bluuebunny/crossref_metadata_2025 huggingface dataset:
Not all plant-based diets are associated with benefits on mortality: the Moli-sani Study
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Ruggiero E , Esposito S , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L
Published: October 2022

Background

Vegetarians diets are characterized by the absence of some animal foods (e.g. red and processed meats), and a high consumption of plant-based foods. However, plant-based foods can include foods with varying nutritional value and health effects. We examined the association of three different pro-vegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), with the risk of all-cause and cardiovascular disease (CVD) mortality in Italians.

Methods

Longitudinal analysis on 22,912 men and women (mean age 55±12 y) from the Moli-sani Study (2005-2010) followed up for 11.2 y (median). Food intake was assessed by a 188-item FFQ. A provegetarian food pattern (FP) was constructed by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful pro-vegetarian FP, which distinguished between healthy (e.g. fruits, vegetables, legumes) and less-healthy plant foods (e.g. fruit juices, potatoes, sugary beverages), were also built up.

Results

In multivariable-adjusted analyses controlled for known risk factors, higher adherence to a gPVG was associated with lower all-cause (HR = 0.83; 95%CI 0.73-0.94) but not CVD mortality (HR = 0.90; 0.72-1.12). Increasing adherence to a hPVG was associated with reduced all-cause mortality risk (HR = 0.82; 0.72-0.95) as well as lower risk of CVD mortality (HR = 0.75; 0.59-0.95). Finally, the uPVG was directly associated with both all-cause (HR = 1.17; 1.03-1.33) and CVD mortality risks (HR = 1.23; 0.99-1.53).

Conclusions

A general pro-vegetarian food pattern was associated with longer survival in Italians. Preferring healthful vegetarian foods provided protection against CVD mortality too. Consistently, a large dietary share of unhealthful vegetarian foods, mostly highly processed, was associated with increased risk mortality. Thus the quality of the plant food consumed is paramount to achieve diet-related benefits on mortality.

Key messages

• A pro-vegetarian food pattern was associated with longer survival but preferring healthful vegetarian foods provided protection against CVD mortality too.

• The quality of the plant food consumed is paramount to achieve diet-related benefits on mortality.
An exploration of reformulation efforts by the food industry in Ireland
Authors: McMenemy D , Sweeney MR
Published: October 2022

Background

Previous research conducted in 2020 by our team examined the progress made by food manufacturers in reformulation between 2014 and 2017 (i.e., improving the nutrition profile of food staples by reducing salt, sugar, saturated fat and overall energy contribution). Our previous study showed improvements in salt and sugars levels across many food staples, but we found rising energy levels, total fat, and saturated fat in many food categories.

Methods

This study aimed to explore the ongoing progress in reformulation between 2017 to 2021. We photographed the labels of food staples in supermarkets with the leading market share in the Republic of Ireland (Tesco's, Dunnes, SuperValu, Lidl, Centra, Aldi, and M&S). We extracted the data, collated it in an excel spreadsheet, and analysed it to examine the nutrients of interest to the study (i.e., salt, sugar, fat, saturated fat, energy, carbohydrates, protein, fibre, and micronutrients). We compared the levels captured at this time point with those previously recorded in 2017.

Results

Eight hundred and seventy-two products were directly compared, including 80 spreads, 34 cereal snacks, 87 fruit juices, 193 cereals, 210 breads, 88 milks, and 169 yoghourts. This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.

Conclusions

Fat and saturated fat levels that were once on the increase now appear to be reducing, possibly implying that as salt and sugar go up, fat levels go down and vice versa. This may relate to product taste and palatability.

Key messages

• This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.

• Fat and saturated fat levels that were once on the increase now appear to be reducing, as salt and sugar go up, fat levels go down.
Improving communication with hard of hearing and D/deaf patients: a capacity-building intervention
Authors: Bodenmann P , Singy P , Graells M , Schmutz E , Sebaï T , Favre V , Richème-Roos J , Cantero O , Morisod K , Grazioli VS
Published: October 2022

Background

D/deaf and hard of hearing (D&HoH) populations are disproportionally affected by physical and mental health problems while facing barriers to accessing health services. These barriers stem from communication challenges with healthcare providers, who are often unprepared to meet their specific needs. This study aimed to develop and evaluate an intervention to improve healthcare providers’ skills to communicate with these patients.

