bluuebunny/crossref_metadata_2025 huggingface dataset:
The development of HTA collaboration at European level and the challenge of the EU regulation
Authors: Ruether A , Petelos E
Published: October 2022

Issue

The establishment of HTA has been an important topic in Europe for many years. The engagement of HTA agencies, scientists, politicians and many other stakeholders throughout more than 20 years lead to the EU-HTA regulation, which came into force beginning of 2022. Now it is time to prepare for a sustainable European Network for HTA.

Description

The implementation of HTA in Europe is of high importance of the EU-commission for more than 20 years. Started with the first projects in 1994 (EUR-ASSESS) it needed quite a bunch of different projects and, in the end, three joint actions for finally providing legal ground for HTA with the EU-HTA regulation. This journey seemed a long one. However, referring to the need of addressing the requirements of Health Care of 27 Member States combined with the demand of reliable high methodological quality and applicability, investing all the time and effort for a sustainable European Network of HTA was definitely worthwhile. Joint Scientific Consultation (JSC) and Joint Clinical Assessments (JCA) will play a central role for national HTA and decision making in health care. But for understanding role, content, national uptake and further development of means, products and results of a European Network for HTA it is quite important to get a perception of the development of HTA collaboration in Europe. Based on this the challenge of the EU-HTA regulation and its implementation will be tackled easier.

Effects

Through provision of the main pillars of the previous EU-HTA collaboration the appreciation and understanding of the differences and complexities behind the HTA processes in the EU-healthcare systems will made aware. Based on this understanding the challenges of the implementation of the EU-HTA regulation will be discussed.
“We will take money from anywhere to support our work”: industry funding of humanitarian assistance in crises
Authors: Makhoul J , El-Ashkar C , Nakkash R
Published: October 2022

Background

Corporate funding has been described to be beneficial for humanitarian assistance in times of shrinking financial resources globally. Despite the growing global research on commercial determinants and their impact on population health, evaluations of corporate partnerships with humanitarian organizations and victims of multiple crises are rare. Conflicts of interest and corporate interference in public health policy and practice are well-documented. Health-harming industries are currently funding large scale projects for refugees in the eastern Mediterranean region which has witnessed humanitarian crises from armed conflicts. For example, food and beverage corporations and tobacco industries have funded projects to integrate migrants in their host countries, and offered educational scholarships to refugee children in Europe and beyond.

Methods

This research presents the experiences of humanitarian agencies in Lebanon on their funding from corporations, and the perceived influences on the populations served over a two-year period coinciding with a long-lasting refugee crisis, the COVID-19 pandemic, an epic economic collapse and the devastation of a large part of Beirut from a cataclysmic explosion in its port. The study used qualitative in-depth interviews with representatives of non-governmental organizations working in Lebanon with Lebanese and refugees.

Results

Funding from corporations starts with a two-way communication process between the organizations and the corporations, which recently started to be initiated by the corporations themselves after the Beirut blast. Funding from the tobacco, food and beverage industries is reported to come with conditions described to enhance their visibility, yet described as necessary, helps disadvantaged communities and sustains the organizations’ operations. Other results relating to the availability of guidelines for detecting and managing COI from corporate funding are discussed.
Corporate Capture of the laws application in Colombia: a new form of capture for public policy actions
Authors: Salcedo Fidalgo H
Published: October 2022

The law popularly known by the title ‘Junk Food’, was approved in Colombia in 2021 after years of advocacy from the Civil Society. Many authors as M. Mialon (2019, 2020, 2021) have documented the level of actions to intervene in the legislative space of the Parliament in Colombia created by the food industries to change the terms of the content of this law. Nowadays and after the approval of the text interpreted as a victory for Civil Society, Colombia is confronted with the re-regulation of the law, leading to a new form of capture: the capture of the spaces of decision-making actors in public health policy in the country. We present an analysis of the case from a follow-up study designed by our organization FIAN Colombia (human rights organization that advocates for the right to adequate food and nutrition). The data used in this process of monitoring and action research comes from the observational data of the advocacy scenario made during the debates of the law in the Colombian parliament, based on the proceedings of the work meetings with congressmen, academia and civil society. This research-action process makes it clear that the collective action of advocacy from civil society manages to mobilize conditions to denounce the corporate capture of decision-making spaces and the execution of public health policies, and generates pressures based on research free of conflict of interest to reduce this capture. Similarly, there is a capacity to demand accountability that was generated from this process in Colombia, and that turns out to be a pilot experience for other regions.
Contribution of compositional changes in the workforce to sickness absence trends in Finland
Authors: Leinonen T , Hartikainen E , Salonen L , Viikari-Juntura E , Solovieva S
Published: October 2022

Background

Information on factors driving work disability trends helps to evaluate the potential of interventions to improve the health and work ability of the workforce. We assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce.

