bluuebunny/crossref_metadata_2025 huggingface dataset:
5.B. Round table: From Knowledge to Action: Inclusive & Tailored Interventions for Underserved Groups
Authors:   Organised by: Pandemic and Disaster Preparedness Center (Netherlands),   Chair persons: Jeannette de Boer (Netherlands), Valerie Eijrond (Netherlands)
Published: October 2023

The disease burden of COVID-19 infection, morbidity, and mortality is unevenly distributed across different groups in the population, affecting especially those of lower socioeconomic status, and with a migration background. The one-size-fits all policy and practice approach during the COVID-19 pandemic did not reach certain subgroups of the population. Information campaigns, access to vaccination and testing facilities were not tailored to the barriers experienced in some communities. Furthermore, behavioral insights studies were not sufficiently targeted for different population groups, including those underserved. Although behavioral insights were gathered during the global pandemic, implementing them in the pandemic response remained a challenge for policy makers. The pandemic shined a spotlight on the existing disparities in health and the unmet needs of underserved groups. In the absence of a coordinated government approach to address health inequities, local, bottom-up interventions emerged to address underserved groups’ needs. Examples include the COVID-19 vaccination doubt line initiated by medical professionals of the Erasmus Medical Center in Rotterdam, the Netherlands and doctors offering information about vaccinations in marketplaces and other public areas such as churches and mosques. Lessons from these interventions can guide policy makers and health care professionals in designing more tailored and inclusive approaches, addressing the beliefs, needs and fears of underserved groups specifically. Against this background, this solution-based workshop will bring together representatives from healthcare, public health, academia and WHO to: 1. leverage their experience and share practical examples of interventions for underserved groups during COVID-19 from different countries, 2. discuss which targeted and structural interventions are needed as well as 3. which structures, expertise, capacities, stakeholders, and tools are required to ensure that no one is left behind.

Key messages

• What is needed to translate available knowledge into action for more effective preparedness and response to pandemic threats.

• How to ensure that tailored interventions reach those that need them most.

Speakers/Panelists

Prabhjot Kour

University of Bergen, Bergen, Norway

Katrine Bach Habersaat

WHO/Europe, Copenhagen OE, Denmark

Robin Peeters

Erasmus MC, Rotterdam, Netherlands

Shakib Sana

Erasmus University Rotterdam, Rotterdam, Netherlands

Anja Schreijer

Erasmus Medical Center, Rotterdam, Netherlands
5.E. Workshop: Salutogenic Cities: European experiences in Urban Health
Authors:   Organised by: EUPHA-URB, EUPHA-PMH, EUPHA-ENV,   Chair persons: Stefano Capolongo (EUPHA-URB), Jutta Lindert (EUPHA-PMH)
Published: October 2023

The Workshop titled “Salutogenic Cities: European experiences in Urban Health” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), policy/decision makers and city users, to establish a multidisciplinary approach for understanding together how to create and manage healthy living outdoor urban environments. The Workshops mainly address both the “Climate emergency / Environment and health / Urban health” and the “Global health and Europe's role in global health” EPH23 conference topics. The Workshops purpose is to explore the link between the morpho-typological features of the urban environment and Public Health outcomes, that's crucial in the scientific scenario, taking into consideration the urbanization phenomena that characterizes contemporary society. Health is no longer a specifically individual health issue, but a collective priority strongly influenced by the environmental context and by strategies implemented by local Governments. Urban planning, at large and small scales, can be considered a key tool to protect and promote Urban Public Health. In this scenario, the COVID-19 emergency, has accelerated and emphasized several social, environmental and digital challenges, underling the focus on several aspects such as Urban mobility and walkable environment; Urban Green Spaces and ecosystem services assessment; Urban Health policies and actions. The Workshops program include inputs which they argue current experiences, emerging practices and scientific outcomes related to the Urban Health discipline. From methods, in “Improving health and wellbeing through health-centered, evidence-based urban planning methodologies” to actions, in “The urban burden of disease estimation for policy-making in 1000 European cities”. From epidemiological outcomes, in “Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study” to hospitalizations implications, in “Daily temperature variability in cities and mental health-related hospitalizations”.

Key messages

• Explore the link between the morpho-typological features of the urban environment and Public Health outcomes, taking into consideration the urbanization phenomena that affect the contemporary society.