Methods

This study featured a participative action research design. Consistently, the intervention was developed through iterative phases together with the target populations and key stakeholders. The finale version was tested in healthcare workers in Canton of Vaud in Switzerland. Participants completed a questionnaire before (T0) and 6 months after (T1) the intervention, assessing perceived knowledge of deafness and hard of hearing and tools to improve communication, self-efficacy on how to communicate with D&HoH patients and institutional benefits (application frequency of communication rules and tools).

Results

The final intervention aimed to increase participants’ 1) awareness of D&HoH experience and communication needs, 2) knowledge of the tools and basic rules to improve communication. Two D&HoH trainers led one half-day intervention among 28 healthcare providers (e.g., nurses, pharmacists; mean age=43.6). Paired-sample t-tests revealed significant increases in knowledge between T0 and T1, t (23) = -7.81, p < .001 and in self-efficacy, t (24) = -10.23, p < .001, whereas there was no significant difference between institutional benefits at T0 and T1.

Conclusions

Although findings suggest the intervention is a promising means to increase perceived knowledge and self-efficacy on how communicating with D&HoH patients, complementary approaches, such as a resource person within the institutions providing day-to-day support to the teams besides the intervention, may be necessary to induce institutional changes.

Key messages

• Future research should implement the intervention more broadly within inpatient and outpatient settings in Switzerland to increase knowledge on how communicating with D&HoH patients.

• Intervention implementation should be complemented by an additional structural approach to induce sustainable changes in practice and evaluated over 12 months to ensure sustainability.
Hospital nurse understaffing and short work experience: associations with mortality among patients
Authors: Peutere L , Pentti J , Ropponen A , Kivimäki M , Härmä M , Krutova O , Ervasti J , Koskinen A , Virtanen M
Published: October 2022

Background

Determining and maintaining optimal staffing level in hospitals is crucial, as understaffing may have serious consequences and even increase mortality risk among patients. There is no consensus, however, on the optimal way to determine staffing requirements in hospitals as patients’ care needs vary between wards and days. Nurse work experience may also affect quality of care and ultimately patients’ survival but research on this topic is scarce.

Methods

Administrative register data on patients (N = 254,308) and employees of 40 hospital units was used in one hospital district in Finland from years 2013-2019. Both nurse understaffing and nurse work experience were measured with two different indicators in each unit-day. Mixed-effects survival models were used to analyse the associations of these exposures with mortality at patient-level, when adjusted for patients’ characteristics, such as age, sex and comorbidities.

Results

Preliminary results showed that every one percent increase in the cumulative proportion of understaffed days - measured as low nursing hours relative to planned - was associated with 1.002-fold mortality risk among patients (95% CI, 1.000-1.004, p-value=0.044). Short work experience was not associated with increased risk of death.

Conclusions

This study supports previous findings on the associations between nurse understaffing and increased mortality risk among patients in Finland although no association with mortality was found for the other three staffing characteristics. However, the average daily shares of actualized nursing hours relative to planned hours were quite high in hospital units. An indicator based on actualized relative to planned working hours in routine administrative data could be useful in evaluating understaffing in hospitals.

Key messages

• Adequate level of nursing professional in hospitals is related to patient survival.

• It is also crucial of develop efficient ways to evaluate understaffing in hospitals.
Health System Barriers for HPV-vaccine uptake in females with a Turkish or Moroccan Migration background in the Netherlands
Authors: De Zeeuw J , De Zeeuw J , Vervoort JPM , Jansen DEMC
Published: October 2022

Background

HPV vaccine uptake in female adolescents with a Turkish or Moroccan migration background in the Netherlands is lower as compared to the national average. This study aimed to study health system barriers for HPV vaccine uptake in these groups.

Methods

Semi-structured interviews with Turkish/Moroccan (2nd and 3rd degree migrants) female adolescents (12-18 years old), their parents and grandparents were conducted. In addition a focus group discussion with healthcare providers with particular experience with HPV immunization and the target groups was organized. Data was collected between November 2021-April 2022.

Results

22 interviews were conducted among twenty-three individual participants. Sixteen participants with a Turkish migration background were recruited and seven participants were having a Moroccan migration background. In thirteen cases young women in the families did not receive an HPV vaccination. Health system barriers identified were: language barriers in the information provided, focus on HPV being a sexually transmitted disease in information campaigns, lack of knowledge and awareness on HPV among participants and healthcare providers and inability to reach the target groups with tailored immunization programs. Similar health system barriers were mentioned by the healthcare providers, but also included a lack of trust in the government and healthcare institutions, insufficient coordination and collaboration between different healthcare providers. National immunization programs with mass campaign vaccination is mentioned as a barrier to reach families with a Turkish/Moroccan migration background.