Methods

Utilising register-based panel data on Finnish private and public sector employees aged 30-62, we examined the annual onset of compensated full sickness absence (granted after 10 working days) in the period 2005-2016. We applied random effects models adjusting for changes in observed sociodemographic factors of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for unobserved time-invariant characteristics of the study population over the years.

Results

Of the observed factors, increases in educational level partly explained the decreasing trend in sickness absences, and more so among women than men and among private than public sector employees. Changes in occupational class and industrial sector played little role in the public sector and only slightly further explained the sickness absence trend in the private sector. The decreasing trend in sickness absences appeared to be largely explained by unobserved time-invariant individual characteristics.

Conclusions

The decrease in sickness absences appeared to be more strongly influenced by compositional changes in factors that are established before fully entering the labour market - such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood - than in the work environment or other factors contributing at working age. Attempts to improve the health and work ability of the workforce should not only rely on interventions directed at the working age population, but also on those carried out early during the life course.

Key messages

• Compositional changes in the workforce should be taken into account when assessing sickness absence trends.

• Interventions aiming to improve the health and work ability of the workforce should be implemented already early in the life course and not only in working age.
Excess costs of multiple sclerosis: A register-based study in Sweden
Authors: Murley C , Tinghög P , Sebsibe Teni FS , Machado A , Alexanderson K , Hillert J , Karampampa K , Friberg E
Published: October 2022

Background and Objective

Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to MS, including primary healthcare.

Methods

An observational study was conducted of the 2806 working-aged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS. Register-based resource use was quantified for 2018. Annual healthcare costs (primary, specialised outpatient, and inpatient healthcare visits along with prescribed drugs) and productivity losses (operationalised by sickness absence and disability pension days) were quantified using bottom-up costing. Costs were compared between the people with MS and references with independent t-tests with bootstrapped 95% confidence intervals (CIs) to isolate the excess costs of MS.

Results

The mean annual excess costs of MS for healthcare were €7381 (95% CI: 6991-7816) per person with MS with disease modifying therapies as the largest component (€4262, 95% CI: 4026-4497). There was a mean annual excess cost for primary healthcare of €695 (95% CI: 585-832) per person with MS, comprising 9.4% of the excess healthcare costs of MS. The mean annual excess costs of MS for productivity losses were €13,173 (95% CI: 12,325-14,019) per person with MS, predominately from disability pension (79.3%).

Conclusions

The socioeconomic burden of MS in Sweden from healthcare consumption and productivity losses was quantified, updating knowledge on the cost structure of the substantial excess costs of MS.

Key messages

• Primary healthcare contributes around a tenth of the excess healthcare costs of MS in Sweden, primarily owing to contacts with healthcare professionals other than physicians.

• Overall, the excess costs of MS in Sweden from lost production are larger in magnitude than the excess costs for healthcare consumption.
Networking experiences for promoting HIA implementation in Andalusia
Authors: Martin-Olmedo P , Moya Ruano L , Martin Verdugo E , Rodríguez Rasero FJ , Martín-Jiménez JL , Marchena FJ
Published: October 2022

The Health Impact Assessment (HIA) is a useful tool that allows policymakers and project developers to predict and control the consequences of their proposals on the health and equity of the affected population. The existence of a legislative framework for the institutionalization of HIA has been proposed as a critical factor in providing permanent rules and in legitimizing HIA within the decision-making process. In Andalusia (Southern Spain), the HIA is legally binding after the approval of the Public Health Act 16/2011 and Decree 169/2014, which establishes the HIA procedure in the Andalusian context. This new legal framework made necessary to promote capacity-building programs in HIA, but also to develop an online platform that would allow sharing experiences and knowledge among all those public health professionals involved in the review and approval of HIA reports submitted by the developers of proposals. These tasks were addressed by a leading group of the HIA network made up of officials from the Regional Ministry of Health and experts from the Andalusian School of Public Health (EASP). The platform, set up in 2018, integrates around 90 professionals from different administrative bodies according to the proposal's scope (local, regional), covering the great geographical dispersion of Andalusia, and allowing to evaluate more than 2400 proposals in 4 years. The platform also facilitates the traceability of files (both for improving internal management and in responding to external queries), and acts as a source of relevant evidence, supporting the work of professionals involved in HIA. The platform allows extracting data and generating figures, showing information on the number of files created and resolved by different periods, provinces, type of proposals, etc. This tool has been very useful for the continuous training of professionals involved in HIA in Andalusia, following a coaching approach.

