bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of public health scientists within the German political discourse on the COVID-19 pandemic
Authors: von Köppen M , Piel J , Apfelbacher C
Published: October 2022

Background

During the COVID-19 pandemic politics was in search of scientific evidence to underpin decision making like never before. It is remarkable that voices from public health were less noticeable than those of virologists or immunologists. The aim of our ongoing study is to explore how public health scientists perceive their role in the relationship of their discipline and politics.

Methods

We conducted 10 reflexive interviews with epidemiologists and public health scientists from Germany and collected documents (official statements and policy briefs of scientific societies). Data from both sources were analysed using situational analysis (Clarke, 2018), an approach used to map and analyse discourses in complex situations. To ensure data quality we used respondent validation.

Results

According to participants, (1) improving population health was the top priority. Politicians tended to focus on short-term goals rather than long-term consequences. (2) Recognition of public health was increased by the pandemic in Germany. (3) However, politicians favoured virology, biomedical and clinical perspectives. (4) The strong motivation of public health scientists to support politics at the beginning of the pandemic turned into disillusionment. (5) The composition of advisory boards was described as non-transparent. (6) Initiatives by the public health community were not sufficiently impactful. (7) Expectations of policymakers regarding future cooperation were not clear to participants.

Conclusions

The results present different facets of a delicate relationship between public health sciences and politics. The pandemic increased the visibility and impact of public health in Germany on the one hand but also demonstrated that the realms of public health (science) and politics were not well connected. Involving scientific expertise in politics requires more transparency and the normative assumptions underlying the logics of science and politics need to be made more explicit.

Key messages

• The potential of public health to address the covid-19 pandemic has not been sufficiently acknowledged by policymakers, and the involvement of its experts requires greater transparency.

• Reflecting on the normative assumptions underlying the different logics of public health sciences and politics can support their cooperation in the future.
An enhanced version of the PHIRI infrastructure: improving the analytical services
Authors: Estupiñán F
Published: October 2022

The PHIRI federated approach has consisted of the development of four research queries (use cases) mobilising individual data from a number of data hubs (nodes in the federation). Methodologically speaking, use cases have required the creation of specific cohorts of patients, population subgroups or populations, and the identification of events of interest - over-time differences in health status and care healthcare utilisation before and during the pandemic. Technologically speaking, PHIRI infrastructure consists of a distributed end-to-end analytical pipeline containing the statistical analysis workflow, including data quality assessment at origin and the mathematical algorithms. Once datasets are prepared in each data hub, partners run the analyses and produce a research output (dashboards containing the research results and tables with aggregated data) that is shared for results compilation and comparative analysis. An enhanced version of the PHIRI infrastructure should allow more complex data distribution. The research questions covered so far are aiming inference on populations or providers, which implies a very simple distribution methodology, as described. However, when the research questions requires inference on the individuals (eg, quasi-experimental study on the effectiveness of a real-life intervention), when the inference requires a hierarchical approach (ie, part of the variance is at individual level and part at cluster level) or when, several rounds of training are needed (eg, validation of an artificial intelligence) the approach would require sharing coefficients, distances in n-dimensional spaces or models, and, some times various rounds of distribution. Finally, an enhanced version of the PHIRI infrastructure should generalise the current FAIR approach limited to the publication of the analytical pipeline in ZENODO, setting up the services and tools required for an improved version of the PHIRI open-science strategy.
How to involve ‘hard to reach’ population groups in research projects
Authors: van der Ven LGL , van Baar JM , Wispelweij RS , Jambroes M
Published: October 2022

Issue

Addressing and reducing health inequalities is a major challenge in public health. Actively involving the most vulnerable populations groups in research projects in order to assess and address their needs is an important step towards reducing health inequalities. However, the most vulnerable groups are often perceived as the most difficult to reach for researchers.

Description

We conducted a research project to assess and address the health effects of the COVID-19 pandemic in vulnerable population groups. In three neighbourhoods, we identified the 2-3 most vulnerable population groups. We aimed to interview at least 20 participants per neighbourhood, evenly distributed among the groups, using creative and adaptive recruitment methods.