Conclusions

Various health system barriers were addressed to be related to HPV vaccine uptake in females with a Turkish/Moroccan migration background in the Netherlands. Despite similarities concerning health system barriers among community members and healthcare providers, different health system barriers were also mentioned.
Health system barriers to HPV vaccination in marginalized Roma communities in Slovakia
Authors: Filakovska Bobakova D , Dankulincova Veselska Z , Halanova M , Jarcuska P
Published: October 2022

Background

People from marginalized Roma communities often experience poverty, limited access to education, employment, housing, and health care (HC). The aim of the study was to explore the perceptions of people from marginalized Roma communities and health professionals regarding health system (HS) barriers to HPV vaccination.

Methods

A qualitative study was conducted in the Kosice region as a part of the RIVER-EU project. Semi-structured interviews with marginalized Roma parents (N = 18), children (N = 15), and health professionals (N = 18) were audio-recorded and thematic analysis of the transcripts was performed in MAXQDA.

Findings

Four main themes were identified regarding HS barriers: 1. Lack of information (lack of culturally and linguistically appropriate information, lack of information provision from HC providers, unreliable and conflicting information on the internet), 2. Restricted access to HC providers (lack of capacities, work overload, long wait in the waiting room, distance, traffic connection), 3. Financial and organizational barriers (limited coverage of vaccination expenses from health insurance, picking up prescribed vaccines in a pharmacy by parents, parental consent), 4. Attitudes and behaviours of HC providers (neglect of care, double standard, inappropriate behaviour and communication, prejudices, racism).

Conclusions

The reasoning and perception of several barriers to HPV vaccination differ among groups of respondents. Nevertheless, HPV is not viewed as a priority by both - marginalized Roma and health professionals. HS fails to reach marginalized Roma with appropriate information about HPV and HPV vaccination. Moreover, the lack of capacities and motivation of HC providers to address these topics lead to a lack of awareness. Organization and health insurance coverage of vaccination pose additional barriers to HPV vaccination.
Exclusive breastfeeding during the COVID-19 pandemic in 17 WHO European Region countries
Authors: Chertok I , Artzi-Medvedik R , Arendt M , Sacks E , Otelea M , Rodrigues C , Costa R , Linden K , Zaigham M , Mariani I
Published: October 2022

Background

Maternal experience of labour and delivery is multidimensional and is influenced by a variety of factors.

Aim

to report maternal childbirth experience as described by the women themselves during the COVID-19 pandemic in Sweden using a WHO Standards-based tool adapted for an online survey (Quality of maternal and newborn care-QMNC).

Methods

Women ≥ 18 years of age who gave birth from March 1, 2020 to June 30, 2021 were asked to give voluntary consent to participate in an online survey. The survey included 40 questions on four key domains: provision of care, experience of care, availability of human and physical resources and organisational changes due to COVID-19.

Results

5003 women were included in the analysis. Among those who underwent labour (n = 4528), 46.7% perceived a reduction in QMNC due to the COVID-19 pandemic, 50.7% were not allowed a companion of choice, 62.5% reported that health workers were not always using protective personal equipment and 36.5% rated the number of health workers as “insufficient”. Fundal pressure was applied in 22.2% of instrumental vaginal births and 36.8% received inadequate breastfeeding support. In addition, 18.4% of women did not feel treated with dignity and 6.9% reported some form of abuse. In general, findings were significantly worse among women who did not undergo labour (n = 475).

Conclusions

Swedish mothers’ satisfaction of care provided during childbirth was strongly influenced by many variables. Actions to promote high-quality, evidence-based, patient-centered respectful care for all mothers and newborns are urgently needed.
Structural stigma and sexual minority men’s depression and suicidality: A multi-level examination of mechanisms and mobility across 48 countries
Authors: Pachankis J , Hatzenbuehler ML , Bränström R , Schmidt AJ , Berg RC , Jonas K , Pitoňák M , Baros S , Weatherburn P
Published: October 2022

Background

Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association

Methods

The current study uses data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health and psychosocial mediators. We linked these data to an objective indicator of structural stigma related to sexual orientation in respondents’ countries of origin (N = 178) and receiving (N = 48) countries

Results

Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators.