• Establish a multidisciplinary approach for understanding together how to create and manage healthy living outdoor urban environments.
The urban burden of disease estimation for policy-making in 1000 European cities
Authors: Matkovic V , Abbas A , Angelova J , Berardi E , Bussalleu A , Chen X , Daher C , De Hoogh K , Flückiger B , Gehring U
Published: October 2023

In Europe, over 70% of the population lives in urban areas. Cities promote innovation and wealth creation; however, they are also a main source of pollution, disease and mortality, to some extent linked with suboptimal urban and transport planning practices. The aim of the project is to improve the estimation of health impacts and socioeconomic costs of environmental stressors related to urban and transport planning, advance modelling approaches and strengthen evidence-based policy-making.

The analyses focus on air pollution, noise, temperature/heat and lack of green spaces for nearly 1000 European cities. We are (1) developing an overall urban burden of disease impact assessment framework; (2) identifying health and wellbeing indicators; (3) obtaining exposure-response relationships for environmental stressors and health outcomes of interest; (4) developing tools and guidelines for cost-benefit analyses; (5) obtaining health and environmental stressors data for cities for 2015, 2018, 2021 and 2024 and (6) calculating health and socioeconomic impacts and monitor trends. Specific urban and transport planning scenarios will be developed for case-studies cities (Barcelona, Brussels, Manchester, Munich, Utrecht, Sofia, Warsaw and Zagreb) and include additional aspects such as mobility, physical activity and inequities. The science-to-policy translation is a strong component of this research project where we are conducting consultation with and providing knowledge translation to cities and stakeholders, and sharing good practices, for greater science-policy impact. We strive to make the change on city-level policy and action plans, as well as on national and EU level policy making. By improving health impact and socioeconomic costs estimations and engaging with stakeholders we expect to generate impact and promote healthier urban and transport planning practices in European cities.
Significant inequalities in the cost of food for households with children in Israel in 2018
Authors: Kaufman Shriqui V , Blaychfeld Magnazi M , Yaroslaviz-Degania N
Published: October 2023

Background

Dietary guidelines for families with children are designed to reach the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear.

Methods

The distribution of ages and the number of children per household in Israel in 2018 was obtained from the Central Bureau of Statistics. Food prices were purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children was calculated using standard food portions and meal frequency as well as a percentage of the household's net income. The proportion of households for which food expenditures exceed 15% of the net income was calculated by income quintiles, followed by changes in food prices during 2018.

Results

The average daily cost of a healthy diet was 35.51±7.7 new Israeli shekels (NIS). The older the individual, the more food costs increase. The ratio between the average cost of breakfast, lunch, dinner, and two intermediate meals was 1.5:3.4:1.2:1, respectively. The median monthly dietary cost for households with children as a percentage of net income was 20%. There was an inverse association with socioeconomic status (SES) as the median monthly food expenses for the first (lowest) quintile was 55% of the household's income and only 9.3% of the 5th (highest) income quintile. The food group that composed the highest component of the food budget was the vegetable group, with an average cost of 29% monthly, followed by the meat and meat substitutes group (19%).

Discussions

Policymakers should consider steps to decrease health inequality in food affordability targeting the three middle-lower income quintiles. The cost of a healthy diet compared with food expenditure in high-income countries was 1.8 higher in Israel. Our findings indicate that expanding the program to provide school lunches five days a week to more students would reduce household food expenditures by 15%.

Key messages

• Households with children in Israel would need to spend 20% of their net income to meet dietary guidelines.

• Significant gaps by income quintile, number of children, and food group were identified.
Setting the scene on alcohol policies in Europe
Authors: Bartlett O
Published: October 2023

The first presentation sets the scene through giving an overview of the existing developments of alcohol policies in Europe and the context States find themselves in.
“I feel healthy, I don’t need to go”: Analysis of the cancer screening barrier
Authors: Altová A , Lustigová M , Kulhánová I
Published: October 2023

Background

Cancer screening is an essential tool for reducing cancer mortality. However, screening hesitancy is still a quite common issue in many countries. In this study, we focus on one of the most commonly declared reasons for breast and cervical screening non-attendance among Czech women, which is ‘feeling healthy’.

Methods

We use a mixed-methods approach to investigate the ‘feeling healthy’ barrier, trying to connect three data sources. First, we use a representative sample of Czech women to find the most common reasons for screening non-attendance. Second, we used semi-structured interviews with 10 women to investigate the barriers to screening more deeply. Third, we analyse the data from the European Health Interview Survey (EHIS) 2019, trying to confirm some of the previous findings, using the self-perceived general health variable as a proxy for ‘feeling healthy’.

