bluuebunny/crossref_metadata_2025 huggingface dataset:
Conditions for professional support of school health promotion implementation in the Netherlands
Authors: Vennegoor G , Van Assema P , Molleman GRM , Dieleman J , Jansen MWJ
Published: October 2023

Background

The Dutch Healthy School Program (‘Programma Gezonde School’; HSP) is a whole school approach including education, stimulating physical and social environment, health services, and school health policies. Implementation support is offered by Healthy School Advisers employed at 25 regional Public Health Services (PHSs). To strengthen this professional support, this study aimed to map conditions for the degree of support offered by PHSs and received by schools.

Methods

The data collection plan was developed together with a Community of Practice. In 2021 and 2022, two rounds of semi-structured group interviews were conducted in 8 PHSs (N = 1-4 employees and ±3.5 hours in total per PHS). Interviews focused on the degree of support (intensity, quality, context-focus, position in PHS and region) and 24 contextual factors regarding: 1) Healthy School Advisers, 2) PHS organization, 3) collaboration with partners, and 4) broader context. Additional data were collected from public websites, year reports, and the Dutch registry of implementing HSP. Data were analyzed thematically in Nvivo.

Preliminary results

There is large variation in all aspects of support between PHSs. Main conditions for this variation are related to the PHS organization: its policy, internal support, capacity, and (long-term) allocated budget. Other key conditions are related to collaboration with partners: coordination, division of responsibilities, and communication structure. Prerequisites for all PHSs were cohesive adviser teams, the HSP, and national school health promotion focus.

Conclusions

In order to strengthen professional support for whole school health promotion implementation, it is essential to: 1) establish strong positioning and (long-term) resources in the organization, 2) establish clear coordination between Healthy School Advisers and partners supporting schools, 3) maintain cohesion among adviser teams, and 4) maintain and intensify national (school) health promotion policy.

Key messages

• Degree of professional support for whole school health promotion varies substantially.

• Positioning in the organization and clear coordination among professionals are key in strengthening support.
Work ability trends 2000-2020 and projections until 2040 in Finland
Authors: Lahti J , Reinikainen J , Kontto J , Zhi Z , Koskinen S , Laaksonen M , Partonen T , Elonheimo H , Lundqvist A , Tolonen H
Published: October 2023

Background

Population in Europe and throughout the world is ageing rapidly. Projections of the work ability of the working-age population are of importance for policy makers to prepare for future challenges. The aim of this study is to examine age-group and birth-cohort trends in perceived work ability in Finland in 2000-2020 and make projections of work ability up to 2040 based on the observed birth-cohort development.

Methods

We used a series of population representative cross-sectional surveys conducted in Finland 2000-2020, i.e. the Health 2000 Survey, the Regional Health and Wellbeing Study 2010, 2012, 2013, 2014, 2015, 2017, FinHealth 2017 and FinSote 2018 and 2020. Self-reported estimates of current work ability in relation to the person's lifetime best on a scale from zero to ten were used, scores 8-10 indicating good work ability. For projecting work ability multiple imputation was used (R package mice).

Results

Trends (2000-2020) by 5-year birth-cohorts born between 1961 and 1995 showed that work ability has declined over time among older birth-cohorts while in the two younger cohorts a stable development before 2017 and a steep decline between 2017 and 2020 was observed. Trends by 5-year age-groups showed a declining trend of good work ability among 20-44-year-olds, a stable trend among 45-54-year-olds and an improving trend among over 55-year-olds. Among the under 55-year-olds the prevalence of good work ability ended up around 75% and at 68% among the 55-59-year-olds, 58% among the 60-69-year-olds and 49% among the 70-74-year-olds in 2020. Birth-cohort projections suggest a declining work ability among 30-74-year-olds in the future. By 2040, the prevalence of good work ability is projected to decline 10-15%−points among 45-74-year-olds.

Conclusions

The decreasing work ability seen in younger age groups and the declining projections until 2040 are highly concerning. Efforts to counteract the projected decline in work ability are needed.

Key messages

• The observed decline in perceived work ability in younger age groups and the projected decline in the prevalence of good work ability among the middle aged and older are concerning.