Results

Successful strategies differed per group. Strategies that proved successful were: rewriting information and consent letters together with the target population to help make them more accessible and attractive; using simple language in texts and while interviewing; asking the target population what type of compensation for the interview they would find most attractive; identifying persons who function as social hubs in the neighbourhood, asking them to help recruit participants, and providing them with financial compensation for their time; asking professionals in care and welfare organisations to help recruit among their clients; interviewing people in the places they would normally go to; snowball sampling. We met our recruitment goals.

Lessons

When working with ‘hard to reach’ populations, it takes researchers time, flexibility and creativity to find the right strategy to recruit participants while still respecting the boundaries set by GDPR and ethics committees. We recommend researchers to think about various possible recruitment strategies before starting a project, and to be prepared to change strategies during a project if necessary.

Key messages

• ‘Hard to reach’ populations are not really hard to reach, they just require a different mindset and skillset from the researcher.

• We encourage researchers to be creative and flexible in finding the right recruitment strategies in their project, and to think about various possible strategies before starting a project.
Addressing the relational determinants of health
Authors: Abdikarim I
Published: October 2022

Problem

The persistence of systemic discrimination and inappropriate responses to unmet need by institutions in response to current challenges (COVID-19, austerity, war) requires a fresh look at the gaps in our response to inequities. We found evidence of avoidable inequity and harm associated with the relationships between individuals, communities, organizations, and governance structures. These have been described as the Relational Determinants of Health.

Results

We undertook a scoping review to find research and policy interventions to address this problem. The relationships between individuals, communities and institutions that underpin how health is experienced and lives are lived were rarely considered explicitly in the design and implementation of interventions to address inequalities other than at local level or in response to individual trauma. We found academic work co-created with indigenous peoples did address trauma experienced due to historical structural violence and discrimination. It recognised the importance of land, culture, ceremony, and language in the organization of inter-personal, community and institutional relationships, codified the relational determinants of health and tested interventions that changed them. By applying assemblage theory, relationships with individuals and communities that had been previously excluded and harmed were being redesigned. These promising findings, replicated in different settings, indicate that relationships between communities and authorities that appear structural, are not fixed but can be primed to be changed for the better.

Conclusions

To reduce the scale of future inequalities, it is essential that we chronicle and quantify the impact of the Relational Determinants of Health. We present a model that will enable methods for gathering evidence for change to be established, and to support interventions that will improve our research, advocacy, and policy responses to this challenge.

Key messages

• Discrimination and unmet health need are associated with the quality of relationships between individuals, communities and institutions.

• Attention to the Relational Determinants of Health can help institutions reduce exclusion and harm by working with communities to redesign relationships.
The integrated GOR-COVID-19 health monitor: protocol for a comprehensive approach
Authors: van Duinkerken A , Bosmans M , Tak N , Baliatsas C , Jansen N , de Vetten-Mc Mahon M , Marra E , Dückers M
Published: October 2022

Introduction

The global COVID-19-pandemic influences people's health, both directly through infection and indirectly through the protective measures taken by governments. Previous experience with health research after disasters/crises are generally limited to short-lasting, local disasters with direct consequences for those affected. The COVID-19-pandemic has a different nature: influencing everyone and lasting a longer time. A longitudinal, wide-reaching research-approach is needed to study the health effects of COVID-19. Therefore, the Network GOR-COVID-19, a research group consisting of different organizations, started a monitor on the health effects of COVID-19.

Methods

The monitor consists of three main elements: yearly monitoring, quarterly monitoring and literature reviews. Where possible, existing data structures are used. For the quarterly monitoring, two data sources are used: general practitioners’ [GP] registry data and data gathered from panels. The GP data is used for weekly surveillance, giving insight into the prevalence of health symptoms presented to the GP. The panel data is used to gain insight into current self-reported health and wellbeing of people. For the yearly monitoring, two data sources are used. The first is GP data which gives information about the prevalence, incidence and development of symptoms, complaints and diagnoses. It allows for comparison over time and among different population groups. The second is the corona health monitor questionnaire, an existing questionnaire on health and well-being. Finally, literature reviews are conducted annually to create an overview of international and national research about the effects of the COVID-19-pandemic on health.