Results

‘Not experiencing any symptoms’ was the most common reason for cervical (36.7% of non-attendees) and the second most common reason for breast screening (29.2%) non-attendance. Women in the semi-structured interviews talked about that they felt healthy and thus did not feel the urge to attend screening. This feeling was often related to living a healthy life in the form of eating healthy, having enough exercise, not smoking or not drinking. EHIS data show that women with ‘good’ and ‘fair’ self-perceived health compared to those with ‘very good’ health had higher chances of attending both cervical (OR = 1.67, 95%CI 1.32-2.13 and OR = 1.34, 95%CI 1.03-1.74) and breast screening (OR = 2.14, 95%CI 1.76-2.61 and OR = 1.44, 95%CI 1.14-1.82; all models controlled for age and education).

Conclusions

‘Feeling healthy’ can lead women to believe they do not need to attend cancer screening. Measures should be taken to improve health literacy and cancer awareness to dispel misconceptions about cancer symptoms and encourage women to prioritise screening.

Key messages

• One of the most common resaons of screening non-attandance is ‘feeling healthy’.

• Women with ‘good’ and ‘fair’ self-perceived health compared to those with ‘very good’ health had higher chances of attending both cervical and breast screening.
Private equity investment in Sweden's primary care sector and regulatory responses to avoid risk selection
Authors: Winblad U
Published: October 2023

Background

Until the 1990s primary care centres in Sweden were almost exclusively public and operated by the country's regions. A primary care reform in 2010 that increased competition between approved providers for public funding led to a rapid growth of private providers. Concerns were raised that profit-driven providers would select patients with lower risks.

Methods

We analysed contracts between county councils and private care providers and reviewed strategies employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments.

Results

By 2020 over 270 new private primary care centres had been established, most of which were for-profit. Of the overall approximately 1200 primary care centres, about 60% are still owned by the regions and about 40% are privately owned. About a third of the private for-profit practices were owned by international private equity firms in 2018. Three main strategies were used by local governments to avoid risk selection: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time.

Conclusions

A variety of regulatory instruments can be used to avoid risk selection by private providers. However, due to a lack of systematic research, no firm conclusions can be drawn so far on the overall impact of private equity ownership on primary care provision in Sweden.
Retracted: Adverse childhood experiences (including violence and abuse) and obesity and obesogenic behaviors: result from a population-based sample of children in New Zealand
Authors: Hashemi L , Mellar B , Ghasemi M
Published: October 2023

This abstract has been retracted and withdrawn as the authors were not in a position to release the results. This is being done at the request of the authors, and with the agreement of the editors. Please see https://doi.org/10.1093/ckad205
Coping with stress due to gender prejudice in Chilean transgender people: New findings using a qualitative approach
Authors: Barrientos J
Published: October 2023

Background

Like other nations, in Chile, transgender people confront high levels of prejudice operating across structural, interpersonal, and individual levels. The Minority Stress Model indicates that prejudice-related stress is related to worse health indicators. Coping has been used to understand how people deal with this prejudice-derived stress. This study describes and characterizes how gender ‘prejudice is managed and coped with among transgender people in Chile.

Methods

We used a snowball sample to recruit 26 transgender Chileans. The inclusion criteria were to be Chileans or lived in Chile last 6 months, identify as transgender and be 18 years old. We used a semi-structured interview guide with open-ended questions to capture the subjective self-designation of gender identification. Interviews lasted approximately 75 minutes. We used thematic and critical discourse analyses to identify themes and subthemes.

Results

The results indicate that all participants experienced prejudice at different times and varied intensities. Prejudice occurs at home, where parents dońt accept this identity, & at school in the form of bullying. Prejudices were also suffered in health centers & hospitals, where doctors exercised prejudice. Prejudice also depended on the period of the transition process. Prejudice was most intense at the beginning of the transition process & decreased as transition progressed. The results showed that trans-identifying persons used the following coping strategies: self-concealment, performing their gender (e.g., more feminine appearance), & advocacy for their rights & education. Each strategy is used in varied situations & by how one defined oneself.

