bluuebunny/crossref_metadata_2025 huggingface dataset:
Citizen’s perspective on pandemic preparedness
Authors: Mehra S , Gorter A , de Valk T , Euser S
Published: October 2024

In the aftermath of COVID-19, pandemic preparedness has become a key concern for governments and public health institutes across the world. As policymakers and scientist grapple with the lessons learned and implications for pandemic preparedness, it is also imperative to take the perspectives of citizens into account. To explore the perceptions and expectations regarding pandemic preparedness, the Behavioural Unit of RIVM conducted a qualitative follow-up study amongst a representative sample of Dutch citizens. At different locations in the Netherlands focus groups were organized with diverse participants. The topic guide was based on an analysis of a previously administered pandemic preparedness questionnaire and theoretical framework, also presented in the current workshop. Topics included risk perceptions, trust in government and other institutions versus self-reliance and the role of media and communication. Furthermore, pandemic preparedness was contrasted with other forms of disaster and crisis management. During the presentation the latest results are shared, and we will discuss possible policy recommendations and how the general public can be involved to develop a better understanding of their needs with respect to preparedness.
How to not revert to type: learnings from the pandemic response for universal health system reform
Authors: Parker S , Burke S , Mac Conghail L , Siersbaek R
Published: October 2024

Background

Understanding of the opportunities and learnings for health system change that have arisen during the pandemic is still emerging. Situated in the Irish health reform context of Sláintecare, the programme which aims to deliver universal, integrated healthcare, this study set out to generate evidence on the processes that impacted access to universal, integrated care during COVID-19, with a view to informing universal health system reform and implementation.

Methods

The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with 16 health system professionals (including managers and frontline workers) from a range of responses to explore their experiences during the pandemic. Following thematic analysis, a complexity-informed approach guided the interpretation of the findings.

Results

A range of factors facilitated better access to integrated care during the crisis, falling under three key themes (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a human-centred health system.

Conclusions

Alongside establishing health system structures, we must also incorporate alternative approaches to reform that recognise the value of shared sense-making in an interdependent system, while also allowing for innovation, exploration and learning; and acknowledging the role of social dynamics in driving change.
The IHR Journey: Past Lessons and Future Directions
Authors: Correia T
Published: October 2024

The International Health Regulations (IHR), established in 1969 and revised in 2005, represent a binding framework for 196 countries to combat global health threats. Historically, the IHR emerged in response to the need for a collective defence against the spread of infectious diseases. In the present, the IHR provides a legal structure for the World Health Organization (WHO) and its member states to report public health emergencies of international concern, ensuring a coordinated, prompt, and effective response. As we look towards the future, the IHR’s role is pivotal in addressing the complexities of global health security. The emergence of novel pathogens, the risk of bioterrorism, and the impact of climate change on disease patterns call for the evolution of the IHR. Such ammendments comprise: increasing clarity on multilevel jurisdiction; defining a pandemic emergency; introducing the concept of quarantine as a public health measure; stressing a compromise and solidarity approach between States Parties; reinforcing the need for bidirectional action between the WHO and States Parties; underlining cargo, as well as passengers, as relevant for public health measures; certificate digitalisation; among others. Strengthening the IHR is essential for a proactive approach to health policy, ensuring preparedness and resilience against any health crisis that may arise, although it remains in great controversy the right balance between the respect of national sovereignty and supranational impositions over national, democratically elected governments. Calling upon this reflection aims to bridge the gap felt in most WHO’s member states.
The M-POHL Health Literacy Population Survey 2024-2026 (HLS24)
Authors: Griebler R , Straßmayr C , Link T , Le C , Dietscher C , Levin-Zamir D
Published: October 2024

Background

Inspired by the first European Health Literacy Survey (HLS-EU) and its policy impact, the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was established in 2018 under the auspices of WHO Europe to monitor and strengthen health literacy (HL) in Europe. The Health Literacy Survey 2019-2021 (HLS19) was the first project of M-POHL, focusing on both general and specific aspects of HL. The follow-up survey (HLS24) builds on this work and will provide even more comprehensive data on HL by including more countries and new aspects of HL. By also focusing on NCDs and prevention, HLS24 is a key partner in the European Joint Action PreventNCD.

Methods

The HLS24 is a cross-sectional study based on nationally representative samples of the adult population (18+) in more than 20 participating countries. The HLS24 core questionnaire includes items on general HL, sociodemographics, health behavior, health status, and health care utilization. Some countries also include questions on prevention and early detection of chronic diseases and health problems. Five optional packages (OPs) enable countries to focus on specific aspects of HL, namely digital, communicative, navigational, vaccination and mental HL.

