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YOUNG RESEARCHERS' FORUM_ AMSTERDAM 2010 INSTRUCTIONS FOR THE

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									YOUNG RESEARCHERS’ FORUM, AMSTERDAM 2010
          INSTRUCTIONS FOR THE JUDGEMENT OF THE ABSTRACTS

You are kindly requested to judge these abstracts on a five-point scale (1 insufficient to 5
excellent). I will process these ratings (and compute average and standard deviation) based on
which the decision about acceptance or rejection will be taken. Only 8-9 top-scored abstracts
will be accepted for the oral presentations. The remaining abstracts that will score higher than
2.5 will be offered an opportunity of the poster presentation.

Please be so kind to send your scoring no later than Monday, 20 September by 18:00 CET.

The abstracts should be judged taking into account the following five questions:
   1. Is the design of the study appropriate?
   2. Have the data been collected and processed?
   3. Are there (preliminary) results?
   4. Does the study provide new insights in the field of the study/is it innovative?
   5. Is it an internationally relevant study?

If you have any questions, please do not hesitate to contact me (robert.otok@aspher.org).

Best regards,
Robert Otok
1
    Evaluating the outcomes and the impact of drug prevention programmes
    General purpose:
    To evaluate the impact of drug prevention programs amongst young people aged 12 years and above on
    substance use.

    Specific purposes:
    1. To evaluate different paradigms, theories and methodologies underpinning drug prevention
         programmes
    2. To identify which drug prevention activities are effective at altering initiation and level of substance
         use
    3. To identify, for specific target-groups, which components of drug prevention programmes are most
         effective;
    4. To examine any iatrogenic effects associated with drug prevention activities
    5. To identify contextual variables related with programs’ level of efficacy
    6. To assess the level of influence that proximal, distal and ultimal variables have on programs’
         outcomes for participants
    7. To identify early risk factors for substance use

    Study object:
    20 drug prevention programs representative of paradigms, theories and strategies underpinning drug
    prevention programmes, having as specific purpose preventing drug (ab)use in nearly 4000 cases.

    Methodology:
    We will use combined quantitative and qualitative research methodologies, within five data collection
    episodes (pre-test, intermediate assessment, post-test, follow-up at 6 months and follow-up at 12
    months).

    Type of assessment:
    1. Process Evaluation: assessment of fidelity of implementation and level of exposure to programs’
        activities;
    2. Outcomes Evaluation: collecting pre, intermediate and post-test data, through a self-report
        questionnaire;
    3. Impact Evaluation: collecting follow-up data six and twelve months after programs’ implementation
        ending, both through a self-report questionnaire and qualitative research methodologies;
    4. Comparison Groups: programs will be compared with each others, acting as comparison groups;
    5. Control Groups: a control groups for each program under evaluation will be settled.

    Instruments:
    The main data collection instrument is a questionnaire, developed specifically for this research, which
    will give us information on variables such as perception of risk, attitudes and expected costs and benefits
    of substance use, perceived access to drugs, peers prevalence estimates of substance use, beliefs that
    important others encourage use, substance use experience, intention to use, quality of life, etc.

    Expected outcomes:
    Through this research we expect to contribute to:
    1. Increase the understanding of the efficacy and iatrogenic outcomes
    2. Identify specific target-groups more permeable to efficacy effects and more vulnerable to iatrogenia
    3. Identify which programmes’ components are more effective for specific target-groups
    4. Increasing the quality of drug prevention programmes
    5. Identify and disseminate good practice
    6. Make future prevention programmes more efficacious in reducing the incidence and the prevalence
        of drug use


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2
    Pharmacovigilance of Antiretroviral drugs in resource-limited settings:
    A systematic review of the toxicity and adverse events linked to the use
    of tenofovir (TDF) in treatment naïve HIV infected patients.
    Background:
    As a result of the scale-up of antiretroviral therapy (ART) programmes, the availability of ART in
    resource-limited settings has increased in recent years. Antiretroviral therapy is known to decrease
    morbidity and mortality in HIV-infected patients but is associated with significant toxicity and adverse
    events. Safety profiles of antiretrovirals from developed countries can not necessarily be generalized to
    resource-limited settings. There is an increasing concern for pharmacovigilance research in these
    settings. Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor, which was
    recommended by the updated HIV treatment guidelines of the WHO in 2006 to be included in the first line
    regimens in resource-limited settings. In developed world, tenofovir use has been associated with kidney
    abnormalities and bone toxicity effects. The toxicity profile of TDF in resource-limited settings needs to
    be assessed.

    Objectives:
    The main purpose of this study is to create a systematic map of empirical research that has been
    undertaken to evaluate the toxicity profile of tenofovir in resource-limited settings. Secondary objective is
    to perform a systematic in-depth review of the best evidence from studies that have investigated the
    toxicity effects of tenofovir in these settings using the Grades of Recommendation Assessment,
    Development and Evaluation (GRADE evidence profiles).

    Methods:
    Systematic review of the current evidence base was performed. This involved exploration of electronic
    databases using a tailored search strategy to find the relevant studies. Risk of bias was assessed for each
    of the included studies. This was followed by a Meta- analysis of the data. The GRADE evidence profile
    was presented in order to assess the quality of evidence for toxicity linked to TDF use.

    Findings and conclusion:
    The findings of GRADE evidence profile suggest that there is insufficient evidence to identify renal and
    bone toxicity effects associated with the use of tenofovir in treatment naïve HIV infected patients in
    resource-limited settings. Further research undertaken for longer durations is very likely to have an
    important impact on the confidence in the estimate of these renal and bone toxicity effects and may
    change the estimate.




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3
    Women experiencing spousal abuse are at risk of delivering low birth
    weight babies: A case control study from Pakistan
    Abuse by an intimate partner is the most common form of violence against women. More recently, a
    significant attention is being paid to the intricacies of the relationship between pregnancy and abuse.
    Abuse during pregnancy can result not only in obstetric complications; but can also have serious
    implications for the health and the well being of the fetus or infant.

    This study sought to assess the risk of low birth weight from spousal abuse during pregnancy in Karachi,
    Pakistan. We performed a case control study comprising 400 women who delivered low birth weight (<
    2500 g) babies (cases) and 400 women with normal birth weight babies (control group). Data collection
    for the study was undertaken in the obstetric wards of secondary and tertiary care hospitals of Karachi
    from July 2007 to February 2008. Abuse was determined by WHO Domestic Violence Module. Data were
    analyzed using appropriate descriptive analysis and multiple logistic regression analysis methods.

    Overall, less than one fourth of the women (23.9% cases, 22.1% controls) reported life time prevalence of
    physical abuse. The prevalence of physical abuse during index pregnancy was nearly 10.6 and 7.8 percent
    in cases and controls respectively. Relatively more cases experienced emotional abuse as compared to
    controls (Cases 33.6%, Controls 27.0%). Approximately 24.2 percent of cases, while 21.4 percent of the
    controls reported one or more act of emotional abuse in the index pregnancy. The final multiple logistic
    regression model included history of ever emotionally abused (OR: 1.462; 95% C.I 1.056-2.023), weight of
    the mother (OR: 0.970; 95% C.I 0.955-0.985), history of preeclampsia (O.R: 1.791; 95%C.I 1.187-2.702),
    mode of delivery (O.R: 1.508; 95% C.I 1.114-2.04) and age of the women (O.R: 0.964; 95% C.I 0.934-
    0.995) as associated factors for low birth weight.