Conclusions

Coping strategies & the concept of coping must be revisited among trans-identifying persons. The coping strategies used are relevant for planning clinical and social interventions aimed at trans people who still live in prejudice due to their identity in many countries.
Application of the Syndemic Theory and Analysis of Synergy
Authors: Küçükali H
Published: October 2023

Syndemic Theory is a relatively new theory developed first within the field of medical anthropology and later adopted by social epidemiology and public health. The term “syndemic” stands for “synergistic epidemics” where two or more health (related) problems (1) co-occur and (2) synergistically interact with each other (3) within a specific socioenvironmental context which itself also interact with the health problems. These deleterious interactions result in an increased health burden. The first example in the literature was the SAVA syndemic (Substance Abuse, Violence, AIDS) identified among the urban poor. More recent studies applied the theory to the COVID-19 pandemic and the global system of Obesity-Undernutrition-Climate Change. The theory also suggests that a syndemic requires different prevention strategies than it would do if those problems were independent of each other. This theory aligns with the systems approach that we employ in the SPACE project and it has a great potential to provide actionable insights. SPACE contributes back to the theory not only by testing it on less studied cognitive and environmental health domains but also linking it with the systems approaches. This presentation provides a worked example of the application of syndemic theory to investigate air pollution, physical inactivity and cognitive decline. We will explain the use of a variety of methods to analyse synergistic interactions while recognizing the central role of the social and environmental contexts.
How important is evaluator's alignment for the reliability of assessment procedure for recognizing the good practice?
Authors: Rados Krnel S , Lesnik T , Vinko M
Published: October 2023

Implementing evidence-based interventions that are proven to be successful and effective in improving individual, community, and population health is widely recognized as the best approach to addressing public health challenges. To avoid the development and implementation of less effective or successful or even harmful practices, clear criteria for the assessment of practices that are considering different dimensions of the interventions in public health, are needed. Registers of programs and interventions in the field of prevention and health promotion play an important role here, provided that appropriate evaluation/assessment criteria are used for the selection of practices presented on the portals. Nevertheless, the challenge of choosing the “right” approach and criteria in assessing the health promotion and disease prevention interventions still remain. The development of the system for the assessment of health promotion and disease prevention interventions consists of several steps, from defining the criteria, development of evaluation methodology, selection of evaluators, piloting the assessment procedure and finally to regular use of the entire system/portal. An often-overlooked, but important step is how the evaluators understand the criteria and methodology and if it is properly used in assessing the interventions. In this workshop we will present how we used statistical tools to assess the consistency between the evaluators and thereby gaining insight into the reliability of the criteria as a measuring instrument for the assessment of the interventions as well as to check how the evaluators understand the criteria and methodology and if it is properly used in assessing the interventions.
Does physical activity mediate the association of health literacy with cognition in older adults?
Authors: Meier C , Wieczorek M , Maurer J
Published: October 2023

Background

Health literacy (HL), defined as the ability to find, understand, and use health-related information and services, is positively associated with global cognitive functioning and healthy behaviours. Also, current evidence suggests that physical activity may prevent or delay cognitive decline and dementia. This study explores the mediating role of physical activity in the relationship between HL and cognition in a representative sample of older adults aged 58+ living in Switzerland.

Methods

We used data from 1,603 respondents to Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe (SHARE) in Switzerland. HL was assessed using the HLS-EU-Q16 questionnaire. Mild cognitive impairment (MCI) was defined as 1.5-standard deviation below the mean of the age- and education-specific global cognition score. Physical activity was self-reported based on a question on the frequency of engagement in activities requiring a moderate level of energy. The associations between these three variables were assessed using separate probit regression models, controlling for social, health, and regional characteristics. A causal mediation analysis with parametric regression models was used to test the mediation hypothesis.

Results

Preliminary results showed that lower levels of HL were associated with a lower likelihood of being engaged in physical activity (p < 0.05) and with a higher likelihood of having MCI (p < 0.05). In addition, being engaged in physical activity was associated with a lower probability of having MCI (p < 0.01). Causal mediation analysis indicated that 30% of the association between low HL and MCI was mediated by physical activity.

Conclusions

Given the mediating role of physical activity in the relationship between low HL and MCI, improving HL in older adults may foster engagement in physical activity, which could act as a protective factor in MCI.

Key messages

• Improving health literacy may have the potential to foster engagement in physical activity and may contribute to the prevention of mild cognitive impairment.

• Healthy aging programs should not only promote physical activity as a preventive measure to reduce or delay cognitive decline but focus on strengthening individuals’ health literacy skills.
Can a volunteer-based befriending service reduce loneliness and social isolation and improve mental health in older people? A quasi-experimental effectiveness study of existing non-governmental befriending services in Denmark
Authors: Friis Bo A , Lasgaard M , Christiansen J
Published: October 2023

