bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting the mental health of working migrants during the COVID-19 pandemic
Authors: Benavente P , Ronda E , Diaz E
Published: October 2023

Background

The COVID-19 pandemic consequences were amplified in groups in vulnerable situations, and migrants have been overrepresented in the COVID-19 statistics worldwide. Specifically, the consequences on mental health might have differential mechanisms for migrants. Particularly, working migrants could be in more vulnerable situations as they often work in essential jobs, with high exposure to disease and are subject to high unemployment rates. Studies suggest that complex interactions between individual and structural factors could help explain the differential impact of the pandemic among migrants. Our study aimed to explore the experiences of migrants working in Norway during the COVID-19 pandemic. This study is a secondary analysis to identify factors affecting migrants’ mental health and well-being.

Methods

We conducted in-depth personal interviews with 20 working migrants from different working sectors in Bergen and Oslo, using a purposive sampling method. Thematic analysis was used.

Results

Migrants’ mental health was affected by several factors classified into two levels: workplace and host country context. Discrimination was the only migrant-specific factor and was found at both levels. Among workplace-related factors, the pressure from companies to vaccinate against COVID-19 negatively affected mental health. At the host country context, the effect of the Norwegian welfare system was predominantly positive on migrants’ well-being. Like increased discrimination, social isolation was found at both levels and might have a differential impact on migrants.

Conclusions

Several factors negatively and positively affected the mental health of working migrants during the pandemic. Further research on these factors with an intersectional perspective is needed. This knowledge is crucial to design policies and developing strategies to improve health for everyone.

Key messages

• During the pandemic, pressure to get vaccinated and increased discrimination at the workplace negatively impacted migrants’ mental health, while effects of Norwegian social benefits were positives.

• In addition to workplace discrimination, other factors such as social isolation may have had a differential impact on migrants’ mental health during the pandemic and need further study.
Health Literacy in a migrant portuguese speaking community in Portugal and healthcare use
Authors: Garcia M , Machado R , Serra I , Tiago V
Published: October 2023

Background

Health Literacy is strongly related with barriers to accessing healthcare services. Migrants may represent a vulnerable population in this matter, usually correlated with the language barrier. We aim to answer the question “Which are the perceptions, behaviors and skills of a migrant Portuguese speaking community using and getting access to health care in Portugal?”

Methods

Descriptive, cross-sectional and exploratory study. The Health Literacy Questionnaire (Osborne et al.,2013) was applied with a sociodemographic and health characterization. Data were collected and processed from a sample of 101 participants from a group of 570 people from a migrant community, all native Portuguese speakers mostly born in African Countries with Portuguese as an Official Language.

Results

The sample represented 17,7% of the total population. Thus, a confidence level of 95% and a margin of error of 9% were assumed. In the Health Literacy Questionnaire, the Cronbach's Alpha internal consistency coefficient was calculated as between 0.714 and 0.928. The analysis dimensions were mostly positioned below the average of the scale and were influenced by education, migratory status and age. “Feeling understood and supported by health professionals” had the worst score. There were better results in those who sought primary health care services and who had chronic illnesses. Self-rated health worsened with increasing length of stay in the country. Approximately 31% never attended healthcare in Portugal because they did not feel the need or were unable to access it.

Conclusions

This study demonstrated the association between health literacy with migrants and healthcare use excluding the language factor. This community presented low healthcare services use and low health literacy levels despite the use of the same language. Interaction with primary healthcare services improved migrants health literacy. This study supported a community intervention with public and private stakeholders.

Key messages

• Migrants places potential constraints on healthcare utilisation in destination countries that are not necessarily related to language barrier.

• Health Literacy is crucial to migrants health, health care access and Public Health improvement.
Infodemics surveillance system to detect and analyze health misinformation using big data and AI
Authors: Zakir Hussain I , Kaur J , Lotto M , Butt Z , Morita P
Published: October 2023

Background

Health misinformation disseminated on social media detrimentally affects the public's reactions toward public health measures. This has led to costly and harmful public health crises. Due to a lack of a comprehensive expert system that collects and analyzes large volumes of social media data, public health officials are incapable of mitigating health misinformation trends online. This study aimed to remedy this by designing and developing a big data pipeline and ecosystem (Health Misinformation Analysis System (HMAS)) capable of identifying and analyzing health misinformation online.

Methods

The HMAS system relies on Python, Elastic Stack, and the Twitter V2 API as the main technologies forming the backbone of the system. It comprises of five main components: (1) Data Extraction Framework (DEF); (2) Latent Dirichlet Allocation Topic Model; (3) Sentiment Analyzer; (4) Misinformation Classifier; (5) Elastic Cloud Deployment. Components 1-4 are hosted on a virtual machine with low computing and memory requirements. Through the DEF, HMAS extracts data from the Twitter V2 API. The HMAS expert system uses pre-trained models to perform automatic health misinformation analysis. The analyzed data are loaded and visualized in Elastic Cloud through dashboards and analytics.

