bluuebunny/crossref_metadata_2025 huggingface dataset:
Outbreak economic analysis of six imported hemorrhagic fevers following detection at 24 hours
Authors: Learoyd T , Yeo K
Published: October 2023

A ten-language search found no economic analysis of symptomatic hemorrhagic fever importation for Crimean Congo (CCHF), Hantavirus (HV), Lassa (LV), Marburg (MARV), Middle East Respiratory Syndrome (MERS) or Nipah (NV) into the USA/EU/UK. This study used available literature to calculate the cost of importation of the six selected fevers with each outbreak detected at 24 hours. A PRISMA search of Pubmed and grey literature was undertaken to uncover respective R0, case fatality ratios, average hospital stay, time to death, frontline casualty frequency and contact histories. A simulated breakout, t24 intervention, Borel distribution contact model, with R0 determined infection (0-1.59) and death rate (CFR: 0.01-0.5) was formed. Treatment inc. plasma therapy, and PPE best prices were determined. ICU median operational costs were factored with contact tracing. Indirect admin costs, based on national mean values, frontline replacement, GNI per capita productivity losses through isolation (21 days as standard), hospitalisation and death were factored. Mean patient discharge ranged 4.4 - 28 days (CCHF to MERS). Time to death ranged 2 - 15 days (HV, NV). The number infected at t48 ranged 1 - 9.59 (CCHF/HV to MARV). Contacts ranged 27 - 169 (CCHF to MARV/NV/MERS). Direct costs of outbreak care, labour, and tracing ranged €424707 - €2850083.07 (CCHF - MARV). Indirect costs, attributed to administrative burdens ranged €5264 -€32800.02 (CCHF to MARV). Productivity losses, attributed separately to the isolated, treated, and dead totaled €2042613 - €26198606 (CCHF - MARV). The total outbreak cost ranged €2488512.78 - €29081489.72 (EU, CCHF - MARV). Significant direct, indirect and productivity costs were attributed to the importation of a single case of six hemorrhagic fevers when detected at t24. The significant societal cost of MARV in particular highlights the importance of continued hemorrhagic fever research and preparedness to healthcare systems in protecting future budgets.

Key messages

• The importation of hemorrhagic fevers has significant direct and indirect budgetary, and productivity, impacts.

• Besides human cost, financial costs demand public health enhanced surveillance and response plans for hemorrhagic fever importation.
The approach to developing Ireland’s first national health protection strategy and lessons learnt
Authors: Kelly C , Doherty L , Gallagher J , Odewumi L , Black M E , Concannon K , Conway R , Marron L
Published: October 2023

Health protection is recognised as an essential public health function by the World Health Organization. It includes the prevention and control of infectious disease, environmental and radiation risks, and the emergency response to major incidents. The COVID-19 pandemic has highlighted the importance of strengthening this function worldwide. To address this as a public health priority in Ireland, between January and October 2022 the first national first Health Protection Strategy (2022-2027) for the Health Service Executive (HSE) was developed. This was led by the then National Clinical Director for Health Protection supported by a Project Working Group (PWG), with governance and oversight from a multi-disciplinary Steering Committee (SC). Key steps in strategy formation included detailed stakeholder analysis, exploration of the policy context for the strategy, and development of a consultation plan with guidance of an external facilitator. Two SC consultation workshops were held (March and June 2022). Workshop 1 focused on defining strategic vision, aim, and objectives. Workshop 2 verified objectives and identified enablers. A subsequent e-consultation invited feedback from wider stakeholders (July 2022). The strategy, published 13th October 2022, outlines 10 strategic objectives and 11 associated enablers. Progression of strategy implementation will require further stakeholder engagement, development of implementation plans, and establishment of a monitoring and evaluation framework, including annual review of implementation. Strengths of the strategy development approach included multidisciplinary SC input and oversight, review of the national and international policy context, detailed stakeholder analysis and engagement, and the comprehensive consultation plan developed with external facilitator input. Lessons from our experience can support colleagues internationally to strategically set out their priorities for health protection beyond COVID-19.

Key messages

• The development of the first HSE Health Protection Strategy 2022-2027 is a critical step to ensure a clear framework for the delivery of national health protection functions going forward.

• As the COVID-19 pandemic continues, public health bodies should strategically set out priorities for health protection beyond COVID-19 – lessons from our experience in doing so can inform this work.
Attitudes toward vaccination in the Croatian adult population
Authors: Miskulin I , Pavic Z , Dmitrovic B , Barac J , Sabadi D , Barac I , Miskulin M
Published: October 2023

Background

The COVID-19 pandemic emphasized vaccine hesitancy as one of the major threats to global health. Attitudes toward vaccination are important predictors of vaccination behaviour. This study aimed to investigate attitudes toward vaccination and factors which influence them in the Croatian adult population.

