bluuebunny/crossref_metadata_2025 huggingface dataset:
HL-Kids-NRW – Study of fourth-graders’ health literacy
Authors: Bollweg T , Okan O
Published: October 2022

Background

Although children are identified as a key target group for interventions targeting the development of health literacy, little data is available on children's health literacy and how it is related to health outcomes at a young age. This study addresses this research gap by providing data on fourth-graders’ health literacy and associated health outcomes.

Methods

A cross-sectional study was conducted among fourth-grade students in the state of North-Rhine Westphalia, Germany. The study was designed as a representative survey starting in 12/2020, which could, however, not be realized due to pandemic-related constraints. Data collected between 07/20 and 11/20 is included in the analyses presented here. Among others, we assessed self-reported health literacy with the HLS-Child-Q15 questionnaire, while also assessing various self-reported health outcomes.

Results

n = 364 students are included in the analysis, 49,5% of which are female. The mean age is 9.5 years (SD=.7). The HLS-Child-Q15 demonstrated high internal consistency (Cronbach's α=.812). Self-reported health literacy is high, with a HLS-Child-Q15 mean score of 3.13, indicating that it is rather easy for participants to deal with health-related information. Health literacy is significantly associated with a number of outcomes related to health status (KINDL-R subscales physical wellbeing and mental wellbeing, Spearman's ρ = .280 and ρ = .271, respectively; p < .001) and health behaviour (freq. of brushing teeth: ρ = .173; p < .01; freq. of eating fruit and vegetable: ρ = .217 and ρ = .299; p < .001; freq. of physical activity: ρ = .279; p < .001).

Conclusions

While the overall level of health literacy in our sample is high, higher health literacy is associated with better health behaviours, as well as improved mental and physical wellbeing. Further analyses are necessary to explore the causal pathways between the investigated variables, and representative survey are needed to verify these findings.
5.M. Workshop: The need to account for vaccine-specificities in the implementation of the EU Regulation on HTA
Authors:   Organised by: EUPHA-HTA, Vaccines Europe, HTAi,   Chair persons: Chiara de Waure (EUPHA-HTA), Elena Petelos (EUPHA-HTA)
Published: October 2022

In January 2022, the EU Regulation on Health Technology Assessment (HTAR) entered into force. The HTAR provides for the centralized conduct of EU-wide joint clinical assessment (JCA) for oncology treatments (2025 onwards), and for other medicinal products incl. vaccines (2030 onwards). HTA is a multidisciplinary process aiming to disentangle the value of a health technology in comparison to other. It has been used, to different extent across EU countries, to inform vaccine price and reimbursement decisions. Nevertheless, existing assessment frameworks utilized by HTA bodies, incl. National Immunization Technical Advisory Groups (NITAGs), as well as the relative effectiveness assessment (REA) framework developed by the European Network for Health Technology Assessment (EUnetHTA), do not fully account for the specificities of vaccines. In fact, to account for the broad value of vaccines several aspects ought to be considered, including societal benefits. Attention has been paid to these topics for years by the public health community, and in particular EUPHA-HTA, and also Vaccines Europe, a specialized vaccines group within the European Federation of Pharmaceutical Industries and Associations (EFPIA), has recently released a position statement on the need to tackle vaccine specificities in future JCA. Furthermore, as the COVID-19 pandemic has highlighted, such aspects are critical for joint procurement efforts to combat the current and future pandemics. The objective of this workshop is to address the current and future role of HTA in vaccine regulation across EU countries, inform on key specificities of vaccines in respect to JCA and HTA as a whole and discuss opportunities to develop vaccine-specific methodological guidelines within the HTAR. Following an introduction, the following topics will be addressed:

• Competent bodies and HTA impact on vaccine decision-making process, incl. a discussion of implementation challenges and potential impacts of the HTAR.

• JCA specificities in respect to vaccines and the importance of addressing the whole value of vaccines and vaccinations.

• The proposal of Vaccines Europe for guiding principles to account for vaccines specificities in JCA built on the outcomes of an ‘across-the-industry’ project incl. also non-industry experts.

The presentations will be followed by a panel discussion to further explore the themes, consider next steps and address questions from the audience.

Key messages

• The new EU HTAR is paving the way for JCAs of several medicinal products, incl. vaccines necessitating expert guidance in terms of determining their whole value.