Conclusions

This study provides evidence that structural stigma is associated with the mental health of sexual minority men, both through proximal experiences and as a function of length of exposure to structurally diverse contexts, at least for those who move higher-to-lower structural stigma contexts. Findings suggest the importance of routinely assessing life-course structural influences on mental health and deploying interventions to address those influences.
The future of health digitalization: The case of Primary Health Care in Portugal
Authors: Peyroteo dos Santos M , Lapao L
Published: October 2022

Background

The sustainability of Healthcare Services will depend on the proper implementation of the digital transformation of Primary Health Care (PHC) Services. COVID-19 Pandemic have shown precisely this, where there was pressure from health Professionals and managers for the integration of teleconsultations within the health work processes. This study aims at developing scenarios for the digitalization of PHC in the Portuguese Health System.

Methods

This study follows the methodology of scenario development, similar to the future of community pharmacy services scenario study. A conceptual model of PHC services was developed, based on the literature and a set of interviews. The target group was the primary healthcare professionals: family doctors, nurses, and operational assistants. The time horizon was 2032 and, by selecting actors from different regions of Portugal, it was possible to achieve broad representativeness.

Results

Three focus groups were conducted. The first enabled to identify the two driving forces that may influence the digitalization of PHCs in the next 10 years: 1) service innovation and 2) Governance and Regulations. These two driving forces enabled to design three plausible scenarios: a) Innovate or Fade-away; b) Isolated PHC and c) Digital PHC. These scenarios were developed, and their impacts were reflected upon. It was found that the role of human Resources is critical.

Conclusions

The process of reflection and discussion for the identification of the different driving forces made the different actors discuss the different points of view and find a meeting point to reach a conclusion. Furthermore, this study allowed the different stakeholders to understand the measures and actions to be taken for PHC digitization to be implemented in the most effective way, allowing the sustainability of the National Health Service in Portugal, which until this point were only ideas discussed at the institutional and individual level.
Potential gains by effective early detection of diseases: proposal to approach informing public health policy in the Czech Republic
Authors: Majek O , Ngo O , Hejduk K
Published: October 2022

Background

Significant amount of disease burden could be averted by early detection and treatment of diseases. In the Czech Republic, National Screening Centre (NSC) of the Institute of Health Information and Statistics is responsible for informing public health policy in the field of early disease detection. The objective of the proposed early detection public health foresight study (PHFS) is to gather evidence, use available computational tools, utilise knowledge and opinions of stakeholders, and summarize it in a systematic manner to inform public health policies. The presentation outlines the approach undertaken within the proposed early detection PHFS.

Methods

The key source of data for monitoring of population health status and healthcare system in the Czech Republic is the National Health Information System (NHIS). The study will also utilise external sources of data, namely demographic projections and data on global burden of disease, as well as qualitative data from stakeholders. The study will also utilise analytical tools and outputs developed by NSC (situational analyses, decision modelling, etc.). The conceptual model of the study will cover important underlying aspects like public policies, driving forces, population health and healthcare system, and health impact variables.

Results

The proposal for early detection PHFS has been developed within the PHFS capacity building course, utilising the experience and insights of tutors and fellow participants. The development of study methodology was accompanied by gathering of evidence and consultations with relevant stakeholders.

Conclusions

PHFS is a very useful approach to assess possible future developments of public health system, achieve participation of stakeholders, and to inform public health strategies. Following finalisation of the early detection PHFS protocol, governing board of the NSC will decide on the degree of implementation of the study.
Foresight methodologies to unravel the indirect health economic impact of the COVID-19 pandemic on cancer care and management in Belgium studied in the HELICON project
Authors: Khan Y
Published: October 2022

Background

The COVID-19 pandemic had indirect effects on segments of the population affected with non-COVID-19 diseases e.g. through delayed care and management of cancer patients. Early diagnosis and appropriate treatment are key to improving patient outcomes and reducing societal and health care costs. Tio support policymakers to anticipate these trends a public health foresight study (PHFS) was done.

Methods

The PHFS follows a structured approach provided through a compact guide and is supervised by PHIRI team members. Its evolution is measured through a template gathering data on the study's contextual information, objective, main target groups, conceptual model, indicators, driving forces, time horizon, spatial unit, identifying uncertainties, scenario logics, scenario type, stakeholders, data, tools and instruments, projection methods, communication strategy/products, and the uptake of results and evaluation.