Results

The HMAS system performance is accurate and efficient. It has been successfully utilized by independent investigators to extract significant insights, including a fluoride-related health misinformation use case, which analyzed data from 2015 to 2021. Moreover, HMAS has been applied to a vaccine hesitancy use case (2007-2022) and a heat-related illnesses use case (2011-2022).  

Conclusions

The novel HMAS expert system can potentially aid public health officials globally to detect and analyze concerning trends in health misinformation online. This system can also grow to integrate social media data from several platforms for multiplatform analysis and support non-Western language content.

Key messages

• The novel HMAS pipeline can collect, detect, and analyze the rapidly increasing amounts of misinformation proliferating on social media related to a particular topic or set of related topics.

• Identifying and monitoring health misinformation trends prevalent on social media through analytics dashboards and anomaly/risk detection alerts can lead to prompt governmental intervention.
Lampedusa Island hotspot is a crucial migrant health checkpoint. Is enough attention being paid?
Authors: Zjalic D , Farina A , Famà F , Cadeddu C
Published: October 2023

Background

The migrant reception system in Italy operates on two levels: first and second reception centers. The first reception is carried out in collective centers -called hotspots- where newly arrived migrants are identified. Approximately, ¾ of the landings take place on Lampedusa, a small Italian island 113 km away from the Tunisian coast, that has its own hotspot. Here migrants should receive the first medical care and the first health screening and identification. The aim of this study is to understand the quality of healthcare provided at the Lampedusa hotspot.

Methods

A survey was conducted in April 2023 on all the 80 doctors and nurses who worked in the Lampedusa hotspot clinic between 2020 and 2022. In the first part, questions concerning their work in hotspot, experience, training before starting the task, and the actual needs of the migrant population were asked. In the second part, the focus was on available medical tools and screening for infectious diseases.

Results

Thirty-nine (46%) of the healthcare professionals responded to the survey, with half of them in their first work experience. Less than 40% had previously worked in a migrant assistance context. 93% of them started the job without a training course. 80% of respondents have never had access to protocols or guidelines and 80% believe that the structure is unsuitable for screening infectious diseases. Four out of 10 migrants seek treatment and ⅔ of the respondents state that there was no health screening.

Conclusions

These results highlight the need for health screening and treatment implementation, to prevent the spreading of infectious diseases, the development of antibiotic resistance, and the good management of economic resources. The migrant reception system in Lampedusa is highly present in the political and journalistic debate, but not as much in the scientific, as the latest publication dates back to 2015.

Key messages

• Lampedusa hotspot is an essential checkpoint for infectious disease and migrants’ health screening.

• Migrants’ health at arrival is a public health issue that must be better tackled by the scientific community.
Self-reported health status using EQ-5D-5L among refugees from Ukraine arriving in Norway in 2022
Authors: Hansen T , Labberton A S , Skogheim T S , Helland Y
Published: October 2023

Background

The full-scale invasion in Ukraine has led to a sharp increase in the number of refugees coming to Norway, and a rapid upscaling of the asylum system, including temporary solutions, which may have led to poorer information and access to services. This study assesses self-reported health status among refugees from Ukraine arriving in Norway during 2022.

Methods

Data were collected via a digital questionnaire in a cross-sectional study design between 28.10.22-31.01.23, via multiple physical contact points, including asylum reception centres, municipalities, non-profit organisations, as well as Facebook groups for refugees in Norway. Results were weighted by age and sex against all Ukrainian refugees registered with collective protection in Norway. Linear regression assessed association of age, sex and having higher education with estimated EQ-5D-5L values using a Romanian EQ-5D-5L value set.

Results

Results are preliminary and may be altered. Respondents (n = 731) were 83% female, 65% aged 30-49 years, 69% with higher education. Mean EQVAS score weighted for age and sex was 69.5 (95% CI 67.9, 71.1). The ten most commonly reported EQ-5D-5L health states, reported by 425 respondents, had a mean estimated value of 0.94; mean value for all reported health states was 0.87. The most severe levels were most often reported for anxiety and depression. Regression models showed higher estimated EQ-5D-5L state values for men compared to women (male: +0.026, p < 0.05) and for those with higher education (+0.026, p < 0.05), and lower estimated valued health states for the oldest age groups compared to the youngest (age 50-59: -0.066, p < 0.01, age 70+: -0.096, p < 0.01).

Conclusions

Self-reported health status using EQ-5D-5L differed by sex, age group and educational level. Whilst most respondents reported relatively mild health states, when severe levels were reported these were most often for anxiety and depression.

Key messages

• Self-reported health status using EQ-5D-5L among refugees from Ukraine arriving in Norway differed by sex, age group and educational level.