• Vaccines specificities should be duly considered in JCAs to inform national and EU-wide decision-making for vaccination programmes, reimbursement, and pricing.
Do EU countries comply with the right to healthcare under the UN Convention on the Rights of the Child?
Authors: Hernandez Quevedo C , Scarpetti G , van Ginneken E
Published: October 2022

Children's health status varies within and between European countries. To what extent this is associated with access barriers to timely and effective care children may face is not yet fully understood. Article 24 of the UN Convention on the Rights of the Child (UNCRC) guarantees a fundamental right to healthcare for all children, regardless of their legal status in terms of citizenship, residence, or insurance. Using information contained in the Health Systems in Transition reports produced by the European Observatory on Health Systems and Policies, additional relevant literature, and responses to a structured questionnaire filled out by key informants from all 27 EU MS and the United Kingdom, we evaluated whether European countries comply with the specific obligations that can be drawn from the UNCRC. While all countries considered have ratified the UNCRC, only four countries have included a specific disposition in their legislation that establishes an unconditional, universal right to health services for all children living in their territory. In other countries, the fragmented way of defining children's access rights can create gaps in legislation which can leave certain groups of children without coverage. Children with irregular residence are the most vulnerable group when it comes to eligibility problems, but other groups of children may also fall between the cracks or be only entitled to restrict-ed or conditional access to health care. These insights show that international treaties, such as the UNCRC, can help monitor health coverage and ensure that basic human rights to health services are guaranteed in times of crisis, such as the Covid-19 pandemic and the Ukraine Displacement, but may be insufficient without concrete transposition into national legislative frameworks.
What can we learn from the effects of the COVID-19 pandemic on hospital care for children in Germany?
Authors: Mauer N , Tille F , Nimptsch U , Panteli D
Published: October 2022

The COVID-19 pandemic created substantial disruptions in the delivery of health services around the world. Reductions in hospital admissions have been reported for several conditions in the adult population; less evidence currently exists for children. To what extent such changes reflect a risk for patients due to unmet care needs, or a “correction” of previous overprovision of care has not been thoroughly examined yet. Based on complete national hospital discharge data, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020 and 2021 in Germany. We also analyse the development of monthly admissions between January 2019 and December 2021 for three tracers of variable urgency and severity. Total admissions were approximately 20% lower in 2020 and 2021 compared to 2019. The composition of the most frequent diagnoses did not change dramatically across years, although changes in rank were observed. The number of admissions for acute lymphoblastic leukaemia (tracer 1) showed a slight increasing trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions (tracer 2) decreased by about 9% in 2020 and a further 8% in 2021, while tonsillectomies/adenoidectomies (tracer 3) decreased by more than 40% in 2020 and a further 30% in 2021; for these tracers, monthly changes are in line with pandemic waves. Observed variations in child hospitalisations reflect the effects of pandemic mitigation measures and/or changes in demand. In Germany, inpatient care for critical conditions appears to have been largely upheld, potentially at the expense of elective treatments. Complementary data on ambulatory care and health outcomes would enable a better understanding of change in healthcare patterns and effects on children's health.
Obesity, body weight stigma and biomedical oversimplification: moving beyond BMI
Authors: Stranges S
Published: October 2022

Body Mass Index (BMI) is one of the most important factors considered to analyse health status. High BMI scores are usually associated with physical or mental disorders, such as cardiovascular disease, diabetes, inflammation, dyslipidemia and depression. However, obesity is usually characterised by the presence of various comorbidities that should be addressed as part of a unique, more complicated picture. Emerging evidence suggests that a deeper acknowledgment of the complexity of obesity as disease, including its comorbidities, should take place in the near future. Overweight, obesity and related disorders have been associated with direct healthcare-related costs and the indirect costs of productivity loss, mostly due to the presence of comorbidities rather than to body weight in general. The belief that weight loss is the best recommendation for people with high BMI as the only path to health could be questioned. In fact, it would seem that weight loss in some subjects does not necessarily coincide with any health improvement. Thus, the relationship between weight status and health expenditure is complex with particular reference to the fact that costs of disease are higher in high-comorbid profiles independently of weight status. Over the last years, researchers have also studied some conditions, such as metabolically healthy overweight and obesity. Recent studies deal with alternatives to conventional weight-loss approaches that could be more effective in health terms. Conventional methods of weight loss are based on calorie restriction and increased energy expenditure instead of unconventional methods, such as the weight-neutral program, which is based on the crucial concept of “mindfulness” to underline the importance of intuitive eating, self-care, pleasurable exercise and size-acceptance. The health benefits related to such types of approaches include physical, psychological and behavioural improvements.
EHDS2 pilot infrastructure for the secondary use of health data
Authors: Bacry E , Jendrossek M
Published: October 2022

The EHDS2 Pilot consortium brings together 16 European partners (national platforms, research infrastructures, EU agencies and associations in the area of health) to respond to the EC's call for projects to set up a test version of the future European Health Data Space (EHDS) for the secondary use of health data (EHDS2). It aims to build this pilot version of EHDS2 by interconnecting data platforms in a network of nodes, implementing and testing a first user journey for creating, deploying and running health data research projects at EU level. The network will investigate the technical tools and set up the standards allowing researchers to query the metadata of all nodes, to request selected data via a single application form and to analyze data across national nodes. To build this network, the EHDS2 Pilot will propose legal and technical frameworks based on use cases selected by the EC. These will also serve to illustrate the powerful impact of exploiting health data from several countries and address topics from population health to healthcare pathways, cancer, rare diseases and genomics. This presentation will give an overview of the planned activities by the coordinating team.
Organizational health literacy in health care: Results from a participatory project in Germany
Authors: Rathmann K , Salewski LD , Zelfl LV
Published: October 2022