Results

HLS24 uses a harmonized set of HL instruments that provide a solid database for health policy decisions to strengthen HL and health equity in Europe. In addition to the three OPs on digital, communicative and navigational HL discussed in the following presentations, an 11-item set on vaccination literacy and a 21-item set on mental HL are provided.

Conclusions

Covering NCDs, prevention, digital health, immunization, and mental health, the HLS24 provides important data on current health challenges and highlights the needs of the European population regarding health information and services upon which policy and action interventions can be based.
Analysis of traffic injury trends, and strategies for road safety promotion in Lithuania
Authors: Strukcinskiene B
Published: October 2024

Every year, about 1.3 million people die on the world’s roads. The aim of the study was to analyze the mortality trends from traffic injuries, and to discuss strategies for the prevention of road traffic injuries and road safety promotion in Lithuania. A longitudinal study was conducted, and regression analysis was applied. The study showed that, when analyzing the changes in mortality from the main causes of death over 2009-2019, the greatest progress in mortality reduction was observed in the category of deaths from external causes; whereas, the number of deaths from diseases of the circulatory system did not change, and the number of deaths from malignant tumors increased slightly. In Lithuania, the death rate from traffic injuries per 100,000 inhabitants decreased significantly over a 50-year period (1971-2020) (in the whole population, and in the subgroups of men and women). In Lithuania, during the fifty-year period (1971-2020), pedestrian mortality rates decreased significantly in the whole population, and children and adolescents (0-14, 15-19, and 0-19 years). Over 1998-2020, road traffic injury deaths decreased significantly in children age groups 0-14, 15-19, and 0-19. After exploring the preventive strategies used for road safety promotion, it was revealed that the most effective results were achieved, when education, safe environment creation, and legislation with enforcement were used. It was important to create a safe engineering environment, to separate pedestrian and bicycle paths from high-speed traffic on roads, to improve the visibility of road users, to apply measures that reduce driver’s fatigue, and to combat the usage of mobile phones while driving. Preventive activities were aimed at alcohol control, speed limitation, education of safe behavior of drivers, promotion of safe cars operation. The usage of safety belts and safety seats, helmets for motorcyclists and cyclists were increased through legislative and educational measures.
Risk communication with asylum-seekers: Insights from the COVID-19 Pandemic experience in Munich
Authors: Öcek Z , Link F
Published: October 2024

Background

The COVID-19 pandemic has created a ‘double crisis’ for asylum-seekers, whose lives were already in crisis. Many reports indicated the syndemic consequences on asylum seekers’ health, underscoring the need for their inclusion in risk communication (RC) and community engagement (CE) and infodemic management (IM) actions. This study aims to describe RCCE experience with asylum seekers in Munich during the COVID-19 pandemic from an expert perspective and thus gain a thorough understanding of the requirements for inclusive RCCE.

Methods

Our qualitative study involved people who conducted COVID-19-related RCCE for asylum-seekers. Volunteers/workers of civil society organizations and health professionals were interviewed using purposeful sampling. After reviewing international guidelines, an interview form was created. The content analysis resulted in themes and categories.

Results

Four of the interviewees were health managers, while 8 were working in civil society organizations. The first category of the results describes the context in which RCCE occurs; syndemic factors (uncertainty; social exclusion and stigma; precarious housing; limited access to healthcare and unmet mental health needs) and pandemic management. The second category includes determinants of RCCE from both the asylum-seeker (trust; risk perception; health literacy; language; culture and gender) and RCCE member (competences; overburden; continuity) standpoint. The third category focuses on various RCCE-IM measures, including their effectiveness and consequences.

Conclusions

Syndemic factors hampered the effective implementation of RCCE for asylum seekers in Munich. RCCE determinants show that pre-crisis actions are necessary for an effective response and individual interactions should accompany community-level activities, particularly for female and marginalised migrants. This study’s scope will be expanded by incorporating the IM component.
Refugee mental health - systematic review and meta-analysis
Authors: Chatarajupalli P , Lindert J
Published: October 2024

Background

Mental health conditions of forcibly displaced persons are unknown as the characteristics of the population change over the years. This study aims to estimate the prevalence rates of mental health conditions among refugees (depression, anxiety and posttraumatic stress).