Methods

This cross-sectional questionnaire study was conducted from June 2020 to December 2020 in the convenience sample of adults from Split-Dalmatia County in the primary healthcare setting. The Vaccination Attitudes Examination Scale (VAX) was used to assess attitudes toward vaccination. The higher scores on the VAX scale reflect more negative attitudes toward vaccination.

Results

The study sample consisted of 632 subjects (52.7% males and 47.3% females). The median age of all subjects was 38.0 (interquartile range 29.0 - 48.0) years. The median VAX scale score was 42.0 (interquartile range 35.0-50.0). The more negative attitudes towards vaccination were found in females (p = 0.015), subjects aged 25-44 years (p = 0.026) and subjects living in suburban areas (p = 0.040).

Conclusions

The Croatian adult population displayed quite negative attitudes toward vaccination. The study showed that some sociodemographic characteristics such as gender, age group and place of living had influenced attitudes towards vaccination in the studied population. Bearing in mind that attitudes are closely connected with the practices the development of public health programs created to promote vaccination should take into consideration the sociodemographic characteristics of the population for which they are intended.

Key messages

• It is highly important to improve attitudes towards vaccination in the Croatian adult population.

• Understanding the factors that influence attitudes towards vaccination is crucial to design an appropriate public health program that promotes vaccination in selected population groups.
Level of sanitary preparedness of European facilities during the COVID-19 pandemic
Authors: Kaziuk M B , Kosiba W
Published: October 2023

Introduction

On March 11, 2020, the World Health Organisation (WHO) declared the series of COVID-19 cases a pandemic. A series of sanitary and epidemiological restrictions were introduced in most countries.

Aim

The aim of the study was to evaluate the level of sanitary and epidemiological preparedness of European accommodation and catering facilities during the COVID-19 pandemic by Polish tourists and their perception of safety in selected destinations.

Material and methods

300 Polish tourists (125 women, 175 men, age 46.5+/-12.9 years) travelling to southern European countries during the COVID-19 pandemic were included in the study. The five most common destinations were selected: Italy, Austria, Greece, Croatia and Mediterranean islands. Tourists rated accommodation and catering establishments on the basis of a proprietary questionnaire on sanitary and epidemiological preparedness and their perception of safety. 70% of the respondents had a COVID passport, and 50% of them had additional health insurance in case of a COVID-19 infection.

Results

The higher the sanitary regime, the greater the feeling of safety in the group of female respondents aged 45-50 years (p < 0.005), while the higher the sanitary and epidemiological standards, the shorter the stay (p < 0.001). Milder restrictions provided a greater sense of freedom and mental rest in the group of male respondents than in the group of female respondents (p < 0.05).

Conclusions

The respondents’ opinions revealed that the highest level of safety with regard to sanitary and epidemiological requirements was observed in Austria and Italy, while shorter length of the stay in these countries resulted from high prices, particularly in catering establishments. According to the respondents, less stringent restrictions, among others lack of the necessity to own the COVID passport, were linked to Croatia and Mediterranean islands. The sense of safety was satisfying while the sense of freedom and mental rest was high.

Key messages

• Most of the sanitary-epidemiological procedures used during the pandemic could have prevented many other infectious diseases, including gastrointestinal diseases.

• Sanitary regimes should correlate with a sense of security.
Post COVID-19 Condition in adults: results from a bibliometric analysis
Authors: Damiani G , Heidar Alizadeh A , Raspolini G M , Altamura G , Santoli G , Pasca GFM , Pascucci D , Nurchis M C
Published: October 2023

Background

Post COVID-19 Condition (PCC) in adults, as defined by the WHO, is a newly discovered syndrome consisting of symptoms persisting for at least two months and arising usually three months after SARS-CoV-2 infection. Among the over 200 symptoms reported, the most common ones (fatigue, dyspnoea, cognitive dysfunction) significantly affect everyday life. PCC is an urgent and complex public health issue; therefore, we aimed at estimating the impact of published studies on the matter through a bibliometric analysis.

Methods

Pertinent papers on adult PCC were retrieved from three databases (PubMed, Scopus and WebOfScience), according to eligibility criteria based on a Population-Intervention-Context-Outcome (PICO) model. The relevant Medical Subject Headings (MeSH) and non-MeSH search terms regarding PCC in adults were combined in a Boolean search string. A bibliometric analysis of the collected studies was conducted, consisting of citation counts and a linear regression analysis to investigate the research trends. The dependent variable was the number of articles per year.

Results

According to our inclusion criteria, 1975 papers were screened. Twenty-seven percent of the studies were published in European countries, 48% in Asia and 25% in America. Preliminary results on the pattern of publications from 2020 to 2023 show an increase by 14% [(CI 95%) 10%-17%] from 2020 to 2021, by 17% [(CI 95%) 13%-20%] from 2021 to 2022, and by 22% [(CI 95%) 19%-25%] from 2022 to 2023 as of January.