• Whilst most refugees from Ukraine responding to the survey reported relatively mild health states, when severe levels were reported these were most often for anxiety and depression.
Suitability of tools assessing adverse childhood experiences in young refugees – a systematic review
Authors: Abdelhamid S , Kraaijenvanger E , Fischer J , Steinisch M
Published: October 2023

Background

With the persistence of ongoing crises and subsequent displacement of individuals, including children, gaining knowledge about adversities experienced in this context is crucial - given the harmful effects of adverse childhood experiences (ACE) on mental and physical health. While questionnaires for ACE in children exist, it is uncertain if they comprehensively address adversities faced by refugee children. This review's objectives are to (1) identify and analyze current ACE questionnaires and determine if they are suitable for assessing refugee children's adversities, and (2) identify and analyze those previously used among refugee populations.

Methods

A systematic literature search was conducted in 2022 across five databases for articles published since 2010, including studies using an ACE questionnaire that recognized multiple adversities in healthy children and were published in English.

Results

A total of 103 ACE questionnaires were identified in 506 studies. Only 14 of the 103 questionnaires addressed a refugee-specific adversity with exposure to war/conflict and family separation being addressed most frequently (10 and 7 questionnaires). Their ability to capture refugee children's experiences was limited: available questionnaires used a maximum of three items to assess refugee-specific adversities, covering only a fraction of forms of adversities relevant to refugee children. Out of the 14 questionnaires that included a refugee-specific adversity, only three had reported psychometric properties. In addition, only two ACE questionnaires were used within a refugee population.

Conclusions

With the tools currently available, it is not possible to comprehensively assess the exposure to and severity of the adversities faced by refugee children. Adequate tools of exposure assessment are essential in order to understand refugee children's wellbeing and develop targeted mitigation strategies for those at risk.

Key messages

• Adverse childhood experiences (ACE) can harm mental/physical health. Adequate tools assessing ACE exposure in flight contexts are needed in order to develop mitigation strategies for those at risk.

• With the tools currently available, it is not possible to comprehensively assess the exposure to and severity of the adversities faced by refugee children before, during and after flight.
Designing comprehensive and politically feasible food environment policy: the promise of packaging
Authors: Wahnschafft S , Spiller A , Lemken D , von Philipsborn P
Published: October 2023

Policy packaging has been identified as a promising approach to increase public support for effective and comprehensive policymaking by bundling measures that are unpopular from a behavioral and/or fiscal perspective with those that are popular; however, this potential has yet to be examined for improving food environments to promote healthy diets. We examine public preferences for a policy packaging approach amongst eligible voters in Germany (N. 1,200), as well as which policy design and voter characteristics underpin said preferences, via a survey-embedded conjoint experiment. Policy package attributes are drawn from recommended measures for improving food environments in Germany based on the INFORMAS Food-EPI assessment. We examine three inclinations towards policy packaging: those who are (1) resistant, (2) inclined, but sensitive to the design, and (3) enthusiastic, irrespective of design. We use linear and logistic regression models to examine the effect of policy design attributes and voter characteristics on policy package support inclinations. Most voters (73%) were inclined towards policy packaging, but sensitive to package design. We found that ‘costly’ measures - I.e., those that restricted or disincentivized unhealthy behaviors - were generally less popular than ‘compensatory’ ones - I.e., those that enabled or incentivized healthy behaviors - in policy packages; however, most participants preferred some combination of both. Participant beliefs regarding the topic of food environment policymaking predicted packaging preferences more so than any socio-demographic, political, or health characteristic. Packaging policy measures together, particularly those with counteracting effects across behavioral and fiscal axes, allows for more comprehensive and politically feasible policymaking to improve food environments. Enhancing science communication on environmental drivers of food choices is vital to bolster support for food environment policy packages. .

Key messages

• There is an appetite amongst voters for improving food environments that extends beyond the adoption of single measures, and rather towards a policy packaging approach.

• Communication that fosters a paradigm shift towards acknowledging environmental influences on diet and health would be vital for fostering support for comprehensive food environment policy packages.
Precarious housing and health inequalities in Spain since the crisis
Authors: Caroz Armayones J M
Published: October 2023

Background

Housing is considered crucial to human existence and has been recognized as a key social determinant of health. However, the “housing question” has become a major issue in high-income countries. In this context, the concept of precarious housing has emerged to describe the increasing prevalence of insecure and unstable housing conditions. However, its research has been limited to very specific national and temporal contexts. To address this gap, the present paper aims to study the predictors of precarious housing and its impact on health inequalities in the Spanish context since the GFC.

Methods

The methodology will consist of a multilevel analysis of pooled cross-sectional data from the Spanish Survey of Living Conditions (ECV) 2007-2020 (N = 51882) to identify the predictors of housing precariousness. Then, we are going to examine the associations between precarious housing and health outcomes and inequalities through multivariate logistic regressions.