• Efforts to counteract the projected decline in work ability are urgently needed.
6.O. Workshop: Overview of Comprehensive Sexuality Education Status in Moldova, Georgia, Tajikistan and Kyrgyzstan
Authors:   Organised by: BzgA - Federal Centre for Health Education (Germany),   Chair persons: Johanna Marquardt (Germany)
Published: October 2023

Sexual and reproductive health (SRH) is a key dimension of overall health and wellbeing of individuals. Comprehensive Sexuality Education (CSE) is one of the most important means of promoting and supporting youth is their sexual and overall development, and a key component of HIV and sexually transmitted infections (STIs) prevention. It is widely recognised that school plays a central role in learning about health and health promotion skills, including sexuality and sexual health. Nevertheless, there is often a lack of evaluation of CSE implementation in school curriculums. This is why UNFPA (United Nations Population Fund) and BZgA (Bundeszentrale für gesundheitliche Aufklärung), in cooperation with UNESCO((United Nations Educational, Scientific and Cultural Organization), WHO (World Health Organization) and IPPF EN (International Planned Parenthood Federation), conducted a study in Moldova, Georgia, Tajikistan and Kyrgyzstan to assess the status of CSE. In this workshop, we will describe the study process, reflect on the main findings in four countries and discuss two case studies of Moldova and Georgia. The speakers will also share their experiences of translating these findings into advocacy measures and achievements since the study conducted in 2022. The data was collected using the standardized Sexuality Education Review and Assessment Tool (SERAT) via desk reviews of relevant policies, curricula and national data, questionnaires, stakeholder interviews (e.g., with teachers, representatives of technical working groups and ministries of education, young people) and discussions to validate the findings. Overall, we have seen that all four countries teach sexuality education, which is supported by adequate legal and policy frameworks, and integrate it into their school curricula. The comprehensiveness of the curriculum, teacher training and learning methods differ across the four countries. In Georgia, the biggest CSE-related challenge is that there is a stigma in society around sexuality-related issues and there is a need to support an open dialog with key stakeholders. In Moldova, this was the second SERAT assessment within 5 years, which demonstrated a significant progress in the development of sexuality education program since 2017, achieving a much higher score of compliance with the international standards for CSE.

Key messages

• This study shows that the four countries assessed are on a positive track in implementing and expanding their sexuality education programmes, which are supported by a legal and policy environment.

• Gaps still remain in teacher training, monitoring and evaluation, and the comprehensiveness of the delivered content.
Social exclusion of the SGM community in Rwanda: public perceptions and lived experiences of SGM
Authors: Stojanovski K , Igonya E , Otukpa E , Twahirwa L , Rukundo A , Ushie B
Published: October 2023

Background

Sexual and gender minorities (SGM) are “othered” from society. This study quantifies and explores the process of “othering” of SGM Rwandans through the lens of those who “other” and those who experience “othering.”

Methods

We conducted a mixed methods study surveying 499 & conducting focus groups with 59 SGM. We surveyed 1,254 & conducted 16 interviews with non-SGM. Among non-SGM, the outcome was a continuous variable measuring attitudes toward SGM. Among SGM, the continuous dependent variable was from 13 questions measuring discrimination across life contexts (e.g., work, health). We conducted adjusted linear regressions to explore predictors of “othering” among non-SGM and associations between discrimination and SGM identity among SGM. We report beta coefficients and 95% confidence intervals. We used thematic analysis to analyze the qualitative data to examine the context and nuance of “othering” and its impacts on SGM.

Results

The average score for SGM support among the public was 12 (SD = 4.7) (20 is more discrimination). As compared to those who knew zero SGM, persons who knew 5+ had scores that were 1.3 points lower (95% CI -2.2, -0.5), while the score was lower for those that knew 1-5 (-0.2), it was not significant (95% CI -0.8, 0.5). Among SGM, 67% experienced discrimination. In adjusted models, we found that transgender & non-straight participants experienced more discrimination. The qualitative findings found that “othering” occurs in many contexts, such as housing, employment, healthcare, and virtually, but trans persons are most impacted. One participant shared, “A transgender [person] may face more discrimination than a gay based on their physical appearance.”

Conclusions

SGM Rwandans are widely “othered” with negative implications for their ability to live authentically and participate in everyday experiences. However, results indicated that if non-SGM persons were acquainted with LGBTQ+ community members, discrimination is lessened.
Transgender people in different European and Latin American countries: A cross cultural comparison in some relevant measures
Authors: Giami A , Barrientos J , Scandurra C , Valerio P
Published: October 2023

Background

Prejudice against transgender & gender-diverse people persists & is associated with physical & mental health harm. This study describes & characterizes comparative data between countries on gender self-definition/expression & its relationship to gender incongruence diagnosis.

Methods

We used snowball sampling for a face-to-face survey in France (N = 379; 2010), Italy (N = 167; 2015-2016), Brazil (N = 391; 2016), & Chile (N = 377, 2018). Participants were 18+ years & identified as transgender. An open-ended item was used to capture the self-designation of gender: “How would you describe your gender identity in your own words?” We conducted chi-square bivariate analyses and multivariate regression models to examine variation in gender self-definition across countries & its relationship to obtain a change of legal sex/gender markers between countries & incongruence diagnoses.

