bluuebunny/crossref_metadata_2025 huggingface dataset:
Health care disruption inequalities during Covid-19: Evidence from eleven longitudinal studies
Authors: Parsons S , Maddock J , Di Gessa G , Green MJ , Thompson EJ , Stevenson AJ , Kwong ASF , McElroy E , Silverwood RJ , Katikireddi SV
Published: October 2021

Like other health systems worldwide, the UK, the National Health Service (NHS) has faced major disruptions due to high Covid-19 burden and repeated lockdown measures. These disruptions can have both short and long-term health impacts. The NHS provides free healthcare and prioritises equity of delivery, but despite this, inequalities in access to health care remain and it is plausible that pandemic-related disruptions affect different groups disproportionally, thus widening health inequalities. This paper investigates associations between well-established axes of health inequality (sex, age, social class, education and ethnicity) and self-reported health care disruptions (medication access, procedures, or appointments) in over 65,000 participants across eleven longitudinal studies in the UK. Participants reported disruptions from March 2020 through to as late as January 2021. We obtained study-specific estimates using logistic regression models and combined them in a random-effects meta-analysis. Analyses were adjusted for sex, age and ethnicity where relevant. Between 10.1% (Millennium Cohort Study) and 31.8 % (Understanding Society) of study participants reported experiencing health care disruptions. Results show that females (OR: 1.27 [95%CI: 1.15,1.4]; I2=56%), older participants (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and non-white ethnic minorities (OR: 1.17 [1.02,1.34]; I2=0% vs white) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.18 [1.08, 1.21]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed for education. Our findings highlight inequities in healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.
Diet, physical activity, and sleep in relation to furlough during the COVID-19 pandemic in the UK: evidence from eight longitudinal studies
Authors: Maddock J , Wielgoszewska B , Green MJ , Gessa G Di , Parsons S , Griffith GJ , Croft J , Stevenson AJ , Booth C , Ploubidis GB
Published: October 2021

The recent Covid-19 pandemic, and its mitigations, are expected to have long-term consequences on the health and health behaviours. In an effort to reduce the effect of lockdown on the economy, the UK government launched their Coronavirus Job Retention Scheme (commonly known as furlough) in March 2020, which entitled employees who were unable to work to 80% of their monthly pay up to a cap of £2,500. We investigated the association between changes in economic activity and health behaviours of the working-age participants of eight longitudinal studies, during the early stages of the pandemic. Specifically, we investigate the post-pandemic levels, and the pre-to-post pandemic change, in fruit and vegetable consumption, physical activity, and sleeping patterns. We obtained study-specific estimates using modified Poisson regression, adjusting for a comparable set of potential confounders, and combined results in a random-effects meta-analyses. Compared to those who continually worked, furloughed workers were more likely to report an increase in their fruit and vegetable consumption (1.22 [1.04-1.43]; I2 = 52%), and an increase in their physical activity (1.19 [1.04-1.35]; I2 = 73%). However, furlough appears to have a polarizing effect on sleeping patterns (change from 6 - 9 h to outside this range: 1.46 [1.03, 2.08]; I2 = 75%; change from outside of the 6 -9 h to within this range: 1.78 [1.03, 3.07]; I2 = 75%), especially amongst women and those with no higher education degree. This polarization is partially explained by the age of the survey participants, indicating that sleeping patterns of the younger cohorts were more adversely affected. Furlough schemes may be associated with better diet and more physical activity, while inconsistent effects on sleeping patterns may place younger generations at particular risk of atypical sleep.
Changes in the utilisation of acute hospital care in Ireland during the first wave of COVID-19
Authors: Marron L , Burke S , Kavanagh P
Published: October 2021

Background

Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study was to quantify and characterise changes in acute hospital healthcare utilisation during the first wave of COVID-19 in Ireland to inform healthcare service planning and public health policy.

Methods

A retrospective, population-based, interrupted time-trend study was conducted, using two national datasets, from 6th January to 5th July 2020.

Results

Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed that there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%). Reductions were greatest at the peak of population restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, healthcare utilisation remained below pre-COVID-19 levels however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028).

Conclusions

Public health implications of delayed and lost care will become fully apparent over time. In the short-term, backlogs in care need to managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses, including the adoption of a pandemic recovery plan. In the long-term, COVID-19 has highlighted weaknesses in the health system and is an opportunity to progress reform towards a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

Key messages

The COVID-19 pandemic impacted non-COVID-19 healthcare utilisation in Ireland with evidence of delayed and lost acute hospital care and increased need for emergency mental health and alcohol services. Population health and health system recovery from COVID-19 is a public health priority.
Impact of the COVID-19 pandemic on the intensity of health services use in general practice
Authors: Rachamin Y , Senn O , Streit S , Dubois J , Deml MJ , Jungo KT
Published: October 2021

Background

The COVID-19 pandemic affects non-COVID-19-related health services use due to shutdown measures and fears of potential coronavirus infection or fears of overwhelmed health systems. We aimed to explore the impact of the shutdown in spring 2020 on the intensity of health services use (consultation counts, chronic disease measurement counts) in Swiss general practice.