Discussion

Since most of our knowledge about the potential impact of the pandemic stems from research on short-term disasters, limited to specific places, this study is expected to provide valuable new insights.
The integrated GOR-COVID-19 health monitor: research-informed policy-making through dialogue
Authors: Jansen N , Marra E , de Vetten-Mc Mahon M , Dückers M
Published: October 2022

Introduction

Like in many other countries, the COVID-19 pandemic and the government restrictions introduced to contain the spread of the virus had major consequences for the health and wellbeing of the population in the Netherlands. To monitor the short and long-term public health impact, a nationally coordinated research program was initiated with the intention to guide decision-making by local and national public health authorities. This contribution presents the process to establish a continuous dialogue with end-users of information to add focus to the monitor, make sense of the findings and formulate policy recommendation and practical guidance, both at the national and regional level.

Methods

To facilitate the translation and dissemination of research results among policy makers, practitioners and scientists, an ongoing series of dialogue sessions is organized during the monitoring program. Apart from the objective of evidence-informed public health decision-making, the dialectic process seeks to ensure multi-sectoral learning and co-creation and contribute to a broad sense of ownership among stakeholders. National and regional health participants serve as hub coordinators. New stakeholders are invited and will be actively approached wherever considered relevant.

Results

At the EUPHA conference experiences with organizing the dialogue in app. the first two years of the program will be presented together with preliminary results and a reflection on factors that helped or hindered the implementation and uptake of findings.

Discussion

Monitoring data collected using robust methods and analyzed in such a way that vulnerability factors are carefully considered, is invaluable for decision-making. However, in order to effectively serve as guidance to public health policy, whether in the context of the COVID-19 pandemic or in non-crisis situations, a constructive, ongoing exchange between end-users of the information needs to be facilitated.
8.H. Workshop: Health equity and Chronic diseases: Public health and Primary care roles
Authors:   Organised by: Western University (Canada),   Chair persons: Saverio Stranges (EUPHA-CHR), Tatjana Makovski (France)
Published: October 2022

Publicly funded health systems are based on the principle of universal access to care. However, significant gaps still exist between services needed and services received (i.e. unmet need for healthcare), especially in chronic disease management and prevention, particularly affecting marginalized groups in the society. Public Health and Primary Care should be working in integrated systems, as they are crucial in addressing health needs in the community and population at large. Several international organizations and leading scholars in the field have been advocating for the integration or primary care and public health to improve population health as well as to tackle complex issues such as multimorbidity. However, these two sectors are still working in silos across several countries, with a significant negative impact in terms of efficiency of the services provided and health care costs. The aim of this workshop will be to provide a global perspective on the issue of health equity in chronic disease management and prevention, with focus on marginalized population subgroups, such as elderly, immigrants and people from low socioeconomic status. We will discuss as well the determinants of unmet health needs for access to primary care in middle-aged and older adults, and examine the reasons for unmet need. We will further discuss about the need and strategies for enhanced integration between public health and primary care in chronic disease management and prevention.

Key messages

• Public health systems are based on the principle of universal access to care. However, significant gaps still exist between services needed and services received (i.e. unmet need for healthcare).

• Public Health and Primary Care should be working in integrated systems to tackle complex issues such as multimorbidity.
Core Features of the GP to be transferred during JADECARE and transfer challenges
Authors: Txarramendieta J , Roca J , Zahorka M , Strand Kudajewski K
Published: October 2022

In this second presentation, the representatives of each of the four JADECARE oGPs, Jon Txarramendieta (Kronikgune, Basque Country, Spain), Josep Roca (August Pi i Sunyer Biomedical Research Institute, Catalonia, Spain), Manfred Zahorka (Optimedis AG, Germany) and Kuno Strand Kudajewski (Health Innovation Centre, Southern Denmark) will describe the main traits of the Core Features of their practices and the Next adopters that will transfer and adapt them highlighting the transfer challenges.
The salutogenesis perspective of Health Literacy
Authors: Saboga-Nunes L , Medeiros M
Published: October 2022

Introduction

Health Literacy (HL) is the third pillar of Health Promotion and contributes to the sustainability agenda set earlier in Rio de Janeiro and latter in Shangai (e.g. WHO Shanghai Declaration, 2016). Nevertheless HL per se lacks consistency and structural modus faciendi implementation and practice. Therefore it is proposed that a discussion be developed based in the salutogenesis embodiment of health literacy from the perspective of children's Sense of Coherence.