Background

Health care facilities (i.e., hospitals, care facilities and integration assistance) play an important role in providing health-related information and strengthening health literacy (HL) of patients/clients, staff and at the organizational level. The project “Development of Health Literacy in Health Care Facilities (EwiKo)’ aims at implementing tools to promote and strengthen organizational health literacy (OHL) in health care institutions in Germany. Objectives are 1) to assess needs for strengthening OHL in pilot facilities and 2) to examine factors that are beneficial to strengthen OHL in health care facilities.

Methods

N = 6 pilot institutions (n = 2 hospitals, n = 2 care homes for elderly people, n = 2 facilities for people with disabilities) and their members of the “working groups on HL” filled in a self-assessment tool to assess the level of OHL, accompanied by focus group interviews (n = 6-9 persons per pilot facility). Regarding conducive and obstructive factors when implementing tools to strengthen OHL, focus group interviews (n = 6-9 persons per pilot facility) and semi-structured interviews (n = 1 coordinator per organization) were conducted.

Results

Results of the self-assessment tool showed a need to strengthen OHL in all types of health care facilities, particularly in the fields of action ‘training of employees in HL tools’, “communication” and ‘participatory development and testing of documents, materials and services on HL’. Results of the focus group interviews showed a special need to strengthen OHL in the area ‘HL of employees’. Beneficial factors by implementing tools to strengthen OHL are, for instance a supporting management, resources, a participatory approach and trainings by the project team.

Conclusions

Due to the ongoing corona pandemic and accompanying challenges (e.g., personnel resources), it is comprehensible that health care facilities emphasize a need for strengthening HL of employees.
6.L. Round table: Digitally literate health workforce for a resilient future
Authors:   Organised by: Young Forum Gastein, EUPHAnxt,   Chair persons: Matthias Wismar (European Observatory)
Published: October 2022

Currently, health systems worldwide are experiencing an unprecedented challenge after the shock caused by the COVID-19 pandemic. However, there lies an opportunity for renewal to strengthen health systems. The importance of collaboration becomes imperative in times of health workforce (HWF) shortages and demanding working conditions. This workshop, organised in partnership by the Young Forum Gastein and EUPHAnxt, will focus on connecting generations to explore, discover and share best practices for HWF education and (re)training in digital skills to deliver better patient care. The COVID-19 pandemic has accelerated digitalisation across many sectors including healthcare. Yet it has also served to highlight the digital divide, which has the potential to hinder health experts in providing optimal care. Concurrently, the demanding working conditions of the HWF can be improved by making use of digital tools. It is high time to discuss how digital literacy can be improved across a multi-generational HWF and how to empower the next generation of healthcare leaders to re-imagine health services. The workshop will bring different perspectives to the table - policy-making, science & academia, and governance - on the approaches for better intergenerational collaboration by making use of digital literacy. At the end of the session, participants will understand the realistic potential of digital literacy and how it can be used to ensure effective communication across the HWF, support the resilience of health systems, and ultimately, safeguarding patient care.

Key messages

• Digital literacy is not a stable level of knowledge - the health workforce needs opportunities to advance their knowledge and (digital) skills.

• Acknowledging the shortages in health workforce planning, it is essential to ensure adequate skills of the health workforce personnel.

Speakers/Panellists

Natasha Azzopardi Muscat

WHO Regional Office for Europe, Copenhagen, Denmark

Marius-Ionut Ungureanu

Department of Public Health of the Babeș-Bolyai University, Cluj-Napoca, Romania

Brian Wong

EUPHA-DH

GHFutures2030, I-DAIR, London, UK

Ellen Kuhlmann

Medizinische Hochschule Hannover, Hannover, Germany
Overview of availability of harm reduction interventions in European prisons
Authors: Montanari L , Mazzilli S , Tarján A , Hasselberg I , Hall W , Vandam L , Vernooij A , Stöver H
Published: October 2022

Introduction

Prisons are high-risk environments for the transmission of drug related infections, due to over-incarceration of people who inject drugs; often inadequate healthcare, substandard prison conditions; and others. An overview of the availability and coverage of prison-based harm reduction interventions in Europe is presented.

Methods

National Focal Points of the EMCDDA (30) collected 2019 data, which were integrated with findings from the European funded project HA-REACT (Joint Action on HIV and Co-infection Prevention and Harm Reduction).