Methods

Based on electronic medical records from 278 general practitioners in Switzerland, we built two patient cohorts: (1) Jan-Jun 2019 (173,523 patients); (2) Jan-Jun 2020 (179,086 patients). We used linear regression analysis to model weekly consultation counts, as well as weekly blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts, per 100 patients. We calculated expected values in absence of a shutdown and compared them to actual observed values in 2020. The analyses were repeated for selected at-risk groups (patients with hypertension, diabetes, or cardiovascular disease) and different age groups (<60 years, 60-80 years, and >80 years).

Results

During the shutdown period (calendar weeks 13-19 in 2020), weekly consultation counts were lower than non-shutdown models predicted. Consultation rates reduced by 17.2% for the total population, 16.5% for patients with hypertension, 17.5% for patients with diabetes, and 17.6% for patients with cardiovascular disease. Between different age groups, consultation counts reduced by 15.7% for patients aged <60 years, 20.4% for patients aged 60-80 years, and 14.5% for patients aged >80 years. Weekly BP counts reduced by 35.3% in the total population and by 35.0% for patients with hypertension. Weekly HbA1c counts reduced by 33.2% in the total population and by 29.8% for patients with diabetes. P-values were <0.001 for all reported estimates.

Conclusions

We found a significant decrease in the intensity of health services use in Swiss general practice during the shutdown in spring 2020.

Key messages

We demonstrate that the intensity of health services use in general practice decreased during the first Swiss shutdown in spring 2020, overall and among patients with chronic conditions. It is crucial that health systems remain able to meet the non-COVID-19-related health care needs of patients during shutdowns, especially for patients with chronic conditions who require regular care.
Effect of COVID-19 on maternal and neonatal healthcare services in Guinea: a hospital based study
Authors: Delamou A , Millimouno TM , Dioubate N , Semaan A , Delvaux T , Lenka B
Published: October 2021

Objective

The objective of this study was to analyze the effect of COVID-19 on routine maternal and newborn health services in three referral facilities in Guinea.

Methods

This was a cross-sectional study using routine facility data covering two years (2019-2021). COVID-19 effects were quantified using interrupted time series models. The use of services (intra-hospital deliveries and neonatal admissions) and outcomes (obstetric complications and neonatal deaths) were analyzed for the periods before (March 2019-February 2020), and during (March 2020-February 2021) the COVID-19.

Results

The mean number of monthly deliveries did not vary significantly before and during COVID-19 but that of induced labor increased significantly during COVID-19 (p < 0.001). Also, the monthly mean of neonatal admissions significantly decreased during COVID-19 (167 versus 124; p < 0.001). The mean number of monthly hospitalizations significantly decreased (123 before COVID-19 versus 87 during; p = 0.001). The mean number of monthly neonatal admissions in the pre-COVID-19 period significantly increased. Immediately after the start of the epidemic in Guinea (March 12, 2020), admissions declined significantly (64 admissions, 95%CI 102-27; p = 0.001). The mean number of monthly maternal deaths increased significantly during the pandemic (p = 0.002), as did the number of babies with low birth weight (p = 0.04). In the pre-COVID-19 period, there was a monthly increase of three neonatal deaths (95%CI 1.5 - 4; p = 0.001) but from the start of COVID-19, the monthly trend declined significantly and continued throughout the COVID-19 period (5 deaths/month, 95%CI 7-3).

Conclusions

The ongoing COVID-19 pandemic is jeopardizing efforts to achieve Millennium Development Goals for maternal and child health in urban settings in Guinea. For the country's health system to be resilient to crises such as COVID-19, there is a need for interventions to ensure the continuity of maternal and neonatal care.

Key messages

COVID-19 decreased monthly hospitalizations but increased maternal deaths in big urban maternities in Guinea. COVID-19 decreased neonatal admissions and deaths but increased low birth weight in referral neonatal units in Conakry, Guinea.
Covid-19 and population mental health in perspective
Authors: Galea Sandro
Published: October 2021

COVID-19 was accompanied by an increase in common mood-anxiety disorders in populations worldwide. This increase is consistent with what has been observed after other prior large-scale disasters but is larger in scale, scope, and duration. This has important implications both for our understanding of population mental health, and for how we may mitigate the mental health consequences of large-scale events.
Towards a human rights-based research ethics in intersex studies: Reflections from the INIA project
Authors: Mestre Martínez Y , Tamayo Velázquez MI , Suess Schwend A
Published: October 2021

Background

Intersex authors and allies identify human rights violations and ethical challenges in clinical practice and research. The Intersex - New Interdisciplinary Approaches (INIA) project trains 10 early stage researchers who develop research projects aimed at supporting the wellbeing and rights of intersex people. The INIA project includes the establishment of ethical procedures and discussion of ethical aspects. One of the INIA research projects focuses on the development of ethical principles in intersex studies.