Speakers/Panellists

Robert Otok

ASPHER, Brussels, Belgium
Enablers and barriers associated with high MMR uptake among the Finnish Somali population
Authors: Hussein I
Published: October 2022

Introduction

In Finland, the Somali-speaking community is the fourth largest migrant group after Russian, Estonian, and Arabic-speaking communities. Finland is home to 21,000 Somali-speaking individuals, with around 70 % of them living in the capital region. Even though vaccine uptake in most ethnic minority communities is usually lower, MMR coverage in Finnish Somali children is partly higher than that of ethnic Finns.

Methods

We interviewed 30 Somali-origin mothers living in the capital region of Finland in terms of childhood vaccination acceptance, and in specific, issues affecting their children's MMR vaccine uptake. All interviews were conducted by a Somali researcher either in Somali or Finnish language. The interviews were recorded, transcribed, translated, and analysed using thematic analysis of the transcripts. To understand the enablers presented by the health care system in Finland, 10-15 public health nurses working in maternal and child health clinics in the capital region will be interviewed.

Results and discussion

Preliminary results show that trust in the health care system is the main enabler of high MMR vaccine coverage in the Somali population - even when mother's knowledge of the vaccine was very limited. In terms of information sources, mothers indicated that they ask, and trust maternal and child health clinics in all vaccine-related information- often more than any other source, including the internet.

Conclusions

This study enhances our understanding of system level enablers in the Finnish Somali community regarding MMR vaccination. The results of this study are applicable to improve vaccine uptake in other underserved minority communities throughout Europe.
Reported Barriers and Enablers to Undertaking Childhood Vaccinations by Bangladeshi Parents in East London
Authors: Ali I
Published: October 2022

Introduction

The Bangladeshi community living in the East London borough of Tower Hamlets is one of the UK's most socioeconomically deprived communities. Despite being a highly disadvantaged ethnic group with suboptimal health, the data suggests the uptake of several childhood vaccinations including the MMR vaccine is notably higher amongst this group, relative to other ethnic groups in Tower Hamlets.

Methods

This study employs a qualitative research design. One-to-one, semi-structured interviews will be conducted with Bangladeshi parents, alongside relevant healthcare and public health professionals involved in vaccination delivery in Tower Hamlets to understand the barriers and enablers to childhood vaccinations. Interviews will be conducted in English by the researcher or in Bengali/Sylheti using an interpreter. Interviews will be audio-recorded, transcribed, translated and analysed using a thematic analysis. The socioecological model will be utilised as a theoretical framework to guide the data collection and analysis.

Results and discussion

The preliminary results indicate parental trust in the safety of vaccinations, perceived health importance of childhood vaccinations, ease in accessibility and positive attitudes towards vaccinations within the community are notable enablers. Regarding barriers, parents have expressed reluctance on religious grounds towards childhood vaccinations which contain animal derivatives. The data also suggests differences exist between immigrant and non-immigrant parents in the decision-making process to undertake the vaccinations, with non-immigrant parents demonstrating a higher level of agency in their decision-making.

Conclusions

The study provides valuable insight into the barriers and enablers for childhood vaccinations amongst the Bangladeshi community in Tower Hamlets. This data may inform tailored initiatives to improve childhood vaccination uptake amongst other underserved communities with suboptimal uptake.
Setting targets for population health improvements: Trends in perinatal health in Europe over the past five years
Authors: Szamotulska K , Loghi M , Weber G , Heller G , Zile-Velika I , Isakova J , Monteath K , Jané Checa M , Zhang WH , Gissler M
Published: October 2022

Background

The Euro-Peristat network documented disparities in perinatal outcomes between countries in Europe in its reports published every 5 years, but trend analyses were limited because data were not collected annually.

Methods

Using the Euro-Peristat PHIRI protocol, we estimated rates and assessed trends between 2015 and 2019 for preterm birth, stillbirth, neonatal mortality and caesarean delivery. Country-specific relative risks (RR) for year, modelled as a continuous variable, were estimated and random effects meta-analysis used to generate pooled RRs. Heterogeneity was measured with the I2 statistic (percentage of variability in estimates due to heterogeneity rather than sampling error).

Results

Stillbirth rates ≥24 weeks of gestational age (GA) varied in 2019 from <2.5 per 1000 births in Denmark, Estonia, Finland and Slovenia to over 4 per 1000 in Belgium, Cyprus, UK Wales and Lithuania. Preterm birth rates ranged from <6% in Lithuania, Finland, Latvia, Estonia and Denmark to 8% or more in Portugal, Belgium, UK Scotland and Cyprus. Fewer than 20% of births were by caesarean in Norway, the Netherlands, Finland, Estonia in comparison to one-third in Cyprus, Ireland, Italy, UK Scotland. Trends over time differed between countries and were not related to the level of the indicator: the pooled RR by year for preterm birth was 0.99 [0.99; 1.00] with five countries having significant decreases and three countries having increases. Caesarean section rates were stable overall (RR: 1.00 [0.99; 1.01]RR:1.00, 95% CI: 0.99-1.01), but with high heterogeneity (I2=99%); in six countries rates increased significantly, whereas in nine rates decreased between 2015 and 2019.