Methods

We conducted a systematic review using MEDLINE (Ovid), Embase, Web of Science Core Collection (Clarivate), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), and PTSDPubs (ProQuest) published between 1994-2022. We set up clear eligibility criteria and developed a data extraction sheet. The risk of bias of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Heterogeneity was assessed using I² statistics.

Results

The search yielded 4,381 records, of which 171 were included in the full-text review. 54 studies were included in the final review. These 54 studies comprised of 62,522 forcibly displaced populations (49.22% males, 50.78% females). Pooled prevalence rates for anxiety, depression, and PTSD were 36.3% (95% CI 30.0-43.2), 35.9% (95% CI 31.9-41.3), and 35.4% (95% CI 29.0-42.4) respectively.

Conclusions

The prevalence of PTSD, depression and anxiety is significant among forcibly displaced persons. Screening for mental health conditions among these populations might prove beneficial to prevent more severe mental health conditions through the implementation of early intervention strategies.
Needs and perceptions regarding healthy eating among people at risk of food insecurity in the Netherlands
Authors: van der Velde L , Nyns C , Engel M D , Neter J E , van der Meer I M , Numans M E , Kiefte-de Jong J C
Published: October 2024

Background

Healthy eating behaviour is an essential determinant of overall health. This behaviour is generally poor among people at risk of experiencing food insecurity, which may be caused by many factors including perceived higher costs of healthy foods, financial stress, inadequate nutritional knowledge, and inadequate skills required for healthy food preparation. Few studies have examined how these factors influence eating behaviour among people at risk of experiencing food insecurity. We therefore aimed to gain a better understanding of the needs and perceptions regarding healthy eating in this target group.

Methods

We conducted a qualitative exploration with 10 participants at risk of experiencing food insecurity in the Netherlands.

Results and conclusions

The analysis using an inductive approach identified four core factors influencing eating behaviour: Health related topics; Social and cultural influences; Influences by the physical environment; and Financial influences. Overall, participants showed adequate nutrition knowledge. However, eating behaviour was strongly influenced by social factors and physical environmental factors. Perceived barriers for healthy eating behaviour included poor mental health, financial stress, and high food prices. Participants had a generally conscious attitude towards their financial situation, reflected in their strategies to cope with a limited budget. Participants were familiar with several existing resources to reduce food-related financial strain and generally had a positive attitude towards these resources. An exception was the Food Bank, of which the food parcel content was not well appreciated. Proposed interventions to reduce food-related financial strain included facilitating social contacts, increasing healthy food supply in the neighbourhood, and lowering prices of healthy foods. The insights from this study increase understanding of factors influencing eating behaviour of people at risk of food insecurity.
6.Y.2. AI and health care: what are the capabilities and limitations?
Authors:   Organised by: The Commonwealth Fund (USA),   Chair persons: Evan Gumas (USA), Reginald Williams (USA)
Published: October 2024

With the rapid advancement of artificial intelligence (AI) technologies and their implementation in health care, there is a critical need to explore the different applications and implications of AI. This workshop seeks to look at different aspects of AI, both potential applications for AI technology in health, public opinions of use of AI in health care, and the reality of implementing AI in different contexts. Understanding health care approaches to AI from different countries is a unique opportunity for shared learning of innovations across various sectors of health care and patient engagement in order to most effectively engage this emerging field. AI, in whichever form it may be incorporated into health care, has the opportunity to impart meaningful, innovative change, but understanding this new technology comes with important questions. This session will dive into research on AI in various areas of health care by 1) looking at different ways AI is being harnessed in health care; 2) discussing lessons which can be learned and adapted from other countries; 3) discussing promising solutions and approaches to implementing AI in health care; 4) discussing the limitations or concerns of integrating AI in health care.

The panel will be composed of 1 moderator and 2 panelists. Panelists are experts in their fields, established researchers and practitioners, and alumni of the Harkness Fellowship from Germany and the United Kingdom. A moderator will briefly frame the discussion for the audience and introduce the speakers and their presentations before leading an interactive, engaging question and answer portion. The coherence of this panel lays in its theme of leveraging AI to enhance healthcare delivery and understanding ways we can work across countries to foster ethical, equitable AI technologies that revolutionize healthcare practices with the ultimate goal of improving patient outcomes and health system efficiencies. Dr. Saira Ghafur from the U.K. will begin by presenting her research on evidence-based reasons for implementing AI in health care and Dr. Benedikt Simon from Germany will close out by discussing his work in AI in Germany and the challenges that have prevented robust integration. Each panelist will speak for roughly 8-10 minutes, with about 5 minutes reserved for moderator and audience questions.