Objectives

To present ethical procedures established in the INIA project, as well as reflections on research ethics. To summarise preliminary findings of the INIA research project “Research ethics in intersex studies”.

Results

The INIA project established ethical procedures based on international and European standards, an Ethics Advisory Board, as well as training activities on research ethics. The INIA consortium and researchers discussed ongoing ethical aspects, taking into account specific characteristics of research in the field of intersex studies. The INIA research project “Research ethics in intersex studies” reviewed ethical challenges in intersex-related research and ethical recommendations mentioned in the recent literature.

Conclusions

For guaranteeing the human rights of intersex people, the development of ethical principles for intersex-related research is identified as a relevant aspect. The INIA project aims at contributing to this process, understanding research ethics as an ongoing, reflexive practice.
How ready are European healthcare systems regarding the use of genomics in medicine? The Beyond 1 Million Genomes (B1MG) Maturity Level Model
Authors: Vicente A
Published: October 2021

The adoption of genomics by healthcare systems is crucial to fulfill the potential of Personalised Medicine for patients and citizens. This is a challenging undertaking, and requires from healthcare systems extensive adjustments in key issues, such as technical infrastructure, health professional competences or ethical and legal frameworks. The starting point requires an effective identification of specific challenges and barriers to the development and sustainability of each healthcare system regarding the efficient use of genomic data in medical or preventive care. For this purpose, we developed a Maturity Level Model (MLM) covering key aspects of genomic medicine programmes, including governance, ethics and legislation, genomics standards and best practices, clinical infrastructure and workforce organization, economic aspects and others. The alignment of healthcare systems to this MLM allows the identification of gaps and needs for progression within the model, and to systematically chart a path towards optimization of genomic data integration in mainstream healthcare.
Selecting indicators for signalling and monitoring the wider effects of the COVID-19 pandemic
Authors: Verschuuren M , Novillo D
Published: October 2021

Background

The COVID-19 pandemic and the actions taken to control the spread of the coronavirus have a substantial impact on population health beyond the morbidity and mortality caused by the virus directly. To provide a comprehensive picture of the pandemic's impact, suitable indicators for signalling and tracking these wider effects should be incorporated into monitoring activities. Therefore, WHO/Euro developed a tool to select indicators for this purpose.

Methods

Based on desk research and extensive expert consultation, a framework was developed for the main pathways through which the COVID-19 pandemic influences population health. For each pathway in the framework, underlying mechanisms and related indicator areas were defined. In addition, groups that are particularly vulnerable to the wider effects of the pandemic were identified, as these require specific attention in monitoring exercises.

Results

The main pathways through which the pandemic impacts general population health as used in the tool are:

Fear of getting infected or spreading infection Impaired healthcare for non-COVID-19 conditions Direct effects of containment measures Indirect effects of containment measures through risk factors Indirect effects of containment measures through wider determinants of health

A total of 27 underlying mechanisms and related indicator areas were defined. E.g., one underlying mechanism under the first pathway involves stockpiling disinfectants and cleaners. This results in people being more exposed to dangerous substances and applying disinfectants improperly, which leads to an increase in poisonings. Identified vulnerabilities relate to people's age, gender, socioeconomic status, place of residence/living situation, morbidity/disability status, and refugee or migrant status.

Conclusions

Developing a conceptual framework provides a useful approach for structuring widespread and complex developments such as the wider health impacts of the COVID-19 pandemic.
Digital Marketing of unhealthy products to children: evidence from the WHO CLICK framework
Authors: Wickramasinghek K , Hetz K , Zhiteneva O
Published: October 2021

The rates of childhood obesity are rising, the “on-screen” times of children are increasing, and the marketing strategies are more personalized and targeting than ever. Exposure to digital marketing of unhealthy foods to children and adolescents is a major concern as food and beverage companies can target advertisements to specific children or adolescents based on their online profiles, personal characteristics, and previous browsing history. The WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) developed the CLICK monitoring framework to support Member States to objectively monitor digital marketing as well as to enable them taking action in regard to marketing related regulations and policies, and to support their implementation. The CLICK frameworks address several important aspects of marketing that countries should consider when evaluating the national digital ecosystem. In two steps of the framework applications are used to monitor the marketing exposure of children and adolescents. One application captures all paid for advertisements children see when spending time on smartphone apps like social media platforms or YouTube. The second app complements these collected data by capturing indirect marketing like product placements and products advertised and promoted by influencers. Even though the monitoring framework provides important insights and clearly presents the need for strict marketing regulations, some areas where children are heavily exposed to marketing of unhealthy products are still understudied. One example is the field of online gaming.
Developing a proposal for an updated digital public health curriculum
Authors: Vital Brito D , Wong B , Buttigieg S
Published: October 2021