     Abuse is more common during pregnancy than some well known conditions such as gestational diabetes
    and pregnancy induced hypertension for which women are routinely screened and evaluated. It has
    important consequences on the physical, mental and social status of the women during pregnancy. We
    recommend including abuse as an integral part of the standardized screening for risk factors of adverse
    pregnancy outcome. Moreover we need to improve the nutritional status of the women and efficiently
    identify obstetric complications such as placenta previa and a genuine need of cesarean section in order
    to reduce the burden of low birth weight. We also need to take social measures to increase the age of
    marriage and the age of first pregnancy in order to reduce the burden of low birth weight and
    consequently neonatal mortality.




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4
    Modeling the health workforce requirements at the national level (Serbia)
    Introduction:
    Health workers are important resource for health system performance improvement.

    Objectives:
    To plan the health workforce requirements by application of basic workforce planning models (the Health
    Workers Supply; Health Service Demand; Health Needs-Based; Benchmarking; and the WHO Workforce
    Planning Models), and to develop specific long-term health workforce planning model for the public
    sector of Serbian health system by 2017.

    Methods:
    With the cross-sectional analysis health workers density, distribution and performance (in 2007) were
    described and the baseline for long-term health workforce modeling was set. The previous health
    workforce planning efforts were reviewed with trend analysis of health workers (density per 100.000
    population, 1961-2007) and of contextual factors in the period of 1997-2007 (demographic [population
    growth, sex and age structure], epidemiological [mortality rates], political [students` enrolment and
    graduation], social [workers` deployment and unemployment], and economical [health expenditures and
    salaries]). Accordingly, the six workforce planning models were developed. Macroeconomic feasibility of
    projected numbers of health workers were tested (in the baseline, optimistic and pessimistic scenarios).
    Physicians, (with and without specialist degree, and at specialist studies), nurses and midwives (all
    educational levels), dentists and pharmacists employed in the public health care sector were investigated
    by age, sex and workplace. Data derived from the Institute of Public Health of Serbia registrars, the
    Republic Statistical Office and the National Employment Biro databases, and documentation of the
    Ministry of Health, Ministry of Finance and Ministry of Education. Beside description (numbers, %, mean,
    standard deviation, 95% confidence interval, Box-Ljung statistics and MaxAE), with statistical significance
    at p<0,05 applied were Student t-test of related samples, Kolmogorov-Smirnov test, time-series models
    (two-parameter, Joinpoint analysis, ARIMA, and Transfer Function models). The WHO/Keel HRH software
    1.-2006, Joinpoint Regression Program 3.4, and PASW Statistics 18 were used.

    Results:
    The health workers density rates are rising. Most workers were females and with lifetime and full-time
    job contracts. The university level staff was old. Health workers (1995-2007) were dieing before age of
    60. The annual productivity was low and varied across health services and districts. By 2017, the Health
    Services Demand Model (assuming increased utilization or productivity) projected lower health workers
    density rates, while higher rates were projected by: Supply, Needs-Based, Benchmarking and the specific
    model for Serbia. Five of six health workers’ planning models were feasible in three predefined
    macroeconomic scenarios.

    Conclusion:
    Combinations of health workers’ planning models and economic feasibility tests provided decision
    makers with relevant information for health workers’ development.




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5
    Social Networks and Mental Health: Evidence from SHARE

    The relationship between social support and wellbeing is an area of continued focus for the social
    sciences, and has been well-documented, both theoretically and empirically. Using data from a large scale
    international survey, this study examines the causal effect of social support network type on mental
    health in the context of the two competing models identified in the psychology literature. The main effects
    hypothesis predicts that individuals with strong social support experience higher levels of wellbeing than
    those with weak social support, while according to the stress-buffering hypothesis, it is only upon
    exposure to unexpected negative life events that individuals with weaker levels of social support are
    adversely affected. The dataset used comprises over 60,000 observations from adults aged 50 and over
    from two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE 2004 & 2006). Cluster
    analysis was used to identify four social support network types based on objective criteria such as
    proximity of family members, exchanges of informal support, and social engagement. In line with
    previous studies, the existence of four distinct networks was established: self-contained; spouse-reliant;
    family-dependent; and family and community integrated. We profile these networks and establish that
    they differ in terms of a number of socio demographic indicators, including age, education, and place of
    residence. Network variation across countries is also evident, for example Sweden, Denmark, Belgium
    and the Netherlands have the highest proportion of those in the family and community integrated
    network, while Spain has by far the lowest. Using the EURO-D scale of depressive mood as a measure of
    wellbeing, we find similar cross country differences in depression. The rich nature of the survey allows us
    to control for a wide variety of personal characteristics, and standard panel data techniques allow us to
    determine whether omitted variables such as personality are driving the observed relationship between
    social support and wellbeing. Across all approaches we find a robust result that being in a social network
    characterised by low levels of support and social engagement is associated with higher levels of
    depressive mood (the main effects hypothesis), but only for women. The magnitude of this effect is
    comparable to being widowed, and appears to be mediated through feelings of loneliness. We find no
    evidence that being in such a network exacerbates the distress associated with traumatic, negative life
    events (the buffer hypothesis).




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6
    Comparing paediatric hospital admission rates between emergency
    departments in England - A descriptive analysis using Hospital Episode
    Statistics data.
    Aim:
    To investigate whether children living near paediatric emergency departments have lower paediatric
    admission rates than children living near general emergency departments.

    Design:
    (i) Descriptive analysis of paediatric admissions using routine hospital episode statistics data (HES data).
    (ii) Spatial analysis of paediatric and general emergency departments and census output areas using
    Geographical Information Systems (GIS).

    Subjects:
    All paediatric emergency admissions of 0-14 year olds in the financial years 2001/02 – 2005/06 in all
    hospitals in England.

    Hypothesis:
    Null (H0): there is no difference in paediatric admission rates between children living near paediatric
    emergency departments and children living near general emergency departments.
    (H1): children living near paediatric emergency departments are less likely to be admitted than
    populations of children living near general emergency departments.

    Main outcome measures:
    Relative risks (RRs) of admission with adjustment for age, sex, deprivation and year of admission, both
    overall and for specific disease categories: asthma, respiratory diseases, gastroenteritis, other infections,
    signs and symptoms, injuries and other admissions.

    Results:
    There were 3,156,479 admissions over the five-year period. Children living near paediatric emergency
    departments have a lower risk of admission (relative risk 0.77, 95% CI 0.76 to 0.77) compared with
    children living nearby general emergency departments.

    The highest admission rates came from the most deprived areas (Carstairs 5) and the lowest from the
    least deprived (Carstairs 1). Boys had higher admission rates than girls for all diagnoses and the under-
    1s had the highest admission rates followed by the 10-14 year olds.

    Conclusions:
    Paediatric emergency departments may have a significant impact in reducing childhood admissions.




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7
    Tobacco use and exposure to tobacco promoting and restraining factors
    among adolescents in Ghana

    Background:
    With a long history of tobacco cultivation and manufacturing in Ghana, Ghanaian adolescents stand at a
    relatively higher risk of the emerging tobacco epidemic in developing countries but information on their
    tobacco use is scanty. We explored the association of the social environment and individual tobacco
    promoting and restraining factors on smoking and smokeless tobacco (tawa) use.

    Method:
    We used school-based data from Ghana Adolescents’ Health Behaviour and Lifestyle Survey (GAHBLS)
    conducted in 2008 (N=1,165, response rate =89.7%). Logistic regression models were used to study
    factors predicting tobacco use.