Results

Several foresight elements were identified. Contextual information on the resources and governance structure were elucidated. The objective was made clear by identifying the topic, general issue, and sub-issues of the initial study. A conceptual model was developed to analyse the interaction of the topic with other aspects that could influence it. The main driving forces, which are factors that influence the studied topic, were then determined through the DESTEP method. Stakeholders were identified and classified through the power-interest matrix.

Conclusions

Establishing a foresight study on the indirect impact of the COVID-19 pandemic on the care and management of cancer patients allows exploring potential and unsuspected issues that may affect society, health care systems, and patients. Those groups should not be considered individually but as an ecosystem continuously interacting, where a decision may affect everyone. This type of information may be of high relevance to policy- and decision-makers in their public health interventions.
Applying Essential Public Health Functions in building health systems’ resilience globally
Authors: Zhang Y , Mustafa S , McDarby G , Seifieldin R , Saikat S , Schmets G
Published: October 2022

Background

The COVID-19 pandemic has exposed Public Health system weaknesses due to chronic underinvestment in Public Health. In this context, Essential Public Health Functions (EPHFs) have been revitalized as an integrated, cost effective and sustainable approach to operationalising Public Health. The World Health Organization's recent position paper on building health systems resilience towards universal health coverage and health security recommended investing in EPHFs as a key mean for countries’ health systems recovery and transformation during COVID-19 and beyond. There is a need for conceptual and operational clarity of EPHFs to support countries to build back better, fairer and more resilient health systems.

Methods

A rapid review of peer-reviewed and grey literature regarding the EPHFs was conducted to identify different actors’ understandings of EPHFs and key lessons of applying the EPHFs at the global, regional and national levels, in order to identify the added value and key enablers to operationalising EPHFs. A crosswalk analysis of different authoritative lists of EPHFs was conducted to develop a common list of EPHFs as a reference for countries in response to Public Health challenges.

Results

A consolidated list of 12 EPHFs derived from the crosswalk analysis of different authoritative lists is presented, underpinning the consideration of health systems components and pressing health challenges. Six key enablers are identified from evidence and experience. These enablers are fundamental for countries to build holistic and strong Public Health capacities.

Conclusions

The EPHFs provide a clear and integrated framing to operationalise Public Health in countries that can be adapted to country contexts to build resilience. Health authorities and other Public Health stakeholders must seize the opportunity brought by COVID-19 recovery to continue advocating for and strengthening Public Health as a priority in health systems’ reconstruction and reform.
Health services during Covid-19: What do we know of the degree of service disruption and size of the backlogs?
Authors: Tille F , Zapata T
Published: October 2022

Since the onset of the COVID-19 pandemic, there have been concerns that shifting health system capacities towards acute COVID-19 cases can affect the provision of non-COVID-19 essential health services, causing severe disruptions and lack of care. Examples of this have been seen during other epidemic outbreaks, such as the 2014-2016 Ebola outbreak in West Africa. To capture the degree of service disruption across the European and Central Asian region, we analysed data from the World Health Organization's Pulse Survey on the Continuity of Essential Health Services, conducted in three rounds in 2020 and 2021. The key findings include:

– Health service provision has been heavily disrupted in virtually all countries. 91% of countries reported service disruptions in late 2021, indicating that health services continue to be disrupted at large scale.

– Service discontinuation has been substantial across all levels of care and in most service areas, often resulting in delays and cancellations of elective and emergency procedures, routine visits, prescription renewals, and referrals to specialty care. This has led to growing backlogs and record waiting times for services.

– Countries have been affected to varying degrees and report different levels of service disruption, size of the backlog, recovery of services aiming for pre-pandemic levels, and interventions to manage waiting lists.