Methods

A population cross-sectional study included (n = 725) children enrolled in the school year 2018/2019 of four schools in Santarem and Lisbon, Portugal. Indicators of anthropometric data, Health literacy (HL), water intake (WI) and nutrition status (NS) and their Sense of Coherence (SoC) levels (using the HLS-EU-PT questionnaire) were collected with the CrAdLiSa online self-administered questionnaire.

Results

Preliminary results show that the instrument to measure HL (HLS-EU-PT) show satisfactory internal consistency (Cronbach's alpha coefficient 0,94) and association with SoC (Cronbach's alpha coefficient 0,89). The higher is HL levels the higher results are found in the Comprehensibility component of the SoC. The older the age, the amount of WI perception is adequate (p = 0.03); male children (p = 0,02) and children that attend schools in urban area (p = 0,01) drink more water; and have a higher SoC. Also the older the age, the lower the levels of HL (p = 0.000); children with higher levels of HL have greater WI (p = 0.01) as they have a broader perception of the adequate amount of water needed to be healthy.

Conclusions

These results of CrAdLiSa study explore further on the theoretical perspectives influencing HL. They also showed the usability of the SoC and the HLS-EU-PT questionnaires adapted for children to assess their SoC and HL levels.
8.L. Round table: Breaking the barriers: gender equality and women empowerment in public health practice
Authors:   Organised by: EUPHAnxt, EUPHA-PHPP, EUPHA SDG5WG,   Chair persons: Sofia Ribeiro (EUPHA-PHPP), Jinane Ghattas (EUPHAnxt)
Published: October 2022

Gender equality is an issue in the public health arena. Though women make 70% of the healthcare workforce, there is an average 28% pay gap. (WHO, 2019). Other barriers have been identified in the literature. (Lancet, 2019) Work-life balance, gender discrimination, sexual harassment or assault in the workplace are pointed out in research studies. Consequences of poor work-life balance include insufficient time with families, difficulties in handling work and all household responsibilities, affecting childbearing decisions. Women also decline leadership opportunities, such as promotions and committee chair positions, because of family obligations. Gender discrimination included feeling inferior and discouragement from promotions or leadership positions on the basis of gender. Another identified barrier was the lack of a safe and unbiased system for seeking help following harassment or assault. Issues related to work-life balance became even more apparent during the COVID-19 pandemic, which placed a disproportionate burden in female public health workers. In the recovery phase, we have an opportunity to rethink public health delivery in order to make it a more equal, less biased, and safe place for women. This should be a concerted effort, involving men and vulnerable populations such as trans women and underrepresented ethnic groups, to ensure that no one is left behind. As one of the leading public health organizations in Europe, the European Public Health Association is committed to join efforts to address this issue in the multiple public health arenas: public health practice, policy and research. This panel discussion is a collaboration between the EUPHA Working Group on gender equality and women's and girl's empowerment, the Policy and Practice section and EUPHAnxt, and is for any conference participant that is committed to reducing the gender gap in public health. The aim of this panel discussion is two-fold. First, we aim at discussing the barriers that female healthcare workers face on an everyday basis, and their impact on their careers. Secondly, we aim at discussing how institutions and individuals can address these barriers and contribute to enhanced gender equality in the public health arena. Following panelists’ interventions (additional speakers have been invited and will be confirmed at a later stage), the audience will be invited to participate in a discussion on gender barriers they have experienced and how those could be addressed.

Key messages

• Public health practice still faces several barriers to gender equality.

• Identifying barriers to gender equality and discussing strategies to overcome them is a step towards achieving gender equality in the workforce.

Speakers/Panellists

Marie Guichardon

EUPHA

Marleen Bekker

EUPHA-PHPP
Adolescent Binge Drinking in the West of Ireland: Associated Risk and Protective Factors
Authors: Kelly C , McNamara Á
Published: October 2022