Results

Prison based harm reduction interventions are available in European countries, but only few of them are available in most countries and often with a low coverage (e.g. less than 10% of prison population in Opioid Substitution Treatment (OST) in most countries). Interventions available in most countries (20 or more) include: HIV, HBV, HCV testing (29), OST continued from community (29), Referral to HIV treatment upon release (28), HIV treatment (27), Referral to HCV treatment upon release (25), HCV antiviral treatment (25), Testing for TB (23), HBV antiviral therapy (25), OST initiated in prison (22), Treatment for TB (21), Vaccination for HBV (20). Interventions available in 10 to 19 countries are: condom distribution (19), OST (re)initiated before release (17), prison/community guidelines for implementation of OST (13). Interventions provided in < 10 countries include: distribution of disinfectant (9), condom with lubricant (9), take-home naloxone (5), needles and syringes programs (3).

Conclusions

Compared to the community, the availability and coverage of harm reduction interventions in European prisons are limited and large information gaps exist. Scaling up harm reduction in prison can achieve important individual and public-health benefits.
Predictors of delayed vaccination in infants born in Tuscany, Italy: an area based cohort study
Authors: Lastrucci V , Puglia M , Pacifici M , Rusconi F , Buscemi P , Alderotti G , Sica M , Belli G , Berti E , Voller F
Published: October 2022

Background

Timely vaccination is essential to protect infants from vaccine-preventable diseases. The aim of the study was to evaluate the determinants of vaccination timeliness for hexavalent (HEXA) and measles-mumps-rubella (MMR) vaccines.

Methods

The study is part of the PREHMO project funded by Tuscany Region, Italy. Data on the 2017 and 2018 full birth cohorts of Tuscany (N = 41,493) were retrieved from the Birth Registry and linked to those of the Vaccine Registry up to 24 months after birth. Sociodemographic and at birth characteristics of mothers and infants were retrieved. The primary outcome was the timeliness of HEXA 1st and 3rd doses, and MMR 1st dose. Timeliness was defined as the administration of the dose a day after the period recommended by the vaccination schedule. Multiple logistic regression models were performed.

Results

For all the vaccines considered, a significantly increased risk of delayed vaccination was observed in preterm infants and in infants born in hospital of second level of newborn care, while infants conceived by assisted reproductive technologies and first-born infants showed a significantly decreased risk for delayed vaccination. Multiple births, small for gestational age status, maternal unemployment, and rural residence were significantly associated with an increased risk of delayed HEXA-1 vaccination (OR 1.31, 95%CI 1.13-1.51; OR 1.12, 95%CI 1.03-1.22; OR 1.06, 95%CI 1.01-1.13; and OR 1.1, 95%CI 1.03-1.16). As for MMR vaccination, a low maternal education was significantly associated with high risk of delay (OR 1.12, 95%CI 1.06-1.18), while rural residence, maternal foreign nationality and female sex were significantly associated with a decreased risk of delay (OR 0.91, 95%CI 0.87-0.96; OR 0.82, 95%CI 0.78-0.87; and OR 0.95, 95%CI 0.91-0.99).

Conclusions

Several common and vaccine-specific predictors of vaccination timeliness were identified. Strategies to improve a timely vaccination should take into account these predictors.

Key messages

• Several maternal and infants factors may influence vaccination timeliness of routine immunization in childhood.

• Tailored vaccination strategies are needed to improve vaccination timeliness in infants at high-risk of delayed vaccination.
Potentials of participatory approaches for urban mental health
Authors: Wasmer A , Müller H , Rehn-Groenendijk J
Published: October 2022

Aspects of mental health, society, space and environment share entangled relations being studied in health geography. Recreational spaces as well as places that are commonly perceived as strenuous, unsafe, or highly stressful are unevenly distributed within urban areas, which is also associated with spatial differences in mental disorders. Spaces in general represent social constructions that reflect power inequalities; they are filled with subjective emotional resonances and sometimes visualize stigmatization of specific groups. As such, the interplay of socio-demographic factors, socio-economic factors and built environment is complex. To capture these entanglements represented in heterogeneous user groups, participatory approaches promise valuable insights. Yet, despite their great potential for fostering mental health in urban space, participatory approaches are still less common in health geography. Therefore, critical voices question whether the limitations of marginalized groups have been sufficiently considered in this field of study so far. Similar challenges arise in urban planning processes: Specific (vulnerable) groups such as children, women, foreign residents, and people with disabilities or elderly people are insufficiently included in planning processes, leading to an underrepresentation of their needs in the resulting environments. To tackle this shortcoming, the approach of co-creation offers a process in which participants jointly develop a solution without being the object of research or interview partners, but creators. Using rather practical or creative (e.g., joint mapping of the built environment, photo-elicitation) than discursive techniques allows contributions from population groups otherwise often excluded from planning processes. Despite certain limitations, participatory approaches promise the possibility to develop appropriate and just solutions in urban mental health.
6.P. Skills building seminar: Children and young people: engaging the unheard stakeholder
Authors:   Organised by: EUPHA-CAPH, EUPHAnxt,   Chair persons: Hellen Skirrow (UK), Jinane Ghattas (EUPHAnxt)
Published: October 2022