Digital health is a strategic priority for the future of health in Europe. But development and deployment of digital solutions is not enough to guarantee a successful implementation. Public health services require a workforce that is ready to search and evaluate the best digital solutions for specific public health activities, such as epidemiological surveillance and health planning. Although there are some examples of digital health updated curricula in medical and public health schools, a coordinated and comprehensive approach should be proposed in Europe, including undergraduate, postgraduate and continuous education. Young professionals are certainly more digitally literate and should be involved in this discussion, but public health professionals from different ages and backgrounds should be considered. This presentation aims to promote discussion about digital public health education, identifying proposals for a renewed curriculum. During this discussion participants will be organized in small groups and will discuss proposals for a digital public health curricula, specifically tailored for three different target audiences: undergraduate medical students, public health students and public health professionals. This discussion will be guided by a facilitator and main conclusions will be considered for a concrete proposal prepared by the EUPHA Digital Health section. All participants will be offered the chance to be involved in following discussions.
3.H. Workshop: The role of HTA for COVID-19 vaccines: present and future perspectives
Authors:   Organised by: EUPHA-HTA, EUPHA-ECO, HTAi,   Chair persons: Chiara de Waure (EUPHA-HTA), Elena Petelos (EUPHA-HTA)
Published: October 2021

It is well known how vaccines typically require many years of research and testing before being on the market, but in 2020 the COVID-19 pandemic pushed scientists to embark on a race to produce safe and effective SARS-CoV-2 vaccines in record time. In such an emergency situation, striking the right balance between urgency and acceptable safety and efficacy evidence is challenging. Furthermore, other relevant issues need to be more comprehensively addressed, including cost-effectiveness of vaccination campaigns and real-world data on effectiveness and safety. Currently the European Medicines Agency (EMA) has approved for use four vaccines against COVID-19. Data on their efficacy and safety will continue to be collected beyond licensure and submitted to EMA, but the need for a more complete assessment, which includes contextual and societal considerations (e.g. impact on population health, population's demand, attitudes and behaviours, ethical considerations) and economic analysis, is unquestionable to support national decision-maker processes. In this kind of “holistic” approach, the Health Technology Assessment (HTA) could be the answer in order to support the allocation of resources into different COVID-19 vaccines and to make it possible a timely and equitable access to vaccination. As also stated in the HTAi Position Paper on “HTA's Critical Role in the (Early) Assessment of (potential) Vaccines to prevent the spread of COVID-19 globally”, the following issues should be carefully tackled: 1) affordability, sustainability and distributional effects; 2) cost-effectiveness considerations; 3) fostering HTA collaborations; 4) need for early, adaptive and living HTA. Accounting for such issues is essential to ensure that HTA is successfully implemented in the field of COVID-19 vaccines, at the present time and in its future developments on a national and international scale. This workshop will discuss how HTA could help the EU-wide and national decision-making process about COVID-19 vaccines.

Key messages

An adapted and living HTA framework considering the unique characteristics of COVID-19 vaccines could be an answer to current and future challenges in vaccination campaigns. There are several challenges in current and future HTA of COVID-19 vaccines, namely the evaluation of their broad economic impacts, their effectiveness and safety and organization issues.
The role of HTA in COVID-19 vaccination campaign: the Italian experience
Authors: Cadeddu C , Ricciardi W
Published: October 2021

Issue/problem

Italy was one of the four European countries that started to join forces to accelerate access and distribution of a much-needed vaccine against COVID-19. When the first vaccine was approved, a National Strategic Plan for COVID-19 vaccination, examining the most relevant domains for Health Technology Assessment (HTA), has just been issued in Italy.

Description of the problem

Considering the possible provision of COVID-19 vaccines in the short time, in Autumn 2020 the necessity for a comprehensive assessment came up. In Italy HTA has been identified as the method for assessing the broad value of existing and new vaccines by the last two National Immunization Plans. However, the pandemic highlighted the need for a quick introduction and distribution of COVID-19 vaccines. A multidisciplinary Steering Group was therefore appointed by the Ministry of Health, in order to define vaccination strategies, organizational models, economic aspects, communication and social issues.