Results

The preliminary results indicate that self-definitions vary across countries. In France, categories were man, trans man, woman, trans woman, & trans. In Brazil & Chile, a traditional cultural category not in European countries was expressed: travesti. Results showed that a “non-binary” had to be included too. Results showed that lower percentages of trans persons in Chile (22% of trans men & 15% of trans women, Brazil (25% & 12%, respectively) & Italy (10% and 21%, respectively) changed their legal gender markers, as compared to France (34% and 35%, respectively) (p < 0.000). The results showed differences between countries considering the self-definition made by each participant regarding obtaining gender incongruence diagnosis with higher rates of diagnosis in Italy and France (p < 0.001).

Conclusions

These findings show that transgender identity varies between countries & over time. The results indicate the importance of self-identification in trans-health studies, which have implications for global policy and research on the health of trans-identifying persons.
JAPreventNCD
Authors: Klepp K I
Published: October 2023

The EU has approved a proposal for a Joint Action on Cancer and other NCDs prevention - action on health determinants. This is a large and ambitious initiative with more than 20 participating EU member states along with Iceland, Norway, and Ukraine. The aim of the Joint Action is to support strategies and policies designed to reduce the burden of cancer and other non-communicable diseases (NCDs). Cancer and other NCDs constitute a large proportion of the total burden of disease in Europe, and a large part of this disease burden can be prevented. The objectives of this Joint Actions are:

• To improve joint capacities of Member states to plan and implement cancer and other NCD prevention policies and activities both at a national, regional, and local level.

• To improve data and the monitoring system for cancer and other NCDs and their common risk factors.

• To contribute to reduced social inequalities in cancer and other NCDs.

• Engage with and support key actors in the field of cancer and NCD prevention, including decision makers at all levels of government, civil society organizations, professionals, the general population, and patients’ groups to facilitate cooperation and joint efforts.

As part of the JA Best-ReMaP, we have seen important development regarding tools and methodology related to policies that can influence the food consumed by children. This includes policies related to food reformulation, reduction of food marketing, and public food procurements. While the new JA-PreventNCD will cover NCD prevention more broadly through the various life stages, specific tasks are being planned for that will allow us to build on and expand the valuable work performed as part of the JA Best-ReMaP.
Pfizer COVID19 vaccine is not associated with acute cardiovascular events
Authors: Keinan Boker L , Fluss R , Dichtiar R , Rosenberg A , Ben Lassan M , Huppert A
Published: October 2023

Background

Previous reports on acute cardiovascular events and sudden death following administration of COVID19 vaccines usually reported no association, but this issue still stirs much ado. We aimed to assess the risk for acute cardiovascular events that require hospitalization in the short-term following administration of the second Pfizer COVID19 vaccine dose in Israel.

Methods

We have used a self-controlled case series (SCCS) study design, and included second-dose vaccinees in the period from Jan 11th, 2021 to Oct 31st 2021, who had not been diagnosed with COVID19 and who had an acute cardiovascular event (acute myocardial infarction or acute stroke or acute thromboembolic event; myocarditis events excluded) that required hospitalization in the 60 days following vaccine administration. National databases (COVID19 vaccines; COVID19 infection; Hospitalizations) were used to assemble the study population. The first 30 days were defined ‘high risk period’ while the next 31-60 days were defined ‘control period’, and the risk for an acute cardiovascular event was compared between these periods using a conditional logistic regression model. Possible moderators such as: sex, age group and seasonality were included.

Results

Out of 5,700,112 second-dose vaccinees in the defined time period, 4,163 had an acute cardiovascular event in the 60 days following vaccine administration: 1,979 in the ‘risk period’ and 2,078 in the ‘control period’ (Odds ratio, OR = 0.95, 95% confidence interval, CI 0.90-1.01, p = 0.12). Moderation of sex, age group and recent (less than 60d prior to vaccination) acute cardiovascular event were not significant. A sensitivity analyses looking at 100 days of follow-up post-vaccination did not change these results.

Conclusions

We found no indication for an increased risk for an acute cardiovascular event in the 30 days (compared to 31-60 days) following administration of the second vaccine dose of Pfizer COVID19 vaccine.

Key messages

• We found no indication for an increased risk for an acute cardiovascular event in the 30 days (compared to 31-60 days) following administration of the second vaccine dose of Pfizer COVID19 vaccine.