Conclusions

European countries have varying rates and trends of the principal perinatal health indicators. Investigation of policies in high-performing countries could provide guidance for improvement elsewhere.
The inseparable relation between foresight and uncertainty
Authors: Hilderink H , Moye Holz D
Published: October 2022

This presentation starts with an interactive mentimeter poll to involve the audience. They will be asked several questions about what they find important in dealing with uncertainty in public health foresight studies.

Background

The future is per definition uncertain. Our knowledge about the future is obviously limited, especially when we look further into the future. Next to limited knowledge, people also have different ideas about what they consider a desirable future. All these aspects of uncertainty play a role when doing a foresight study. One of the challenges when doing a foresight study is to address these uncertainties in a systematic manner.

Methods

The cognitive uncertainty addresses the lack of knowledge, which can easily be extended to the information that can be inaccurate or unreliable. These cognitive uncertainties can vary widely, and can be classified according to location, level and nature of the uncertainty. Especially in foresight studies with a strong quantitative character, the cognitive uncertainties can be crucial and can form the basis of developing scenarios. Next to the cognitive uncertainties, normative uncertainties can be distinguished which address desirable futures. These represent the obvious differences in norms and values that people have when valuing health. There are several examples of public health foresight studies that include a proper consideration of uncertainties involved.

Conclusions

Applications of foresight studies in the field of public health are still limited. However, the recent years we see a broadening of initiatives of doing a foresight study, including addressing uncertainty in an more systematic way. Especially in public health, the normative uncertainty might play a rather relevant role.
Normative uncertainties in public health foresight
Authors: Den Hertog F , Ruiter H , Hilderink H
Published: October 2022

Background

People value health differently, based on the norms and values. This is important when looking into the future trends in health and health care., and the perception of challenges they may arise from these trends.

Methods

Together with stakeholders from a broad range of health-related professions, we identified several challenges for public health and healthy environments. Professionals working on these subjects came up with different goals and different ways to achieve them. These normative goals in health policies provide uncertainties in foresight, because they can be either synergetic or conflicting.

Results

In the Dutch Public Health foresight study of 2014 four societal challenges for public health and healthcare were identified and formulated, as follows: (1) to keep people healthy as long as possible and cure illness promptly; (2) to support vulnerable people and enable social participation’ (3) to promote individual autonomy and freedom of choice; and (4) to keep healthcare affordable. In 2022 we will update and deepen these perspectives on public health and at the same time we will broaden the usability of working with this method by focussing on environmental health.

Conclusions

To explicitly distinguish different perspectives on health leads to a better understanding and dealing with normative uncertainties by taking into account the trade-offs between competing interests and values. The challenge then is to identify policy options that have positive effect from different perspective, the win-wins.
3.B. Workshop: Quality of COVID-19 science: meta-research and the ethical implications for public health
Authors:   Organised by: EUPHA-EPI, EUPHA Research Pillar, EUPHA-ETH, EUPHA-PHG, EUPHA-HTA, UK Faculty of Public Health,   Chair persons: Stefania Boccia (EUPHA-EPI), Alastair Leyland (EUPHA)
Published: October 2022

Since the beginning of the COVID-19 pandemic, scientific researchers have had to balance the need to disseminate information rapidly while still maintaining high-quality standards of research design and reporting. Early meta-research efforts comparing the methodological quality of COVID-19 research with pre-pandemic medical research found a higher prevalence of observational studies with a shorter time from submission to acceptance, lower methodological quality scores, higher risk of bias, and lower number of participants. This workshop is intended to showcase some public health relevant meta-research that has assessed COVID-19 study quality during later phases of the COVID-19 pandemic, analysed transparency and integrity indicators, and revisited earlier studies in the light of stronger evidence. After three more technical presentations that will examine the role of meta-research in addressing some of the COVID-19 pandemic research challenges, an ethical overview of the concept of “the science” as an idea used in public decision-making and policy will be given.

Key messages

• Meta-research role of scrutinizing evidence as it is produced is even more important when scientific information is diffused at an expedited rate.

