Room
Auditoire Georges Spengler ( en face de l'accueil )
Theme
Children - Promoting healthy children and adolescents
Chair
Christina Akré
Title
Effects of adverse delivery outcomes on future delivery location decisions: evidence from 81 low- and middle-income countries
Name
Emma Clarke-Deelder
Affiliation
Swiss Tropical & Public Health Institute
Abstract
Introduction:Despite significant increases in facility-based delivery, maternal and neonatal mortality remain high in many low- and middle-income countries (LMICs), in part because many deliveries take place in facilities that are not equipped to manage complications. Current service delivery redesign efforts aim to address this challenge by encouraging delivery in higher-level facilities. To inform these efforts, it is critical to understand how pregnant people make decisions about where to deliver. In this study, we examine how delivery location decisions change over multiple births and evaluate the extent to which these decisions are shaped by past delivery outcomes.
Methods:
We analyzed Demographic and Health Survey data on delivery location and health outcomes from 81 LMICs. We defined institutional delivery as delivery in any public or private health center, clinic, or hospital, and hospital-based delivery as delivery in any public or private hospital. We examined how delivery location varied with birth order, adjusting for maternal characteristics, country fixed effects, and birth year. We then conducted a within-mother analysis to evaluate the impact of adverse delivery outcomes on delivery location decisions in subsequent pregnancies.
Results:
The study sample included 2.4 million deliveries. Higher birth-order children were significantly less likely to be delivered in health facilities and in hospitals than lower birth-order children. The probability of an institutional delivery decreased by 5.4 percentage points (pp) (95% CI: 5.2-5.6) between a first and second child, and the probability of a hospital delivery decreased by 4.5 pp (95% CI: 4.3-4.6). Mothers whose first live birth resulted in a neonatal death were 7.5 pp (95% CI 6.2-8.8) more likely to choose an institutional delivery for their second child and 5.5 pp (4.2 to 6.8) more likely to choose a hospital delivery.
Discussion:
The probability of institutional delivery (and hospital delivery) decreases with birth order, but increases in response to adverse events in past deliveries. These findings shed light on the complexity of delivery location decisions and can help inform current policy discussions around service delivery redesign to ensure that all deliveries take place in health facilities that are adequately equipped to manage complications.
Title
Wie ist die Datenlage zu Kinder- und Jugendunfällen in der Schweiz? Eine Machbarkeitsstudie zur Prüfung bestehender Datenquellen und neuer methodischen Ansätze.
Name
Sonja Feer
Affiliation
Institut für Public Health, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften
Abstract
Hintergrund: Unfälle bei Kindern und Jugendlichen sind relativ häufig und gehen mit individuellem Leid und Kosten für das Gesundheitssystem und die Gesellschaft einher. Das Unfallgeschehen bei Kindern in der Schweiz wird bisher nur unzureichend erfasst. Die vorliegende Studie hat die Datenquellen zusammengetragen, die für Monitoring und Präventionszwecke verwendet werden könnten.Methode: Im ersten Studienteil wurde eine Gesamtauslegeordnung der bestehenden Datenquellen in der Schweiz, sowie noch nicht in der Schweiz etablierten Datenquellen und methodischen Ansätzen erstellt. Mittels Interviews wurde eine Experteneinschätzung aus den Bereichen Pädiatrie, Public Health und Gesundheit Monitoring der Datenquellen zu Kinder- und Jugendunfällen eingeholt, zentrale Kriterien für ein Unfallmonitoring und aktuelle Entwicklungen erhoben. Der zweite Studienteil stellt eine vertiefte Evaluation von potenziellen Datenquellen und methodischen Ansätzen dar.
Resultate: Die Resultate der vorliegenden Studie bestätigen die Erkenntnisse zur unzureichenden Datengrundlage von Kinder- und Jugendunfällen in der Schweiz. Bestehende Daten werden zu unregelmässig oder mit zu wenig detaillierten Informationen zum Unfallhergang erfasst. Expert:innen aus den Bereichen Pädiatrie, Public Health und Gesundheit Monitoring betonen den Bedarf an Unfalldaten. Folgende Datenquellen bieten eine hohe Abdeckung, jedoch unterschiedliche Schwächen hinsichtlich des Datenzugangs, der Informationsdichte und der derzeitigen Verfügbarkeit. Die Unfallmeldungen der Krankenversicherungen (KVG) sowie die anamnestischen Notfall-Hospitaldaten liefern Informationen zum Unfallhergang. Die KVG-Unfallmeldungen liegen jedoch nicht digital vor, und die Anamnesetexte werden aktuell nicht ausgewertet. Der Datensatz von SwissPedHealth befindet sich im Aufbau und die Informationsdetails sind nicht bekannt.
Schlussfolgerung und Empfehlungen: Die aktuelle Datenlage entspricht nicht den Anforderungen für ein Unfallmonitoring und erst recht nicht für Prävention. Aktuelle politische Vorstösse zur Verbesserung der Datengrundlage zur Kinder- und Jugendgesundheit sowie Bestrebungen von Fachpersonen bieten jedoch Opportunitäten für die zeitnahe Etablierung eines Monitorings von Kinderunfällen. Idealerweise werden bei der Erhebung von Kinderunfällen neben der reinen Inzidenz weitere Details zum Unfallgeschehen wie z.B. Unfallursache oder Unfallhergang erhoben. Diese liefern wichtige Informationen für gezielte Präventionsmassnahmen.