• These findings did not change when sensitivity analyses were used.
Precarity, agency and trust: vaccination decision-making in the context of the UK asylum system
Authors: Deal A , Salloum M , Hayward S E , Crawshaw A F , Carter J , Mounier-Jack S , Hargreaves S
Published: October 2023

Those living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low. We aimed to understand vaccine confidence and decision-making among those going through the UK asylum system from a sociological perspective. In-depth semi-structured interviews were done on views and experiences around vaccination (09/2020-08/2021) with asylum seekers or those recently granted asylum (<10 yrs in UK). Interviews were conducted remotely, audio-recorded, transcribed and analysed through reflexive thematic analysis in NVivo 12. 25 participants were interviewed (mean age 37 years [SD:7], mean time in UK 6 years [SD:3], 72% female), of whom 13 were living in asylum accommodation at the time of interview. Preliminary analysis has indicated candidate themes relating to trauma, social isolation, agency and precarity running through discussions around vaccination decisions. Past trauma, such as discrimination at healthcare facilities or feeling forced to receive vaccinations in asylum accommodation, often directly impact trust and decisions to reject future vaccination. Participants described how their struggle for basic necessities, social isolation and precarious living situations imposed by the asylum system left them with other priorities than vaccination. Participants who perceived they have been well cared for in the healthcare system or who described feeling empowered to make their own decision about vaccination often suggested they would be likely to accept vaccination if offered. Asylum seekers and refugees have often experienced substantial trauma, precarity and have a lack of agency directly imposed on them by the asylum system, which are likely to impact trust and decision-making around healthcare. Formative experiences in the UK are key to establishing trust; a trauma-informed approach should be central in developing vaccination interventions for these groups, particularly in asylum accommodation.

Key messages

• Trauma, precarity and lack of agency imposed by asylum systems are likely to impact trust and decision-making around healthcare.

• A trauma-informed approach should be central in developing vaccination interventions for asylum seeking and refugee groups, particularly in initial accommodation settings.
Molecular epidemiology
Authors: Gupta Y
Published: October 2023

Environmental exposures increase risk for multiple diseases, including dementia. The modern expansion of industrialization and the combustion of fossil fuels, coupled with extensive application of chemical fertilizers in farming, have led to an increase in the levels of toxic elements in the air, water and food. A key part of this work is to identify biological signatures associated with toxic element exposure, such as arsenic, and its effects on chronic disease conditions. This presentation will showcase a worked example illustrating how arsenic exposure will be assessed in urine samples. iAs, MMA, DMA and AsB will be analysed in urine by ion chromatography interfaced with inductively coupled plasma-mass spectrometry detection (ICP-MS) in Prof. Andy Meharg's lab, Queens's University, Belfast. DNAm data will be processed through Rnbeads 2.0. A principal-component analysis (PCA) was then used to identify technical variability (batch effect) in DNAm data. After removing batch effect, Clean DNAm data will be used in linear regression models to determine CpG loci associated with arsenic exposure.
Development of novel data-driven Irish diets and associations with socio-economic profiles and health
Authors: Burke D , Hynds P , Priyadarshini A
Published: October 2023

Dietary patterns play a significant role in body mass index (BMI) and development of non-communicable diseases (NCDs), which are the leading cause of mortality worldwide, including Ireland, where 90% of all-cause mortality derives from NCDs. A cross-sectional survey was conducted across Ireland to collate respondents’ socio-economic profiles, health status, and dietary patterns with a representative sample size of 957 adult respondents. Principal component analysis (PCA) and statistical analyses were employed. To the author's knowledge, this is the first study to use recent (2021) nationally representative data to characterise dietary patterns in Ireland via dimensionality reduction. Five distinct dietary patterns (‘meat focused’, ‘dairy/ovo focused’, ‘vegetable focused’, ‘seafood focused’ and ‘potato focused’) were identified and statistically characterised. The ‘potato focused’ group exhibited the highest mean BMI (26.88 kg/m2), while the ‘vegetable focused’ group had the lowest (24.68 kg/m2). ‘Vegetable focused’ respondents were more likely to be associated with a categorically “normal” BMI (OR = 1.90, 95% CI [1.39, 2.60]) and urban residency (OR = 2.03, 95% CI [1.39, 2.96]). Conversely, ‘meat focused’ respondents were more likely to be obese (OR = 1.46, 95% CI [1.06, 2.00]) and rural (OR = 1.72, 95% CI [1.28, 2.31]), along with respondents attributed to the ‘potato focused’ group (OR = 2.15 [1.42, 3.26]). ‘Seafood focused’ respondents were more likely to report coronary heart disease (OR = 5.4, 95% CI [1.96, 15.01]) and more likely to have followed the current diet for <1 year (OR = 2.2, 95% CI [1.22, 3.96]). Results show that data-derived dietary patterns may better predict health outcomes than self-reported dietary patterns. BMI and NCD incidence rates may be reduced by shifting from heavy meat/dairy/egg/potato consumption (i.e., “traditional” Irish diet) to a contemporary North-Atlantic/Hibernian/Eireann/Irish diet focusing on vegetables, seafood and lower meat consumption.

Key messages

• Five distinct dietary patterns (‘meat focused’, ‘dairy/ovo focused’, ‘vegetable focused’, ‘seafood focused’, and ‘potato focused’) were identified in Ireland via PCA and statistically characterised.