Conclusions

An increasing number of individuals are reportedly suffering from ongoing PCC, and research trends are escalating accordingly. Implementing appropriate care pathways and management should rely on extensive and updated knowledge on the clinical, social and organizational challenges of PCC; thus, our research aimed at partially broadening the literature, although further research is required and should focus on investigating the complexity of PCC symptoms and impact.

Key messages

• Post COVID-19 Condition is a complex and still partially explored syndrome.

• Public health policies should rely on robust and vast scientific literature.
Exposure to multiple sources of accessible, cheap, energy dense fast foods in a deprived community
Authors: Saunders P , Middleton J
Published: October 2023

This study assesses the levels of fats, including trans-fatty acids, and salt in common takeaway fast foods in a deprived urban community in the West Midlands England and implications in the context of the spatial distribution of fast food takeaways. The results of the compositional analysis of over 250 take out foods were compared with established and derived standards. 70% of products exceeded the recommendation that a meal should contain less than 30% of a Guideline Daily Allowance (GDA). More than half exceeded 50% GDA for at least one metric including 81% of all analyses for saturated fatty acids (SFA). Over 30% samples exceeded the children's GDA for total fat or SFA. 27% of salt analyses exceeded the GDA. For poorer social groups avoiding the expense of cooking entirely is a cost effective way of sourcing calories. These are the same populations experiencing high levels of unemployment and limited opportunities to develop businesses. People in Sandwell are exposed to large portion sizes and high levels of fats and salt in takeaway foods. Given this population's limited options to break out of a highly compromising environment of living simultaneously in a ‘swamp’ of unhealthy, readily accessible and cheap takeaways, and a ‘desert’ of healthy options, an innovative package of interventions is required. There are strong political, social and economic reasons for not considering a blanket restriction on takeaways given the role such businesses play in entry-level employment and business opportunities for disadvantaged communities Rather than trying to ban such foods, a more realistic and effective intervention is to challenge and change what's on offer, how much is on offer, and how it's been prepared, ‘change the menu not the venue', while at the same time enabling communities to access, prepare and cook good quality ingredients for a healthier diet.

Key messages

• This population is living simultaneously in a ‘swamp’ of unhealthy, readily accessible and cheap takeaways, and a ‘desert’ of healthy options.

• A package of interventions is required including local planning and regulatory powers, educational interventions and working with industry to promote healthy and affordable food preparation techniques.
A rapid synthesis of evidence on whole systems approaches to obesity prevention to inform policy
Authors: Reynolds C , Mack J , McAvoy H , Breslin G , Wills W , McGowan L
Published: October 2023

Background

The Department of Health in Northern Ireland is developing a new obesity prevention strategy. To support policy development, the Institute of Public Health commissioned a rapid synthesis of evidence on whole systems approaches to obesity prevention. Objectives were to present evidence from existing reviews on whole systems approach effectiveness, describe case studies where a whole systems approach has been applied and propose key policy considerations.

Methods

A rapid synthesis of evidence on whole systems approaches, rather than a full systematic evidence review, was conducted to meet policy development timelines. Review articles were included, as were national and international case studies that described whole systems approach implementation and/or evaluation. The Methodological Index for Non-Randomised Studies Framework was used to assess the methodological quality of the case studies.

Results

Five review articles and five case studies (majority moderate-borderline strong quality) were included. Results showed whole systems approaches can be associated with improvements in Body Mass Index, physical activity environment and improved community wellbeing, with a school component being particularly effective. Facilitators to implementation included leadership, community involvement, consistent language, adequate resources and evaluation/systems science knowledge.

Conclusions

Whole systems approaches can be effective in enhancing the capacity of communities to create healthier environments and deliver measurable reductions in Body Mass Index.

Key messages

• Whole systems approaches to obesity prevention can be effective in creating healthier environments.

• Findings from this research could support any future pilot of this approach in Northern Ireland.
COVID-19 Health Information System Assessments
Authors: Saso M , Schutte N
Published: October 2023

In the second presentation, the results from the 8 PHIRI assessments conducted between January 2022 and April 2023, that aim to map the health information systems (HIS) that monitor the effects of COVID-19 on population health, assessing the COVID-19 health information flows in European countries, will be presented. The mapping includes an assessment of the underlying needs and how these relate to current gaps in the European HISs. Additionally, it investigates potential future needs and gaps to which PHIRI can respond through its services. The methodology followed to perform the assessment as well as the topics covered such as data collection and data sources, data analysis and data management, development and use of indicators, human and technical resources, knowledge translation, reporting and dissemination will be outlined. Finally, the identified strengths and weakness across countries with connected tailored recommendations for more resilience health information systems will be showcased, setting the scene for the panel discussion later on.
Integrated Knowledge Translation in the Food and Nutrition Security for Manitoba Youth study
Authors: Slater J , Katz A , Chateau D , Cidro J , Falkenberg T , Nickel N , Sanguins J , Urquia M , Pilli B
Published: October 2023

Background

There are concerns that many children do not have healthy diets, which may be related to dietary choices as well as lack of access to healthy foods. The Food and Nutrition Security for Manitoba Youth (FANS) study examined diet, nutrition-related behaviours and food security of 1587 grade nine students in Manitoba, Canada. Results show that while one in five students were food insecure, almost all need significant dietary improvements. Engaging stakeholders through multiple communication channels is key to disseminating research outcomes to drive action for policy change.