Global shocks from the COVID 19 pandemic have disproportionately impacted children and young people (CYP) and their families. Underlying health disparities have widened as a result of disruptions to healthcare, education and economic impacts. There are compelling arguments to engage children and young people in rebuilding society and systems from emerging public health threats including the covid 19 pandemic, the climate crisis and conflicts. Children and young people like others in society have a right to be involved in decisions that impact their lives and health but are too often unheard. Engaging those affected most by health policy ensures relevance and can improve adoption of interventions. Involving children and young people in strategic decision making can also improve their citizenship skills and improve health literacy. Although many children and young people have contributed to debates and publicly demonstrated their collective views on a variety of issues such as climate change, movements including #timesup, #Blacklivesmatter and #Metoo, their voices are seldom heard in policy and decision making arenas. In 2021, EUPHA CAPH and EUPHANxt sections collaborated to host the inaugural Engaging the Unheard Stakeholder workshop, supporting 2 young people aged <25 to attend the EPH and lead the workshop. (links). CAPH is now committed to make this a regular feature as part of our action plan to support young voices in public health.

Learning outcomes

• Develop insight into innovative ways to support and engage young people in public health policy making.

• Practise advocacy skills to facilitate young people's voices in research & policy

Activities

Participants will hear from young people who are championing activism or have been involved in shaping public policy.

Interactive skills building breakout session involving role play and scenarios to challenge their unconscious bias and learn skills as ‘active bystanders’ to empower young people

Key messages

• Despite major movements where children and young people have demonstrated their views on a variety of issues such as climate change, their voices are seldom heard in policy and decision making arenas.

• Public health professionals can advocate, support and engage children and young people in public health policy making but lack awareness and skills in advocacy to do this effectively.
6.Q. Skills building seminar: Integrating social inequalities in the burden of disease framework
Authors:   Organised by: COST Action CA18218– European Burden of Disease Network,   Chair persons: Brecht Devleesschauwer (Belgium)
Published: October 2022

Driven by the influential Global Burden of Disease (GBD) study, the burden of disease (BOD) approach has gained wide interest at national and international level to quantify the state of health and health inequalities. Central to the BOD approach is the Disability-Adjusted Life Year (DALY) metric, which quantifies the health impact of diseases, injuries and risk factors as the number of healthy life years lost compared to a counterfactual scenario of perfect health all life long. The BOD approach offers a valuable platform to quantify social inequalities in health, i.e., differences in health status by socioeconomic and sociodemographic characteristics. This is highly relevant, as health inequalities penalising socially disadvantaged groups are one of the most consistent, and persistent, findings in epidemiology, for almost every health outcome and socioeconomic indicator. Monitoring social inequalities in health is therefore a key priority for national health authorities. There are different ways by which social inequalities can be integrated in the BOD framework, but all come with important data challenges. Individual-level stratification is a common approach for quantifying inequalities by age and sex, but is more challenging for other sociodemographic and socioeconomic indicators. Area-level stratification allows for ecological analyses between BOD estimates and indices of social deprivation. Social inequalities can also be assessed using comparative risk assessment, by which the relative risk for adverse health outcomes in function of social position is to be quantified. This skills building workshop will present the methods that have been applied in different national burden of disease studies to include social inequalities, including a discussion of their strengths and weaknesses. By providing a step-by-step presentation of how the methods have been applied, attendees will gain unique insights in the different ways by which social inequalities can be integrated in the BOD framework.

Key messages

• The burden of disease framework offers a valuable platform to quantify and monitor social inequalities in health, which is a key priority for health authorities.

• Attendees will receive an overview of the different ways by which social inequalities can be integrated in the burden of disease framework, including a discussion of their strengths and weaknesses.
Assessing determinants of SARS-CoV-2 infection in a large older adult representative sample
Authors: Mosconi G , Stival C , Signorelli C , Amerio A , Cavalieri d'Oro L , Iacoviello L , Stuckler D , Zucchi A , Odone A , Gallus S
Published: October 2022