• BMI and NCD incidence rates may be reduced by shifting from heavy meat/dairy/egg/potato consumption (i.e., “traditional” Irish diet) to a diet focusing on vegetables, seafood, and less meat.
Behavioural Sciences for Better Health: WHO Resolution and Action Framework
Authors: Bach Habersaat K , Altieri E
Published: October 2023

Behavioural factors are important contributors to increasing trends in communicable and non-communicable diseases and their risk factors, injuries, and health emergency risks as well as other health challenges that pose a significant challenge to health systems and increase disease burden globally. The World Health Organization (WHO) has recommended the adoption of a Resolution on Behavioural Sciences for Better Health to the Seventy-sixth World Health Assembly #WHA76, held in Geneva, Switzerland on 21-30 May 2023.

Brief summary of the resolution

The resolution recognizes that behavioural science is a multidisciplinary scientific approach that deals with human action, its psychological, social, and environmental drivers, determinants and influencing factors. It acknowledges the contribution of behavioural science in achieving improved health outcomes and the value of high-quality data about behaviours in guiding the health sector. It also recognizes that no single discipline can provide a complete understanding of how to support individuals to enact healthier behaviours to achieve improved health outcomes. The resolution notes that behavioural science can facilitate the understanding of how behavioural influences and communications guide decision-making. It highlights the contribution of behavioural science in achieving Universal Health Coverage (UHC) and in strengthening prevention of, preparedness, and response to public health emergencies. It also recognizes the importance of building capacity to systematically adopt evidence, including evidence from behavioural science and implementation studies. Finally, it urges member states to mainstream behavioural science approaches in health policies and to advocate for necessary structural considerations including behavioural science teams, units or functions, and for the allocation of sufficient funding and human resources.
Building health system resilience in and through service delivery
Authors: Eriksen A
Published: October 2023

Introduction

The ability of a health system to deliver services during and in the aftermath of a shock depends on the capacity of all other health system functions (governance, health workforce, physical infrastructure and finances). Countries have differing service delivery approaches (e.g., more or less emphasis on outpatient vs. hospital care), which influences how they respond to a shock. However, despite the differences in health system organisation of service delivery and the type of shock, there are common approaches that countries can take to increase the resilience of service delivery and deal with fluctuations in demand and supply.

Methods

A framework for understanding the impact of a shock on service delivery was developed by the European Observatory on Health Systems and Policies, and used as an analytical tool to examine the relationship between service delivery and resilience.

Findings

Shocks can impact the demand for and supply of services in different ways. For example, an epidemic/pandemic shock such as Covid-19 may lead to surges in demand and crowd out routine care, while a war or conflict shock (e.g., Ukraine since February 2022) may lead to (local) supply shortages as well as surges in demand, necessitating setting up new infrastructure and transferring of patients. However, health systems also responded to shocks in ways that have increased the resilience of service delivery. These include flexible decision making, innovations in digital health and better planning and management across care settings.

Conclusions

Flexible policies that can increase health service supply flows, rather than one-off increases, are needed to respond to unexpected changes. Furthermore, it is the linking of the impact of shocks on service delivery that ultimately influences the final health system goal of improved health. Finally, shocks can impact service delivery even after a shock, with the opportunity to transform into a more efficient and resilient health system.
Health financing: the impact of shocks and its role in health system resilience
Authors: Cylus J
Published: October 2023

Introduction

Health financing plays a vital role in the performance of the health system. Shocks can have a major impact on health financing but health financing can also protect aspects of the health system during shocks. Understanding the health financing function, how different types of shocks - including pandemics and the current cost-of-living crisis -- affect health financing, and how health financing can be resilient in the presence of shocks is of utmost importance

Methods

A framework for understanding health financing and how a shock can affect health financing was developed by the European Observatory on Health Systems and Policies. Health financing is broken down into revenue raising, pooling, purchasing and the governance of health financing, referred to as sub-functions of health financing. We use this framework to explore country examples in an effort to identify the ways in which health financing systems are resilient to different types of shocks.

Findings

There a range of examples demonstrating resilience to shocks across the sub-functions of health financing. First, there are counter-cyclical financing mechanisms where the revenues allocated to health are automatically adjusted to compensate for unemployment shocks (e.g. Lithuania). Second, there are purchasing practices that ensure resources are allocated appropriately within the health system when there are significant changes in utilization patterns, (e.g. Belgium during COVID-19). Third, automatic adjustment of prices occurs, paid by the health system to compensate for inflationary pressures. Fourth,good practices in the governance of health financing involve adjusted coverage policies to improve access to services when households were under severe financial strain (e.g. Ireland).

Conclusions

There are many different ways to ensure that health financing is resilient to shocks. Policymakers must consider the role of their health financing systems when developing preparedness plans.
A participatory approach to increase HPV vaccination in marginalized Roma communities in Slovakia
Authors: Filakovska Bobakova D , Dankulincova Veselska Z
Published: October 2023

Background

Roma living in marginalized communities are among underserved groups facing limited access to vaccination services. The RIVER-EU in Slovakia aims to identify and tailor the intervention to address health system barriers to HPV vaccination faced by people from marginalized Roma communities.