The findings indicate that even as health systems are better learning to care for acute COVID-19 patients, the pandemic's impact on essential health services is massive and likely to affect the care for people's health and well-being post the acute phase of the public health emergency. Measuring the size of backlogs and implementing innovative care solutions are urgent and paramount.
Health system recovery from Covid-19: What policies are health systems using to tackle backlogs and bring down waiting times in the wake of the pandemic?
Authors: Reed S , Schlepper L , Edwards N
Published: October 2022

The pandemic has left even the most well-equipped health systems vulnerable and required difficult trade-offs to balance both Covid-19 and non-Covid-19 health services. Across the globe, planned and routine health services have been scaled down during peaks of the crisis to meet the needs of acute and Covid-19-related care, resulting in growing care backlogs and increase in the number of patients waiting for treatment. To identify potential policy solutions, we have consulted the Covid-19 Health System Response Monitor, interviewed experts and analysed recovery strategies in 16 OECD and EU countries. Many country responses display striking similarities despite very real differences in the organisation of health and care services. These include:

1) increasing the supply of workforce by widening the scope of authority for different roles, investing heavily in recruitment and training for key roles, and improving the terms and conditions of work;

2) boosting productivity by introducing financial incentives and targets, reconfiguring facilities to better separate planned and emergency work”, optimising referrals and waiting list management, and outsourcing more care to the private sector; and

3) investing in out-of-hospital alternatives to care, including expanding primary and community care models and developing digital, home care and rehabilitative capacity

Policymakers will need to balance the immediate pressures of clearing backlogs with long-term measures that place services on a more sustainable footing. International experience shows how these can be at odds, especially if actions taken in the short term exhaust an already depleted workforce, or resolve Covid-19-specific problems but leave services less prepared for tomorrow's challenges.
Euregional Youth Survey Structure and results of the cross border youth surveys
Authors: Philippsen D
Published: October 2022

The Euregional Youth Study takes place at intervals of currently 4 years since 2001. The Dutch, German and Belgian municipalities of the Euregio Meuse-Rhine (EMR) can participate. Pupils in the 8th and 10th grades are asked about various topics in an online questionnaire. These include: physical and emotional well-being, physical activity, nutrition, media behaviour, drug use and school behaviour. In 2019, 88 schools with more than 13,500 participants took part. With its cross-border approach, the study provides the opportunity to compare the living conditions, behaviour and health situation of pupils in the three countries. Ideally, this would result in common policy and prevention approaches and best practice options. For example, there are differences between the regions of the EMR regarding drug use or overweight, while risky media use is rather universal. It is striking that the Dutch participants almost consistently show the best values. It is also important to stress the importance of insight in policy along the border. Changes in policy actions have a huge effect on border regions. Examples are:

The change in drinking age in the Netherlands: from 16 to 18 resulted in organizing their parties in the neighbouring countries.

The change in cannabis policy in the Netherlands in the 2000s, is clearly reflected in the purchasing behaviour of German young people.

Independent of the cross-border aspects, the Euregional Youth Survey provides a standard data set (also with trends over time) for the adolescents of the participating districts, which the local health offices could not realise on their own and which is not self-evident for German municipalities.On the other hand, it is certainly considered as problematic that there is no binding and uniform participation of the EMR partners in the study. This leads to a partial loss of comparability and significance of the Euregional Youth Study.
Euregional Health Atlas: how to use it for cross-border public health policy Building a common health monitoring platform for the Meuse-Rhine Euroregion
Authors: Stabourlos C
Published: October 2022

Studies show that European border regions -that account for over 30% of all European citizens- are faced with more deficits. Living in a border region still means fewer possibilities in the fields of employment, mobility, care and well-being. In order to tackle this, an absolute prerequisite is to dispose of relevant and comparable data across borders. The Euregional Health Atlas is an initiative that aims to collect and to visualize validated and comparable data for the municipalities of the Euregio Meuse-Rhine (EMR: Zuid Limburg (Nl), Zweckverband Aachen (De), the provinces Limburg, Liège, Ostbelgien (Be)). Themes addressed are: demographics (population, socioeconomic status, vulnerable groups), health care (care contacts, difficulties in daily living, chronic diseases, mortality), lifestyle (use of alcohol, smoking, weight, nutrition) and quality of life (perceived health, happiness).

Data used to feed the Euregional Health Atlas are derived from registers, health surveys and from former and current Interreg projects like the Youth Euregional Scan (YES). During the COVID-19 pandemic, data on the daily number of cases and 7-day incidence, the number of tests performed, the hospitalisation rate and the number of reported deaths related to Covid-19 were processed and presented on our dashboard and this not only for the Euregio Meuse-Rhine, but also for other Euregios. The Euregional Health Atlas is a work in progress: existing data are continuously being updated to improve their suitability for comparison purposes and new data are added to broaden the perspective. It contributes to knowledge-sharing, mutual understanding and cross-border policy development. The Atlas is a free, easily accessible platform, available for everybody; health care professionals, policy makers and citizens, see www.euregionalhealthatlas.eu!
Concept of cross border policy in public health: what is it and how does it
Authors: Van der Zanden B
Published: October 2022