This study aimed to examine potential risk and protective factors for binge drinking among a cohort of 15-16-year-old adolescents in the West of Ireland. This study was a cross-sectional secondary analysis of 4,473 15-16-year-olds who participated in the 2020 Planet Youth survey. Binge drinking was defined as ever consumption of five or more drinks in a two-hour period or less. Data were analysed using SPSS version 27. Multivariable logistic regression was used to examine independent associations between potential risk and protective factors and binge drinking. A p-value of < 0.05 was deemed statistically significant. The prevalence of binge drinking among participants was 34.1%. Female gender (aOR 0.55, 95% CI 0.46-0.67, p < 0.001) and non-White ethnicity (aOR 0.49, 95% CI 0.31-0.77, p = 0.002) were associated with reduced odds of ever binge drinking. Self-rated ‘bad/very bad’ mental health (aOR 1.61, 95% CI 1.26-2.06, p < 0.001), current cigarette use (aOR 4.06, 95% CI 3.01-5.47, p < 0.001) and current cannabis use (aOR 2.79, 95% CI 1.80-4.31, p < 0.001) were associated with increased odds of ever binge drinking. Parental supervision (aOR 0.80, 95% CI 0.73-0.88, p < 0.001) and negative parental reaction to adolescent drunkenness (aOR 0.51, 95% CI 0.42-0.61, p < 0.001) reduced the odds of ever binge drinking among participants. Getting alcohol from parents was associated with increased odds of ever binge drinking (aOR 1.79, 95% CI 1.42-2.25, p < 0.001). Adolescents with friends who drink alcohol had almost 5 times higher odds of ever binge drinking (aOR 4.59, 95% CI 2.65-7.94, p < 0.001). Participating in team sports was also associated with increased odds of ever binge drinking (aOR 1.30, 95% CI 1.07-1.57, p = 0.008 for 1-4 times/week, aOR 1.52, 95% CI 1.07-2.16, p = 0.020 for ≥5 times/week). This study highlights key influences of adolescents’ social environment on their binge drinking, and a need for renewed public health efforts to protect adolescents from alcohol-related harm.

Key messages

• This study identified a high prevalence of ever binge drinking among adolescents in the West of Ireland - this is highly concerning as adolescents are vulnerable to alcohol-related harm.

• This study identified factors in the social environment of adolescents associated with binge drinking. This can inform public health action to protect adolescents from alcohol-related harm.
Early childcare type and child development at age 3.5 years, data from the French ELFE cohort
Authors: Gomajee R , Barry K , Melchior M
Published: October 2022

Background

Early childcare has been linked to child development in some countries. The aim of this study is to evaluate the impact of early childcare in the French context, where children can attend different types of childcare facilities prior to age 3 when they enter kindergarten, and development at age 3.5 years.

Methods

10,683 children from the ELFE French national birth cohort were classified into 4 groups depending on their main type of childcare between birth and age three: childminder (n = 5,014), centre-based childcare (n = 2,583), informal childcare (n = 777) and parents only (n = 2,465). Children's development was measured with the short form of the Child Development Inventory (CDI) via parents-reports at age 3.5 years. The CDI score was transformed into a Development Quotient (DQ) taking into account the child's age, and global developmental delay was defined as DQ < 90. Missing data was imputed by Fully Conditional Multiple Imputation with 10 imputations. Multinomial analyses were carried out adjusted by Inverse Probability Weighting based on Propensity Scores calculated using main selection and confounding variables.

Results

Compared to children who were cared for by parents only, children who were cared for by a childminder or in a centre-based childcare had a higher DQ (103.0 and 104.8 respectively) as well as a lower likelihood of global developmental delay (propensity-score weighted OR = 0.84, [95% CI 0.70-1.01] and propensity-score weighted OR = 0.54, [95% CI 0.44-0.66]) respectively.

Conclusions

In the French context, early centre-based childcare attendance is significantly associated with a lower risk of global child delay. Policies should make centre-based childcare more accessible to a broader number of children.

Key messages

• Early childcare type is linked to child development in France.

• Children in centre-based childhood had a lower likelihood of developmental delay compared to those looked after by parents only.
Leadership in public health crisis: a review to summarize lessons learned from COVID-19 pandemic
Authors: Valz Gris A , Gualano MR , Osti T , Villani L , Corona VF , D'ambrosio F , Lomazzi M ,   Collaborating Group Leadership Coalition, Cascini F , Favaretti F , Ricciardi W
Published: October 2022

Background

During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era.

Methods

The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting.

Results

A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic.

Conclusions

The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the training of tomorrow's European and worldwide leaders to be ready to face future threats.