    Results:
    Boys were more likely to use tobacco than girls. Overall tobacco use was 9% (6.1% smoked, 5.4% used
    tawa). More than half (53%) of adolescents who tried purchasing tobacco products were not refused
    because of their age. Only 4% attended schools where smoking on the campus was allowed and 21.8%
    were not taught in school the harmful effects of smoking to health. Parental smoking was associated with
    tobacco use (OR=7.7; 95% CI: 3.0-20.1). In multivariate analysis, following factors were significantly
    associated with tobacco use: attending a school where smoking on campus was allowed; not having been
    taught in school the harmful effects of smoking; exposure to at least one kind of tobacco advertisement;
    perception that smoking is harmful to health (OR=4.5; 95% CI: 2.2-8.9); perception that smoking is
    difficult to quit (OR=4.0; 95% CI: 2.2-7.4); and perception that tobacco products should be sold to minors.

    Conclusion:
    Tobacco control measures such as a ban on advertisement and education of both adolescents and parents
    on the hazards of tobacco use are needed to create positive and supportive social, familial and individual
    environments in order to reduce tobacco use or maintain the relatively low prevalence among Ghanaian
    adolescents.

    Key words:
    Adolescents, Ghana, tobacco use, tobacco control measures, social environment, individual factors




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8
    Does multiple sites musculoskeletal pain predicts poor work ability?
    A 4-years follow-up study among food factory workers

    Background:
    Musculoskeletal pain is the most common work-related health problem among working population. Food
    factory workers have even higher prevalence of multiple site musculoskeletal pain in Finland because of
    its nature of work which is relatively high physical demanding and poor environmental exposures and
    poor ergonomic condition. Musculoskeletal pain in multiple-sites may be associated with increased pain,
    reduce work ability and sickness absenteeism. The aim of this study is to evaluate the relationship of
    multiple sites pain and future work ability after 4 years of follow-up.

    Methods:
    The study was conducted in 2005 and 2009. A total of 615 workers (64.6% female) participated in the
    study. A survey in the company in 2005 yielded, with a response rate 78% and the corresponding figures
    was 90% in follow-up year. The mean age of the workers was 41 years (SD=9.5) ranging from 20 to 62
    years in the beginning of the follow-up. The data were obtained through a structural questionnaire
    distributed to the employees at the workplace.

    Results:
    The over all prevalence of poor work ability in follow-up year was 22.4%. The proportion of poor work
    ability was increased significantly from 11.0% to 36.4% which corresponded to an increase in the
    number of pain sites from no pain to 4 sites pain. Age modified the effect of pain on work ability. In the
    middle age-group (41-50 years), four sites pain increased poor work ability. In the oldest age-group
    (51+), prevalence of no pain and four sites pain was high. However, the number of pain sites increased
    the likelihood of poor work ability among older age-group and especially among (41-50 years) age-group.

    Conclusions:
    The results of this study conclude that musculoskeletal pain at its multiple sites in the baseline predicts
    poor work ability in four years of follow-up. It can also be concluded that the occurrence of multiple sites
    pain has large extent of effects to work life especially among older workers. It might have considerable
    implication in future work force, probably in clinical medicine and social insurance too.

    Key words:
    Musculoskeletal disorder, multiple sites pain, work ability, food industry, follow-up




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9
    Exposure to iron and welding fumes and the risk of lung cancer
    Objectives:
    Exposure to iron fumes and dust and welding fumes is widespread and may increase the risk of lung
    cancer. The aim of this study was to identify associations between exposure to iron and welding fumes
    and the incidence of lung cancer among Finnish men.

    Methods:
    The cohort of all economically active Finnish men, born in 1906–1945, who participated in the national
    census in 1970 was followed through the Finnish Cancer Registry for lung cancer cases (N=30 137)
    during 1971–1995. Their census occupations in 1970 were converted to estimates of cumulative
    exposure to iron and welding fumes with the Finnish job-exposure matrix on the basis of likelihood,
    average level, and estimated duration of exposure. Relative risk estimates for categorized cumulative
    exposure were defined by a Poisson regression, adjusted for smoking, socioeconomic status, and
    exposure to asbestos and silica dust.

    Results:
    The relative risks for lung cancer increased as the cumulative exposure to iron and welding fumes
    increased. The relative risks in the highest exposure category was 1.35 [95% confidence interval (95%
    CI) 1.05–1.73] for iron and 1.15 (95% CI 0.90–1.46) for welding fumes. The respective relative risks
    estimated for squamous-cell carcinoma of the lungs were 1.94 (95% CI 1.35–2.78) and 1.55 (95% CI
    1.08–2.24). There was no excess risk of small-cell carcinoma in any exposure category.

    Conclusions:
    Occupational exposure to iron and welding fumes was associated with an increase in lung cancer risk,
    mainly that of squamous-cell carcinoma. The simultaneous exposure to both of these agents and other
    potential work-related carcinogens complicates the interpretation of the independent roles of the risk
    factors.




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10
     Occupational exposure to wood dust and formaldehyde and risk of nasal,
     nasopharyngeal and lung cancer among Finnish men
     Objective:
     The objective of the study was to assess the risk of nasal, nasopharyngeal and lung cancer in relation to
     occupational exposure to wood dust and formaldehyde among Finnish men.

     Methods:
     The cohort of all Finnish men born in 1906-1945 and employed in 1970 was followed-up through the
     Finnish Cancer Registry for incident cases of cancers of the nose (n=292), nasopharynx (n=149), and lung
     (n=30137) during 1971–1995. Their census occupations in 1970 were converted to exposure estimates
     to wood dust, formaldehyde, asbestos and silica dust with the Finnish job-exposure matrix. Cumulative
     exposure (CE) was calculated based on the prevalence, average level and estimated duration of exposure.
     The relative risk (RR) estimates for CE-categories of wood dust and formaldehyde were defined by
     Poisson regression, adjusting for exposure to asbestos and to silica dust, smoking, and socio-economic
     status.

     Results:
     Men exposed to wood dust had a significant excess of nasal cancer overall (RR 1.59, 95% confidence
     interval 1.06-2.38) and specifically in nasal squamous cell carcinoma (1.98, 1.19-3.31). Workers exposed
     to formaldehyde had a RR of 1.18 (1.12-1.25) for lung cancer. There was no indication that CE to wood
     dust or formaldehyde would increase the risk of the nasopharyngeal cancer.

     Conclusions:
     Occupational exposure to wood dust in Finland, which is mainly soft wood, appeared to increase the risk
     of nasal cancer but not that of nasopharyngeal cancer or lung cancer. The slight excess risk of lung cancer
     seen for formaldehyde may be due residual confounding due to smoking.




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11
     Prevention of Passive Smoking Among Vulnerable Groups: An Intervention
     Study in Ankara
     Introduction:
     Tobacco is the single most preventable cause of death in the world. In Turkey (2008), 31.3% of adult
     population (47.9% of men and 15.2% of women above 15 years old) smoke. According to the
     comprehensive anti-tobacco law, enacted in 2008, smoking ban has been widened to cover all public
     places. However, indoor passive exposure to tobacco smoke continues to be an important public health
     problem in private living areas. This intervention at the primary health care (PCH) level aimed to
     sensitize and train active and passive adult smokers to reduce indoor passive smoking in private living
     areas to protect vulnerable groups such as children, elderly and pregnant women.

     Method:
     The intervention consisted of in-service trainings to PCH workers, who in turn, conducted individual 15
     min. training sessions for both active and passive smokers attending any of the four selected PHC centers
     in Ankara during May-June, 2009. Pre-post intervention surveys with the participants as well as
     structured interviews with the PHC workers were conducted for monitoring and evaluation. The overall
     aim was to assess if short individual trainings in PHC settings would be effective to reduce passive
     smoking in private living areas and if the behavioral change would be maintained over time. SPSS 15.0
     software (Chi-square, t-test, ANOVA) and content analysis were used for quantitative and qualitative data
     analysis, respectively.