Results

Our descriptive results show that precarious housing has become a persistent problem in the Spanish context. Furthermore, we found that precarious housing levels are unevenly distributed across the population along axes of inequality. In this respect, tenure status emerges as a critical predictor. Compared to outright homeowners, mortgage homeowners, market rental tenants, social rental tenants, and free cession dwellers experience significantly higher levels of housing precariousness (RR: 6.53, CI: 5.97 - 7.15; RR:8.10, CI:7.37-8.91; RR:5.72, CI:5.06-6.48; and RR:1.41, CI:1.21-1.65 respectively). Finally, we show that precarious housing conditions are significant predictors of health outcomes and inequalities. The odds ratio (OR) of reporting lower self-reported health increases with the number of precarious housing levels: 1.68 (CI: 1.52-1.85) for one level, 2.43 (CI: 1.94-3.03) for two levels, and 3.55 (CI: 2.23-5.67) for three levels.

Key messages

• Precarious housing is influenced by axes of inequality such as age, gender or nationality.

• Health inequalities are strongly associated with precarious housing conditions.
Planning matters: a document analysis of 23 Portuguese national health programs
Authors: Lima D , Costa S , Pinheiro-Guedes L , Barbosa S , Salvador S , Carvalho A , Morais Vilaça I , Oliveira P , Teixeira M , Barbabela R , Vieira A , Caveiro D , Chaves A C , Leão T
Published: October 2023

Background

Health planning is crucial for effective public health interventions and optimal use of resources. Portugal has a long history of developing health plans and programs, with the General-Directorate of Health (GDH) publishing programs for communicable and noncommunicable diseases. Yet, these programs’ evaluation is rare, not only in terms of results but also in their design and content. This study aimed to analyze all available GDH programs to assess their structure and content.

Methods

We performed a document analysis of the 23 national health programs, analyzing the items well-established by the literature as fundamental to be present in these plans and programs. Each program was analyzed independently by two independent researchers, and discrepancies were resolved within the authors’ group. Besides assessing items as present or absent, comments were added.

Results

Programs largely varied: of the 23 programs, 17 were outdated, and four were dispersed among multiple documents. Sixteen complied with at least 75% of the predefined items, with priority programs having a higher compliance rate compared to non-priority ones (83% vs 33%). The definition of goals was the most commonly fulfilled criterion, present in 91.7% of the analyzed documents. Though, the time scope of the programs was updated only in 20.8% of the programs, accounting for the criterion least commonly met.

Discussion/Conclusions

Despite being published by the same institution, the programs analyzed were heterogeneous, and most were not updated. Establishing a standardized structure for the design of these health programs would ensure that fundamental items are present, accelerate the update of the programs, and facilitate communication and collaboration with partners and stakeholders in public health

Key messages

• This study analyzed 23 national health programs published by the Portuguese General-Directorate of Health (GDH) and found great heterogeneity in their structure and availability.

• Establishing a common standardized structure for health planning is essential to ensure all fundamental aspects are taken into consideration and improve communication and stakeholders partnership.
Perception of informal care for elderly by healthcare and social care workers in Kazakhstan
Authors: Zhylkybekova A , Koshmaganbetova G , Grjibovski A , Glushkova N
Published: October 2023

Background

The challenges of providing care for the elderly are often underestimated by the general public. Informal caregivers for the elderly frequently require support, and this issue is the subject of much attention in developed countries worldwide. However, it remains a blind spot in post-Soviet countries, particularly Central Asia. The purpose of this study was to investigate the perceptions of informal care for the elderly by healthcare and social care workers in Kazakhstan.

Methods

Ten key stakeholders were interviewed using a semi-structured interview. The sample included three managers, two general practitioners, one district nurse, two social workers, and two psychologists. The thematic qualitative study was conducted between October and November 2021. The data analysis was conducted using MAXQDA 2022 software.

Results

Most of the interviewed workers believe that caring for elderly parents is the duty and responsibility of their children, which is in line with the norms of law and the culture of society. While there is a general understanding that caring for the elderly presents challenges for informal caregivers, there is no consensus among workers on the necessary support to provide them. It is important to note that informal caregivers for the elderly are not identified or registered, and medical services are only provided in response to complaints, without regard for their specific needs. There is also no assessment of the caregiver's burden or quality of life. Additionally, necessary psychological assistance and counseling are not provided.

Conclusions

To address these issues, it is necessary not only to change the legislative framework, but also to improve communication between services, as well as to conduct ongoing informational work with healthcare and social care workers about the needs and requirements of those who provide care for the elderly.

Key messages

• Legislation is needed in Kazakhstan to support informal caregivers for the elderly, including their identification and registration, and their inclusion in medical and social assistance programs.