Key messages

• Sharing cross-country experiences and research enables us to better understand how AI can impact health care.

• In weighing both the benefits and challenges or limitations of implementing AI, we can best understand effective approaches to utilizing AI in health care.
Challenges to implementing AI in health care
Authors: Simon B
Published: October 2024

Germany, renowned for its robust healthcare system, finds itself at the early stages of AI integration. This is a reality for many European countries, emphasizing that, despite general technological prowess, AI adoption remains in its absolute infancy. However, in Germany there are areas where AI shows promise, notably in fields like radiology. Beyond such niche applications though, Germany grapples with a significant challenge - the scarcity of robust data essential for meaningful AI utilization, particularly in the realm of public health. While these insights are specific to the German context, understanding the intricate hurdles impeding widespread AI implementation is a meaningful takeaway for countries around the world. In order to effectively leverage new technologies, there is an acute need for advancements in data infrastructure and governance to unlock the full potential of AI in healthcare. Overcoming barriers and charting a path towards a future where AI serves as a transformative force in German healthcare, could one day lead to enhanced system efficiencies and patient experiences, but for now we have to be thoughtful about the realities of implementing AI within current existing health system infrastructure.
Applying a Planetary Health approach in the European urban context: Lessons from Preparing Traditional Lasagna
Authors: Cadeddu C
Published: October 2024

Lasagna is a quintessential Italian dish, renowned worldwide. The most traditional version is “alla Bolognese”, which requires a complex preparation process involving careful attention to mixing ingredients and layering to achieve the final delicious result. The images depicting the preparation steps of this typical Italian dish will be used to inspire participants to creatively reflect on how to implement a transdisciplinary approach to address a planetary health issue, such as heatwaves, in a European urban context.

The presentation will be structured as follows: 1. Identification of current problems; 2. Stakeholder analysis; 3. Possible solutions; 4. Barriers and limitations.

The first phase will focus on selecting quality ingredients, analogous to analyzing the urban map of the city, the presence of green areas, identifying vulnerable residents, mapping transportation, etc. The second phase will identify all relevant stakeholders to be involved in creating transdisciplinary solutions for the city, paralleling the proper mixing of lasagna ingredients. The third phase will propose various solutions to be applied, taking into account the inputs and viewpoints of the involved stakeholders, showcasing best practices already adopted, and comparing them to different variations of lasagna alla Bolognese. The final phase will present barriers and limitations to implementing such an approach in a European urban context (e.g., costs, historical monuments, lack of stakeholder collaboration), drawing parallels to challenges in preparing lasagna, such as ingredient unavailability, oven issues, or overcooking. Through this original modality, participants will learn about the process of implementing a planetary health approach to one of the major climate change issues affecting the European landscape.
Mental health support for healthcare workers: what is it about governance and policy implementation
Authors: Falkenbach M , Kuhlmann E , Brinzac M G , Correia T , Panagioti M , Ungureanu M-I
Published: October 2024

Background

We adopt a health system and governance perspective to address the mental health needs of healthcare workers, considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support.

Methods

A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. The assessment matrix comprises four key categories: health policy and data, social policy and psycho-social conditions, organisation of work, and job and professional conditions. We conducted a rapid assessment of healthcare workforce developments in the European context, drawing on secondary sources and country experts. The country sample comprises Germany, Portugal, Romania, Switzerland and the United Kingdom.

Results

Awareness of mental health threats among healthcare workers increased, but policy discourse is driven by service delivery and labour market demands. The attention to healthcare workers’ needs is stronger on the international level especially supported by WHO action, and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses.

Conclusions

There are similar problems across countries. Mental health policy is driven by labour market needs and ignores research evidence and the individual needs. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms, and generally greater attention to the ‘human side’ of the healthcare workforce.

Speakers/Panelists

Sara Alidina

Central Administration of the Health System, Lisbon, Portugal

Tomas Zapata

WHO/Europe, Copenhagen, Denmark
9.X.2. Activating the ASPHER-WHO Public Health Core Curriculum: Interprofessional Skills
Authors:   Organised by: ASPHER, Faculty of Public Health (UK),   Chair persons: Alison Mc Callum (UK), Judit Simon (Austria)
Published: October 2024

The updated ASPHER-WHO Public Health Core Curriculum builds on ASPHER’s previous work on Competencies for Public Health Professionals (2006-2020), reflects the changing needs of our population and planet and public health professionals.