Most COVID-19-related deaths occurred in older adults, however to date, evidence on determinants of SARS-CoV-2 infection in this population is limited and mostly based on case series without a comparison group. A telephone-based cross-sectional study was conducted in November 2020 on a representative sample of 4,400 people aged ≥65 years from the Italian region of Lombardy. We determined the prevalence of participants reporting a SARS-CoV-2 infection in the period between the onset of the pandemic and the time of the interview. To investigate the determinants of the infection, we estimated odds ratios (OR) and their corresponding 95% confidence intervals (CI) thorough unconditional multiple logistic models. We further evaluated if the infection was a determinant of a worsening in mental health wellbeing. Overall, 4.9% of participants reported a history of SARS-CoV-2 infection. No significant relationship between sex and infection was observed. SARS-CoV-2 infection was less frequently reported in subjects aged ≥70 (OR = 0.55; 95% 0.41-0.74) compared to 65-69 years. We didn't observe any trend after 70 years of age. Participants reporting at least one chronic condition had a lower infection rate compared to healthy subjects (OR = 0.68 95% CI: 0.49-0.93). Separated/divorced subjects more frequently reported infection than married/cohabiting ones (OR = 2.33 95% CI: 1.29-4.20). Self-reported history of SARS-CoV-2 infection resulted being a determinant of an increase in depressive symptoms (OR = 1.57; 95% CI: 1.17-2.10). In this large study - among the few assessing the determinants of SARS-CoV-2 infection in a representative sample of older adults -, the prevalence of a history of infection in November 2020 approached 5%. We found that persons aged 70 and above and those with chronic conditions, thus individuals with likely less social interactions, were less frequently exposed to SARS-CoV-2 infection.
mHealth platform improved health worker's compliance to WHO’s IMNCI guideline in Nairobi, Kenya
Authors: Shah M , Sang E , Afeworki A , McLaughlin M , Finette B , Kwamboka L , Ogaro D
Published: October 2022

Poor access to quality health services, especially in urban slums, is a global challenge. Given similar challenges in Nairobi's Kibra informal settlement area, we collaborated with the Langata/Kibra sub-county health management team to conduct a pilot program for improving the quality of child health services delivered by health care providers (HCPs). The pilot introduced a digital mHealth platform to HCPs working in Kibra informal settlement area in Nairobi. This mHealth platform was compliant to WHO's recommended guideline for integrated management of newborn and child illnesses (IMNCI) and was designed to help sick child assessment, diagnosis and management by HCPs. We aimed to determine if using this digital platform, coupled with supportive supervision and community outreach, would lead to improve compliance to the IMNCI guideline for assessment, diagnosis and treatment of sick children. We conducted baseline (February 2019) assessment, trained selected HCPs on the mHealth platform on handheld android tablets, conducted end line (March 2020) and measured any change in HCP's compliance to IMNCI guidelines. Total 89 HCPs were the mHealth platform users during end line assessment. When asked about the choice of antibiotic for treating childhood pneumonia, we found proportion of HCPs who preferred Amoxycillin dispersible tablet, the recommended treatment for childhood pneumonia, increased from 3% at baseline to 38% at end line. Proportion of HCPs who were aware that antibiotics should NOT be used for the management of simple diarrhea increased from 14% (at baseline) to 50% (at end line). At end line, more than 90% HCPs were found compliant in their practice to IMNCI guidelines for sick child assessment, diagnosis and management. These results demonstrate the use of the IMNCI compliant mHealth platforms as a potential important effective way to improve capacity and compliance among HCPs who are serving communities like Kibra informal settlement in Nairobi, Kenya.

Key messages

• WHO recommended IMNCI compliant mHealth platform enables health care providers to offer quality child health care.

• Using mHealth platform to ensure WHO’s IMNCI guideline implementation by health care providers might have potential impact on saving sick children’s lives from preventable deaths.
Cost-effectiveness of two psychological treatments for the reduction of alcohol consumption
Authors: Flores S , Feldman I , Sampaio F
Published: October 2022

Background

Up to 7% of the Swedish population meets criteria for harmful use or alcohol dependency but only 10-20% seek treatment. One of the most recommended psychological treatments for controlled drinking is Motivational Enhancement Therapy (MET). Behavioural Self-Control Training (BSCT) is another treatment that is unique in that it is based on the psychology of learning and specifically focused on skills training. To our knowledge, no previous studies exist that evaluated the cost-effectiveness of BSCT for alcohol use disorders (AUD). The aim of this study is to assess the cost-effectiveness of BSCT compared to MET for patients with AUD aiming for controlled drinking over the longer-term from a societal perspective.

Methods

We modelled a cohort of patients with AUD who aim for controlled drinking, over a 10 year time horizon, and estimated the expected costs and outcomes of BSCT and MET. The model reflects the epidemiological transitions between drinking states, which reflect different levels of daily alcohol intake. Each drinking state is connected to temporary or long-term complications attributable to alcohol consumption, different costs and utilities. The data was sourced from a randomized trial evaluating the effectiveness of MET vs BSCT. Risks for complications and associated costs, utilities and mortality were sourced from the literature.

Results

Compared to MET, BSCT resulted in less total QALYs gained (4,7 vs 6,6 QALYs per patient). MET remains a cost effective treatment compared to BSCT [incremental cost-effectiveness ratio (ICER) = SEK 8497,79 per gained QALY] and a No Intervention scenario BSCT [incremental cost-effectiveness ratio (ICER) = SEK 16321,07 per gained QALY] at a threshold of 500.000 SEK per QALY.