     Results:
     In total, 1800 people -living in a house with indoor smoking- received individual trainings and
     informational materials on health effects of passive smoking as well as smoking cessation centers in four
     PHC centers. Of the 1338 participants surveyed before the intervention, 70.2% were female and 58.0%
     were current smokers. Of the 311 participants surveyed three months after the intervention by random
     sampling, 88.9% stated that they’ve warned and asked the smoker/s at home not to smoke indoors. Of the
     current smokers who were smoking indoor before the intervention, 41.0% have started to smoke
     outdoor, 23.0% have reduced the number of cigarettes smoked per day and 6.0% have quitted smoking.

     Conclusion:
     Results of the intervention indicate that apart from strong anti-tobacco regulations in public places,
     educational interventions are also needed to protect vulnerable groups such as children, pregnant women
     and elderly from passive exposure in private living areas. Short individual trainings in PHC settings is a
     cost-effective way to reduce passive smoking and recommended for other countries with high smoking
     prevalence.

     Key words:
     Passive smoking, tobacco, primary health care, training.




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12
     Young child injury prevention and safety promotion at home and
     playgrounds in Polish magazines for parents and caregivers edited in 2009.
     In Poland the most frequent causes of injury related mortality, except transport, among young children
     are drowning, poisoning, falls and fires (smoke, fire, flame). Deaths from these four hazards have declined
     since 1999, but current rates are still high, and did not changed significantly. In 2003-2007 average death
     rate, excluding TRA and intentional injuries, was 4,85 per 100.000.

     The aim of the study was to review national magazines for parents and caregivers regarding publications
     about young child injury prevention and safety promotion at home and playgrounds.

     There were reviewed 6 main national magazines published in 2009. The number of edition of all titles
     was about 775.000 issues per month. The review was conducted according to areas of injuries defined by
     the WHO.

     In total there were published 19 articles regarding this subject. They mainly concerned prevention of
     accidental poisoning including safe storage of toxins (4 articles), prevention of falls including head injury
     (3 articles), prevention of choking and suffocation including first aid (3 articles), prevention of scalds
     including first aid (1 article), safe home arrangement and prevention of product-related injuries (4
     articles), safety standards of playgrounds equipment (1 article), and first aid in general including CPR (3
     articles). The highest number of publications in one title of reviewed magazines was 6 articles.

     Results of this analysis showed that there was not sufficient number of articles concerning young child
     safety at home and playgrounds, published in national journals for parents and caregivers in Poland in
     2009. There were not published any articles regarding water hazards and prevention of drowning or fires
     hazards and prevention of burns. Regarding relatively high death rates caused by injuries in young
     children, the printing media activities seem to be poor in Poland. There is a need to encourage the boards
     and journalists of these magazines to strengthen the education in young child injury prevention and
     safety promotion.




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13
     Perceived control and cardiovascular disease risk factors in Poland
     Background:
     Perceived control was found to be related with CVD and risk factors control in populations of Western
     Europe. Studies in this area are scarce in Eastern Europe.

     Goal:
     To assess the relation of perceived control over life, over health and general control with prevalence of
     CVD risk factors, i.e. smoking, hypertension, overweight and dyslipidaemia.
     Studied group: 10 728 men and women at age 45-64 years, random sample of permanent residents of
     Krakow.

     Study design and methods:
     Cross-sectional study; participants were interviewed at home using a structured questionnaire and
     invited for measurements to the clinic. Data on perceived control were collected with 9-item
     questionnaire. Multivariate logistic regression was used to assess the relation between prevalence of CVD
     risk factors and perceived control with adjustment for age, and education.

     Results:
     In women, the group with the lowest perceived general control and over life control had significantly
     higher prevalence of smoking. In men, perceived control was not related with current smoking. However,
     in ever-smoking men, very high perceived control over life and high general control were associated with
     higher chance for cessation of smoking (OR=1.25, 95%CI 1.02-1.54 and OR=1.24, 95%CI 1.18-1.50,
     respectively). In women with a very low perceived control over life, low HDL cholesterol and high
     triglycerides were more prevalent. High level of perceived general control was associated with 16%
     lower prevalence of hypertension (OR=0.84 95% CI 0.71-0.99). In men, increase in perceived control was
     strongly associated with an increase in prevalence of overweight. This relationship was observed for
     general and over life perceived control with an apparent dose-effect. In men and in women perceived
     control over health was not related with risk factors.

     Conclusions:
     Our result suggest that in women, low levels of perceived control were associated with hazardous health
     behaviors which affected HDL cholesterol and triglycerides levels. In men, the increase in perceived
     control was associated with a chance of smoking cessation but also had a negative effect on prevalence of
     overweight.




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14
     Using nominal group technique for development of american-ukrainian
     health management training program

     Background
     The aim of our work was to develop an optimal implementation strategy in postgraduate medical
     education in the health management area, including a discipline curriculum that would meet the needs of
     target groups - health executives.

     Objectives
     Fulfillment of this goal has caused one of the objectives of the study, namely, the need to clarify what
     knowledge and skills of healthcare management are in need for development and improvement. Solving
     this problem was made in the framework of international cooperation between National O.Bohomolets
     Medical University and University of Alabama at Birmingham, whose representatives proposed the
     nominal group technique (NGT). Professors Robert Hernandes and Rick Shewchuk ensure transfer of this
     technology, having a master class for Ukrainian experts and taking part in pilot studies.

     Design
     We convened three groups of chief doctors and university tutors, to elicit their perceptions on the
     following question: 'What kind of issues should be included in an intensive program that aims
     improvement of managerial skills and leadership abilities among the head-doctor in Ukraine?'.

     Methods
     The nominal group technique uses a structured group process to elicit and prioritize answers to a
     carefully articulated questions.

     Results
     Although there was same overlap in doctors' and tutors' perceptions, chief doctors identified
     psychological training as the most important factor; whereas tutors viewed human resource issues as
     most important.

     Conclusions
     Thus nominal group technique has capacity to produce a large number of ideas, evaluate the importance
     of each idea provides a level of choice ideas, excludes too fast decision making, ensures a high level task.




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     Telephone call reminders – a way to increase the response rate in health
     surveys?
     Abstract background:
     Postal questionnaire surveys often suffer from low response rates. At worst this causes bias and
     misleading results.

     Generally it is assumed that higher response rates improve the representativeness and reduces bias. By
     developing methods to increase the response rate it will be possible to improve the quality of health
     research. This study investigates the efficacy of telephone call reminders as a way to increase the
     response rate in the public health survey How are you? 2010 conducted in Central Denmark Region.

     During the data collection period, the current response rate was closely followed. It was observed that
     younger respondents had a relatively low response rate, particularly young men.

     Abstract methods:
     A controlled study was designed to investigate the effect of telephone call reminders. 1000 randomly
     selected respondents at the age of 16-40 years was called and asked to complete the questionnaire that
     they had previously received by mail. A control group of 2000 respondents did not receive telephone call
     reminders. The study included both men and women. At the end of the study, the response rate of the two
     groups was compared.

     Abstract results:
     An overall effect of nine percent increase in the response rate was obtained, with considerable variation
     across age and sex. For men, the difference in response rate was 14 percent, for women it was five.
     Telephone call reminders have a greater effect on 16-24 year olds of both sexes. They have no effect on
     25-40 year old women.

     Abstract conclusions:
     The study found that telephone call reminders have a positive effect on response rates in postal
     distributed health questionnaires.




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     Health literacy study in a population of primary health care patients in
     Belgrade, Serbia
     Background:
     Over the last decade, health literacy has become vibrant area of research. Our objective was to evaluate
     the health literacy and its association with socio-demographic variables, the self-perception of health, and
     the presence of chronic conditions in primary health care patients in Belgrade.