Results

Taking into account plans already released by other countries, a National Strategic Plan for COVID-19 vaccination was issued in December 2020. Main topics covered were: epidemiology and priority groups to be immunized, logistic and organization, efficacy and safety monitoring, economic and burden of disease assessments, communication. The application of these recommendations has finally proven to be difficult, because of vaccines procurement delays, suspected adverse events, inequalities in the different Regional settings.

Lessons

Given the concerns and difficulties faced by Italy and other European countries in the appraisal and management of COVID-19 vaccines, a HTA adapted framework could be an option for guiding the definition of National Strategic Plans. This could offer a common structured approach, make decision-making process more transparent, and be significant for a timely, convenient, and affordable access to new vaccines against SARS-CoV-2.
3.I. Workshop: Getting real with future shocks: How to test health system resilience?
Authors:   Organised by: European Commission, HaDEA,   Chair persons: Massimo Fagnini (European Commission)
Published: October 2021

Resilient health systems should be able to both respond to sudden shocks and adapt to structural changes. Structural fragilities in the health systems of EU countries were present before the COVID-19 pandemic and the crisis has just exacerbated these weaknesses, along with creating acute response capacity shortages. It became clear that health systems were largely unprepared for a shock of this magnitude. In order to be better prepared and able to respond more effectively towards the next health emergency, it is important to have robust tools and methods to measure the level of resilience in health systems. The workshop will present a new concept to carry out resilience testing of health systems against potential future shocks and adverse scenarios based on the opinion of the European Commission's Expert Panel on effective ways of investing in health. This will be followed by a discussion with experts on the practical development and implementation of this methodology.

Format of the workshop:

Pitch on the resilience testing concept by a member of the Expert Panel on effective ways of investing in health (10 minutes) Responses by experts from three EU Member States and discussion (40 minutes) Concluding remarks by the OECD and the Observatory on Health Systems and Policies (10 minutes)

Speakers/Panelists

Heather L. Rogers Biocruces Bizkaia Health Research Institute, Barakaldo, Spain Lenka Poliaková Health Insurance Supervision Department, Ministry of Health, Czechia Judith de Jong NIVEL, Utrecht, Netherlands Sabrina Montante National Institute of Health of Italy, Brussels Office, Brussels, Belgium Gaetan Lafortune OECD, Paris, France
Individual and organizational perceptions of hospital workers during COVID-19: the link with burnout
Authors: Bashkin O , Davidovitch N , Asna N , Schwartz D , Dopelt K
Published: October 2021

Background

The COVID-19 crisis poses challenges to healthcare systems and their employees. Medical staff are at the front of the battle against COVID-19. They must cope with a crisis accompanied by personal health and occupational ramifications and ongoing job stressors, which may lead to adverse mental health symptoms and may affect the quality of medical care provided to patients. This study evaluated health workers' perceptions and concerns about the COVID-19 crisis and its management in an Israeli hospital.

Methods

At the end of the pandemic's first wave in Israel, 547 healthcare workers responded to an online survey, which inquired about COVID-19 concerns at the individual and family level, perceptions at the national and organizational level, perceptions of the way the crisis was managed, self-assessment of coping with the crisis and burnout, and demographics.

Results

Findings showed that healthcare workers expressed deep concerns for family members and apprehension at a national level. Respondents noted that they were coping well with the crisis while expressing negative perceptions of how the crisis was managed. The regression model showed that concerns for family members, perceptions at the system level, working directly with COVID-19 patients, and having negative perceptions towards the crisis management at the national level, were associated with burnout.

Conclusions

The findings of this study deepen our understanding of issues that require systemic attention to strengthen mental resilience among hospital staff. Several actions are recommended to improve healthcare systems' ability to continue fighting the virus and confront future health crises:

Further examination and monitoring of healthcare workers' concerns and job stressors. Providing psychosocial support plans for frontline workers to ensure their safety and health and prevent burnout. Strengthening supportive organizational culture.

Key messages

Healthcare workers express deep concerns and perceptions associated with burnout. Health services management needs a good understanding of workers' concerns and develop strategies to address them.
Capacity building of health professionals in Guinea: a successful e-learning experience (2017-2021)
Authors: Delamou A , Millimouno TM , Kolie JM , Van Bastelaere S , Delvaux T
Published: October 2021

Background

Strengthening the capacities of health professionals (HPs) in public health is a necessity in the context of recurrent epidemics in Africa. The objective of this study was to describe the process and results of an innovative online training program implemented in the post-Ebola context in Guinea between 2017 and 2021.

Methods

The courses were developed in French in 2017-2018 by the Maferinyah Training and Research Center in Guinea with technical support from the Institute of Tropical Medicine (ITM) of Antwerp (Belgium). The Moodle platform was used to locally manage and deliver these courses. A cross-sectional study using mixed research methods was carried out.