Methods

Principles of integrated knowledge translation were followed, including a breadth of dissemination activities, to maximize impact of study results. These included diverse partnerships, academic and non-academic research outputs, and use of media.

Results

Study partners including academic co-investigators, school authorities, government agencies and non-profit organizations advocating for child nutrition contributed to study design, interpretation and dissemination. Results were published in academic journals, as well as translated into a suite of non-academic outputs including a community report, infographics (circulated on social media), and a searchable data dashboard, available through a web-based portal. This approach allows for tracking of research output downloads, which number over 500 to date. Due to active outreach to traditional media, study results received widespread attention adding to the breadth of knowledge translation methods employed. This also led to uptake by provincial health education curriculum developers. Results will also be circulated during an upcoming provincial election as part of engaging candidates around child nutrition and food security issues and policies.

Conclusions

This broad approach to integrated knowledge translation has resulted in extensive distribution of FANS study results and has potential to influence public health nutrition policy.

Key messages

• Integrated knowledge translation and a breadth of dissemination strategies in the FANS study has led to extensive distribution of research outputs and media coverage.

• The FANS knowledge portal, with diverse academic and non-academic research outputs including a data dashboard, is strategic for public health nutrition promotion and advocacy.
Implementation of the Baby-Friendly Hospital & Community Initiatives in Europe: a scoping review
Authors: Matthews A , Walsh A , Pieterse P , Mishra N , Chirwa E , Chikalipo M , Msowoya C , Keating C
Published: October 2023

Background

Promotion of and support for breastfeeding is essential for public health, to improve nutrition globally and save the lives of over 800,000 children annually. Since its launch in 1991, the Baby-Friendly Hospital Initiative (BFHI) has been implemented in 150 countries, to promote the ‘ten steps to successful breastfeeding', with the Baby-Friendly Community Initiative (BFCI), arising from the 10th step.

Aim

To synthesise evidence about BFHI and BFCI implementation in European countries.

Methods

This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Data were charted by country, study design, setting, study population, BFHI steps, study aim and objectives, intervention, results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken.

Results

A total of 278 articles were included in the review, of which 60 studies covered the implementation of the BFHI or BFCI in 18 European countries. Most studies were found from the UK (n = 11) Italy (n = 9) and Switzerland, Spain and Turkey (n = 6 each). Most were hospital-only based (n = 48) and most covered all ten steps of the BFHI (n = 44) and fewer BFCI (n = 4). Studies were carried out with health workers (n = 17), mothers (n = 34) and policy makers. Most studies were quantitative (n = 39) with many others designs used. Our charting of results highlights that effective implementation required political commitment, legislative and regulatory underpinning; support at organisational level; ongoing multi-professional leadership, education, training and teamwork, and effective education for women.

Conclusions

While contextual country-level factors are seen, there are clear patterns underpinning successful BFHI/ BFCI implementation, which can guide effective implementation.

Funded by the Irish Research Council and Department of Foreign Affairs Ireland, grant number: COALESCE/2019/89

Key messages

• Strong political and professional leadership is required to support the effective implementation of public health initiatives to support breastfeeding.

• Ongoing, effective multi-professional education and training is required to support breastfeeding.
Green Climate Fund adaptation's interventions on food security: metrics and health outcomes
Authors: Serli D , Parrish R , Lauriola P , Zeka A
Published: October 2023

Introduction

The Green Climate Fund (GCF) is the largest public climate fund, it claims to use an innovative approach in climate adaptation actions, however, it has faced significant criticism since its inception. 2016-2025 is the Decade of Action on Nutrition and climate change's impact on food security is one of the biggest threats to human health. Current models predict that Africa will be the most affected continent. Food security is a polyhedric concept that requires definitions and indicators to acquire meaning and provide in-field applications.

Methods

Among the GCF's projects the ones that address the result area “health, food, and water security” in the African countries have been selected. The means of verification (MoV) has been searched in every funding proposal, simplified approval process, and other relevant documents, if not found, were requested to the Fund and local managers. Projects have been divided into ‘International’ or ‘Local’ based on GCF's definitions. The study also sought to identify the food security definition adopted by the Fund and reviewed available food security indicators.