     Methods:
     A cross-sectional study. One thousand and five hundred adult patients from 16 primary health care
     centers were enrolled. Functional health literacy was measured by Serbian version of the Short Test of
     Functional Health Literacy in Adults (STOFHLA). Chi-square testing and multilevel logistic regression
     analyses were applied.

     Results:
     We found that inadequate and marginal health literacy existed in 631 participants (46.4%), and adequate
     health literacy was present in 730 participants (53.6%). Better health literacy score was present among
     younger participants, the employed, participants with a high level of education, participants with a good
     self-perception of health and good material status, and participants without chronic conditions. If, in
     multivariate analysis, the primary health center and individual variables (socio-demographic variables,
     the self-perception of health, and the presence of chronic conditions) are included, the following results
     are obtained: the probability for adequate health literacy was higher among younger participants, the
     employed, higher educated, and without chronic conditions.

     Conclusions:
     Primary health care patients do not have the literacy skills necessary to function adequately in the health
     care environment. Attention should be directed to the population groups that appear most likely to have
     low level of health literacy. These results encourage efforts for further monitoring.




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     Influence of weather variables on domestic violence
     Aggression and related violence are a major public health issue. Each year millions of people die from
     physical violence. The number of people wounded and injured as a result of the self-induced injury,
     interpersonal or collective violence is even greater. Violence is the leading cause of death among people
     aged between 15 and 44. The economic loss due to this unfortunately widespread phenomenon is
     estimated at billions of US dollars annually of the budget allocated to health. The present article displays
     the results from a research on the influence of the weather on acts of domestic violence in the city of Sofia.

     Data for the aggressive acts had been obtained from the Foundation “Animus Association” and includes
     1520 days within 5-years period (1998-2002). Method of the statistic grouping of the values of
     meteorological elements was used. Correlation analysis and t-test has been used in order to determine
     the significant influence of the factors under consideration on the phenomenon examined.

     The results show that the acts of violence experience statistically significant influence by average daily
     temperature, minimal and maximal temperature and thermal amplitude, relative air humidity, general
     cloudiness and the duration of daylight, while the remaining examined elements are not significantly
     influenced. Between the meteorological elements and their indicators a difference in the direction of
     influence exists, which should be taken into consideration when making a possible prediction. There is a
     straight connection between the average daily temperature, the thermal amplitude and relative air
     humidity, and there is a reversed connection between the general cloudiness, the duration of daylight, the
     maximal and minimal temperature. The abrupt weather changes have a statistically significant influence
     and are in a straight correlation with the acts of violence.

     Given the large dimensions of the problem “domestic violence”, it engages a large variety of specialists. In
     this sense, the role of such works as the present research is becoming increasingly significant, due to the
     necessity of identifying the factors which affect domestic violence and of planning the economic and
     human resources in a way that would limit the consequences from the aggressive acts.




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     Prevention of Mother-To-Child Transmission of HIV in Nigeria: A
     comparison of the HAART and the Short course ARV approaches in some
     AIDSRelief ART facilities.
     Context: Evolution of prevention strategies provides multiple options for managing HIV infection in
     pregnancy. These options include the use of triple agents (HAART) or short course therapy primarily for
     the purpose of PMTCT. The choice of appropriate strategy is typically based on immunological status of
     women at baseline and costs .This is further complicated by the need to minimize risks of HIV infection or
     death associated with chosen infant feeding methods. There is the need to evaluate the successes and risk
     determinants associated with both PMTCT strategies.

     Objective: To compare the efficacy of HAART to Sc-ARVs PMTCT in resource limited settings.

     Methods: This was a retrospective cohort study. Records of mothers who had received either of the two
     PMTCT strategies were linked with infant records and analyzed.

     Results: A total of 286 paired records were analyzed; 225 (78.7%) received HAART, 38 (13.3%) received
     Sc-ARVs while 23 (8%) received no ARV drug in pregnancy. The overall transmission rate was 2.4%
     (5/208) in infants whose mothers received HAART and 7.9% (3/38) for the Sc-ARV group. At the ninth
     month of life 1% of infants in the HAART group and 13% in the Sc-ARV group were infected. Factors
     found to be associated with increased risk of vertical transmission in the univariate analysis included
     duration of ART use < 3 months (P=0.036) and mixed feeding (P=0.05) while HAART (P<0.001) and
     giving infants ARV prophylaxis (P=0.02) reduced the risk, whereas the multivariate analysis revealed no
     significant associations. Breastfeeding was common practice in all groups. While no death was recorded
     in exclusively breastfed infants, 3.3% of non exclusively breastfed infants died.

     Conclusions: It could not be concluded from this study that HAART was a comparably more efficient
     PMTCT strategy. Further studies are recommended. Benefits of breastfeeding (which HAART allows for)
     in improving HIV free survival among exposed infants was however demonstrated.

     Keywords: HIV epidemic, Sub Saharan Africa, PMTCT, Vertical transmission, Transmission risk, Sc-ARV,
     HAART, Resource limited setting.




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     Local Positioning of the National Platform in the case of Health Crisis
     Situation in Macedonia – plans and activities providing in local and urban
     communities
     Keywords: Health Crisis Situation, Crisis Management Center, Ministry of Health – Institute of Public
     Health, Regional Crisis Headquarter, Regional Health Crisis Headquarter.

     In case of an existing danger of health crisis situation (e.g. pandemic influenza) the operative plans and
     activities for handling the situation are immediately activated. The Crises Management Center (CMC)
     together with the Ministry of Health - Institute of Public Health (IPH) is responsible for organizing
     activities related to the needs on national level (as a Government institution). However, IPH and CMC are
     also responsible for enforcing the measures and activities at a regional and local level, about setting up
     and activation of the operative plans throughout the Regional Centers of Public Health, Regional Crises
     Management Centers and Municipalities, i.e. the Local Authorities. The activities are lowered to a regional
     and local level because only in that manner the situation on the field can be monitored in more detail and
     precision. Subsequently, the gathered information and notifications are sent to the regional headquarters,
     through which they are transferred to a central or national level. In this manner, the complete situation in
     the state can be monitored continuously and the system is always prepared for early warning and timely
     alerts if there is a need for them.

     The Regional Crisis Headquarters as an operational and professional body, which is managed by the Head
     of the Regional Crisis Management Center and with mutual cooperation of the Head of the Regional
     Health Crisis Headquarters, is also comprised of representatives from the district units of the ministries
     and the other state authorities (Ministry of Internal Affairs, Ministry of Health, Ministry of Defense, Health
     Institutes and Veterinary Directorate), and if necessary other experts may participate, as well as
     representatives from the municipalities whose area and domain are comprised within the regional
     centers.




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     Role of living with family on cigarette smoking habits in second and third
     year students at Tehran University of Medical Sciences
     Background: Many risk factors have been known for smoking habits. Risk factors for Smoking including:
     risk behaviors, protective factors, associated conditions, and genetic factors. Friends or parents who
     smoke, socioeconomic state, and trying cigarettes at a young age are all linked to adolescents being more
     likely to become smokers. Social risk factors play a key role in this issue.

     Objectives: To evaluate the protective role of living with family on cigarette smoking habits in second and
     third year medical students at Tehran University of Medical sciences.

     Methods: Two hundred male medical students were asked to answer to an anonymous checklist and
     determine if they are smoking, and if they are native and living with their family in Tehran.

     Results: Unfortunately 68(34%) of students were smokers, while only 10(14%) of them were native.
     Among 50(86%) of smokers, 50(86%) were live in dormitory. In fact, among 56 residents of university
     dormitory 50(89%) were smokers. On the other hand, only 11.11% of native students were smokers.
     There was a statistically significant difference between smoking prevalence of native and foreign students
     (p <0.05). Living in dormitory was also linked to a high prevalence of smoking in foreign students (P
     <0.05, r = 0.742).