• Ethical questions might be as relevant as epidemiological ones when science is not able to be all that leads decision-making.
Quality of COVID-19 research: An overview of large-scale assessments and a case study on excess mortality estimates
Authors: Belbasis L
Published: October 2022

COVID-19 is an ongoing public health emergency, which affected individual and population health, whereas it disrupted social and economic activities for more than 2 years. High-quality research evidence, which is published without delays in the peer-review and publication pipeline, is the most powerful tool for evidence-based decision-making by physicians, public health and health policy specialists, and politicians. However, from the early stages of the pandemic till now, there is a debate on the quality of COVID-19 research, whereas it has been observed that the decrease in the time from submission to publication was accompanied by a decrease in research quality. This presentation discusses the findings and main conclusions from two research projects. The first part focuses on a systematic review of published large-scale qualitative evaluations of COVID-19 research. By taking advantage of these large-scale assessments, we will provide a bird's eye view on the quality of COVID-19 research done so far. The second part focuses on a case study describing the methodological quality of studies calculating excess mortality estimates during COVID-19 pandemic. Excess mortality estimates depend on important choices about the pre-pandemic reference period, the pandemic period of interest, and the modelling of the comparison between these two periods. Such an assessment has not been done yet although there is an abundance of published approaches to estimate excess mortality during the COVID-19 pandemic. Overall, these two projects highlight the importance of meta-research in the time of pandemic by scrutinizing and assessing scientific evidence while deriving recommendations for improvement of future research. This presentation concludes with a summary of the implications of low-quality COVID-19 research in decision-making and some general considerations to improve research quality and integrity in the case of future pandemics.
Main findings of the European Health Report 2021
Authors: Zelviene A
Published: October 2022

The EHR2021 examines the WHO European Region's progress towards the health-related SDGs, the impact of the COVID-19 pandemic on population health, and approaches to build back better from 2022 onwards. It provides insight into the main challenges related to the 3 core priorities of the EPW, which are moving towards UHC, protecting people better against health emergencies, and ensuring healthy lives and well-being for all at all ages. In this presentation, we will have look at these 3 core priorities in more detail. Although the European Region is making good progress for some of the SDG targets, challenges and delays exist across the core priorities. For example, the incidence of catastrophic health spending ranges from 1% to 19% across countries, and the European Region is one of two global regions where the overall number of new HIV infections is increasing. One year into the pandemic, 29% of health services were still at least partially disrupted in the Region. The impact of the pandemic aggravates the effort Member States will have to make to reach the health-related SDGs by 2030. Furthermore, there are large and persistent differences between Member States. The COVID-19 pandemic has exacerbated existing health inequalities by impacting vulnerable groups most severely. To build back after the COVID-19 crisis, the EPW will be the leading policy framework for the coming years to take on the challenges identified. The report shows that the evidence base for supporting the policy efforts that Member States will have to make for reaching the SDGs and working on the EPW core priorities is suboptimal. While the COVID-19 pandemic has emphasized the importance of health information and sparked innovative ways of data collection and processing, there are still data gaps for key indicators and operational challenges in HISs. Overcoming these issues in health information is critical for improving the health of the people in the WHO European Region.
The importance of digitalisation and data science for HIS strengthening
Authors: Novillo D
Published: October 2022

The COVID-19 (coronavirus disease 2019) pandemic has underscored the critical need for all countries to strengthen their health data and information systems and ensure the routes the data travel, from submission to use, are unobstructed. Timely, credible, reliable, and actionable data are key to ensuring that political decisions are data driven and facilitate understanding, monitoring, and forecasting. To ensure that critical decisions related to the wider health and socioeconomic effects of this pandemic are data driven, each country needs to develop or enhance a national data governance plan that includes a clear coordination mechanism, well-defined and documented data processes (manual or electronic), the exchange of data, and a data culture to empower users. In addition, countries should now more than ever invest and enhance their data and health information systems to ensure that all decisions are data driven and that they are prepared for what is next. Furthermore, strong enabling environments and advanced and digitized health information systems are vital to controlling epidemics. Sustainable finance and government support are required for the continued implementation and enhancement of HIS. It is important to promote digital solutions beyond the COVID-19 pandemic. Now is the time to discuss potential solutions to obtain timely, accurate, and reliable health information and steer policy-making while protecting privacy rights and meeting the highest ethical standards.
Classification and risk factors of Post COVID-19 condition: a longitudinal study in the Belgian population
Authors: Smith P
Published: October 2022

Background

Since the onset of the COVID-19 pandemic, most research has focused on the pathophysiology and management of the acute symptoms of COVID-19, yet some people tend to experience symptoms beyond the acute phase of infection, that is, Post COVID-19 condition (PCC). However, evidence on the prevalence of PCC, its symptoms, and mechanisms are still scarce. This study aimed to assess the distribution, patterns of symptoms, and associated factors of PCC in adult with confirmed COVID-19 infection in Belgium.