Results and discussion

21 projects, amounting to an investment of $887.2 million, met the criteria. National projects accounted for 17% of the investment, while international projects comprised the remaining $733 million. 7 of the 21 projects (circa 40% of the funds invested) did not provide measurable food security outcomes. The majority of the projects provided some measurable outcome but it is rarely possible to know how this will be measured, as only 3 projects, all from the World Food Program (WFP), declared their MoVs. The GCF seems to not adopt a clear definition of food security. The WFP's indicators, while validated for caloric adequacy, are not consistently validated for micronutrient deficiencies and other health outcomes.

Conclusions

Insufficient information on monitoring and evaluation may raise further concerns about the GCF's governance.

Key messages

• Food security is a poliedric concept that requires defintions and indicators to acquire meaning and provide in-field applications, evaluation processes are essential to detect real adaptation.

• The Green Climate Fund is the largest public climate fund, it claims to use an innovative approach in climate adaptation actions but it seems to lack robust monitoring and evaluation processes.
Correlates of adherence to a posteriori derived dietary patterns of an Italian sample of adults
Authors: Scarsi N , Pezzullo A M , Savoia C , Raspolini G M , Pastorino R , Boccia S
Published: October 2023

There is emerging evidence that the Italian population is switching away from the traditional Mediterranean dietary pattern towards unhealthy eating habits. We derived adults’ dietary patterns (DP) using a principal component analysis (PCA) on food groups intake of a representative sample of the Italian population (INRAN-SCAI 2005-2006), and correlated diet adherence scores with sociodemographic characteristics through multivariable linear regressions. After PCA, “High-fat”, “Western”, “Health-conscious”, “Italian, traditional” and “Junk, out of meal” DPs were retained. Female gender (β = 0.5103; p < 0.001) showed an association with higher adherence scores on the Health conscious pattern. Conversely, being female was associated with lower Z-scores on the High fat (β=-0.1849; p = 0.024), Western (β= -0.0711;p= 0.004) and Italian traditional (β=-0.4799;p<0.001) patterns. Age (β per one year increase=-0.0077;p<0.001) was associated with lower adherence scores in the Western and in the Junk, out of meal (β=-0.0078;p<0.001) pattern. Having either a secondary (β=-0.1301;p=0.016) or tertiary (β=-0.2156;p= 0.001) education level were independently associated with lower dietary Z- scores in the Italian traditional” pattern. Finally, there was wide regional variation, coming from different regions predicted adherence to different DPs. A substantial share of our sample showed unhealthy eating habits, which is consistent with the latest Italian dietary trends.

Key messages

• Future policies to improve diet quality at the national level should promote food literacy interventions targeting the differences between women and man among different age groups.

• This work will provide the basis to investigate the environmental impact of higher pattern adherence scores.
The Top 100 Most Cited Papers in 2022 on Global Health indexed in Web of Science
Authors: Taneri P E
Published: October 2023

Background

Even if it is a controversial topic, citation counts are frequently used as an indicator of how popular and valuable published articles are. In this study, we aim to identify and analyze the characteristics of the most cited articles in the global health area.

Methods

We searched the Web of Science (WoS) database with the keywords: (TS=global health) AND (PY = 2022) AND (SU=public health). We filtered highly cited articles and selected the top 100 for our analysis. Scopus was used for extracting the journals’ CiteScore 2022 metrics. We conducted frequency analysis and Spearman's correlation test wit using SPSS 27.

Results

Most of the articles were about COVID-19 (37%) and environmental health (36%). One of four studies about COVID-19 was investigating COVID-19's effect on the mental health of adults or children. Affiliations of the first authors were mostly from (USA 21%) or China (20%) and they were followed by India (10%). Most of the papers were reviews (38%). The other frequent study types were prevalence studies (12%), estimation studies (11%) and systematic reviews (9%). The median of the WoS core citations was 48.5 (min. 33, max 770) and overall it was 49 (min. 33, max. 792). The papers were mostly published in Lancet (7%), Science of the Total Environment (7%) and Environmental Research (6%). CiteScore median for the journals was 16.7 (min 3.8, max 131.8). There were no correlations between WoS core citations of the papers and CiteScore of the journals (Correlation Coefficient=0.075, p = 0.459) and overall citations (Correlation Coefficient=0.083, p = 0.409).

Conclusions

Most of the highly cited papers about global health in 2022 were published by the authors from USA and China, and the papers were mostly about COVID-19 and environmental health. The majority of the publications were reviews. This might refer to the lack of powerful original research on the topic.

Key messages

• Most of the highly cited papers about global health are reviews.