Results

Three courses of three months duration each (6 to 8 modules) were developed and delivered between 2018 and 2021 on primary health care (eSSP), management of sexual and reproductive health services (eSSR), and research methodology. The online training on the Moodle platform was followed by a face-to-face capacity-building workshop. Of 479 HPs from 13 nationalities enrolled in the courses, 68.1% (326/479) completed the training and 80.4% of them (262/326) validated it (54.7% among all registrants). The success rate of women (56.7%) was higher than that of men (54%) and remained higher among Guineans (55.3%) compared to foreigners (51.4%) but these differences were not statistically significant. The success rates for the eSSP (47.7%), eSSR (58.5%) and eMR (59.1%) courses were also comparable. The learner satisfaction score ranged from 60 to 100% for different aspects of the courses.

Conclusions

It is possible to offer online courses in a limited resource setting like Guinea. However, involving women in online training remains a challenge.

Key messages

It is possible to offer online courses in a limited resource setting like Guinea. Involvement of women in online training remains a challenge.
Life is a rollercoaster: an exploration of a support group for parents and carers of those with children and young people with mental health difficulties
Authors: Fothergill-Misbach N , Perkins N , Rutter N , Wood M , Henderson E
Published: October 2021

NHS Digital reported that one in eight children aged 5 to 19-year-old in England were identified with a mental illness, the most prevalent being emotional disorders. A diagnosis of a mental illness has a clear impact on children or young people and can also impact the health and wellbeing of family members, in particular parents and carers. We will share and discuss findings from a co-produced evaluation of a nationally recognized support group, Rollercoaster, a well-established and popular parent support group in the UK, for carers of children and young people with mental health difficulties. We will illustrate “what works” in setting up and running a support group for parents in the UK and more widely. The audience will learn what matters to the parents and carers regarding support and in terms of offering support, and how to effectively run a successful support group. Specifically, the evaluation focused on what principles could be drawn from Rollercoaster, given the wide gap in local services offering targeted support for carers. We therefore created a framework to aid in the development of other, unique support groups designed to meet the needs of their local populations. We carried out a parent/carer survey; interviews with parents/carers, support group workers and wider stakeholders; and observations of support group activities. Applying a “lesson drawing” method, we grouped what participants said around the following areas: 1) specific activities offered by Rollercoaster; 2) people who set up and run a parent/carer support group; 3) how to make a parent/carer support group successful. Engaging a wide range of parents/carers and stakeholders at every stage in the design of activities was seen as paramount. A range of skills are required by different people at various points in setting up and running the group. Success rests on constantly adapting to internal and external developments and having a bedrock of being parent led and professionally supported.
Systemic biomarkers for the preclinical diagnosis of dementia
Authors: Biarnés-Martínez M , Hernáez A , Subirana I , Martínez-González MA , Corella D , Salas-Salvadó J , Ros E , Estruch R , Fitó M , Castañer O
Published: October 2021

Background

As a consequence of aging and the age-related cardiovascular risk, both of them closely associated to neurodegenerative diseases, dementia has become one of the major public health concerns for governments and the scientific and medical communities. Up to date, there isn't any front-line screening tool implemented at a population level. In this regard, we aim to assess the association of several systemic biomarkers related to neuroinflammation [lactate dehydrogenase (LDH), complement component 3, C-reactive protein, alpha-1-antitrypsin, alpha-2-macroglobulin (α2M) and pancreatic prohormone], lipid metabolism [apolipoprotein E, 24S-hydroxycholesterol], and neuronal integrity [tau protein], with dementia risk in an adult-elderly population at high cardiovascular risk.

Methods

We designed a case-cohort study nested in the PREDIMED cohort (110 incident cases of dementia, 251 non-cases). Participants were at high risk for cardiovascular disease (CVD), but had no clinical CVD neither dementia at the time of enrolment. Inclusion criteria were an age of 55-80 years old and the presence of diabetes type 2 or at least 3 cardiovascular risk factors (smoking, overweight or obesity, hypertension, dyslipidemia, and family history of premature CVD). We used Cox proportional hazard models to estimate hazard ratios (HR) of the association between these nine plasma biomarkers and dementia risk adjusted for several covariates.

Results

Dementia cases were older, presented higher levels of fasting glucose and were more likely to have type 2 diabetes. The prevalence of dyslipidemia and smoking in patients with dementia was lower. Dementia cases had higher levels of LDH and α2M. Higher LDH levels were associated with a higher risk of developing dementia after adjustment (HR = 1.19).

Conclusions

Higher LDH plasma levels are associated with a higher risk of dementia incidence in population at high cardiovascular risk.