Conclusions

This study suggests that MET should remain the recommended treatment for AUD patients with a goal of controlled drinking in favor of BSCT.

Key messages

• Motivational Enhancement Therapy should remain the recommended treatment for AUD patients with controlled drinking as their goal.

• A future study comparing Motivational Enhancemente Therapy to Behaivoral Self Control Training as recommended treatment in patients wanting to achieve abstinenece is suggested.
Personalised Medicine in shaping sustainable healthcare: a Delphi survey within the IC2PerMed project
Authors: Beccia F , Causio FA , Farina S , Savoia C , Osti T , Di Marcantonio M , Morsella A , Cadeddu C , Ricciardi W , Boccia S
Published: October 2022

Background

Personalised medicine (PM) has the potential to transform health systems and make them more sustainable, by making the population healthier and allocating resources efficiently. European Union and China have become world leaders in the field of PM, increasing collaborations worldwide. In this context, the EU Commission in 2020 launched the IC2PerMed (Integrating China in the International Consortium for Personalised Medicine) project to provide key solutions to enable the convergence of European and Chinese stakeholders toward a common approach in PM.

Methods

From a mapping exercise of policies and programs in PM in EU and China, we identified 20 priority items for shaping sustainable healthcare. Such items were submitted to several Chinese and European experts in PM involved in a 3-round Delphi survey. Experts were asked to review the items’ content and rate their validity and relevance on a 5-point Likert scale. Priorities reaching a Content Validity Index of more than 79% were included, between 70 and 79% were revised, and less than 70% were excluded.

Results

Of 20 priorities submitted, 9 reached consensus. The priorities hinge on the resources allocation, defining in advance priority investment, and identifying new payment models for public reimbursement, health technology impact, and assessment importance, while integrating end-user perceptions into the whole innovation process. In addition, the pivotal role of multidisciplinary and cross-sectorial collaborations emerged. Ethical, legal, and social implications and the related costs should be always considered in policymaking, evaluation, and management of technological innovation.

Conclusions

Integrating resources and setting a clear agenda for the implementation of PM would lead to a faster and more efficient translation into clinical practice. Developing policies valuing all the stakeholders’ contributions would implement PM adoption.

Key messages

• Healthcare systems sustainability is a priority and PM could make the population healthier and help allocate resources more efficiently, hence reducing the overall costs of healthcare.

• The inter-sectoral collaborations in healthcare are fundamental to achieving the best standard of care. All stakeholders and policymakers should engage to foster sustainability.
Burden of disease assessment for Germany and its regions – results from the BURDEN 2020 study
Authors: Porst M , von der Lippe E , Wengler A , Leddin J , Anton A , Rommel A
Published: October 2022

Background

Epidemiological measures such as incidence, prevalence, or deaths are essential for monitoring population health. However, evaluating them in isolation cannot adequately compare and assess the relative importance of different diseases. Assessments of the burden of disease (BoD) are therefore of growing importance in supporting health policy decisions. Using disability-adjusted life years (DALY) as a summary measure of population health, BoD integrates morbidity and mortality in a transparent approach.

Methods

Within BoD methodology, deviations in the health of the population from an ‘ideal’ health status is quantified in the unit of life years. DALY are the sum of years of life lost due to death (YLL) and years lived with disability (YLD). While YLL describe the gap between age at death and statistical life expectancy, the indicator YLD quantifies years lived with a disability or disease. Calculations were based on different primary and secondary data sources for Germany, especially cause-of-death statistics, epidemiological survey data, and statutory health insurance data.

Results

In Germany, there were about 12 million DALY in 2017, the equivalent of 14,584 DALY per 100,000 population. Coronary heart disease contributes the most to the overall burden of disease, followed by lower back pain and lung cancer. In women, headache disorders and dementias account for more DALY as compared to men. Men have a higher burden of disease from lung cancer or alcohol use disorders. Pain disorders and alcohol use disorders lead the DALY rankings for both sexes in younger adulthood. The burden due to cardiovascular disease, COPD, and diabetes mellitus increases with age and also varies by region.

Conclusions

The results suggest age- and gender-specific prevention as well as regional health care needs. BoD studies therefore provide comprehensive data for population health surveillance and can support health policy decisions.

Key messages

• The importance of specific diseases as measured by DALY differs greatly by age and gender, highlighting the need for targeted prevention measures.