Befriending services are a widespread intervention that is mainly implemented in community and residential settings to counter social disconnectedness in older adults. The services involves a structured relationship (e.g. weekly visits and agreed upon in-house or out-of-house activities) between a befriender, who is most often a volunteer, and a befriendee, who lack social connections or experience loneliness. Social and humanitarian non-governmental organisations are the primary provider of these services, playing a vital role in supporting and connecting older adults worldwide. Previous research on befriending services has been limited by non-controlled study designs, small sample sizes, high attrition rates, and poor measurement. Additionally, befriendees often face vulnerabilities related to their physical and mental health, which pose significant barriers for research in this field. These limitations highlight that befriending services remain poorly understood, particularly regarding their effectiveness in improving social connections and reducing loneliness. This presentation provides a brief overview of current knowledge on befriending services for older adults, leading to the introduction of an ongoing nationwide effectiveness study of the befriending services provided by two Danish social and humanitarian non-governmental organisations. The quasi-experimental, pragmatic study design will be thoroughly introduced, discussing opportunities and challenges when evaluating large-scale volunteer-driven interventions in a real-world setting. This will involve reflecting on critical methodological decisions, such as the study design, selection of outcome measures, and implementation of procedural steps to minimize attrition.
Willingness to Pay for Universal Health Coverage among the General Population in Armenia
Authors: Aslanyan L , Sahakyan S , Muradyan D , Khachadourian V , Petrosyan V
Published: October 2023

Background

In Armenia, as in many low and middle-income countries, a large segment of the population is still required to make high out-of-pocket payments to obtain essential services at the secondary or tertiary levels of healthcare. Countries are showing growing interest to provide financial protection to their citizens via a universal health coverage system. We assessed the willingness to pay for universal health coverage (UHC) among the general population of Armenia, and the factors that influence their willingness to pay.

Methods

We administered a national telephone survey (random digit dialing), among the adult population (18-65 years old) of Armenia. Multivariable logistic regression was applied to analyze the data.

Results

The total number of survey participants was 787 with a 67% response rate. The mean age of the study participants was 41, and 55% of them were women. The majority of participants (60%) were employed. Around 45% of participants had an average monthly expenditure below AMD 200,000 (about USD 510) and more than one-third (36%) of participants had an average monthly income below AMD 200,000. The majority (72%) of participants were willing to pay 2%−6% of their monthly income to obtain UHC. Multivariable logistic regression analysis showed that one year increase in participants’ age was associated with a small decrease in willingness to pay (OR = 0.97, CI = 0.96; 0.99). Participants with an average monthly expenditure of more than AMD 200,000 (about USD 510) were about 3.4 times more likely to pay 2%−6% of their monthly income than those with an average monthly expenditure of less than AMD 200,000 (OR = 3.44, CI = 1.63; 7.30).

Conclusions

UHC could be a viable solution for improved healthcare access; however, socioeconomic factors influence public readiness to pay for it. To successfully implement a UHC system, governments need to design progressive premium contributions providing more subsidies to lower socioeconomic groups of their populations.

Key messages

• Socioeconomic factors of a population can impact their willingness to pay for a universal health coverage system.

• Governments must tailor premium contribution to UHC systems to the socioeconomic composition of their populations and implement progressive contribution approaches.
Action for Health and Equity, Addressing medical Deserts (AHEAD)
Authors: Hinlopen C
Published: October 2023

The Project AHEAD (Action for Health and Equity, Addressing medical Deserts) aims to support policy makers in their health workforce reforms targeting medical deserts: ‘the end point of a complex ‘medical desertification’ process, that implies continuous and increasing inability of a given population to access health services in a timely and contextually relevant manner’. The AHEAD project is carried out in Italy, Moldova, the Netherlands, Romania and Serbia, highlighting different manifestations of medical deserts.

AHEAD features two unique selling points: a medical deserts diagnostic tool (MDDT) and a consensus building methodology.

1. The MDDT intends to support policy makers in identifying and monitoring medical deserts (and areas at risk), by visualising health worker and health services densities, at disaggregated level, on interactive maps. Evaluation findings indicate great interest for this tool among policy makers, as well as challenges in data availability.

2. The Consensus Building (CB) Methodology brings together a broad group of stakeholders playing a role in, or affected by, medical desertification. During a series of interactive workshops, they jointly explore causes and effects of medical desertification, exchange experiences, and develop feasible and context-specific policy solutions. These policy solutions are subsequently discussed during national policy dialogues, where commitments are made by the various actors and duty bearers to implement them. Evaluation findings acknowledge the added value of this participatory, multi-stakeholder approach.