Methods

Following principles of participatory action research, a wide spectrum of stakeholders was engaged to discuss the transferability of promising evidence-based interventions. Interviews and focus groups aimed to assess the suitability of interventions and identify barriers and facilitators for the transfer and implementation taking contextual characteristics into account.

Results

Key stakeholders included community members (parents and daughters), Roma health mediators, healthcare providers, policymakers, and representatives of the municipality, school, and public health authority. The most challenging was to engage community members as they had almost no information about the HPV vaccination. Building relationships and trust with communities require intensive cooperation with field services, time and energy. Engaging primary care providers was difficult due to their restricted capacities and work overload causing their motivation to engage in time-consuming collaborative processes to be low. Successful engagement of all stakeholders required concentrated efforts and specific strategies of the research team.

Conclusions

Active participation of all those who will be affected by the intervention and those whose cooperation will be necessary for successful implementation requires to engage keep on board a number of stakeholders holding different opinions. Facilitating consensus about the design of tailored intervention requires intense communication and revisiting the ongoing integration of emerging ideas until the consensus is reached. It is a responsibility of a researcher to ensure that at the end of the process, all voices are heard and all needs are met.
BELHEALTH: a longitudinal study to monitor the mental health of the Belgian population post-pandemic
Authors: Bruggeman H , Charafeddine R , Demarest S , Nélis G , Gisle L
Published: October 2023

Between April 2020 and June 2022, the Belgian Health Institute (Sciensano) launched 11 online “COVID-19 Health Surveys” to assess the impact of COVID-19 and the subsequent policy responses on people's attitudes, behaviors and overall physical, mental and social well-being. Results showed an increase in the prevalence of anxiety and depression when policy measures became stricter to contain the rise of COVID-19 infections and deaths. Due to the substantial impact the crisis had on mental health, it is crucial to continue the monitoring efforts in the aftermath of the COVID period. In order to track changes over time and explore potential predictors and risk factors, the study design of the COVID-19 Health Surveys shifted to a longitudinal cohort approach (BELHEALTH). Among the 50,000 participants in the COVID-19 Health Surveys, a total of 12,000 individuals agreed to be part of the BELHEALTH cohort and participate in the online surveys every three months. Results of the BELHEALTH cohort (October 2022 and February 2023) show that the percentage of adults experiencing anxiety and depression are significantly lower compared with the percentages during high restriction periods, but remain high compared to the percentages during pre-pandemic times (Health Interview Survey 2018). Several other mental health indicators are monitored, such as subjective mental health, life satisfaction, sleep quality, concerns regarding current societal challenges, etc. The mental health indicators from the COVID-19 Health Surveys and the BELHEALTH cohort, together with mental health indicators from other sources, are communicated on the epidemiological dashboard of the institute.
Smart City and the digital measurement of solar ultraviolet radiation in Outdoor workers in the City of Lisbon
Authors: Paulo M
Published: October 2023

The growing incidence of skin cancer over the years has made it a significant public health problem. However, technology can be used to tackle the skin cancer which is highly preventable, mainly through reduced exposure to solar ultraviolet radiation (UVR). Digital services can be used to promote individual and collective protective measures and interventions. Specifically, there is an opportunity when the exposure is intermittent or continuous, and occurs in an occupational or leisure setting. We are using a digital platform to contribute to raising public and policy awareness on solar UVR-inflicted occupational skin cancers in the municipality of Lisbon. The digital platform is performing direct measurements of the solar UVR dose received by outdoor workers. Results will likely contribute to further understanding the risk estimates for keratinocyte cancer estimations in this population. The digital platform integrates a personal electronic dosimeter (GENESIS-UV system) to assess occupational solar UVR doses of gardeners, masons, and gravediggers of the municipality of Lisbon. Two hundred and ten outdoor workers were selected to wear the dosimeter for 1 month each, between April and October during their daily working hours. The digital platform that offers private access to information through dashboard visualization provided information for the outdoor workers and facilitate communication with the participants. Study data provides the outdoor workers with information on their personal solar UVR exposure during their working hours and an estimate of their risk of developing skin cancer. The results prospectively should flow into the design of adequate prevention campaigns for skin cancer in outdoor workers.
Case report Norway
Authors: Lyshol H
Published: October 2023