Cross-border cooperation depends on many factors. Not least because of the perception of a border and its influence. Literature shows that the perception of a border is different for different stakeholders. A citizen has a different perception of a border than a policy worker of the government. This influences the effects of cross-border policies. The first three presentations already show this indirectly. Apart from the perception of a border, it is important to look at how cross-border policy in the field of public health is actually made in Europe. On the basis of European policy documents, it has been analysed how policy and policy issues concerning cross-border public health care in Europe are established and what can be deduced from this for policy in cross-border regions such as the EMR. Elements in this are the ‘existence’, ‘genesis’, ‘influencers’ (+/- stakeholders) of cross-border policy and the potential relation with public health. Questions that will be addressed during the presentation are: What does cross-border policy look like? Is this also available in the field of public health? When yes how has this come about (genesis)? How is this concept of cross-border policy influencing the current way of looking at cross-border public health? Are there currently main ‘influencers’ that have impact on creating cross-border public health policy?
Sustainable dietetic models: strategies for communication and promotion
Authors: Scazzina F , Biasini B , Rosi A , Franchini C
Published: October 2022

Global Burden of Disease identifies the makeup of diets as a significant risk factor for mortality and morbidity, with 11 million deaths and 255 million disability-adjusted life years attributable to dietary risk factors. 690 million people lack sufficient food and economic projections suggest that COVID-19 pandemic may add an additional 83 to 132 million people to the ranks of the undernourished, as the outbreak has exacerbated the global food flaws and insufficiencies, impacting the most vulnerable populations. Diets and related food systems also contribute to significant environmental degradation and climate change. Demand for animal-source foods is also increasing, particularly in emerging economies, which entails risks for the environment. 1.3 billion tons of food are wasted globally yearly, utilizing 38% of total energy consumption in the global food system. The real cost of acquiring enough nutrient-rich food to meet national dietary guidelines for a healthy diet exceeds available income for ∼38% of the world's population. A balanced diet that meets food-based dietary guidelines calls for even larger quantities of more costly food groups than would be needed just for nutrient adequacy, owing to their many functional attributes beyond just the essential nutrients that they contain. Faced with this scenario, there is urgent need for an appropriate strategy to increase people's awareness of the relationship between specific food choices and health and to facilitate the educational environment on this issue. Actual examples of current strategies for communication and promotion of healthy and sustainable diets will be discussed. With awareness and knowledge, clear and precise information, a supportive social environment, available and accessible healthy and sustainable food items, and the implementation of related policies, individuals have a great potential to achieve healthiness and environmental sustainability by choosing healthier and more sustainable foods.
What is interdisciplinarity, and how can we apply it to research and practice?
Authors: Freye M
Published: October 2022

The concept of interdisciplinarity is an integral part of contemporary academia. Successful academic careers or innovative study programs: Interdisciplinarity is often claimed, expected, or required. Public health scientists also claim to facilitate health-related interdisciplinary research under the umbrella of public health and to apply findings from interdisciplinary research in practice. These aspects already point to one of many problems in using the term interdisciplinarity: When using the term, it is not always evident whether it is a merely descriptive term or whether normative expectations are also associated with it. We consider that successful interdisciplinary research is enabled by a shared understanding of what is meant by interdisciplinarity in concrete research projects. This urgency is re-emphasised by the participation of new disciplines in digital public health. Through this presentation, we would like to give participants a brief theoretical overview of the concept of interdisciplinarity and related concepts such as transdisciplinarity and multidisciplinarity. In this way, all workshop participants will have a shared understanding that will serve as a basis for further work in groups during the workshop. After the terminological distinctions, we will turn to the practical challenges of interdisciplinary research, which arise beyond the clarification of terms. We will outline these challenges in fundamental terms and then provide some best practice examples on how interdisciplinarity in scientific competence can be promoted among individual scientists and in research groups. In the best case, the workshop participants will draw inspiration for the subsequent group work from the best practice examples to generate new motivation for interdisciplinary work in this way. A concise summary will conclude this compact-informative presentation. Merle Freye will host the tables on law and ethics during the world coffee.
Discussion table on health economics
Authors: Maass L
Published: October 2022