• Our findings suggest there is no correlation between one paper’s citation number and the CiteScore of the journal that published it.
Organising for health equality: assessing contexts for implementing integrated health access
Authors: Mejsner S B , Beck M , Fehsenfeld M , Lundberg L , Westergaard C L , Vixoe K , Burau V
Published: October 2023

Background

Social inequalities in health are complex and vulnerable people therefore need cross-sectoral initiatives that provides integrated access to different sectors of the health system. However, specialization makes systems fragmented, and health organization is an important but overlooked determinant of social inequalities in health. The Flexible Assertive Community Treatment (FACT) model offers integrated health access to people with severe mental illness, through interprofessional teams across health and social services. This study aimed to assess the organizational contexts that shape the implementation of this model of integrated care.

Methods

The study applied the theory of the Organizational Fields to identify the specific mechanisms by which organizational contexts influence the implementation of the FACT model. We analysed political and administrative documents at national, regional, and local levels to assess relevant contexts. We complemented with semi-structured interviews with managers and health professionals in three municipalities and the region in Denmark that implemented the model.

Results

Overall, this study found that the contexts for implementing FACT are highly complex both horizontally, between the health and social care sector, and vertically, between the national, regional, and local level. This leads to conflicting demands on the implementation of FACT in the municipalities. Local cultures of collaboration may nonetheless offer a lever to handle these demands, although this varies across municipalities.

Conclusions

For health systems, it is challenging to organize integrated health access as contexts are complex both horizontally and vertically. Assessing these contexts is therefore highly important to identify key determinants for successful implementation of models such as FACT. This may in turn reduce social inequalities in health through more coherent and accessible care.

Key messages

• Vulnerable people need integrated access to different sectors of health systems to secure health equity, but this is challenging to organise as health systems are complex horizontally and vertically.

• Assessing the contexts of health sytems is key to identifying the determinants for successful implementation of initiatives to reduce health inequalities through more coherent and accessible care.
Restrictions on access to medical care for the uninsured in Bulgaria
Authors: Kostadinov S , Stefanova P , Georgiev A , Vasileva R , Kamburova M , Stoilova I
Published: October 2023

Introduction

There are two forms of health insurance in Bulgaria - mandatory and voluntary. Despite the fact that all Bulgarian citizens are required to have health insurance, a high proportion of persons with interrupted health insurance rights due to irregularly paid health contributions is reported every year. These persons have limited access to health services, as they cannot be provided with free preventive activities, planned hospitalizations, and for pregnant women there is a minimum number of free examinations (4 examinations during the entire pregnancy). The purpose of the present study is to determine the share of persons with suspended rights and their opportunities to access health services.

Methods

Official data from the annual reports of the Health Fund and the National Statistical Institute for the period 2020 - 2022 for the Pleven region were used. The data were processed with statistical methods.

Results

It was found that for the period from 2020 to 2022, an average of 20.6% of the population had interrupted health insurance rights. Provided that persons under 18 and those of retirement age are insured by the state, persons with suspended rights are only of active age. Among this group, the share of the uninsured is 34%. Uninsured women giving birth in 2020 are 19.35% of all women giving birth, in 2021 - 16.54%, and in 2022 - 18.33%.

Conclusions

The high share of persons with interrupted health insurance rights in Bulgaria represents a serious problem for the access to basic medical care of these people. Limitation of activities for prevention, planned treatment and regular monitoring of pregnant women. poses a risk to both their individual health and the health of the population.

Key messages

• In Bulgaria, a high proportion of persons with interrupted health insurance rights is observed.

• The uninsured have very limited access to free medical care, preventive activities and planned treatment.
Prediabetes and lifestyle habits in Reunion Island: Need for targeted interventions
Authors: Bun R , Laguës-Hugouvieux H , Kichenapanaïdou L , Marimoutou C , Nobécourt E
Published: October 2023

Background

Prediabrun is a cohort study of prediabetic patients settled in primary care in Reunion Island, focusing on the transition to diabetes. This study aimed to analyze the lifestyle habits of the first 330 prediabetics included.

Methods

A dietary score was calculated from the food frequency questionnaire to assess the adherence of participants to the National Nutrition and Health Plan 4 (PNNS-4) recommendations (-14 to 13.25). Physical activity was classified according to the WHO recommendation of 30 minutes of moderate activity per day.

Results

The mean dietary score of the participants was 3.7 with an equal distribution of patients between ‘moderately close’ and ‘close’ adherence to PNNS-4 recommendations. Although the average perception of their dietary balance (6/10) seemed consistent with the mean dietary score, there was no correlation between the two variables. The main discrepancies concerned fruits and vegetables consumption: only 2.4% consumed at least five fruits or vegetables per day, and less than half at least one. About 9/10 prediabetic subjects declared 30 minutes of physical activity per day, mainly consisting of walking, and housework. Prior knowledge of prediabetes had no impact on the lifestyle habits.

