of SE and social inclusion (SI) and health among adults in EU and OECD countries.
Methods
The protocol was registered on Prospero (CRD42017052718). Three major medical databases were searched to identify studies published before January 2018, supplemented by reference and citation tracking. Articles were included if they investigated SE or SI as a multidimensional concept with at least two out of the four dimensions of SE/SI, i.e. economic, social, political and cultural. A qualitative synthesis was conducted.
Results
Twenty-two observational studies were included. In the general population, high SE/low SI was associated with adverse mental and general health. For physical health, the evidence was inconclusive. In groups at high risk of SE, support was found for the association between high SE/low SI and adverse mental health but no conclusions could be drawn for physical and general health.
Conclusions
This review found evidence for the association between high SE/low SI and adverse health outcomes, particularly mental health outcomes. The evidence is mainly based on cross-sectional studies using simple and often ad hoc indicators of SE/SI. The development and use of validated measures of SE/SI and more longitudinal research is needed to further substantiate the evidence base and gain better understanding of the causal pathways.

Posted on 5 August 2018 | 7:00 pm

Debt and mental health: new insights about the relationship and the importance of the measure of mental health

Abstract
Background
Empirical research suggests that household debt and payment difficulties are detrimental to mental health. Despite well-known measurement problems that may contaminate analyses using subjective self-reported health measures, our knowledge is very limited concerning the effect of payment difficulties on ‘objective’ measures of mental health. Moreover, few studies use longitudinal data to examine the relationship. This study combines rich survey data and longitudinal data from administrative registers on a representative sample of the Swedish population to examine the relationship between payment difficulties and subjective and objective measures of mental health.
Methods
We use data from a large survey of Swedish inhabitants (The Swedish Living Conditions Surveys) combined with data from administrative registers. We investigate both directions of the relationship between mental ill health and payment difficulties, controlling for previous mental health status and previous experiences of payment difficulties. We compare the association between payment difficulties and a self-reported measure of anxiety with the associations between payment difficulties and objective measures of mental ill health from a register of psychopharmaceutical drug consumption.
Results
Payment difficulties associate with subjectively reported mental ill health, but less to psychopharmaca use. For objective measures, we find stronger evidence of a link running from mental ill health to later payment difficulties.
Conclusions
Self-reported and objective measures of mental problems may convey different messages regarding the impact of payment difficulties on mental health. Policy measures depend on whether the primary target group is individuals with severe mental problems or individuals with mild anxiety.

Posted on 2 February 2018 | 6:00 pm