• Need train healthcare and social care workers to be attentive to the needs of both the elderly and their caregivers, including assessing their mental health and preventing psychological breakdowns.
Health and quality of life development plan: from theory to practice
Authors: Carmezim Pereira S , Godinho Simões D , Durão J , Martinho J , Alho M , Pita Ferreira P , Sequeira R , Sousa P , Campos Fernandes A
Published: October 2023

In 2019, a decentralization process in Portugal transferred health governance competencies and autonomy from central to municipal level. Despite empowering local authorities to shape health policies and strategic partnerships, municipalities turned to academia for public health planning expertise. This work depicts how the National School of Public Health devised a Health and Quality of Life Development Plan for one such municipality. A two-stage approach was used. Firstly, a comprehensive overview of population health status and determinants was produced. It involved analysing local and national legal frameworks and worldwide strategic literature; assessing sociodemographic, economic, environmental and health indicators; questioning residents and key stakeholders; and city council and local health authorities working sessions. Secondly, detailed strategies were laid out to address specific health needs and determinants. It involved analysing similar municipal plans; selecting priority health actions; and designing evidence-based interventions with target, timeline, estimated resources and outcomes measures. The authors built and applied a public health planning methodology, resulting in a profound health diagnosis. Public and stakeholder scrutiny ensured prioritization of key action areas and effective working pathways in strategic planning were introduced. Furthermore, evidence-based actions adapted to local capacity, budget and resources were presented. Outputs range from health literacy sessions in schools to contingency plans for public health emergencies. Health governance responsibilities’ redefinition evidenced a knowledge gap and drove the need to consult academia to develop evidence-based health policies. By creating this methodology, the authors defined strategic pillars and tailored operational recommendations for municipalities, which rely on ongoing indicator monitoring and, ultimately aim to improve population health through concerted efforts.

Key messages

• The decentralization of health competencies granted local autonomy in shaping health policies. To support decision and policy-making, a comprehensive tool for health diagnosis assessment was designed.

• The need for a concerted local action with definition of territorialized development strategies, highlights the value of a deep connection between decision-makers and academia as a consulting entity.
From genome inspection to clinical significance: source attribution of a foodborne botulism outbreak
Authors: Arnaboldi S , Magagna G , Monastero P , Todeschi S , Bornati L , Losio M N , Finazzi G
Published: October 2023

Background

Foodborne botulism is a neuro-paralytic disease caused by the ingestion of botulinum neurotoxins (BoNTs). Given its high fatality rates and economic consequences, prompt management of human cases requires collaboration among public health authorities, supporting hospitals in rapid diagnosis, food inspections, and formal analysis. This study aims to investigate the food source responsible for a botulism outbreak in Northern Italy, which resulted in the hospitalization of a person.

Methods

Faecal specimen from the patient, and suspected food were collected (industrial-made asparagus cream, both packages consumed and still closed). BoNT presence and identification was performed by mouse-test. After the enrichment in TPGY broth, samples were plated on CMM medium to observe the proteolysis, and on EYA medium for colonies isolation. DNA was extracted and genome was sequenced by Illumina MiSeq. Typing was performed by MLST. SNP-based phylogenetic analysis was conducted, including isolated strains from outbreaks occurred in the same year and geographic area.

Results

The strains were identified as group I proteolytic Clostridium botulinum, with BoNTB responsible for the outbreak. Faeces and the ingested food exhibited the same Sequence Type (ST178), differing by only one SNP. Notably, the closed package had a distinct ST (ST29), and a significant divergence from the outbreak strains (7282 SNPs). Conversely, the other strains displayed SNP differences ranging from 11116 to 46536.

Conclusions

Genome characterization enabled the identification of the outbreak source as the ingestion of BoNTB present in asparagus cream, suggesting also the circulation of several different strains of Cl. botulinum causing foodborne outbreaks. These findings highlight the ongoing public health concern of foodborne botulism, even in industrial-processed foods. Our study underscores the importance of source attribution and effective outbreak management in preventing hazardous botulism outbreaks.

Key messages

• Genome sequencing enabled the source identification of a foodborne outbreak caused by Cl. botulinum toxin B.

• Our study emphasizes the current significance of foodborne botulism as a public health issue.
Monitoring inequalities in cancer prevention and care in Europe
Authors: Stepien M , Rodriguez Rasero F , Ben E , Nicholl C
Published: October 2023