     Conclusion: With respect to the results of this study, family could play a protective role on cigarette
     smoking habits.




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     Planning of health professionals in the Netherlands: the Environmental
     Health Physician
     Background
     Health manpower planning can be an important instrument to control shortages or oversupply within the
     health care labour market, in particular by adjusting the numbers to be trained. The Netherlands has ten
     years of experience with manpower planning in health care. In 2001, a demand-based model was
     developed to estimate the required number of health professionals in training to meet the demand for
     care in the Netherlands. This model is based on realizing an equilibrium in the target year based on
     assumptions and statistics about the demand and supply sides of the health care labour market. The
     model is suitable for different kinds of health professionals.

     Methods
     In this presentation we will describe the model with regard to the Environmental Health Physician. At the
     supply side, trends are modelled for different cohorts of Environmental Health Physicians, for example
     about their age of retirement. At the demand side, trends in the demand for health care services are
     projected, based on mostly demographic and epidemiologic developments. The difference between
     required supply (demand) and available supply can be translated into advice regarding the future
     number of Environmental Health Physicians to be trained. Forecasting and planning results are presented
     in scenarios that vary on basic dimensions, resulting in a range of required inflow in training.

     Results
     Based on demographic developments regarding the occupational group, we can conclude that the number
     of Environmental Health Physicians in the Netherlands will decline rapidly. The demand for
     Environmental Health Physicians will probably increase in the future and is influenced by managerial
     developments regarding the regional availability of Environmental Health Physicians and the increasing
     societal interest with respect to environmental health care. The required inflow in training is, depending
     on the scenario, between 1 and 7.6 students a year.

     Discussion
     Although manpower models have successfully supported policy makers to steer the entrance in the
     Environmental Health Physician training, it can be questioned if these remain feasible for the
     developments to come. Specifically, two trends need to be incorporated in the manpower planning for
     Environmental Health Physicians that are yet underspecified. First, substitution within the occupational
     structure will increasingly change the Environmental Health Physician position - as tasks are re-allocated
     to other health occupations. Second, the need for local and regional health care planning will increase - in
     line with the policy trend to match health demand and supply as close to clients as possible.




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     Teenage pregnancy as a route to social exclusion? An investigation of the
     experiences and future expectations of Teenage Mothers in Sefton (North-
     West England).
     Objective: To investigate the experiences and future expectations of teenage mothers in Sefton to identify
     any disparity between the views of the teenage mothers and the UK Teenage Pregnancy Strategy aim of
     increasing participation in education, training and employment. To explore the link between teenage
     pregnancy and social exclusion and inform policy by providing insights from the lived experiences and
     needs of the young mother’s themselves.

     Design: A qualitative study conducted from a symbolic interactionist perspective.

     Setting: The research was conducted in Sefton in the North-West of England. Participants were recruited
     from drop-in-centres for young mothers at two children’s centres located in deprived wards of Sefton
     with high rates of teenage pregnancy.

     Method: Ten semi-structured interviews were conducted. Interviews were recorded, and transcribed
     verbatim. Findings emerged through a process of thematic analysis. The method was inductive with the
     codes and themes being generated by the data.

     Results: The results were grouped under four themes; the mother identity, stigma, social exclusion or
     inclusion and future aspirations. The results of this qualitative study dispute the view of the Teenage
     Pregnancy Strategy that teenage pregnancy has a negative impact upon the lives of young women leading
     to social exclusion. The young mothers interviewed felt motherhood was a positive experience and one
     which afforded them a symbolic identity. The young mothers all expressed future aspirations to get back
     into education and employment.

     Conclusions: This research study contributes to the small but growing number of qualitative studies that
     challenge the solely negative portrayal of teenage pregnancy. The evidence base would benefit from the
     inclusion of more qualitative research. Policy should take a wider view of social inclusion recognising the
     important social role motherhood plays for these young women. It is important to question the
     construction of teenage pregnancy as a public health problem. The disadvantage young mothers face is
     largely as a result of their pre-pregnancy disadvantage and this therefore should be the focus of policy
     intervention.

     Key words: Teenage pregnancy, Young mothers, social exclusion, education, qualitative research




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     An assessment of the association between Green Space and Psychological
     Distress in Sandwell, England
     Background
     Mental illness accounts for some 20% of the burden of disease in the European Region, representing a
     significant cost in terms of finance and personal suffering. Psychological distress is one of the “Common
     Mental Conditions” and a common factor in the manifestation of many forms of mental illness. Previous
     studies have demonstrated the restorative properties of green space. Economic evaluation in the USA
     suggests that the use of green space can result in major saving to health budgets. This quantitative study
     strengthens one aspect of the epidemiological evidence base for Public Health, exploring the association
     between self reported psychological distress and perceptions of the availability and characteristics of
     neighbourhood green areas. This represents a new area of study in this field and builds on previous
     research.

     Methods
     This is a cross sectional study based upon a stratified randomised sample from the population of
     Sandwell, a deprived region of the West Midlands, England (n=1680). Data was gathered using the
     validated Euro-Urhis 2 Questionnaire on Urban Health. This included GHQ-12 which assessed self-
     reported psychological distress, and questions related to perceptions of neighbourhood green areas;
     access, maintenance, safety, relaxation, recreation, walking distance from the participant and sufficiency.
     Univariate and multivariate logistic regression analysis were utilised to explore the independent
     relationship between these attributes of green space and self reported psychological distress. From the
     Odds Ratio it was possible identify the chance of reduced psychological distress associated with the
     availability, design and use of neighbourhood green areas.

     Results
     Univariate logistic analysis demonstrated an inverse association between self reported psychological
     distress and a number of attributes of green space. The results suggested that the lack of perceived
     access to green areas increased the chance of experiencing psychological distress by 80% (OR=1.8,
     CI=1.1-2.9); absence of a context for relaxation increased it by 70% (OR=1.7, CI=1.1-2.5); lack of
     recreational opportunity increased it by 70% (OR=1.7, CI=1.2-2.6), and lack of sufficient green areas by
     70% (OR=1.7, CI=1.1-2.6). Multivariate analysis concluded that the primary independent variable
     associated with self-reported psychological distress was the absence of recreational opportunity in green
     space; this increased the chance of psychological distress by 60% (OR=1.6, CI=1.1-2.6).

     Conclusion
     This study strengthens the epidemiological evidence base within Public Health for the use of green space
     and the greening of the urban environment in the alleviation and treatment of psychological distress.




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     Models for health manpower planning and their use in two EU countries
     Background
     Public health depends, to a great extent, in the balance of manpower at all levels of healthcare systems
     (HCS) – preventive, curative and palliative. Health manpower planning (HMP) is an instrument to prevent
     mismatches in the workforce, but little is known about how it is being done in the EU. The objective of
     this study is to identify, describe and compare forecasting models used for HMP.

     Methods
     As a first step, we reviewed published literature on forecasting models for HMP. We used the extracted
     information to build a classification framework of forecasting models for HMP.

     The second step consisted of using this classification framework as part of an international comparative
     analysis between two EU countries, the Netherlands and Portugal. To investigate their HMP, we
     described, for each country: (1) the context surrounding HMP, (2) the forecasting models used in HMP,
     and (3) the factors that potentially explain the differences found.

     Results
     The preliminary classification framework derived from the literature review consists of nine overlapping
     forecasting models: service target-based; needs-based; demand-based; effective needs-based; effective
     demand-based; health workforce density; international benchmarking; effective infrastructure; and
     adjusted service target.