Discussion

Effective management of prediabetes requires a balanced diet and regular physical activity to avoid evolution to diabetes. These study results highlight the necessity of lifestyle interventions to assist prediabetic patients in modifying their habits. While subjects perceived their dietary balance to be adequate, they did not comply with dietary recommendations, regardless of their knowledge of their prediabetic condition. This indicates the need for specific dietary and physical activity support, easily accessible that can be prescribed by physicians and reimbursed by the national healthcare system.

Key messages

• Prediabetics in Reunion Island need targeted lifestyle interventions to improve adherence to dietary recommendations.

• Prediabetic patients in Reunion Island require specific dietary and physical activity support, easily accessible and reimbursed by the national healthcare system.
Transitions in and out of work across the life course of patient with a NCD diagnosis
Authors: Machado M , Perelman J
Published: October 2023

Background

Coupled with its impact on quality of life, non-communicable Diseases (NCD) may degrade both the quality and quantity of the workforce, and stunt economic growth and productive employment. However, there is limited information about the social costs of NCDs to identify priorities in resource allocation, particularly in regard to retirement policies. In this paper, we investigate if NCDs affect them employment status, i.e., the patients’ ability to work beyond middle age, using longitudinal data.

Methods

We used longitudinal data from employed men and women who responded to the sixth and seventh waves of the SHARE project from several European countries and Israel. We restricted the sample to all people working up to 3 years before the expected retirement age for each country. To achieve a representative sample of employed people from each country we calculated calibrated longitudinal individual weights for participants in these two waves. It was to adjust for non-response, sample selection bias, and attrition (N = 9645). We modelled the probability to change employment status on Wave 7 as function of having a NCD, adjusting for age, gender, marital status, job satisfaction, education level, and country, using multinominal logistic regressions.

Results

Overall, 30.3% of the study population self-reported one NCD and 28.3% mentioned at least two chronic health conditions (multimorbidity). Among multimorbid individuals the risk of unemployment is 1.27 times more (OR = 1.271, 95% CI (1.266-1.276).), while the risk of retirement is multiplied by 1.26 (OR = 1.259, 95%CI (1.255-1.262)).

Conclusions

Having one NCD or multimorbidity is a common phenomenon in the working middle-aged European population. It is associated with unemployment and retirement, controlling for educational level, age, marital status, gender, job satisfaction, and country. This result highlights that early retirement will persist unless health policies are implemented to decrease the burden of NCDs.

Key messages

• This study shows that there is a strong association between having one or more NCD with unemployment and retirement, controlling for educational, age, and occupational type.

• Results reinforce that we need health policies focused on alerting society about real impact of NCD on employment.
Socio-economic burden of cystic fibrosis in Europe: a systematic review of cost of illness evidence
Authors: D'Ambrosio F , Nisticò A , Russo Sanjuanbenito M , Ricciardi R , Calabrò G E
Published: October 2023

Background

Cystic Fibrosis (CF) is one of the most prevalent severe genetic diseases, with a high economic impact on healthcare systems due to its complexity. The life expectancy of CF patients has substantially lengthened due to early diagnosis and improvements in therapeutic regimens with Cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Therefore, strategies to ensure equitable access to these treatments should be optimized. Our study aimed to summarize existing literature regarding the costs of CF in Europe.

Methods

A systematic literature review was performed querying three online database (PubMed, Scopus, Web of Science) from January 2013 to March 2023. Studies carried out in European countries, written in English language, and focused on the socio-economic burden of CF were selected.

Results

Overall, 11 studies were considered. Across countries, the average total annual cost for a CF patient amounted to €14.174,00-53.256,00, higher for children (€15.771-60.412,00) compared to adults (€15.714-€47.217,00). The largest expenditures were recorded for annual direct healthcare costs, which amounted, per patient, to €9861,00-28.827,00, followed by direct non-healthcare costs (€4512,00-18.329,00). For adults, drugs, tests, and hospitalizations represented the primary cost drivers of direct healthcare costs, while for children, direct non-healthcare costs, especially for caregivers, were predominant. Moreover, indirect costs, whose main expenses were related to productivity loss and early retirement, ranged between €1,094-12,443 per patient per year.

Conclusions

The CF management is associated with relevant costs. CFTR modulators represent an important therapeutic opportunity of reducing the clinical and economic burden of CF. Therefore, new evidence and value-based economic evaluations, that also take into account a social perspective, are needed to support the decision-making process.

Key messages

• The use of new health economic models is needed to guide the policy-makers in a value-based evaluation of Cystic Fibrosis treatments that take into account their whole value.