The European Cancer Inequalities Registry (ECIR), a flagship initiative of the Europe's Beating Cancer Plan, was launched by EC President Ursula Van der Leyen in February 2022. The aim of the registry is to identify, communicate and monitor inequalities in cancer prevention and care across Europe. The ECIR data tool presents cancer-related indicators on cancer burden, from prevention, screening and early detection, to diagnosis, treatment and quality of life of patients and survivors. Where possible, the indicators are presented along six inequality dimensions: country, sex, age, education, employment status and urbanisation. Furthermore, this data tool is complemented with regular reporting mechanisms, factsheets, and a roadmap that presents data quality criteria and future, planned enhancements of the data tool. Stakeholders can always submit suggestions for additional indicators. The data already reveals important socio-economic and demographic inequalities in cancer prevention and care. For example, in most EU countries obesity, low intake of fruits and vegetables or physical inactivity tend to be more prevalent for groups with lower education, income, or those living in rural areas. The same applies to participation in cancer screening. For example, the EU average for women eligible for breast cancer screening that reported not to have ever had a mammography is 11%. However, in some EU countries, this percentage is more than double. It is highly likely this contributes to the unacceptable differences in breast cancer 5-year survival. In conclusion, there are still striking geographical and socio-economic disparities observed for cancer prevention, screening or treatment indicators. By transparently communicating such observed inequalities in Europe, the ECIR data tool can help guide future financial EU investments, identify best practices to effectively tackle these inequalities and also monitor the effectiveness of the new cancer policies.

Key messages

• Inequalities in cancer prevention and care are observed among EU countries.

• ECIR helps to monitor cancer inequalities in Europe and guide financial investments.
The National Health Index shows regional differences in morbidity and workability loss in Finland
Authors: Koponen P , Lindell E , Sarnola K , Luoto R , Jousilahti P , Lumme S , Koskinen S
Published: October 2023

Background

The development of the National Health Index (NHI) aims to provide data on the need for social and healthcare services, and social security benefits, in relation to health problems with the greatest burden. It also aims to contribute to targeting preventive measures to promote wellbeing, health and workability.

Methods

Data from registers maintained by several national authorities were combined and compared to identify numbers of persons with diagnosis for care (ICD-codes), medication (ATC-codes) and/or received benefits in at least one of the data sources. To determine the burden caused by the different health problems, their prevalence was weighted based on the associated costs, effects on quality of life, mortality, and workability loss. Both age-standardised and non-standardised indexes were calculated for each region in relation to Finland's entire population (index 100).

Results

The subindexes show significant regional variation, index figures ranging from 28 to 148 for the disease groups: cancers, cardiovascular diseases, diabetes, memory disorders, musculoskeletal diseases, severe mental health problems, accidents, chronic respiratory diseases, and alcohol disorders, as well as for workability loss (sickness benefit, disability pension, vocational rehabilitation, index figures 27-242). The overall NHI was highest in northeastern regions, and lowest in the capital region and the western coast regions. Age standardization mitigated the regional differences.

Conclusions

The NHI and the subindexes provide information for evaluating and planning services and benefits. They can be used as key indicators in regional welfare reports. Regional differences in access to care and register data coverage may have an impact on the results. The next phase in our project will analyze socioeconomic differences and develop methods to forecast future trends, taking into account demographic changes and the potential for disease prevention.

Key messages

• The overall NHI results, covering ten disease groups, are in line with previous data on highest disease burden in northeastern regions.

• Differences in access to services and register data coverage need to be evaluated when interpreting the differences between regions, both in morbidity and in workability loss.
He who seeks finds: surveillance of Enteroviruses and Human Bocaviruses in Northern Italy wastewaters
Authors: Righi F , Mangeri L , Galuppini E , Tilola M , Bertasi B , Losio M-N
Published: October 2023

Background

Wastewaters surveillance has proven to be a valuable tool in detecting the spread of SARS-CoV-2 and other pathogens. Enterovirus (EV) and Human bocavirus (HBoV) are viruses that can infect humans, causing mild to severe pathologies transmitted also through the fecal-oral route. EVs are ssRNA viruses, grouped among four taxonomic species EV-A to D. HBoV is ssDNA virus mainly affects infants. Genus Bocavirus includes 4 genotypes: HBoV1 to 4, detected mainly in feces. EVs and HBoVs infections are often not notified, causing loss of data on the actual incidence. The aim of this study was to investigate the presence and diffusion of EVs and HBoVs in wastewaters.

Methods

200 wastewater samples were collected during 2022, at the inlet of wastewater treatment plants in three cities of the Lombardy Region (i.e.: Brescia, Bergamo, and Cremona). EVs and HBoVs were detected by RT Real-time PCR and Real-time PCR respectively using specific primers for target region of the viral genome. Positive samples were genotyped by Sanger sequencing. Prevalence was calculated with the Blaker's method.

Results

Overall EV and HBoV prevalences were 20.5% (CI95% 15.5-26.2%) and 37% (CI95%.30.6-43:9%), respectively. EV was mainly detected in the mild season with a prevalence of 68.3% (CI95% 53.0-80.4%). Sequence analysis reported that EV-B species was the most prevalent in this study (9 samples). HBoVs positive samples’ prevalence was higher in cold season (71.6% CI95% 60.5-80.6%), than mild season. HBoV2 showed higher prevalence (85.6% CI95% 75.6-92.0%) than HBoV3.

Conclusions

This study provided insight into the seasonal spread of EVs and HBoVs circulating and can contribute to understand the disease burden. Wastewaters surveillance provides a wide and more complete epidemiological data than the clinical one of a single person, rather providing information of a community of individuals making the data very valuable to the competent authorities.