Key messages

Higher levels of LDH are associated with higher risk of dementia incidence among adult-elderly individuals with a high cardiovascular risk profile. The early detection of this biomarker could enable an early intervention and to delay, or perhaps even prevent, the onset of clinical symptoms.
4.F. Round table: Clear communication in the face of changing evidence: the example of COVID-19 prophylaxis
Authors:   Organised by: EUPHA, EuroHealthNet,   Chair persons: Alastair Leyland (EUPHA), Alison Maassen (Belgium)
Published: October 2021

Clear communication of scientific evidence remains important, as dramatically highlighted by COVID-19. But what does clear communication look like if the evidence keeps changing? Along with the known problems of fake news, disengagement and science scepticism, there is the problem of scientists presenting conflicting views on the same topic. Alternatively, changing evidence can lead to scientists saying something but, in the light of new evidence, revising their conclusions and the scientific message. In the case of COVID-19, the lack of clear scientific messaging in the early days of the pandemic opened the debate to politics and culture, lowering trust in science and politicizing mitigation measures such as mask wearing. What lessons can be learned from the COVID-19 experience in order to improve future scientific communication, even in the face of uncertain evidence? What are the roles of different actors, such as epidemiologists, behaviour change specialists, science journalists, policymakers and international actors like the WHO in shaping this narrative? How can they improve their future collaboration so that scientific communication with the public becomes more transparent, equitable and trust-building?

Short presentations:

Prophylactic measures taken in times of COVID-19 - Ricardo Mexia, Portugal (vice-president EUPHA-IDC) Contribute to the effectiveness of COVID-19 prevention measures, by making available state-of-the-art behavioural and communication science expertise - Mariken Leurs, RIVM Key considerations for risk communication and community engagement - Cristiana Salvi, Communication Officer, WHO Europe How protective masks went from don't wear to must have - Megan Molteni, journalist Panel discussion with the audience

Key messages

Transparency in communicating evidence is essential for clear and usable communication. Open dialogue on what we know and what we do not yet know is key to communication evidence.
Identifying the carers’ profiles of health literacy, eHealth literacy and caregiving concepts
Authors: Efthymiou A , Middleton N , Charalambous A , Papastavrou E
Published: October 2021

Background

Carers of people with dementia (PwD) undertake the role of supporting their relatives in everyday life and caring tasks, sometimes without adequate knowledge of the progression of the disease, practical advice and support mechanisms or services. This study aims to describe the Health Literacy (HL) and eHealth Literacy (eHL) profiles of carers of PwD in Greece and Cyprus and to explore associations with dimensions influenced by the delivery of care.

Methods

This descriptive correlational design study measured HL (HLS-EU-Q16 tool), eHL (eHeals-Carer) and dimensions of care (Brief-COPE, caregiving self-efficacy, COPE index and Multidimensional Perceived Social Support). In total, 174 primary carers of PwD and 67 secondary carers participated in a face-to-face survey. Correlation and regression analysis were performed to explore associations between the concepts of interest and cluster analysis (N = 123) to identify profiles of carers.

Results

Carers, primary and secondary, reported high scores of eHL and HL. HL scores were associated with eHL and both variables with the two dimensions of caregiving self-efficacy: “obtain respite” and “behavior management”. Three carers' profiles were identified: 1) carers with high levels of HL, eHL, Self-Efficacy and low coping strategies, 2) carers with problematic coping, negative caregiving perceptions, and lower HL and eHL, and 3) carers with high HL and eHL, with strong Social Network, high emotional-focused coping strategies and low problematic coping.

Conclusions

Understanding the role of HL and eHL in the caregiving process and identifying carers' profiles could assist healthcare professionals in their educational role with families and planning of care. There is a need to develop more ways to assess these concepts for this population and to develop training courses focusing on enhancing the HL skills of carers and healthcare professionals.

The COST action NET4AGE-friendly supported the conference participation.

Key messages

HL and eHL are related to the caregiving role and may not only influence health-related decisions made by the carers on behalf of their relatives but also their own self-efficacy and coping. HL and eHL should be appropriately assessed and taken into consideration by healthcare professionals in management plans for PwD and their families.
Can AI learn to identify systematic reviews on the effectiveness of public health interventions?
Authors: Read K , Husson H , Dobbins M
Published: October 2021

Issue/problem

Health Evidence™ aims to make it easier for public health professionals and decision-makers to use evidence in their programs and policies. We provide access to over 7,000 critically appraised systematic reviews on the effectiveness of public health interventions. On average, 8,000-10,000 records are screened each month to identify around 50 relevant reviews that are critically appraised and uploaded to the registry. As the number of published reviews continues to grow each year, maintaining an up-to-date Registry is becoming increasingly resource intensive.