• Regional patterns emerge for cardiovascular disease, COPD, and depressive disorders, among others, which may indicate health care needs.
Implementing Mental Health Promotion Initiatives - Process Evaluation of the ABCs of Mental Health in Denmark
Authors: Cantarero Arevalo L , Hinrichsen C , Koushede VJ , Rich Madsen K , Nielsen L , Santini ZI , Meilstrup C
Published: October 2022

Treatment and prevention alone are unlikely to make a significant difference in reducing the burden of poor mental health and mental illness. Therefore, mental health promotion (MHP) initiatives are advocated. In 2014, the ABCs of mental health (ABCs) partnership was established in Denmark; in the partnership, partner organisations, e.g., municipalities and NGOs, use a research-based framework for MHP, the ABC-framework, to develop and implement MHP initiatives. This presentation has two aims: (1) to outline the overall characteristics of these MHP initiatives; and (2) to explore local coordinator and stakeholder perceptions of the implementation processes and the impact of the MHP initiatives. Questionnaire surveys, individual interviews and group interviews were conducted during 2017-2020. The MHP initiatives were grouped according to three strategies: building MHP capacity, campaign activities to promote mental health awareness and knowledge and establishing and promoting opportunities to engage in mentally healthy activities. The ABC-framework was positively received and viewed as providing relevant knowledge for working with MHP as well as fostering intersectoral and interprofessional collaborations. However, using a bottom-up approach to develop and implement MHP initiatives can be time-consuming and resource demanding, and it requires a deliberate balancing of local adaptability and concrete guidance when engaging stakeholders and implementers. Overall, using the ABC-framework to develop and implement MHP initiatives holds great promise for advancing and promoting MHP practice.
COVID-19 restrictions and NUTS-3 deprivation: multilevel approach in Italy during the second wave
Authors: Dei Bardi L , Acampora A , Di Martino M , Davoli M , Agabiti N , Cesaroni G
Published: October 2022

Background

To face the second COVID-19 wave, Italy implemented a tiered restriction system with different risk levels (yellow=low; orange=medium, red=high). It is unknown whether the effect of the tiers was equal among provinces with varying levels of socioeconomic deprivation (SED). At each restriction level, we analyzed the impact of the province's SED on the SARS-CoV-2 daily reproduction number (Rt).

Methods

We considered the Rt (Nov 2020-May 2021) as the dependent variable and the SED as the independent variable. The Rt was estimated using daily incidence data from the Civil Protection Department as the instantaneous Rt. The province SED was measured using the percentage of individuals whose yearly income was less than 10,000€ (2019 data from the Ministry of Economy and Finance). We used multilevel linear regression models with random intercepts stratified by restriction level to estimate the effect of the SED on Rt (β) and its Standard Error (SE). Our analyses adjusted the estimates for the number of days into the tier first and then for other covariates.

Results

We found different levels and trends of Rt by SED in every restriction. Days-adjusted models found a containing effect for the red and the orange tier, while the Rt had an increasing trend in yellow. Higher SED was associated with higher Rt: β was positive and significant in red (β = 0.004 SE = 0.001) and orange (β = 0.002 SE = 0.001) but not in the lowest tier (β = 0.001 SE = 0.001). We found a significant interaction between the number of days into the restriction and the SED in the complete models. Compared to less deprived, more deprived provinces had slower Rt reduction in the highest tier. However, they had steeper Rt reductions in orange and slower increasing trends in yellow.

Conclusions

The highest restriction had milder effects in more deprived provinces, while lower tiers were more effective. These results underline the importance of accounting for SED when implementing public health measures.

Key messages

• Area-level deprivation can modify the effects of public health measures.

• Socioeconomic characteristics of the areas should be considered when implementing policies aimed to prevent the spread of epidemics.
What the PHIRI federated research infrastructure has achieved so far?
Authors: Gonzalez-Garcia J
Published: October 2022

PHIRI infrastructure follows a federated approach that is governed following the European Interoperability Framework. The vision of PHIRI is to create an infrastructure for individual level data processing following the privacy-by-design principle in a data-centric approach. As a basis to legal interoperability and compliance with the GDPR, the queries or algorithms are moved to the data instead of moving the data. So far, the PHIRI technological developments have focused on a client-server architecture. In this architecture a Coordinator Hub, the server, is in charge of orchestrating the deployment of the data-centric analysis solutions, in the form of R and Python scripts, that will be later executed in the partner nodes (data hubs), the clients. To perform the orchestration the Coordinator Hub encapsulates the scripts in software containers, using Docker images; all the outputs are published in Zenodo. The software containers are then deployed manually from Zenodo in the partner nodes and executed by its IT specialists using their own individual level data - the software containers have represented the technical interoperability layer. The data used on each partner has been previously adapted to a common data model (CDM) and the quality of the dataset has been assessed against the data model by each partner -this has represented the semantic interoperability layer. Finally, the outputs of the analysis's execution are aggregated data that are sent back to the Coordinator Hub to perform a comparative analysis. This stepwise approach has been tested in various research questions promoted by a leading researcher and agreed by the partner nodes who act as data hubs. A help-desk services and a developer's forum and a help-desk service have been set up to ease the implementation and deployment of the research queries - these both have represented the organisational interoperability layer