Key messages

• Wastewaters surveillance is a useful tool for investigating the spread and circulation of viruses in population.

• EVs and HBoVS are widespread in Northen Italy population.
Enhancing global health accountability through results-oriented monitoring: EC/WHO collaboration
Authors: Roura M , Capa E , Appelt B , Lecompte M , Fernandez M , Schmets G , Porignon D
Published: October 2023

Issue

Governments and organizations must demonstrate accountability and delivery of results. Results-Oriented Monitoring is a European Commission mechanism to enhance internal control and management. The Health System Strengthening for Universal Health Coverage program - the largest Commission grant to the World Health Organization - provides support towards achieving Universal Health Coverage through policy dialogue in 119 countries.

Description

We employ a Results-Oriented Monitoring review of the program conducted in October 2021- April 2022 as a case study to examine the question: what is the value of the Commission's Results-Oriented Monitoring system as a tool to enhance accountability of large Global Health interventions?. We conducted 87 face-to-face/remote interviews to engage stakeholders in assessing specific criteria such as relevance, efficiency, effectiveness, sustainability and human rights, in 12 purposively selected countries including Timor Leste, Colombia, the Democratic Republic of Congo, Zambia, Burkina Faso, Nigeria, Uzbekistan, the Philippines, Mongolia, Egypt, Jordan and Morocco.

Results

The Health System Strengthening for Universal Health Coverage program is a relevant intervention that responds to the needs of target groups because it is demand driven, flexible, and well-integrated within national health plans/regional frameworks. The absence of robust Monitoring and Evaluation frameworks for Universal Health Coverage at country level is a missed opportunity to pull the case for continued investment in health systems strengthening. Co-developing country level monitoring and evaluation frameworks could enhance multi-stakeholder policy dialogues anchored in the Universal Health Coverage concept.

Lessons

Our innovative adaptation of Results-Oriented Monitoring approaches to assess a large Global Health intervention (+100 countries) provided critical data to inform program implementation and fostered consensus building over subsequent steps.

Key messages

• The European commission’s results-oriented monitoring system is a valuable instrument to assess large scale global health interventions.

• Co-developing monitoring and evaluation frameworks at country level could serve as a tool to facilitate multi-stakeholder policy dialogues and to track progress towards universal health coverage.
An evaluation of the severe acute respiratory infection (SARI) surveillance system in Ireland
Authors: Marron L , Duffy R , O'Donnell J , Domegan L
Published: October 2023

Background

Expansion of the current single hospital site Severe Acute Respiratory Infection (SARI) surveillance programme in Ireland, to create a sentinel network, will commence in 2023. This evaluation aimed to assess the performance of key surveillance system attributes to improve and guide expansion.

Methods

A mixed quantitative and qualitative evaluation was conducted from September 2021 to November 2022. SARI surveillance data were analysed to assess completeness, timeliness and positive predictive value (PPV). An online stakeholder questionnaire, semi-structured focus group discussions and key informant interviews evaluated usefulness, simplicity, flexibility and acceptability. Qualitative data were analysed using thematic analysis.

Results

Among SARI cases (n = 747), completeness of key variables including age, sex and outcome was 100%. Symptom data were completed in > 90%, COVID-19 vaccination status was completed in 89% and completeness of ethnicity data was 0.6%. Median times from hospitalisation to data entry commencement and completion were one day (IQR 1-3) and 48 days (IQR 21-81) respectively. Time to receipt of whole genome sequencing (WGS) results was 40 days (IQR 30-61). PPV was 95% (95% CI 93%-97%). The questionnaire response rate was 21% (75/362) and 96% (72/75) agreed that SARI surveillance is important. Key themes identified in the qualitative study (n = 11) were the complexity and importance of SARI surveillance. Suggested areas for improvement included process automation and additional designated resources to improve timeliness, flexibility and acceptability; particularly during epidemic or pandemic surge periods.

Conclusions

The SARI surveillance system reports high-quality data. Timeliness of WGS data and recording of vaccination status and equity stratifiers e.g., ethnicity should be improved. Priorities for expansion should be automation and adequate resource allocation to enable reliable SARI surveillance at all times.

Key messages

• The SARI surveillance system is a resource intensive, complex system that is an important component of national surveillance in Ireland and reports high-quality and timely surveillance data.

• The priorities for expansion are process automation where possible and ensuring adequate resources, specifically skilled staff. These evaluation findings should inform SARI expansion in Ireland.
Impact of the heat waves the Italian elderly population: not just a hot issue
Authors: Cadeddu C , Zjalic D
Published: October 2023

Background

Italy is considered a hotspot for climate change in the Mediterranean Sea e.g. due to heat waves. The year 2022 was the hottest in the past decade, with mean temperatures exceeding those in 1981-2010 by far. Further, it is well-known that socioeconomic disadvantage has a negative impact on health consequences and the risk of death during heat waves.