Because the policy options are context-specific, policy dialogues yielded a wide variety of policy solutions. However, several common themes emerged relating to the variety of actors needed at the tables, the importance of their different and complementary mandates, and the need to address related power dynamics.
Sustaining treatment of vulnerable people: assessing needs for integrated care in mental health
Authors: Mejsner S B , Aslaug J , Burau V , Mark D , Fehsenfeld M
Published: October 2023

Background

About half the population in Denmark will experience mental health challenges during their lives. Among them a group of vulnerable people often experiences higher unmet needs and lack of coherence between sectors. They therefore require cross-sectoral initiatives. The Flexible Assertive Community Treatment (FACT) model offers integrated healthcare access to people with severe mental illness, through interprofessional teams across health and social services. The model is implemented in Central Denmark Region between the specialist (regional) and the (municipal) community mental health services. This study aimed to explore the pathways through the healthcare system of citizens with severe mental illness, and to analyze the abilities of provider organizations to meet the needs of the target group.

Methods

The study draws on interviews and observations with participants of FACT that suffer from severe mental illness, interviews with the health and social care professionals involved, and observations of interactions between the two groups of informants.

Results

The participants of FACT experienced smoother pathways between the regional and municipal sectors and more integrated access to services, as they had only one gateway instead of several. They further experienced closer relations with and between the professionals in the FACT teams (e.g., psychiatrists, community and social workers, nurses). These professionals to a larger extent understood and pursued the participants’ individual needs. This created for example higher levels of trust and contributed to the sustainment of the participants in treatment.

Conclusions

People with severe mental illness struggle to cope with many different aspects of life, including navigating the health system and sustaining treatment. To retain this vulnerable group in treatment it is key that health systems provide continuous and integrated treatment that meets individual needs.

Key messages

• The current study finds that FACT provides valuable tools to offer integrated and person-centered care for people suffering from severe mental illness.

• The current study finds that FACT provides valuable tools to offer integrated and person-centered care for people suffering from severe mental illness.
10.F. Workshop: Projecting future burden of disease for informed public health decision making
Authors:   Organised by: COST Action CA18218–European Burden of Disease Network, EUPHA-FS, EUPHA-PHMR,   Chair persons: Brecht Devleesschauwer (Belgium), Henk Hilderink (EUPHA-FS)
Published: October 2023

What are the most relevant diseases in a country? As the need for prioritising the use of available resources constantly increases, a timely, sound and comprehensive answer to this question is more than ever needed to inform public health decision making. The burden of disease metrics such as the Disability-adjusted Life Years (DALY) are important indicators for health information. The DALY provides a comprehensive indicator of the health gap in a country, addressing both premature mortality and health loss due to the occurrence of diseases. The European Burden of Disease Network (COST Action CA18218) acts as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. The Action places a key focus on identifying and addressing data challenges, methodological choices and the need for translating research into policy. Where many Burden of disease (BoD) studies aim at producing the best estimates for the recent years, some countries are also making future projections of DALYs. By doing so, BoD studies become even more relevant for the policy making process since the do not cover only current best estimates, but also show what policy makers might be anticipating on. There are different methods to make future projections, varying from trend extrapolations and forecasts to developing scenarios as part of and advanced foresight approach. Future projections of the DALY estimates bring along additional data requirements. To be able to calculate future DALYs, projections of prevalence and causes of death, but also of population demographics, are needed. In addition, methodological choices have to be made to calculate future DALYs, for example regarding life tables. In this workshop, all these aspects will be addressed. Several countries (i.e. The Netherlands, Belgium, Scotland and Norway) will present their approaches to estimate future DALYs. The workshop will start with and interactive Mentimeter session to get a better view on how the audience is familiar with (future) Burden of Disease. Then, a brief presentation is given as introduction to the European Burden of Disease Network. This is followed by the four presentations of future DALYs. The workshop will be concluded by a discussion with the presenters on the lessons learned regarding their experience of doing future projections.

Key messages

• Burden of disease becomes even more relevant for policy makers when projections are included in the Burden of Disease study.

• Data and methodological issues should be properly addressed to better inform policy makers.
Navigating end-stage dementia: Between the quality of life and life expectancy, A qualitative study
Authors: Halevi Hochwald I , Yakov G , Radomyslsky Z , Nissanholtz-Gannot R
Published: October 2023

Background

Caring for people with end-stage dementia living in the community and restricted to their homes is mainly done by home care units (HCU). Another uncommon program, in Israel, is implemented by the home hospice unit (HHU), specializing in palliative end-of-life care (EOLC). The aim of this study is to characterize ethical aspects, conflicts and dilemmas raised by staff and family caregivers, caring for people with end-stage dementia.