     Using this framework in our two-country analysis, we classified the Portuguese forecasting models as
     international benchmarking, and the Dutch one as demand-based. Regarding the context for HMP, a
     Taskforce created by the Portuguese Government in 1998 prepared a HMP report (published in 2001 and
     updated in 2005), which forecasted the supply of physicians, nurses and allied health personnel until
     2021, whereas, in the Netherlands, a “Capacity Body” was erected in 1999, to annually monitor the
     demand and supply of healthcare manpower and project the required numbers of doctors and nurses to
     be trained for the following 10 to 15 years.

     Discussion
     We have provided insight into how the context for HMP and the organisation and financing of the
     healthcare systems are related to the differences found in the forecasting models used for HMP in two
     European countries. This project is still ongoing. Our next step will be to expand the two-country
     comparison to the EU level. This will allow us to describe HMP in the EU, and to identify factors that
     explain cross-national variation found. Together with the classification framework we presented, this will
     provide a knowledge base of international experience that can be used at country level to improve HMP
     and health labour market efficiency.




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     Economic Impact of Iron Deficiency Anemia for the Republic of Moldova
     To estimate the economic impact of iron deficiency anemia associated with cognitive deficits in young
     children and productivity losses in adults for the Republic of Moldova (RM).

     Methods. To assess the economic losses caused by iron deficiency anemia we used algorithms proposed
     by Jay Ross and Susan Horton in the work "Economic consequences of iron deficiency", data from the
     Demographic and Health Survey, 2005 (DHS) and Statistic Yearbook of the Republic of Moldova. Iron
     deficiency is the most common nutritional disorders in the world that frequent leads to anemia. A lot of
     studies document association of iron deficiency anemia (IDA) with poor motor and mental performances
     in children, low work productivity in adults, and poor pregnancy outcome. The consequences of iron
     deficiency are extending far beyond the population with iron deficiency anemia due to many physiological
     functions of iron other than its role in hemoglobin synthesis. Combining the effects of childhood anemia
     on cognitive achievement with those of adult anemia on physical productivity, total productivity loss due
     to iron deficiency anemia was estimated from the following: Cog loss + BC loss + HML loss = [0.04 x WS x
     GDP/cap x Pr(child)] + [0.01 x WS x BC Share x GDP/cap x Pr(adult)] + [0.12 x WS x HML x GDP/cap x
     Pr(adult)] Where: Cog loss is productivity losses due to lower cognitive scores related to childhood IDA;
     BC loss - losses in productivity for blue-color workers; and HML loss - losses in productivity for blue-color
     workers performing heavy manual labor; WS - wage share (labor) in GDP; GDP/cap - per capita GDP; BC
     Share - share of blue collar employment in total employment; HML - heavy manual labor share in GDP; Pr
     (child) - prevalence of anaemia in children; Pr (adult) - prevalence of anemia in children. Applying the
     most recent data (the last study that evaluates prevalence of anemia was done in 2005 - DHS) we
     calculated total productivity loss due to iron deficiency anemia for the RM: Cog loss + BC loss + HML loss
     = [0.04 x 0.38 x 10225 lei x 0.33)] + [0.01 x 0.38 x 0.36 x 10225 lei x 0.195] + [0.12 x 0.38 x (0.575 x 0.16)
     x 10225 lei x 0.195] = 62.38 lei This calculation yields an annual loss of 62.38 lei MD per capita in 2005,
     equivalent to 0.61% of GDP for this year. Effect associated with cognitive deficits in children and low
     work productivity in adults provides the justification to the urgent need to prevent iron deficiency in all
     groups of population, beginning with young children.




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     Evaluation of the impact of resource use prioritisation in South Central
     England
     Introduction
     The Priorities Support Unit (PSU) at Solutions for Public Health provides NHS primary care trusts (PCTs)
     in South Central (SC) of England (population 4.2 million) with evidence based advice to inform priority-
     setting and decision-making where NICE guidance is not available. This represents one of the best
     established systems of local evidence based prioritization in the UK. These recommendations inform the
     development of commissioning policies governing which health care technologies should be low priority,
     restricted to sub-groups or recommended for commissioning. This helps the PCTs (statutory budget
     holders) make difficult decisions on prioritisation through an ethical framework which supports
     transparency and robust decision-making.

     The PSU in conjunction with PCTs identifies topics where commissioning policies would have an impact
     on resources while maintaining high quality health care, and supports development of policies based on a
     synthesis of the available evidence for effectiveness and cost-effectiveness with comments from experts
     and patients. The evidence synthesis with expert, patient and lay representation is considered by
     priorities committees of PCTs to develop evidence based policies.

     Methods
     All policy statements from the priorities committees in SC that were conducted by PSU for the last three
     years (April 2007 to April 2010) were retrieved and analysed. The baseline expenditure prior to policy
     implementation was extracted from the papers where available. Savings from full implementation of
     these policies was estimated from one month after policy adoption. This allowed PSU to estimate the
     potential cost impact of the priority setting process.

     Results
     Over the last three years 84 technologies were evaluated by the priorities committees in South Central.
     Where baseline spending prior to policy implementation was available, the opportunity for financial
     savings was in the order of £30 million (assuming full implementation of policies). This presentation will
     describe the numbers of technologies that were deemed low priority or restricted to particular
     population sub-groups, and will present the potential and actual cost-impact for the health economy.

     Conclusion
     By providing robust, consistent evidence-based policies, the PSU has provided the NHS in South Central
     with the opportunity to focus investment on cost-effective treatments. This has had a significant effect on
     resource utilisation and has generated real savings, the scale of which may be even larger than could be
     estimated from available information. In addition, full implementation of all policies would have had an
     even larger cost-impact with greater potential for investing in effective treatments while maintaining high
     quality health care.




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     Health Equity audit of breast and cervical screening in East Lancashire
     Introduction:
     Health equity is a concern at global, national, and regional level. The North West Strategic Health
     Authority focused on reducing inequalities in life expectancy related to the major causes of ill-health in
     the region. Locally, NHS East Lancashire requires the ‘health equity audit’ to formulate an appropriate
     response. Ethnic minority populations and populations in areas of relative deprivation represent a
     challenge to health services throughout Europe. East Lancashire has a substantial ethnic minority
     population of mainly South Asian descent, and areas of substantial deprivation. Both factors are
     associated with inequalities in screening services and this study set out to identify the individual
     contributions of both to breast and cervical screening attendance in these population sub-groups.

     Research question:
     What is the attendance for breast and cervical cancer screening in East Lancashire, particularly in relation
     to ethnicity and deprivation?

     Methods: Design: descriptive epidemiological study using screening data.
     Participants and Setting: Screening data for the eligible registered general practice population of NHS
     East Lancashire for one entire screening period covering the entire eligible population, (01/01/2005-
     31/12/2008) for breast screening, and (01/04/2004-31/03/2009) for cervical screening), obtained from
     Lancashire and South Cumbria Agency (LaSCA), for this study.
     Outcome variable for logistic regression: Screening behaviour as a dichotomous (‘screened’ or ‘not
     screened’) outcome variable was compared to ethnicity, deprivation, age, and general practice.

     Results:
     There was a strong, independent and statistically significant and adverse association of ethnicity (odds
     ratio OR of 0.566, p<0.001, CI 0.519-0.618, breast; and OR 0.717, p<0.001, CI 0.680-0.755, cervical), and of
     deprivation (OR 0.491, p<0.001, CI 0.453-0.533, breast and OR 0.450, p<0.001, CI 0.418-0.485, cervical),
     with screening. There was also a small, significant association of age with screening, for cervical screening
     only.