Methods

This is a longitudinal cohort study of Belgian adult population with recent COVID-19 infection confirmed via a molecular test and systematically recruited via national tracing call centers. A total of 5181 people were followed-up using online questionnaires at the time of their infection and 3 months later (from April 2021 to February 2022). Their physical, social and mental health was evaluated as well as their acute COVID-19 symptoms and persistent PCC symptoms. These different variables were self-reported.

Results

Half of the participants reported PCC (49.6%). The most frequent persistent symptoms 3 months after infection were fatigue (28%), headache (18%), and memory problems (12%). Women (OR = 1.67,CI95%=1.40-1.99), people with a lower level of education (OR = 1.23,CI95%=1.02-1.48), obese people (OR = 1.23,CI95%=1.02-1.48), people with chronic disease (OR = 1.97,CI95%=1.40-2.77), and people with a higher number of acute COVID-19 symptoms (OR = 2.56, CI95%=1.83-3.58) or hospitalised (OR = 2.19,CI95%=1.25-3.82) were more likely to report PCC. Finally, a latent class analysis on the 29 PCC symptoms highlighted 3 different classes of symptoms.

Conclusions

With the growing number of people infected with COVID-19, PCC is becoming an important public health issue. To allow people with PCC to recover, it is essential to have a multidisciplinary approach and to provide early post-acute physical and psychological rehabilitation interventions according to symptom patterns.
Perspectives of long COVID patients on their (unmet) needs: a national quantitative and qualitative study
Authors: Dauvrin M , Kohn L , Detollenaere J , Primus-de Jong C , Maertens de Noordhout C , Castanares-Zapatero D , Cleemput I , Van den Heede K
Published: October 2022

Introduction

After COVID-19, many people continue to experience various symptoms for several weeks, even after a mild acute phase, and encounter difficulties when confronted with the healthcare system. Patient associations asked the Belgian Health Care Knowledge Centre to investigate the needs of these patients to improve their management.

Purpose of research

An online quantitative survey was conducted in 2021 among Belgian patients with history of COVID-19; having/had persisting symptoms for at least 4 weeks. Alongside questions on symptoms, treatment and impact on employment, Health-Related Quality of Life (HRQoL) before and after COVID-19 was measured through the EQ-5D-5L. A regression analysis identified the factors associated with the impact of long COVID on HRQoL. The qualitative approach consisted in 33 interviews and forum discussions among 101 patients.

Results

1320 patients completed the online survey, most were symptomatic for more than 3 months. The average EQ-5D-5L index score was 0.85(95%CI:0.83-0.86) before and 0.65(95%CI:0.63-0.66) after infection. Duration, number and type of symptoms of long COVID significantly impacted HRQoL. More than half of the patients were unable to work. Qualitative part identified lack of empathy of health professionals, of systematic diagnostic approach, of interdisciplinary coordination. Patients felt misunderstood and developed their own diagnostic or treatment strategies. They questioned the value of medicine and resorted to non-reimbursed alternative therapies.

Conclusions

Long COVID has a significant impact on HRQoL and employment. Because of long COVID, patients were confronted, sometimes for the first time, with the imperfections of the health system. Better informing the health professionals on Long COVID patterns and management options, including reimbursement possibilities, and a comprehensive interdisciplinary assessment would give them the tools to respond to the needs of these patients.
Long COVID: health symptoms, impact on health-related quality of life and mapping to disability weights
Authors: Haagsma J
Published: October 2022

Introduction

Previous studies indicated that a significant share of COVID-19 patients experiences long lasting health complaints; a condition also referred to as “long COVID”. In order to assess the long term burden of disease of COVID-19, including long COVID, information is needed on health symptoms, health-related quality of life and duration of symptoms of long COVID patients. Therefore, the aim of this study was to assess health symptoms and health-related quality of life of long COVID in the general population of the Netherlands.

Methods

A total of 33,903 COVID-19 patients from the region South-Holland South (the Netherlands) whom tested positive between June 2020 and May 2021 at the municipal health services were invited to complete a web-based questionnaire on the presence, nature and consequences of long COVID and health-related quality of life, measured with the EQ-5D-5L.

Results

In total, 3,768 participants who completed the questionnaire experienced long COVID. Most commonly reporting symptoms were reduced physical condition (65.5%), fatigue (59.6%), problems concentrating (49.6%), loss of smell (41.2%) and shortness of breath (37.8%). 648 participants indicated that they experienced long COVID symptoms for 5 months or longer. Preliminary analysis showed that increasing number of symptoms was associated with a decrease in health-related quality of life.