Norway gathers health information about the population through the 18 central law-regulated health registries and a system of questionnaire-based health surveys. The health registries, including the Medical Birth Registry (founded in 1967) and the Cause of Death Registry (founded in 1951) contain information about the entire population, with data linked to the unique personal identification number, which makes them valuable and trustworthy data sources. In general, surveys can be less dependable, in that participation rates are falling, and participants may not be representative. International data reporting has been regarded as important for Norway, which has reported data to WHO's Health for All database back to 1970. When the SDG indicators were requested by the UN and WHO, Norway was able to deliver 26 of the 28 indicators (93%) on the UN list, though some indicators, such as 3.3.3 (Malaria incidence), were regarded as unnecessary. Indicators 3.5.1 (Substance use treatment interventions) and 3.b.3 (Health facilities with essential medicines) are not reported because of the organisation of the health system. From 2015, the Norwegian Ministry of Health and other national agencies have discussed the validity of the SDG targets for Norway. In 2017, Statistics Norway published a report about the availability of SDG indicators for Norway, and in 2018 a meeting between the relevant ministries resulted in a decision to start reporting the official UN indicators. In 2021 Statistics Norway published a taxonomy of the SDG indicators, and the same year, published all available indicators in a bilingual SDG portal on their web pages. The same year, the Norwegian Ministry of Health decided to start adding to the official UN SDG 3 indicators, and in collaboration between the Norwegian Institute of Public Health and Statistics Norway, 16 extra indicators describing the SDG 3 targets have been defined and are being published, with another 20 in the pipeline.
Trends of HAI and AMR in Italian intensive care units: findings from the SPIN-UTI network
Authors: Agodi A , Maugeri A , Favara G , Magnano San Lio R ,   SPIN-UTI network
Published: October 2023

Introduction

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose a significant burden on Public Health. Although it is undeniable that the COVID-19 pandemic provoked challenges in routine clinical practices and surveillance, especially in intensive care units (ICUs), its impact on HAIs and AMR is still highly debated. The present analysis describes trends of HAIs and multidrug-resistant (MDR) microorganisms in Italian ICUs from 2006 to 2021.

Methods

According to the European Center for Disease Prevention and Control (ECDC) protocol, we used data on nearly 22,000 patients and 4,500 isolates from the “Italian Nosocomial Infections Surveillance in Intensive Care Units, SPIN-UTI” project. The study population consists of all patients admitted to Italian ICUs for more than 48 hours. Isolates of Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were classified as MDR if susceptible to at least one antimicrobial agent in three or more antibiotic classes.

Results

Overall, the incidence density of HAIs increased from 17.1 per 1,000 patient-days in 2006-2007 to 24.1 in 2020-2021. Part of this increase can be attributed to the increasing incidence density of pneumoniae (p < 0.001). Although the proportion of MDR microorganisms did not significantly change over the years, increasing trends were evident in the incidence density of MDR isolates for A. baumannii (from 1.3 to 3.2 per 1,000 patient-days) and K. pneumoniae (from 0.5 to 3.1 per 1,000 patient-days). By contrast, the proportion of methicillin-resistant Staphylococcus aureus decreased from 46.9% in 2006 to 30.2% in 2021 (p-<0.05).

Conclusions

Our analysis shows an increasing trend in the incidence of HAIs and MDR microorganisms in Italian ICUs. This scenario has been surely worsened by the COVID-19 pandemic. It is still unclear, however, if the increasing incidence of AMR can be attributed to an overall increase in HAIs or to other causes.

Key messages

• In Italian ICUs, the incidence of HAIs and MDR microorganisms increased from 2006 to 2021.

• Further studies should be conducted to estimate the impact of COVID-19 pandemic on HAIs and AMR.
A WHO/UNICEF manual for health workforce on how to build an infodemic insights report in 6 steps
Authors: Purnat T , Wilhelm E , Abeyesekera S , White B K , Hassan N , Pastorino A , Machiri S , Briand S , Nguyen T
Published: October 2023

Background

An infodemic is an overwhelming amount of information, including mis- and disinformation, that accompanies health emergencies such as outbreaks. Infodemics contain questions, concerns, information voids (where people seek credible, accurate information but cannot find it) and circulating mis- and disinformation. When there is a gap between health guidance and population behavior within a noisy information environment that affects people's perceptions, attitudes and health decisions, infodemic insights can help inform how an emergency response or a health program responds.

Objectives

A manual was developed through an iterative discussion and consultative process between November 2022 and February 2023, to provide a quick overview of the steps required to develop an infodemic insights report that can be used for emergency response or for routine health programming.

Results

The manual and teaching materials have been iteratively adapted based on their delivery at conferences and workshops. The process the manual describes reflects the learnings and experiences of WHO, UNICEF and other partner organizations on conducting social listening and infodemic insights report generation during the COVID-19 pandemic. it explains 6 steps, starting with questions that infodemic insights can help answer, through selection of data sources, conduct of integrated analysis, development of strategies and recommendations, to development and dissemination of the report. Annexes include checklists, templates, worksheets, and key messages for use by practitioners. Accompanying out-of-the box teaching simulation and other reference and training materials facilitate adoption.