Methods

Qualitative research, using 65 semi-structured interviews (25 staff members and 40 family caregivers), was analyzed through a thematic content analysis approach.

Results

Dilemmas regarding palliative care were the main theme, including the definition of the disease as terminal, choosing ‘comfort’ over ‘life-prolonging’, clarifying patients’ wishes, and deciding whether to use artificial feeding. Substantial differences were found between those two settings of care, the main one being the difficulty to predict life expectancy which creates a gap in the caregivers’ expectations, approaches, and goals for EOLC, as well as for making choices and voicing preferences regarding ‘comfort’ and ‘life extension’.

Conclusions

This study shows the importance of developing ethical, felicitous cultural codes for professional staff caring for people with end-stage dementia and their irreplaceable, significant family caregivers. The findings can enable us to develop ethical codes for conducting quality care and practicing equality and mutual help for people with end-stage dementia living at home.

Key messages

• This study emphasizes the need for ethical codes and cultural sensitivities to provide quality care and support to people with end-stage dementia and their families under home care.

• Personalized approaches, training, and support are essential to handle the ethical dilemmas and conflicts that arise during palliative care for people with end-stage dementia living at home.
Breast Cancer Screening: Navigating the Complexities of Informed Consent
Authors: Newport H , Donnelly P
Published: October 2023

Background

Breast cancer ranks as a leading cause of death worldwide, however screening has become controversial in recent years due to new evidence suggesting the risks may outweigh the benefits. Whilst being the target of organised screening programmes, the average women overestimates both their own risk of breast cancer and the benefit gained from screening attendance. It is unclear whether a woman would make the same decision to participate if she was fully informed. This review aims to examine current evidence for the relationship between informed consent and screening participation rates.

Methods

A literature search was performed over 3 databases to find studies relating breast cancer screening, informed consent, and participation. 11 original studies and 4 systematic reviews were identified as relevant. Outcomes for knowledge/informed choice and resultant intention/attendance were extracted then evaluated.

Results

Results were diverse in regards to relationship. 4 of 8 original studies with an increase in knowledge/informed choice found a decrease in attendance/intention. The remaining 4 found no significant difference. Similarly, the systematic reviews found a decrease in 2 of 4, while the remaining found no change. On evaluation, follow up time was found to be a potential confounding factor. Studies measuring outcomes over multiple time periods found more significant differences at earlier recordings. This may indicate a relationship between increased knowledge/informed choice and decreased delay to attendance.

Conclusions

This review highlights the need for healthcare providers to ensure that women are fully informed about the risks and benefits of screening. While some women may still choose to participate, others may opt out, raising questions on the balance of patient autonomy and provision of healthcare. Ultimately, it is the duty of healthcare providers to empower women with the knowledge they need to make informed decisions about their health.

Key messages

• Women may opt-out of breast cancer screening if fully informed about risks/benefits. Providers must empower patients to make informed decisions, while balancing effective healthcare and autonomy.

• The ethical principle of patient autonomy requires informed consent for medical interventions. Empowering women with knowledge about may make them opt out, however this right is crucial to respect.
10.K. Workshop: Evaluating the effectiveness of health promotion and prevention
Authors:   Organised by: BZgA - Federal Centre for Health Education (Germany), RIVM (Netherlands), Finnish Institute for Health and Welfare (Finalnd),   Chair persons: Ursula von Rueden (Germany), Djoeke Van Dale (Netherlands)
Published: October 2023

The discussion about evidence and the ‘right’ form of evaluation for assessing effectiveness in the field of health promotion and prevention continues to be controversial in the relevant literature. Randomised controlled trials analogous to evidence-based medicine as the ‘gold standard’ of effectiveness research are often rejected as inappropriate for the evaluation of health promotion and prevention interventions because they would not do justice to the complexity of the interventions. In the search for alternatives, system-theoretical approaches for dealing with complexity are reflected. The evaluation of effects moves in the field of tension between simplicity and complexity, which is difficult to map. In the application of impact models, the use of a generic framework model, which roughly represents the intervention logic (‘theory of change’) is recommended. An important implication of evaluating interventions in the field of health promotion and prevention is that effects can not only be measured in numerical ways. To address this, approaches are needed to evaluate interventions also with qualitative research and mixed methods. In order to disseminate evidence-based practices which have been evaluated, evaluation criteria are needed to determine the degree of effectiveness, evidence, and practical applicability. The organisers will share their experiences and perspectives of different methods for evaluating the effectiveness of health promotion and prevention, and discuss the advantages and challenges of approaches with the workshop participants. Three countries (the Netherlands, Finland and Germany) will present different approaches resp. aspects of evaluating health promotion and prevention measures. The different contributions will be discussed and the participants will be invited to share their experiences and successes.