Discussion and conclusions

Long COVID covers a range of health symptoms of varying severity and duration. This complicates the calculation of the non-fatal burden of disease of COVID-19, particularly because mapping of long COVID to existing disability weights is hampered.
Costs of air pollution impact on health in the Western Balkans: preliminary results
Authors: Belis C , Ballocci M , Matkovic V , Millo G , Jevtic M , Van Dingenen R
Published: October 2022

Air pollution is the main environmental driver associated with health. It is well documented that poor air quality is responsible for increased risk of mortality and morbidity. The social cost of mortality in 2015 was estimated in 3 trillion (OECD, 2016). The Western Balkans (WB) comprise Albania, Bosnia and Herzegovina, Kosovo*, North Macedonia, Montenegro and Serbia covering area of 218 750 km2 and a population of 19.9 million with total GDP of €94.2 billion (Banja et al., 2020). The WB was selected for this study because it is one of the air pollution hotspots in Europe where the levels of PM2.5, PM10, NO2 and O3 are frequently above the EU Air Quality Directive guidelines. This situation has been associated with a higher proportion of premature deaths attributable to air pollution exposure (4-19% of total deaths) in this region compared to EU member states (EEA, 2021). The health impacts including mortality and morbidity were estimated for particulate matter PM2.5, ozone (O3) and nitrogen dioxide (NO2) at country and city level on the basis of exposure in 2019 derived from monitoring stations and model estimations. Mortality impacts were parameterised using the number of premature deaths. Morbidity costs included: chronic bronchitis, hospital admissions due to respiratory diseases, hospital admissions due to cardiovascular diseases, bronchitis in children, asthma in children, reduced activity days and work lost days. The costs of mortality attributable to air pollution were estimated on the basis of non-market welfare based methods (WTP approach) while morbidity costs were estimated mainly with market based methods combining both direct and indirect costs. The 2019 health costs, both per capita and as share of the GDP, associated with air pollution in the WB were considerably higher than those in EU27.
Adapting and testing a tool to map digital health resources use by older adults in Israel and Taiwan
Authors: Levin-Zamir D , Baron-Epel O , Chang P , Neter E , Eliahu E , Duong T
Published: October 2022

Background

Despite the potential of digital health tools for improving health outcomes, older adults are known to use digital health tools differently than younger adults. Focusing on needs of older populations is critical, as their numbers and proportions are projected to increase dramatically in the coming decades, both in Israel and in Taiwan. A bi-national collaboration was developed to map existing digital health resources available to older adults, as part of a larger study on digital health services use among older adults.

Methods

A mapping tool was adapted from the WHO classification of digital health interventions, based on the experience in the Taiwanese and Israeli health systems. The areas included public health, prevention, self- monitoring and self-care information and services in primary and tertiary care. The mapping documented digital resources offered by governmental/Ministry of Health, public primary care (HMOs), hospitals, and non-governmental organizations. Sources of information were institutional websites, evaluated by two specially trained reviewers for each organization who assigned a dichotomous value (yes/no) for each category. Interrater reliability was computed using a Kappa coefficient.

Results

The instrument included 17 categories and 44 sub-categories of digital resources, ranging from public health information for emergency situations to specific health service characteristics. To date, the Kappa coefficients range from 0.59-0.68 for NGO, MOH and hospital resources, considered substantial; for 3 HMOs, the values ranged from 0.41-0.49, considered moderate.

Conclusions

The mapping tool adapted to the countries’ digital resources allowed for bi-national research to compare/contrast the countries’ experience. The next stage of the study will validate the results through expert interviews, followed by an end user survey with older adults to assess both reported use of services and enabling digital health literacy skills.

Key messages

• To meet the needs of aging populations, attention needs to be given to their engagement with digital health services and resources.

• Mapping digital health resources is essential for estimating how health needs are met nationally.
School tobacco policies and social inequalities in adolescent smoking
Authors: Mélard N , Lorant V
Published: October 2022

Background

Adolescents of lower socio-economic status initiate smoking earlier and smoke more frequently than those of higher socio-economic status. Tobacco control policies, such as school tobacco policies, aim to reduce adolescent smoking, but their implementation has been found to vary greatly from one school to another. Such differences in the implementation might therefore contribute to social inequalities in smoking. This study examines whether school tobacco policies are implemented where they are most needed, and how this implementation according to needs has changed over time.

Methods

Student (n = 18,805) and staff surveys (n = 438) were conducted in 2013 and 2016 in 38 schools from six European cities in six countries. School tobacco policies were measured as a 10-point score taking into account their multidimensionality, and the perceptions of both students and staff. We used concentration curves and indices to measure the inequality in the implementation of these policies depending on the smoking prevalence and on adolescents’ socio-economic status.