The key objectives of this workshop are to: - Share the updated ASPHER core curriculum for public health; - Illustrate examples of public health challenges that young professionals have championed for inclusion; - Share the Faculty of Public Health (UK)’s work on Fair training as a case study on operationalising public health leadership on equality, diversity and inclusion and demonstrating the core competencies in action.

A curricular content survey of member schools and programmes yielded responses from 60 schools, with > 500 submissions of detailed. subject curricula. These have been compiled into 36 Subject Areas in four Domains, namely: (1) Core Subject Areas in Public Health: (2) Subject-specific Areas in Public Health;(3) Core Cross-curricular Subject Areas; and (4) Core Interdisciplinary Professional Skills in PH. The development process was guided and grounded by the expertise and passion of young public health professionals. They are helping us make the core curriculum fit for purpose for the near future and provide them with the skills required to be a competent member of a supportive public health team in an ever changing world. This Workshop will profile selected Subject Areas from each Domain using real life challenges facing WHO European Region to show how the core curriculum integrates research, theory and practice to help build those essential interdisciplinary skills. The examples will focus on Economics in Public Health (Domain 1); Public Health and Criminal Justice; (Domain 2); Health Literacy and Infodemiology, Mental Health and Wellbeing (Domain 3); and Integrative Learning in Action; Communication Skills; Advocacy, Negotiation; Collaborations and Partnerships; and Leadership, Management and Implementation Science (Domain 4). Discussions for each of the Subject Areas will be led by an expert in the area. We will also illustrate an example of these competencies in action, how they are helping shine a light on the challenges we face in creating that supportive team and environment and how the potential for collaboration helps us to capitalise on the expertise available in some schools and programmes for the benefit of all.

Key messages

• Learning interdisciplinary skills are essential for effective public health analysis, advocacy and action.

• Collaboration across countries, schools, professions and generations can create transformational change.

Speakers/Panelists

Mary Codd

University College Dublin, Dublin, Ireland

Karl F Conyard

University College Dublin, Dublin, Ireland

Jenny Houston

University of Edinburgh, Edinburgh, UK

Samia Latif

Faculty of Public Health, London, UK

Olalekan Popoola

ASPHER, UCD, Dublin, Ireland
About the need for a Swiss digital health ‘Sistine Chapel’ – lessons from 25 years of health policy
Authors: Zavattaro F , Gille F
Published: October 2024

Background

The Swiss government’s ‘DigiSanté’ program 2025-2034 aims to address Switzerland’s delay in digitising its healthcare system. Public and professionals’ trust is central for the implementation of digital health initiatives and partially based on past experiences with the digital health system. To inform DigiSanté, it is crucial to analyse the evolution of the socio-political discourse surrounding health data sharing in Switzerland in the past 25 years to identify the main obstacles encountered and lessons learned during this period.

Methods

We designed a multi-method study comprising a policy analysis of 65 Swiss policies on health data sharing from 1998 to 2023; scoping review of 250 editorials; sentiment analysis of 400 news articles from six major Swiss newspapers; and thematic analysis of transcripts from 11 online interviews with key stakeholders.

Results

We identified 32 key policy milestones in Swiss health data sharing, with the COVID-19 pandemic emerging as a trigger for present policymakers’ awareness of health data’s potential and the need for healthcare system digitization. The troubled implementation of the Electronic Patient Dossier (EPD) and its negative narrative are identified as more central in eroding long-term public trust than scandals. Primary obstacles to implementation of the EPD include misaligned stakeholders’ interests, slow policy processes, lack of professional support, low public awareness, and technical interoperability issues. Future strategies involve increasing actors’ involvement to establish a common vision and strategy and improving public communication.

Conclusions

The present socio-political discourse on health data sharing in Switzerland is shaped by past negative experiences with the EPD, compounded by additional scandals. To cultivate public trust, stakeholders should collaborate to align interests and ensure all parties work cooperatively toward common goals.

Key messages

• National and international scandals marginally affect public trust compared to the impact of the negative narrative surrounding the slow EPD implementation.