Title
Clinical preventive guidelines for school-aged children in primary care settings
Name
Dagmar M. Haller
Affiliation
University Institute for Primary Care, Faculty of Medicine, UNIGE
Abstract
Background: Provision of clinical preventive care throughout childhood and adolescence has the potential to improve both short- and long-term health outcomes. Clinical guidance focused on preventive services targeting all healthy children need to be evidence-based, brief and easily applicable in busy primary care settings. The objective of this study was to collect and synthesize evidence from all available guidelines for primary prevention in primary care targeting school-aged children in high-income countries.Methods: We conducted a systematic literature review based on the PRISMA checklist. We searched PubMed, Embase, Web of Science, Cochrane Library as well as guidelines registries and the grey literature from January 2010 to June 2020. We focused on school-aged children (6-18 years) living in the European region, the USA, Canada and Australia. We included reports providing clinical practice guidelines, consensus papers, expert opinion or endorsement documents on preventive actions in paediatric and adolescent primary care settings. Two independent reviewers screened articles and extracted relevant data using the Covidence platform. We analysed reports by thematic condition, described level of evidence if any and provided a narrative meta-synthesis.
Results: We scanned 5,412 records and eventually included 95 papers in the review. Thirty-one preventive actions were identified with the number of documents by theme ranging from 1 to 11. Many guidelines included more than one preventive action. Most publications originated from the USA (N = 57). Two-thirds of documents concerned recommendations of low strength. The top five high-interest preventive actions were screening for hypertension, dyslipidaemia or sexually transmitted diseases, prevention of vitamin D deficiency and counselling on physical activity. Screening for dyslipidaemia or hypertension in asymptomatic children were the most controversial issues. Preventing children’s obesity through systematic monitoring of their growth and counselling on adequate physical activity levels achieved the highest number of favourable reports.
Conclusion: Methodologic rigour significantly varied in clinical preventive guidelines concerning school-aged population and most guidelines were not evidence-based. More research is needed to enhance consistency in the development and reporting of clinical preventive guidance.
Title
Does childhood financial strain predict the potential for healthy ageing? Results from the Lc65+ study
Name
Ekaterina Plys
Affiliation
Center for Primary Care and Public Health (Unisanté), University of Lausanne
Abstract
Introduction. Chronic diseases in advanced age often have their origins in childhood as many physiological functions and lifestyle behaviors are developed in early life. Previous research have reported a consistent association between childhood socioeconomic status and adult morbidity and mortality, as well as cognitive functioning. However, no studies have examined how childhood socioeconomic circumstance relate to healthy ageing, a recent concept developed by the World Health Organization (WHO). The WHO conceptualizes healthy ageing as the interrelation between intrinsic capacity (defined as a person’s physical and mental capacities) and his/her environment (which includes interpersonal factors as well as contextual factors, such as the physical environment and existing policies).In this study, we examine the relationship between indicators of childhood financial strain and intrinsic capacity in a sample of older people recruited at ages 65-70. We consider three indicators of financial strain, namely perceived childhood socioeconomic status, dietary restrictions, and child labor before the age of 16. We hypothesize that exposure to financial strain during childhood is associated with lower intrinsic capacity at later life.
Methods. We will analyze data from the Lc65+ cohort, which is representative of the community-dwelling population aged 65 and over in Lausanne. Childhood financial indicators were assessed through a baseline questionnaire, while intrinsic capacity data came from a combination of questionnaires, in-person interviews, and performance tests completed one year after recruitment and which capture five dimensions of intrinsic capacity: locomotor capacity, sensory capacity, vitality, cognition, and psychological capacity. First, we will carry out a factor analysis to explore the structure of intrinsic capacity measures and test the validity of proposed dimensions of intrinsic capacity. Following this, we will model intrinsic capacity as a function of indicators of childhood financial strain using regression analysis and controlling for a wide range of potential confounders.
Conclusion. This study will contribute to understanding the role of childhood financial strain in developing intrinsic capacity for healthy ageing. Results will help to identify potential domains for intervention that could prevent or ameliorate the harmful effects of childhood adversity on health and functioning in later life.
Title
One size doesn`t fit all: Segmentation and tailoring in health promotion and prevention
Name
Frank Wieber, Steffen Müller
Affiliation
ZHAW
Abstract
For successful health promotion and prevention, it is important to define and understand target groups. While most campaigns and interventions take basic characteristics such as demographics (e.g., age) or socioeconomic characteristics (e.g., educational attainment) into account, there is often a lack of knowledge about behavioral characteristics (e.g., smoking opportunities), psychographic characteristics (e.g., motives for exercising) or health-work characteristics (e.g., ability to work despite chronic diseases) of different target groups. Accordingly, a one size fits-all approach is problematic because it bypasses the individual characteristics of the target groups and is less effective and efficient. Against this background, target group segmentation presents an opportunity that needs to be seized.The aim of this workshop is to introduce the idea, process and requirements of the segmentation and tailoring approach. With the help of three empirical examples, we will illustrate its application and discuss the benefits and potential challenges.
The first example focuses on the “TPF Target group profiles” project on tobacco prevention. Based on the collection of detailed information on the behavioral and psychographic characteristics of adolescents and adults, segments were derived, specific prevention messages on smoking prevention and cessation for the respective target group profiles were developed, tested, and were made accessible to health professionals on a digital platform.
The second example summarizes findings from several projects in the field of exercise and sport promotion. Thereby, different possibilities for tailoring target-group specific measures will be introduced. For example, target-group-specific sport and exercise programs can be developed based on individual motives and physical condition.
The third example, based on an SNSF project, sheds light on labor market integration among older workers with different health profiles. We examine which segments of older workers benefit most from vocational rehabilitation programs and are most likely to remain in employment despite poor health. Evidence from this study will enable us to develop more effective reintegration measures.
After the three examples, we would like to discuss the following questions: 1) What are further possible applications of segmenting in the field of health promotion and prevention as well as health care? 2) What are the challenges and opportunities of the approach?