Key messages

• Effective public health leaders in crisis are empathetic and trustworthy people, who have developed management and communication skills, and are able to make timely and evidence-based decisions.

• In order to create leaders capable of facing future threats, more emphasis in the training of public health workforce on soft skills and management competencies should be recommended.
Learning from COVID-19: The inclusion of vulnerable groups in COVID-19 responses across Europe
Authors: Molenaar J , Van Praag L
Published: October 2022

Background

More than two years into the pandemic, many European countries have begun to evaluate their COVID-19 public health responses and draw lessons for future preparedness. As the COVID-19 crisis has exacerbated intersectional social and health inequalities, it is pertinent to evaluate the extent to which COVID-19 responses have successfully responded to the diverse needs of various vulnerable groups. We present a comparative analysis of how evaluations of European COVID-19 responses have assessed efforts to adapt or tailor COVID-19 responses to vulnerable groups, focusing on public testing and tracing strategies and vaccination campaigns.

Methods

We draw on data collected in the H2020 project COVINFORM. We combine insights from qualitative interviews conducted with public health policy- and decision makers in COVINFORM partner countries with a document review of available evaluations of COVID-19 responses published by both government and academic actors between March 2020 and June 2022.

Results

Across countries, evaluations of COVID-19 responses show that efforts to adapt or target public health responses to specific vulnerable groups became more common as the pandemic stretched on. Differences across countries were observed in relation to which groups were considered particularly vulnerable; the types of responses considered successful; as well as the organisational/governmental level at which responses were coordinated. Analyses reveal that the heavy emphasis on medical vulnerability distracted from efforts to address broader, structural inequalities, complicating the development of tailor-made policies.

Conclusions

The results inform ongoing policies that deal with the long-term consequences of the COVID-19 pandemic and aim to reduce disproportionate impacts faced by vulnerable groups. Our findings also add to a better understanding of how future preparedness structures should take into account how pandemic measures have unequal impacts.

Key messages

• As the COVID-19 crisis has exacerbated intersectional social and health inequalities, it is important to learn from efforts to adapt or tailor COVID-19 responses to vulnerable groups.

• The findings demonstrate how across Europe, the combination of particular sets of country-specific COVID-19 responses, tailor-made or not, yield specific consequences for vulnerable groups.
Readiness of Community Health Agents for COVID19
Authors: Vieira-Meyer A , Guimarães JMX , Morais APP , Dias MSA , Vieira NFC , Farias SF , Oliveira ALS , Meyer CHC , Vasconcelos MIO , Yousafzai A
Published: October 2022

Brazil is one of the countries with the highest COVID19 mortality numbers. COVID19 deaths affected disproportionally different populations/communities, tending to be higher among more vulnerable ones. Brazil has a public-funded unified health system (SUS) built on the aegis of equity and social control. Its Primary Health Care (PHC) is organized by the Family Health Strategy (FHS) through Family Health Teams (FHT), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, health promotion activities, and serve as liaisons between health units and communities. In this context, CHAs have the potential to play an important role in fighting the pandemic by working on contact tracing, collecting information on infected people, and providing guidance to them and the community in order to contain community transmission. However, not much is known about their readiness regarding the COVID19 pandemic in one of the Brazil's poorest regions. Thus, this study evaluated, though CHA perspective, aspects related to their preparedness for COVID19 in Brazil's northeast region. Questionnaires were applied to CHAs from 8 different municipalities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed at their workplace in 2021. 77.8% said that they were acting in the COVID19 frontline, but only 16% referred to have received training for this function. Furthermore, only 13.7% mention to have had access to adequate individual protective equipment during their work, and 91.6% believe that they can get infected by SAR-COV-2 during their work duties. Additionally, 93.9% considered themselves a transmission vehicle due to work. Despite their potential in the fight against COVID19, CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic.

Key messages

• CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic.

• Addequate trainning and work environment are essencial for proper work development.
The burden of musculoskeletal disorders in Belgium: a national population-based study
Authors: Gorasso V , Van der Heyden J , De Pauw R , Pelgrims I , De Ridder K , Vandevijvere S , Vansteelandt S , Vaes B , De Smedt D , Devleesschauwer B
Published: October 2022

Background

According to WHO, approximately one in three people worldwide live with a chronic, painful musculoskeletal (MSK) disorder. Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the most disabling MSK disorders. According to the Global Burden of Disease (GBD) study, LBP was the leading global cause in terms of years lived with disability and OST showed an increase in prevalence and is predicted to be one of the leading future causes. Our study aimed to analyse the burden of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018.