Conclusions

The manual is part of the WHO toolbox for infodemic managers which applies latest evidence-based approaches to monitor, detect, respond to and mitigate harm form infodemics during health emergencies. It will be applied across training and capacity building programmes on infodemic management.

Key messages

• A systematic approach to monitoring infodemics and developing infodemic insights that are reproducible and evidence-based are needed.

• Guidance on integrating diverse datasets in analyzing and understanding infodemics in specific populations and contexts will be published in a manual by WHO and UNICEF.
Integrating Equity Considerations in an International Pandemic Instrument
Authors: Plamondon K , Dixon J ,   A SOLVE research team
Published: October 2023

Background

The COVID-19 pandemic is widely regarded as a catastrophic failure of global governance with far-reaching consequences. Actions from wealthy countries severely limited access to essential medicines and supplies for the majority of the world's population. While the World Health Assembly has established an intergovernmental negotiating body (INB) to draft an instrument to strengthen pandemic prevention, preparedness and response, and equity considerations have been positioned as central to this process, there remains a danger that international power imbalances sabotage meaningful equity action. What priorities should an equity-centred pandemic instrument reflect?

Methods

Using a sequential deliberative dialogue (DD) methodology, international participants were purposefully selected for expertise, life experience, and spheres of influence. Two Fall 2022 dialogues were virtually convened to coincide with the study's official representation at the INB process and participants were engaged to respond specifically to the instrument's development. Dialogue findings were synthesized with a Systematic Equity Action-Analysis1 and participants were invited to review and respond.

Results

Alongside specific recommendations to prevent future inequitable pandemic responses, three overarching equity-centred approaches were identified as crucial: (1) consistently align stated intentions with operational proposals; (2) openly acknowledge causes and contexts of global inequity; and (3) create mechanisms for accountability and enforcement.

Conclusions

Achieving equity in international instruments is possible, but vague language threatens this potential. Beyond aspirational rhetoric, deliberate and coherent equity-promoting mechanisms are needed throughout the pandemic instrument in order to avoid the next catastrophic failure of global governance.

1. Plamondon et al. Turning the tide on inequity through systematic equity action-analysis. BMC Public Health. 2023;23(1):890.

Key messages

• Despite a rhetoric of ‘virtuous’ equity statements by the world's power and resource-wealthy countries, global contexts of inequity will continue or worsen without mitigation.

• Given future pandemics are likely, the cost of not mitigating inequities through this treaty poses risks to global public health.
Social media, conspiracies, and political partisanship must be accounted for during the pandemic
Authors: Duplaga M , Wilk M , Zwierczyk U
Published: October 2023

Background

The infodemic accompanying the COVID-19 pandemic made us aware that many factors not directly associated with the public health system can influence society's adherence to preventive measures. This study aimed to analyze the effects of social media use (SMU), generic conspiracist beliefs (GCB), and political sympathies (PS) on the compliance with general preventive measures (GPM) recommended during the pandemic and uptake of vaccination against COVID-19 (UC19V).

Methods

Data were obtained during an Internet-based survey performed 1.5 years from the beginning of the COVID-19 pandemic in Poland in a representative sample. The effects of SMU, GCB, and PS on the GPM score (wearing the mask, washing hands, and keeping a distance) were analyzed with multivariable linear regression (MLiR) model. The role of these variables in the UC19V was assessed with the multivariable logistic regression (MLoR) model. For MLiR, B coefficients and 95% confidential intervals (95%CI) were reported, and for MLoR, odds ratio (OR) and 95%CI.

Results

Among 2189 respondents, those who accepted COVID-19 vaccination were 73.5%. Users of social media were 93.6%. All three independent variables were significantly associated with the GPM score and UC19V. GCB score was adversely associated with UC19V (OR, 95%CI: 0.42; 0.36-0.48) and with the GPM score (B; 95%CI: -0.15; -0.23 - - 0.76). The most intense SM users were less likely to adhere to GPM than non-users (B, 95%CI: -0.20; -0.37 -0.02). They were also 40% less likely to receive vaccination than non-users (OR, 95%CI: 0.59; 0.43-0.81). The extreme right-wing party supporters less frequently complied with GPM (B, 95%CI: -1.01; -1.28 -0.75) and were 50% less likely to get vaccinated than supporters of the ruling party (OR, 95%CI: 0.47; 0.31-0.70).

Conclusions

The SMU, GCB, and PS remain independent negative predictors of accepting COVID-19 vaccination and adherence to general preventive measures.

Key messages

• Effective implementation of preventive measures during the pandemic requires incorporating several circumstances outside health and public health systems.

• Political sympathies, general conspiracist thinking, and immersion in social media independently decrease compliance with preventive measures and vaccination during epidemic threats.