• Misalignment of stakeholder interests is the main barrier to implementing health data sharing initiatives, causing delays and trust erosion.
Changing the environment: Removing HFSS items in prominent areas of stores in Nottinghamshire
Authors: Brown O , Langley T , Murray R , Bogdanovica I , Bains M
Published: October 2024

This study examines the change in exposure to high-fat, salt, or sugar products (HFSS) after the implementation of a policy restricting the placement of HFSS items in prime locations in England that came into legislation in October 2022. 132 observations were conducted in 2022 and 2023, using a food environment survey. Supermarkets (SM), chain convenience stores (CSS), and independent convenience stores (ICS) were observed in the highest and lowest socioeconomic districts (SED) in Nottinghamshire. Descriptive statistics were used to analyse changes in exposures in prime locations by product category, the policy’s inclusion criteria, the Food Standard Agency’s Nutrient Profile Score (NPS), and the Nova classification. Exposure defined as is the presence of a product at a prime location in stores. A decrease in exposure to restricted products in both SED in SM and CCS was observed. No notable changes were observed in the ICS due to their exemption from the policy. In all SM, the observed exposure to products restricted by the policy was reduced from 39% to 14%. The study found that the policy was successful in reducing exposure to high-sugar products such as biscuits and chocolate. NPS and NOVA showed that exposure rates were notably higher in less healthy and ultra-processed food (UPF) categories compared to the exposure to products restricted due to the policy’s exemption criteria. Exposure to alcohol products increased after the policy’s implementation, with a 20-percentage point increase in alcohol exposure in all SM checkout areas. The study suggests that the policy may have narrowed the differences in environments between the SEDs, highlighted by the findings in the ICS, whereby exposure to less healthy products was higher in the lower SED. The policy also created an opportunity for the alcohol industry to increase its exposure. Shortfalls in the policy’s design were identified through the use of the NPS and Nova classification system.

Key messages

• Despite the equitable outcomes in socioeconomic districts, loopholes in policy design allow the alcohol industry to exploit prime locations and undermine health objectives.

• Policy success is evident in HFSS reduction; however, continued exposure to HFSS items exempt from the policy, and UPF products highlight policy design flaws that undermine health objectives.
Patient and healthcare provider perspectives on a digital first general practice: mixed-method study
Authors: Versluis A , Willemsen R F , Chavannes N H , Aardoom J J
Published: October 2024

Background

General practitioners (GPs) are facing an increased workload as a result of an aging population and a growing prevalence of chronic diseases. Utilizing eHealth may help to enhance healthcare accessibility and reduce costs. A digital platform was developed that integrates eHealth into the organizational aspects of general practices. This study aims to provide insight into the experiences of patients and healthcare professionals with this new, digital way of working.

Methods

A mixed-method study was conducted in three Dutch general practices working with the digital platform. The digital platform focuses on digital communication and remote healthcare delivery in primary care. Primary outcomes included acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation. Patient perspectives were identified through online questionnaires and focus groups, and healthcare professionals’ experiences were explored through in-depth interviews.

Results

Five focus groups and ten in-depth interviews were held. The questionnaires were completed by 616 patients. Patient acceptability of the care concept was high (M = 3.9, SD = 1.0; on a scale from 1-5) and they were satisfied with received care (M = 30.1, SD = 3.4; on a scale from 8-32). Regarding the perceived quality of consults, patients were positive about the longer duration of physical consults (i.e., 20 instead of 10 minutes). Some participants indicated a less personal doctor-patient relationship, because care was provided by various GPs.

Conclusions

Overall, patients and healthcare professionals were positive about the digital platform. The study gives insights into how to improve the care concept, e.g., how to enhance the doctor-patient relationship.

Key messages

• Digital first general practices that integrate eHealth into the practice’s organizational aspects of are considered acceptable by patients and healthcare professionals.

• Digital first general practices can help to improve healthcare accessibility for both patients and healthcare professionals.
Ethical Dilemmas in Home Palliative Care
Authors: Yakov G , Halevi Hochwald I , Weiss M , Sabar R
Published: October 2024

Background

In the past two decades, there has been a noticeable shift towards home-based care, reflecting the broader trend among OECD countries to prioritize a comprehensive approach to health and well-being. This approach emphasizes preventive and proactive measures, often relying on home-based care delivered by multidisciplinary teams providing both curative and palliative care. However, the unique nature of providing care in a home environment raises ethical questions among healthcare providers, necessitating high levels of attentiveness and sensitivity from the caregiving team to address them effectively.

Research Objectives

This study aims to identify ethical challenges encountered by a multidisciplinary team, as perceived by managers of an organization offering home palliative services in Israel.

Methods

A qualitative study was conducted, involving interviews with nine key managers to explore prevalent ethical issues in delivering home-based care.