Methods

Prevalence and disability-adjusted life years (DALY) were computed using data from the Belgian health interview surveys from 2013 and 2018, the INTEGO database (Belgian registration network for general practitioners) and GBD study 2019. Mortality data was retrieved from the Belgian statistical office for people dying from RHE. Following GBD methodology, LBP, NKP and OST were assumed to not generate any deaths.

Results

The prevalence of MSK disorders increased from 2013 to 2018 with OST being the disorder with the highest number of cases (1.7 million cases in 2018). The burden was higher in women and the gender disparities increased with age. Women died also more frequently due to RHE compared to men. In total MSK disorders contributed to 180,746 comorbidity-adjusted DALYs for female and 116,063 comorbidity-adjusted DALYs for men in 2018, with LBP being the largest contributor (140,031 DALY).

Conclusions

The burden of MSK disorders has increased over the years. In 2018, 2.5 million Belgians were affected by at least one MSK disorder that resulted in almost 300,000 DALY. Our study provides valuable information of a part of the health burden that is known to have a great impact on the total burden of disease but that is sometimes disregarded by public health institutions.

Key messages

• MSK disorders represent a major health problem in Belgium.

• Acting on risk factors associated to these disorders is crucial to mitigate their burden.
Social environment and cardiometabolic health outcomes: systematic review and meta-analysis
Authors: Abreu TC , Beulens JWJ , Schoonmade LJ , Mackenbach JD
Published: October 2022

A number of studies investigated the relationship between the social environment (SE) (i.e., the social relationships and social context in which groups of people live and interact) and lifestyle behaviours. However, to what extent this relation extends to cardiometabolic disease (CMD) outcomes is unknown. This systematic review and meta-analysis summarizes the available evidence. We systematically searched PubMed (Medline), Scopus, and Web of Science from inception to 16 February 2021. Outcomes of were type 2 diabetes mellitus and cardiovascular diseases and determinants were SE factors. We assessed the quality of the studies with Newcastle-Ottawa Scale (NOS). We meta-analysed exposure-outcome combinations when ≥3 associations from high quality papers were available. Results are expressed as OR, 95%CI. From 7,671 records screened, 208 were included. Of these, 92% were conducted in high income countries, 58% were cross-sectional studies, and 20% were of poor quality. Among the 208 studies, 746 relevant associations were investigated. The largest number of associations investigated was on the dimension Economic and Social Disadvantage (ESD; 59%), followed by Social Relationships and Norms (21%) and Discrimination and Segregation (9%). Less evidence was found for the remaining dimensions. Meta-analysis of 14 exposure-outcome combinations indicated that worse SE was associated with increased odds of CMD outcomes. Despite this tendency, only the association between ESD and heart failure was statistically significant (1.58, 1.11-2.27; n = 4; I2=92%). Generally, heterogeneity was high. In conclusion, higher levels of ESD seem to contribute to increased risk of heart failure. The existing literature is highly heterogeneous and varies notably in terminology. Moreover, the dimensions Social Cohesion and Social Capital, Crime and Safety, Civic Participation and Engagement and Disorder and Incivilities are underexplored in relation to CMD. (PROSPERO-ID: CRD42021223035).

Key messages

• Worse SE was associated with increased odds of CMD outcomes, with higher levels of Economic and Social Disadvantage being statistically significantly associated with increased risk of heart failure.

• The existing literature is highly heterogeneous and varies notably in study design and terminology.
To what degree are health insurance enrollees aware of the restrictive conditions of their policies?
Authors: Van der Hulst FJP , Holst L , Brabers AEM , De Jong JD
Published: October 2022

Background

Over recent decades, many Western countries have added market incentives to their health systems. In a system of managed competition, health insurers are supposed to be prudent purchasers of health care on behalf of their enrollees. They can contract healthcare providers selectively. Enrollees who choose a health insurance policy with restrictive conditions, will have to make a co-payment if they consult a non-contracted provider. If the co-payment is unexpected, it may cause a problem for the enrollee. This study aims to gain insight into enrollees’ awareness of the conditions of such health insurance policies in the Netherlands.