With the objective to:

• Illustrate the role of health literacy in the evaluation of health promotion and prevention interventions (Germany)

• Present a checklist for qualitative research and mixed methods, criteria for an assessment system of interventions as well as first results of the pilot study (Netherlands)

• Present the evaluation criteria of evidence-based practices to be selected for the national best practice portal (Finland)

• Reflect and discuss the different aspects of evaluation to contribute to a better understanding and implementation of methods to ensure effectiveness in the complex contexts.

Key messages

• To give insight into new attempts of evaluating effectiveness of health promotion and prevention in Europe.

• To reflect and discuss advantages and disadvantages of the different evaluation approaches.
Work-stress, coping, and emotional exhaustion of school principals in Germany and Switzerland
Authors: Sandmeier A , Dadaczynski K , Okan O , Skedsmo G
Published: October 2023

Background

While student and teacher health enjoy a high level of interest in health research, research on the health of school leaders has hardly been studied so far, especially in the German-speaking countries. How school leaders cope with work-related stress and the extent to which work-related coping behaviors are associated with mental health has not been studied to date. This paper focuses on the relationship between work-related stress and exhaustion of school leaders in Germany and Switzerland during the COVID-19 pandemic, using the job demands-resources model.

Methods

Data from the COVID-HL school leadership study are used, which was conducted in 2021 with N = 2186 school leaders from Germany and N = 293 school leaders from Switzerland. Structural equation modeling in R (R Team, 2020) is used to model the relation of stress, coping strategies, and exhaustion. Coping behavior, measured as different strategies for dealing with stress, is examined as potential explanation for the relationship between stress and exhaustion.

Results

The study shows systematic country differences to the disadvantage of German school leaders for all factors: German school leaders report to be more stressed, and they engage more in self-endangering coping strategies such as intensification of work, extensification of worktime or quality reduction in their work. In addition, German school leaders are more exhausted than Swiss school leaders. Stress is associated with exhaustion and is partly mediated through the strategy of intensifying work (working in a pace that is burdensome). Stress also causes school leaders to work longer hours and reduce the quality of work, but this has no further influence on exhaustion.

Conclusions

School leaders should become a target of school health promotion. There is a need for a holistic stress prevention, which promotes not only healthy work conditions but also adaptive coping strategies.
Years of life lost associated with COVID-19 deaths in Portugal: two years of pandemic
Authors: Martins C , Santos J , Assunção R
Published: October 2023

Background

The impact of the COVID-19 pandemic on the Portuguese population is still underexplored. Therefore, the characterization of years of life lost (YLL) due to this epidemic may provide relevant data for establishing effective strategies in future epidemics. The aim of this study was to calculate YLL associated with COVID-19 deaths in Portugal between 2020 and 2022.

Methods

This was an observational, cross-sectional study. Data on the average resident population and life expectancy at birth by age group and sex were obtained from Statistics Portugal (INE) and GBD 2019 standard life-table, respectively. Data on COVID-19 deaths were extracted from the Directorate-General of Health's (DGS) reports. YLL was calculated as the number of COVID-19 deaths multiplied by standard life expectancy at the age of death, globally, by sex and age group. YLL was calculated by 100,000 population and age-standardized.

Results

Between 2020 and 2022, 3413013 cases of COVID-19 were reported in Portugal, of which 21342 (0.6%) eventually died of the disease. The number of deaths by sex was similar globally or by age group. Globally, the YLLs estimated for COVID-19 in Portugal were 309383,8. YLLs were higher for males than for females for most age groups except of age groups 10-19 yrs (76.56 vs 153.11) and > 80 yrs (58710.88 vs 68491.44). YLLs age-standardized also showed a steady increase as we progressed in the age group [from 3.25 (0-9 yrs) to 885.54 (>80 yrs)], in which from the 50-59 yrs age group onwards we observed a steeper slope of increase in YLLs.

Conclusions

COVID-19 has had a major impact on mortality rates in Portugal, with this impact being greater in the older population, especially in people aged over 70 years. Also, males presented higher YLLs than females, with this difference increasing substantially as age increases. These insights can be useful in terms of public health as the disease progresses to an endemic phase.

Key messages

• COVID-19 has had a major impact on mortality rates in Portugal.

• Calculating YLLs associated with COVID-19 in Portugal provides relevant data for establishing effective strategies in future epidemics.