Findings

Thematic analysis unveiled common ethical dilemmas in providing Home Palliative Care. These dilemmas include balancing patient preferences with professional obligations, addressing the needs of both patients and their families, navigating caregiver-patient relationships, understanding patients’ cultural backgrounds, and advocating for home care as the preferred option while considering alternative treatment approaches.

Conclusions

Home palliative care poses ethical dilemmas for caregiving teams. It’s imperative for organizations in the home care sector to devise strategies aimed at assisting teams in navigating these challenges while upholding the autonomy and dignity of patients within their home environment.

Key messages

• Home-based care faces ethical challenges, requiring strategies to balance patient preferences and professional duties.

• Ethical home hospice care needs strategies that respect patient autonomy and dignity.
Standardizing Primary Health Care in Italy: Operational Guidelines for Community Health Houses
Authors: Scotellaro M , Cornio A R , Borghini A , Carini E , Iodice M , Cosentino M , Sposato C V , Rinaldi M , Verrengia M , Mantoan D
Published: October 2024

Background

In response to Italy’s demographic changes and increasing chronic disease burden, there has been a need to standardize Primary Health Care (PHC) through Community Health Houses (CHHs). This study addresses the gap in a unified approach by developing operational guidelines using a consensus-based method among a national Experts Panel, aiming to enhance the effectiveness and integration of healthcare services across the country.

Methods

A multidisciplinary and multiprofessional workgroup was formed, including stakeholders from various health professions and Italian regions, to develop these guidelines that could integrate different health professional skills. The consensus process involved a series of online and face-to-face meetings, utilizing a modified Delphi method. This approach ensured that diverse expert opinions were harmonized and that the guidelines were relevant to different geographic contexts and healthcare settings.

Results

Through iterative rounds of consultation and revision, the workgroup reached a consensus on key aspects of PHC delivery. These included procedures, digital health tools integration and definition of various roles within the CHHs. Preliminary feedback from pilot implementations has shown improvements in accessibility, care continuity, and patient satisfaction, indicating effective adaptation of the guidelines to local contexts in line with the territorial healthcare Italian reform ratified by Ministerial Decree n. 77/2022.

Conclusions

The consensus-driven development of CHHs guidelines represents a significant advancement in Italy’s health policy, promoting a more integrated and efficient healthcare system. These guidelines are anticipated to form the cornerstone of Italy’s strategy to cope with its public health challenges, particularly in managing chronic diseases and aging populations. Future work will focus on national rollout and continuous improvement of these guidelines based on ongoing evaluation and feedback.

Key messages

• Consensus-based guidelines for Italy’s CHHs enhance PHC delivery, improving accessibility and patient satisfaction across the Country.

• Italy’s new PHC guidelines, developed through expert consensus, set a foundation for a unified, efficient healthcare system to address chronic disease and aging.
Governance and health system reform: a case study of new health regions in Ireland, 2018-2023
Authors: Schulmann K , Bruen C , Parker S , Siersbaek R , Mac Conghail L , Burke S
Published: October 2024

Background

While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation.

Methods

The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis.

Results

Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question.

Conclusions

Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.

Key messages

• Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives.

• Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.
Predicting Obesity via Deep Learning: The Role of Chrononutrition
Authors: Di Traglia L , Vestri A , Palla L
Published: October 2024

Background

Obesity is a significant public health challenge, prompting the need for assessing effective tools for its monitoring and prevention. Chrononutrition investigates the role of timing, regularity and frequency of food intake on body metabolism and health. Here we aim to check if data on the distribution of calorie intake in the day may improve BMI prediction as compared to using only data on total day intake.

Methods

We apply deep learning on chrononutritional data on calorie intake over 6 daily timeslots from a nationally representative cross-sectional survey sample of the Italian population (INRAN-SCAI 2005/2006) comprising 2313 Italian adults 18-64 ys old with 3 day diet diaries. In particular, we implemented three deep neural network models, varying network configurations and feature selection. The 1st includes 18 (6 for each day diary) chrononutritional variables and the 3 day total intakes, beside age and sex; the 2nd includes age, sex and the 18 chrononutritional variables only; the 3rd uses age, sex and the 3 day totals only. We applied Early Stopping to limit overfitting. Optimization was conducted using the Adam algorithm, minimizing the mean squared error (RMSE), while mean absolute error (MAE) was the primary performance indicator.

Results

The results highlight that Model 3 outperformed the other models with MAE=2.514 and RMSE=3.476, indicating that for the purpose of predicting obesity, information on the time-of-day distribution of calorie intake is not increasing predictive ability of BMI on top of age, sex and total calorie intake in the day.