Results

A concentration curve below the perfect equity line indicated a concentration of school tobacco policies where smoking prevalence was lower. Moreover, this inequality was larger in 2016 compared to 2013 (concentration indices of .038 in 2013 and .041 in 2016). On the contrary, a concentration curve overlaying the perfect equity line indicated no inequality in the implementation of these policies depending on adolescents’ socio-economic status (concentration indices of .016 in 2013 and -.013 in 2016).

Conclusions

School tobacco policies have been developed to reduce adolescent smoking. They, however, seem to be less implemented in schools where they are most needed. This confirms that smoking prevention is still driven by the inverse prevention law. Next to evaluating the impact of such policies on smoking outcomes, research should also focus on their contribution to social inequalities in adolescent smoking.

Key messages

• School tobacco policies, developed to reduce adolescent smoking, might contribute to social inequalities in smoking.

• School tobacco policies are less implemented where they are most needed.
The role of gender equity in healthy life expectancy in 27 European countries
Authors: Leão T
Published: October 2022

Background

The number of years - and healthy years - a person is expected to live differs according to gender: women tend to live longer than men, but with a shorter healthy life expectancy (HLE). Power imbalance, such as income, prestige, or autonomy gaps, may lead to an unequal health distribution across gender in the older ages. The association between gender equality and longer life expectancies has been described, but little is known about its association with HLE. We aimed to study the association between gender equality, and its components, and HLE in Europe, in the last decade.

Methods

We combined HLE estimates from Eurostat with the Gender Equality Index (and its components) for 27 European countries, from 2013 to 2019. The associations between gender equality and HLE, and its gender gap, were assessed using regression analyses adjusted for Gross Domestic Product, number of medical doctors per 1000 inhabitants (as proxies of economic wellbeing and access to healthcare), and year.

Results

Higher gender equality was associated with longer HLE in men (β = 0.22 p < 0.01), but not in women. Yet, higher equality in education was associated with longer HLE in both genders (βmen=0.49, βwomen=0.40, p < 0.001), as was access to financial resources (βmen=0.27, βwomen=0.20, p < 0.005), and social power (βmen=0.09, βwomen=0.07, p < 0.05). Differently, equality in participation in full-time work was associated with shorter HLE in both genders (βmen=-0.33, βwomen=-0.30, p < 0.001) and a higher HLE gender gap (β = 0.05, p < 0.05). The HLE gender gap was smaller in contexts with higher equality in access to financial resources (β=-0.06, p < 0.001) and education (β=-0.04, p < 0.01).

Conclusions

These results point to a country-level relation between gender equality and HLE. Beyond the social issue, gender inequalities in education, income and social power seem to play a role in the health of women and men through their aging course.

Key messages

• Higher gender equality in education, income and social power are associated with longer healthy life expectancies in 27 European countries.

• Gender equality benefits not only women’s healthy life expectancies but also men’s, and is reflected in smaller gender gaps.
The fish paradox: people with low socio-economic status are not consuming the right type of fish
Authors: Zhu Y , Mierau JO , Riphagen IJ , Dekker LH , Navis GJ , Bakker SJL
Published: October 2022

Background

Fish intake is included in several national food-based dietary guidelines as a component of healthy diet because of its rich source of beneficial omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, heterogeneity among types of fish intake is rarely studied. We investigated the associations of socio-economic status (SES) with total and types of fish intake and validated whether types of fish intake was associated with plasma EPA and DHA.

Methods

From the Lifelines cohort study, 94 246 participants aged 44 ± 13 years old were included to test the association of two SES indicators, i.e., education level and income level, with dietary intakes of total, fatty, lean, fried, and other types of fish. Plasma EPA and DHA were measured in a minor subset of 575 participants (mean age: 50 ± 13 years old). Total and types of fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied, adjusted for relevant covariates.

Results

After adjusting for covariates, middle and low education were negatively associated with total, fatty, lean, and other fish intake (p < 0.001 for all), and positively associated with fried fish intake (β (SE): 0.04 (0.04), p < 0.001 for middle education; 0.07 (0.04), p < 0.001 for high education), with high education as the reference group. Similar results were observed for income level. In the subset population, total and fatty fish were positively associated with plasma EPA and DHA (p < 0.02 for all). Lean and other fish intake were positively associated with only DHA (p < 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p > 0.1 for all).

Conclusions

Lower SES was associated with higher intake of fried fish, which did not seem to be associated with the fish-based EPA and DHA in plasma. Both nutrition education and food price policy could be implemented to increase the awareness and shape people's choice on types of fish.

Key messages

• People with low socio-economic status are consuming the type of fish that is not associated with fish-based omega-3 fatty acids, so nutrition education focusing on avoidance of fried fish is needed.

• Food subsidy programs promoting intake and increasing affordability of healthier fish are needed to improve the nutritional awareness and status of our population.