     Conclusions:
     Ethnicity and deprivation had a strong, independent and significant association with screening, with
     reduced likelihood of attendance for screening in South Asian and deprived populations. These
     inequalities need to be explored further, and addressed with messages and interventions targeted to
     population sub-groups, with arrangements for regular evaluation with data monitoring with LaSCA for
     the population of NHS East Lancashire and similar approaches would possibly be required for other areas
     of the UK and Europe.




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     Pilot Study of Patient Safety in Slovakia

     Patient safety is a priority of EU politic agenda. Member countries created a mechanism how to discuss
     about patient safety issues and try to integrate this issue to priorities of health care area. Patient safety
     has emerged as a distinct health care discipline supported by a developing scientific framework and many
     of research type. The one of them has been made for Health Research and Quality by Agency – AHRQ
     intended to assessment of patient safety intervention implementation and improving health care services.
     AHRQ questionnaire was applied in our Slovakia survey in 2009/2010. In 2 chosen hospitals we
     considered about 300 physicians and nurse views of safety management, medical error, and event
     reporting in their hospital. Results from the pilot survey on patient safety culture showed existing gap in
     safety culture in Slovak hospitals. Views and answers of hospitals staffs were different between
     professions. Outcomes of our survey motivate us to continue in this study in other hospital in Slovakia
     and we will try to make Slovak database of patient safety culture to create huge overview of this health
     issues.




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     Attitudes towards formal patient payments for public health care services
     in six CEE countries - Bulgaria, Hungary, Lithuania, Poland, Romania and
     Ukraine.
     Since the 1990’, many CEE countries have introduced formal charges for public health care services (e.g.
     Estonia, Latvia, Bulgaria, Slovenia, Czech Republic). In other CEE countries (e.g. Romania, Poland,
     Ukraine), the introduction of patient charges has been under consideration, particularly in the context of
     increased fiscal pressure and sustainability problems within the health care systems. Empirical evidence
     suggests that the successful implementation of such charges, to a large extent, depends upon public
     acceptance. This issue is especially relevant for health care systems in CEE countries which grew form the
     Semashko health care model, based on the principle of free health care for every citizen. The right to free-
     of-charge health care is still a strong social perception in these countries. Moreover, the health care
     provision in many CEE countries is characterised with widespread informal patient payments.
     Implementation of formal charges in such context could increase the financial burden to health care
     users, and could provoke public opposition against these charges.

     Therefore, in this study, we analyse the attitudes towards formal patient charges among different groups
     of health care systems stakeholders (health care consumers, providers, insurers and policy makers) in six
     CEE countries - Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. Qualitative data were
     collected based on focus group discussions and in-depth interviews. During these focus group discussions
     and in-depth interviews, additional quantitative data were collected via a standardised questionnaire.
     Data analysis presents a combination of qualitative and quantitative research techniques.

     Our results suggest significant differences in attitudes across stakeholders’ groups and across countries.
     Health care consumers are in general least in favour of formal patient charges, especially in Poland and
     Lithuania. In contrast, patient charges are overall welcomed by health care providers in all countries (but
     less in Hungary). Health insurers and policy makers also express a positive opinion, especially in Hungary
     and Ukraine. We explain these attitudes differences from the perspective of countries’ experience with
     patient payments (both formal and informal) and the objectives of health care system stakeholders.
     Nevertheless, we find some common positions. In all six countries, most respondents see patient charges
     as a source of additional revenues, which could help to improve financial sustainability and quality of
     health care services. According to the majority of opinions, exemption mechanisms to protect vulnerable
     groups (e.g. children and disable people) are required. We use these results to outline recommendations
     for future implementation or amendment of patient charges in a country.

     Disclosure: The study is financed by the European Commission under the 7th Framework Programme,
     Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (Grant Agreement no.
     217431). The views expressed in this publication are the sole responsibility of the authors and do not
     necessarily reflect the views of the European Commission or its services




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     Transactional and Inter-Generational Sex with Older Men (TIGSex Survey):
     A Survey Among Barbadian Girls aged 15-19
     Aims: Demographic trends show a worrying feminisation of the AIDS epidemic in the Caribbean, the
     steepest region tracked by UNAIDS. UNAIDS notes the role of age-mixed sexual partnering in the
     transmission of HIV to young women, recognised in Africa as one of the key drivers of the epidemic. Given
     the suspected common practice of maintaining relationships with older men who, by virtue of their age,
     are more likely to have acquired HIV, this study investigated the practice of inter-generational and
     transactional sexual relationships between young girls and older men in Barbados. It is hypothesized that
     such partnerships may account for the increasing HIV rate amongst young women.

     Methods: 9202 females aged 15-19 were identified from the 2000 Barbadian census, of which a 3.3%
     cohort yielded a nationally-representative sample of 300 individuals. This sample size was powered to
     detect with 90% confidence a 15% prevalence of inter-generational sex, defined as heterosexual
     intercourse with men ≥10 years older. The 98-question survey utilised a multi-stage systematic random
     sample with interlocking quotas for age and gender. IRB approval was secured from The University of the
     West Indies and The Ministry of Health, Barbados. Written informed consent was obtained from
     interviewees aged ≥18, or from the parents/guardians of interviewees aged ≤17.

     Results: 51.3% reported being sexually active, among whom prevalence of IG partnerships (≥10 years
     difference) was: 13% at first sex, 23% within the preceding twelve months, and 36% of girls reporting
     ever having had involvement with an older man. Other relevant findings indicate that the mean age at
     first sex is below the age of consent, and lower in inter-generational sexual encounters. Economic
     pressures may have contributed to risk of IG sex: 38.4% of respondents struggled to pay daily necessities
     whilst 23.8% contributed to their household income. Further analysis of risk factors is ongoing.

     Conclusions: This study establishes robust prevalence of intergenerational sex in a nationally-
     representative survey, revealing rates similar to those in Africa. This work also serves as a foundation to
     mount a regional survey throughout the Caribbean. Further research into psycho-social drivers of age-
     mixed sexual behaviour is essential in order to drive informed policy decisions to minimise HIV
     transmission within the population.




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     Nutritional Evaluation of Food and Beverage Advertising in Spain. Applying
     the UK nutrient profile model.
     Introduction: Child obesity is an important Public Heatlh problem due to its high and growing frecuency
     and serious health consequences, so different countries are adopting policy options to change this
     worrying situation. United Kingdom established in April 2007 restrictions on commercial advertising of
     food and beverage classified as “less healthy” according to a new nutrient profile model developed by the
     Food Standards Agency. Our objective is to apply by first time to a TV sample of food and beverage
     advertising in Spain this nutrient profile model, so we can identifying “unhealthy” food and beverage
     advertisements.

     Methods: Observational, descriptive and cross-sectional study of the food and beverages advertised in
     four Spanish TV channels (TVE1, Antena 3, Canal Sur and Tele Madrid) during two days (80 h of
     programming): a school day (Thursday or Friday) and one weekenday (Saturday). Food advertisements
     were identified and their nutritional information collected in accordance with the requirements of the UK
     nutrient profile model.

     Results: In our study sample there were 499 TV food or beverages advertisements and 103 food and
     beverages advertised. Of these 103 distinct foods and beverages, 43.69% of the products are classified as
     “less healthy”, 22.33% as “healthy” and 33.98% “unclassifiable” according to the requirements of the UK
     nutrient profile model. Attending to the advertising broadcast, 49.50% of advertisements are of products
     “less healthy” and 27.45% “healthy”. When we considered only the TV advertising aimed at children
     63.14% of these are “less healthy” and 14.12% are advertisements of “healthy” products.

     Discussion: According to the results of our study we think it is justified that Spanish policy makers
     consider options similar to this one of United Kingdom for regulating food advertising according to the
     nutritional evaluation of the food and beverage advertised instead of the compliance of ethical standards
     only as nowadays in Spain. (PAOS Code).




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