Methods

Bringing together statistical sources at national and subnational levels, we carry out a descriptive analysis about the vulnerability of specific subgroups of older people towards heat, by age group, region and socio-economic status.

Results

Recent data published by the Italian National Institute of Statistics highlighted 265,000 deaths (about 40% of total deaths) registered in the 4 months with the most critical climate conditions, i.e. January and December for the cold and July and August for hot weather. Except for 2020 when COVID-19 dramatically hit the Italian population, among the most recent 4 years (2003, 2015, 2017, 2022) with mortality rates higher than expected, three of them are concentrated in a period of just 8 years, where the climate crisis has been showing all its negative potential in terms of impact on health and survival, especially for a country where population is highly ageing. We further observe a correlation between the incidence of severe heat waves and the share of socio-economically deprived older people in the Southern part of the country.

Discussion

We identify regions that require specific attention from health policy-makers, especially in the Southern part of Italy where heat waves are extremely severe and older people are more socio-economically vulnerable and/or cannot protect themselves from heat adequately, e.g. due to adequate housing insulation. We underline the need for countries experiencing frequent and prolonged heat waves to rapidly intervene with national mitigation and adaptation plans, to protect vulnerable populations from negative health consequences.
An investigation into the awareness of cancer and it's social determinants in the Fiji Islands
Authors: Naidu C , Harris N , Wiseman N
Published: October 2023

Introduction

Cancer is a major public health concern worldwide, with increasing mortality rates, especially in low-middle income countries. The predicted global cancer burden by 2040 is expected to be over 27 million new cases per year, a nearly 50% increase compared to 2018. This research presents recent statistics on cancer incidence and mortality in Fiji from 2010 to 2018 and the barriers associated with early detection of cancer.

Methods

The study used a mixed-method model to determine cancer incidence and understand the factors associated with accessing breast cancer care in the Fiji Islands. Age-standardized incidence and mortality rates were calculated and semi-structured interviews were conducted with breast cancer patients, community women, a health care professional and a traditional healer.

Results

This study analysed cancer rates in Fiji from 2010 to 2018. Out of 12,433 reported cases, women had higher incidence rates (8,457 cases) compared to men (3,965 cases), but men had a higher death rate of nearly 59%. Breast, cervical, and endometrial cancer were the top three cancers among women, while prostate, liver, and lung cancer were the top three among men. Education, awareness, culture and distance were some of the factors identified as barriers to accessing cancer care services.

Conclusions

The findings emphasize the need to understand lifestyle factors affecting cancer risk, especially among women and rural populations. It underscores the importance of prioritizing cancer epidemiology, prevention, and control at the national level and investing in improved cancer treatment delivery. These efforts can help address the challenges of cancer in Fiji and reduce its burden on individuals.

Key messages

• The analysis serves as a foundation for future research to understand the barrier to access cancer healthcare services.

• This research aims to inform strategies for early detection of cancer and timely treatment for men and women in the Fiji Islands.
Qualitative research for improving positive health in deprived neighbourhoods
Authors: van Pomeren T , van der Meer I M
Published: October 2023

Background

There has been increased interest in the concept of ‘Positive Health’ in recent years, as it includes the ability to deal with physical, emotional and social life challenges. We used quantitative data to illustrate the positive health ‘spiderwebs’ for various deprived neighbourhoods. As this data did not provide information on personal experiences and barriers faced, qualitative data from the residents’ point of view were used to complete the positive health spiderweb.

Methods

Qualitative data from semi-structured interviews with residents and professionals from eight deprived neighbourhoods in The Hague, The Netherlands were used to supplement quantitative data from a recent national health survey. The interviewed professionals worked in and with the community in the field of health and wellbeing. Participants were asked about what is going well in the neighbourhood and what was needed to improve the health and wellbeing of residents. Transcripts were coded and analysed to identify key themes per neighbourhood.

Results

Compared to the average score of the city, the neighbourhood spiderwebs showed unfavourable results on all domains. Interviews with residents and professionals highlighted aspects of the living environment as a priority, such as (useable) green space, environmental safety (traffic, parked cars, safe crossings), lack of (free) space and waste management. These aspects negatively affected the health and exercise habits of the residents. Though data on living environment is collected in national surveys, the qualitative approach provides more detail on the current priorities of residents.

Conclusions

This research shows the key role which living environment plays in the health of people in deprived neighbourhoods. Also, it illustrates the value of using the needs and experiences of residents to shape interventions addressed at improving positive health.

Key messages

• Addressing health of residents in deprived neighbourhoods of the city of The Hague requires a broader approach that includes environmental factors.

• When trying to improve health in neighbourhoods, it is pertinent that existing quantitative data is supplemented with qualitative data from residents themselves.