Description of the problem

Artificial intelligence (AI) may be one way to ensure maintenance of this Registry continues to be feasible. It is important that the use of AI is accurate and efficient to support monthly relevance screening for the Health Evidence ™ Registry. To assess if the use of AI is appropriate in this context, the team uploaded a large, labelled training set (n = 43,273) of relevant and non-relevant records to DistillerSR and used the AI Preview and Rank function to predict the probability of relevance to the Registry. We identified an optimal threshold (0.17) that automatically removes the greatest number of records with minimal classification errors. We then tested this threshold on one year of manually screened records (n = 89,832) from May 2019 to June 2020 to ensure continued accuracy.

Results

Using AI to support our monthly relevance screening has reduced our monthly manual screening burden by over 77% (from ∼9,000 references manually screened per month to ∼2,000) saving upwards of 10 hours staff time per month!

Lessons

The use of AI shows promise to help improve the feasibility of maintaining a large Registry of quality appraised synthesis level evidence relevant for public health decision making.

Key messages

Health Evidence™ provides easy access to high quality synthesis evidence relevant for public health. The use of AI shows promise for helping to automate the Health Evidence™ monthly update and improve the feasibility of maintaining a public health registry of quality appraised synthesis evidence.
Public Health Infographic Design for the public – the evidence base
Authors: Stones C
Published: October 2021

In order to make effective infographics, one needs to understand the science behind public health infographic design. This presentation introduces guidelines for public health infographic design based on gathered academic evidence of effectiveness as well as information design principles. We tackle the topic from a variety of angles exploring issues of attention, comprehension, recall and behavioral change and focuses on infographics designed for a lay audience. Despite the exhaustive research conducted on say, graph comprehension, there remains a gap in how we account for the effectiveness of public health infographic design more broadly. The presentation also covers a brief examination of ‘hidden' historical precedents for the design of engaging health infographics, beyond the oft-cited visual work of John Snow or Florence Nightingale. We argue that notions of data spectacle and the need to grab attention remain vital today. The presentation concludes by reflecting on the future of infographics for displaying public health data, particularly with reference to the use of COVID-19 graphics in 2020/21.
Mental health problems and COVID-19 – which came first, the chicken or the egg?
Authors: Belscak Colakovic A
Published: October 2021

It was very clear that the COVID-19 pandemic will have an impact on mental health from the first day that it was declared.However, the scale and magnitude of the impact changed as the pandemic persisted, progressed, and transformed. After a year of social distancing, distance education, and virtual concerts, the societal fabric has changed to such an extent that it will most likely produce a long lasting impact on public mental health. The presentation will focus on the indicators of public mental health obtained from the SI-PANDA research, a bi-weekly web panel survey with a nationally representative sample of 1000 respondents per each wave of the survey. The 5-item World Health Organization Well-Being Index (WHO-5) was used to measure mental health. A cut-off score of ≤ 50 was used to screen for mental health problems, and a cut-off score ≤28 to screen for major depression. Results of the repeated cross-sectional surveys indicate continuation of trends that were present pre-pandemic. Namely, higher prevalence of mental health problems among people with lower education, adolescents and young adults, people with pre-existing chronic conditions, and people experiencing worsening financial situation during the pandemic. Trends from SI-PANDA research show that the differences (or inequities) in mental health are deepening as the pandemic progresses. People with mental health problems are at greater risk of experiencing worsening mental health during the pandemic as well as experiencing other adverse health outcomes - which are themselves a risk factor for worsening mental health. Is the downward spiral of poor mental health and COVID-19 the story of health inequities or is it a new phenomenon built on top of inequitable society?
Gender issues and revival of inequalities
Authors: Hocevar Grom A , Buzeti T , Gabrijelčič Blenkuš M
Published: October 2021

In Slovenia, the share of the female workforce is one of the highest in the world, with almost 90 % of employed women by generation in some age groups in active years. COVID-19 syndemic has affected women far more than men in their daily working practices. We could observe higher educated women have been working from home in 36 %, in comparison to higher educated men (22,2 %). The difference is even bigger in lower educated women, working from home in 32 %, in comparison to mail workforce (14,7 %). That could mean they were taking care for children, supporting them in distance learning. At the same time, women are reporting on more intensive worsening of their financial situation in the last three months during COVID-19 syndemic - among higher educated women, 26,2 % report on worsen financial situation, in comparison to men with the same education (18,2 %). Comparable results we could observe in lower educated female (33,1 % with worsened financial situation) and male respondents (25,6 %). Women are also more doubtful and are refusing vaccination (33,9 %) in higher share than men (21,3%), putting themselves to higher risk for COVID-19 infection. It is of upmost importance for the governments at any level to consider the gender equity and female perspective of any measure, adopted in the recovery phase.