Conclusions

Additional use of day-time intake information worsened prediction of BMI via deep learning using this cross sectional Italian survey. However the error made is still sizeable and warrants the inclusion of other variables; our results don’t rule out the role of chrononutrition on metabolic health which may act through other biological mechanisms related to specific nutrients.

Key messages

• Chrononutrition data don’t improve BMI prediction over total calorie intake data in a cross-setional representative sample of the Italian population.

• Deep learning approach to BMI prediction shows the importance of targeted selection of features in public health nutrition.
Potential reformulation of food products two years after implementation of Nutri-Score in Belgium
Authors: Vasquez M S , Vandevijvere S
Published: October 2024

Background

Nutri-score is a front of pack labeling system that provides consumers with simplified information of the nutritional quality of food products. It is based on a five color (green to red) or letter (A to E) scheme that grades the quality of the product using an algorithm that takes into account the energy, sugar, saturated fats, salt, fiber, protein content, and percent of fruits and vegetables. In Belgium, Nutri-score was implemented on a voluntary basis in April 2019. This study aims to explore reformulation of products with Nutri-score by comparing their nutrient content and Nutri-score distribution in 2019 and 2021.

Methods

Product data from one of the major retailers was used in the analysis. Similar products in 2019 and 2021 with matched barcodes were used. Descriptive statistics were computed and statistical analyses such as the signed rank test and the McNemars test were performed to respectively evaluate the changes in the nutrient content and Nutri-score. The tests were conducted at 5% level of significance.

Results

From the matched sample of 668 products, about 55% had a Nutri-score of A and B in both 2019 and 2021. The proportion of food products with Nutri-Score of A/B and of D/E was not significantly different after two years of Nutri-Score implementation. Results showed a significant decrease in the median energy content of dairy, sauces, and meat products and in the median sugar content of dairy and fruit and vegetable products. There was a significant increase in the median fiber content of the dairy, meat products, and non-alcoholic beverages. For all food groups, the salt content of the products in 2019 and 2021 was not significantly different.

Conclusions

This two-year interval analysis described the changes in the classification and reformulation of the products with Nutri-score. Favorable changes in the nutrient quality of the product profiles reveals improvement in their reformulation.

Key messages

• In this analysis, changes has been observed in the nutrient content of food products between 2019 and 2021.

• Producers or manufacturers should continue working on commitments to enhance the nutritional quality of the products delivered to consumers.
Air Pollution Reduces the Individuals’ Life Satisfaction Through Health Impairment
Authors: Abed Al Ahad M
Published: October 2024

Background

The impact of air pollution on individuals’ happiness and life satisfaction (LS), and its relationship to other factors became the focus of recent research. Though, the underlying mechanism of how air pollution impacts LS remains unclear. In this study, we examined the direct and indirect effect of air pollution on individuals’ LS through health mediation.

Methods

We used longitudinal individual-level data from “Understanding-Society: the UK Household-Longitudinal Study” on 59,492 individuals with 347,377 repeated responses across 11 years (2009-2019) that was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution. Generalized structural equation models with multilevel ordered-logistic regression were used to examine the direct effect of air pollution on LS and the indirect effect from health impairment.

Results

Higher concentrations of NO2 (coefficient = 0.009, 95%CI = 0.007,0.012, p < 0.001), SO2 (coefficient = 0.025, 95%CI = 0.017,0.034, p < 0.001), PM10 (coefficient = 0.019, 95%CI = 0.013, 0.025, p < 0.001), and PM2.5 (coefficient = 0.025, 95%CI = 0.017,0.033, p < 0.001) pollutants were associated with poorer health, while poorer health was associated with reduced LS (coefficient = -0.605, 95%CI = -0.614,-0.595, p < 0.001). Mediation path analysis showed that air pollution impacted individuals’ LS directly and indirectly. The percent of total effect mediated through health was 44.03% for NO2, 73.95% for SO2, 49.88% for PM10, and 45.42% for PM2.5 and the ratio of indirect to direct effect was 0.79 for NO2, 2.84 for SO2, 0.99 for PM10, and 0.83 for PM2.5.

Conclusions

Health plays a major mediating role in the relationship between air pollution and LS. To alleviate the impact of air pollution on LS, future strategies should focus on health promotion besides reducing air pollution emissions.

Key messages

• Air pollution is related to lower life satisfaction directly and indirectly through health impairment.

• Strategies and policies aiming at reducing air pollution emissions and better health would improve the individual’s life satisfaction and lower the mental health burden.