Methods

In August 2020, an online questionnaire was sent out via health insurers to enrollees with restrictive health plans. In total 13,588 enrollees responded. Descriptive statistics and logistic regression analyses were performed on various outcome measures relating to enrollees’ awareness of the restrictive conditions.

Results

One fifth (19%) of the respondents appeared to be totally unfamiliar with the policy conditions. Men, younger people, people with a low level of education, a lower income, a poorer health status, and non-care users were found to be less familiar with the conditions (p = 0.00 for all). 62% who wanted to visit a healthcare provider whose care was not fully reimbursed, still went to that provider. Of those who had to pay extra because hospital care was not fully reimbursed, 62% did not know this in advance and 30% indicated that paying extra was a serious problem.

Conclusions

Not all enrollees who choose a policy with restrictive conditions are aware of the consequences of receiving care from a non-contracted provider. There seems room for improving the information provision, in particular for people with a low income and people with a poorer health status, as these groups more often reported unawareness about having to pay extra and more often faced financial problems.

Key messages

• Not all enrollees are well informed about their policy with restrictive conditions.

• Selective contracting does not always affect enrollees’ choice of a healthcare provider.
Socioeconomic position and self-rated health among adolescents: the mediating role of the family
Authors: Rattay P , Blume M , Spallek J , Hoffmann S , Sander L , Herr R , Herke M , Reuter M , Novelli A , Hövener C
Published: October 2022

Background

Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents’ health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants.

Methods

Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents’ education, occupation, income, socioeconomic position index, and adolescents’ subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity).

Results

A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained.

Conclusions

The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning.
The role of regional health policy for socioeconomic inequality in health services utilization
Authors: Iashchenko I , Schüttig W , Bammert P , Spallek J , Rattay P , Schneider S , Moor I , Pischke CR , Sundmacher L
Published: October 2022

Background

“J1” is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. “Ticket to J1” is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1.

Methods

We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES.

Results

The introduction of “Ticket to J1” increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1.

Discussion

Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.
Flu vaccination coverage in healthcare workers during a 3-year period in the context of the pandemic
Authors: Scardina G , Ceccarelli L , Casigliani V , Mazzilli S , Padovan M , Petillo A , Tavoschi L , Foddis R , Privitera G , Baggiani A
Published: October 2022

Background

Vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs and maintain essential healthcare services during influenza epidemics. With the present study we aimed to evaluate the efficacy of measures implemented during the three flu campaigns of 2018/19, 2019/20 and 2020/21 in a university hospital in Pisa, Italy, through the assessment of vaccination coverage (VC) in HCWs and to assess attitudes toward flu vaccination.

Methods

Flu VC was stratified according to sex, age, job and vaccination status for each season and the association between each variable and vaccination status was explored. In 2020, a survey collecting data on knowledge and attitudes on flu vaccination was distributed.

Results

Starting from the 2018/19 campaign, an increasing flu VC rate was registered: contained in 2019/20 (from 11.6% to 14.3%, Δ%=23.1) and significant (VC = 39.6%, Δ%=177.6) in 2020/21 as compared with the previous year. Physicians were the professionals most willing to get vaccinated during all seasons. Considering age the situation changed greatly over the study period, with VC rising in 2020/21 in those age groups marked by low VC in previous years (<30 and 41-50 years old, Δ%=293). Having been vaccinated in the previous year represented the most important variable to predict likelihood of accepting flu jab. However, while previously vaccinated HCWs were 13 times more likely to get the flu jab in 2019/20 compared with the others; in 2020/21 they were only 3 times. Only half of HCWS considered themselves at higher risk of contracting influenza compared to the general population, while 71% totally agreed that receiving the flu jab in 2020/21 was more important than the previous years due to COVID.

Conclusions

A significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years, due to the COVID pandemic that positively influenced vaccination uptake.

Key messages

• This study evaluates the impact of subsequent flu vaccination campaigns implemented in a large university hospital in Italy through the assessment of flu VC among HCWs.

• A significant increase in flu VC among HCWs was observed in 2020/21, especially in those categories characterized by lower VC rates in the previous years, more likely due to the COVID-19 pandemic.