• The assessment of the socio-economic burden of Cystic Fibrosis could guide the identification of the main actions to be implemented to respond adequately to the real health needs of patients.
Self-reported chronic pain: Prevalence and characteristics in the Capital Region of Denmark
Authors: Eliasen M H , Lau C J , Grønkjær M , Jacobsen M H , Elsborg P , Toxværd C G , Andreasen A H , Benthien K S
Published: October 2023

Background

Chronic pain is a burden for both the individual and the society. Primary chronic pain has been included in the International Classification of Disease, 11th version (ICD-11), defined as persistent or recurrent pain for more than three months. The aim of the study was to estimate the prevalence of self-reported chronic pain approximating this definition as well as characteristics of persons with self-reported chronic pain in the Capital Region of Denmark, comprising 1/3 of the citizens in Denmark.

Methods

Self-reported chronic pain, defined to approximate the ICD-11 definition, was assessed in the Danish Capital Region Health Survey 2021, including 56,245 participants from the general population aged ≥16 years (response rate 54.9%). The question was validated using cognitive interviewing. Characteristics of persons with chronic pain were assessed using national registries (socio-demographics) as well as questionnaire data (health status and health-related behavior). Descriptive analyses and multivariate logistic regression models weighted for survey design and non-response were performed.

Results

Preliminary results show that 32% in the Capital Region of Denmark in 2021 had self-reported chronic pain. More women (35%) than men (28%) reported chronic pain. The prevalence of chronic pain increased with age, but still, 20 % of persons aged 16-34 years also reported chronic pain. Chronic pain was inversely associated with education; thus, 45% of persons with short education reported chronic pain. Associations between chronic pain and mental and physical health status as well as health-related behavior, pain interference and pain location will be presented.

Conclusions

Self-reported chronic pain is highly prevalent in the general adult population of the Capital Region of Denmark. Knowledge on prevalence and characteristics of persons with chronic pain is important to create effective prevention and treatment strategies.

Key messages

• Chronic pain is highly prevalent in the general population.

• More focus and research are needed on chronic pain – both concerning prevention and treatment.
Intervention Research in Health Promotion: Policy Issues, the Example of the Ten-Year Cancer Strategy in France
Authors: Foucaud J
Published: October 2023

Prevention research covers a wide range of studies, including the identification of unknown risk factors for certain cancers, or health promotion with approaches by population, by living environment or by territory. This research focuses in particular on identified carcinogenic factors (e.g. tobacco, alcohol, food, certain pesticides) but also on the causes of the prevalence of these factors in certain populations. In addition, surveys on perceptions of cancer and cancer risk factors - such as the 2021 French Cancer Barometer - are needed. They provide a better understanding of behaviour in order to propose targeted and effective interventions. In this context, the PHIR makes it possible to respond to these challenges. In 2010, the French National Cancer Institute was a pioneer in the development of PHIR in France and decided in 2021 to make it one of the spearheads of its ten-year strategy. This presentation aims to report on this policy of developing PHIR as a relevant tool for thinking about health promotion policies and actions, particularly on nutrition, with a focus on health inequalities and on certain populations (young people, vulnerable populations). The presentation will address three challenges for the implementation of this research policy: 1/ the development of the French scientific community in order to be able to respond to priority issues; 2/ the support of research on this topic and the animation of this community; 3/ the use of PHIR as a tool to define health promotion policies and actions. The first part will focus on identifying the modalities of implementation of the PHIR in the framework of a national policy of prevention and health promotion. The second part will focus on the challenges of its deployment among the French scientific community.
Decarbonizing healthcare sector: from a review to a framework of practical solutions
Authors: De Marchi C , Cristiano W , Armocida B , Martuzzi M , Mancini L
Published: October 2023

Background and objectives

Climate change is one of the biggest health threats facing humanity. It can be considered as a syndemic, interacting with social determinants of health and pre-existing chronic conditions, exacerbating their effects on human health. Healthcare sector should play a key role in mitigating the climate crisis considering its mission of protecting and promoting health. Despite this, its climate footprint is equivalent to 4.4% of global net carbon emissions, making it a major contributor to the climate crisis. In this context, healthcare sector needs to lead the way to the net zero carbon emissions. The aim of this paper is to identify key actions for reducing the carbon footprint of the healthcare system and develop a framework for emission reduction actions.

Methods

The study consists of two phases: i) conduction of a rapid review of the literature, through which studies on healthcare carbon footprint published worldwide until April 2022 will be collected, screened by title and abstract and analysed; ii) identification of hubs as main causes for CO2 emissions and development of a framework for adopting practical solutions aimed at carbon reduction actions.

Results

From the rapid review of the literature 747 records have been retrieved. Of this, 21 have been selected after screening by title and abstract.

Conclusions

The climate crisis is increasingly compromising human health, so urgent actions are needed. As the healthcare system contribution to the climate crisis is expected to increase in the next years, efforts must be undertaken to mitigate this and become sustainable and climate-smart. Healthcare system and healthcare professionals should be the ones leading the front by reducing its own pressures to climate. The entire scientific community is called to recognise this issue as a high priority.

Key messages

• Climate crisis as a high priority for healthcare professionals.

• Development of a framework for carbon reduction actions.