Laura Maaß is an expert in public health, health economics, and digital health. She will assist the workshop participants during the world coffee at the discussion table for health economics.
Discussion table on psychology
Authors: Niess J
Published: October 2022

Jasmin Niess has a background in psychology and focuses on human-computer interaction. She will support the workshop participants during the world coffee at the discussion table for psychology.
Health System Performance Assessment: how equitable is the Belgian health system?
Authors: Van de Voorde M , Bouckaert N
Published: October 2022

Access to and delivery of effective, high quality and affordable healthcare are fundamental objectives that have shaped health policy and the universal health insurance system in Belgium. A health system should be evaluated against these objectives. Monitoring equity within a health system - an equitable distribution of healthcare use and of payments for healthcare - is a core component of a health system performance assessment. We use the horizontal equity principle to evaluate equity in healthcare use in Belgium. Unfair inequality in healthcare use is measured by the fairness gap, comparing actual use and expected use corrected for needs. The empirical analysis was conducted using a linked dataset which contains data from the European Union Statistics on Income and Living Conditions (EU-SILC) and administrative data. Two sets of results are reported for a selected set of indicators of use: the deviation between the average fairness gap in the population and the average fairness gap in a subgroup of interest and an assessment of systematic socioeconomic inequity in the fairness gap using the absolute concentration index. We show that important socioeconomic inequities in healthcare use exist. Inequities differ by type of care, e.g., the use of hospital care and medications is more equitable than the use of GP, outpatient specialist and dental care. When accounting for healthcare needs, we find that use among high-income groups and individuals with a high educational attainment is higher compared to financially vulnerable groups (individuals at risk of poverty or with severe material deprivation, unemployed, singles). Also, individuals who are entitled to an increased reimbursement of healthcare costs, show a lower use of outpatient specialist care than expected based on their care needs. On the other hand, increased reimbursement is effective in improving accessibility to GP care, while for other financially vulnerable individuals we find a lower use of GP care.
Results from a systematic review of interventions promoting mental health literacy in youth
Authors: Fretian A , Kirchhoff S , Okan O , Bauer U
Published: October 2022

Background

Mental illnesses are amongst the leading causes of ill-health and disability, with most onset of many mental health problems (ca. 75%) emerging before the age of 25 years. Thus, adolescence is an important time period for preventive measures, such as strengthening mental health literacy (MHL). This review aims to give an overview of those interventions which promote MHL on the long run.

Methods

Five databases were searched for English or German articles published between January 1997 and May 2020, leading to a total of 4,375 original articles. Interventions were included only if they had measured MHL and/or stigma on three different time points, had a control group, and delivered an intervention program. Studies reporting means and standard deviations for the outcomes of interest were further included into a meta-analysis using a random effects model. The analysis was carried out with STATA 16.

Results

25 studies were included into the review, and 13 of them were suitable for the meta-analysis. The great majority of studies (76%) were conducted within schools and the addressed topics were general mental health, depression, and schizophrenia. Interventions mostly used psychoeducation or a combination of educational elements and contact as delivery method. The combined use of educational and contact components led to worse results for mental health literacy, but not stigmatizing attitudes or social distance. Generally, interventions led to positive outcomes. The changes were sustained for mental health literacy d = 0.48, as well as for stigmatizing attitudes d = 0.30, and social distance d = 0.16, after an average follow-up of about 5 months.

Conclusions

MHL-interventions targeting adolescents are mostly conducted within schools and generally have a brief follow-up period. They show a stable improvement in mental health literacy and are to a smaller degree able to destigmatize mental illness or improve social distance.
Teachers’ mental health literacy and action competencies
Authors: Dratva J , Kerry M , Albermann K , Robin D
Published: October 2022

Background

Teachers are very important in mental health promotion and early recognition of mental health burden (disorder, illness). Teachers’ surrogate mental health literacy (MHL) may be key to improving mental health in youth but has been little investigated. We assessed surrogate MHL in Swiss teachers and tested a measure of mental health action competencies (MHAC).

Methods

In 2020, all teaching and support staff at compulsory school level were invited to an online survey covering individual and professional characteristics, MHL (finding, understanding, critical appraisal of information) and action competencies (adapted scale Ahnert et al. 2016, range 17 - 68) personal experience with students’ MHB. Data was explored descriptively and with multivariate regression. Item response theory analyses were conducted to examine internal psychometric MHAC scale properties, and group-mean differences tested between school levels.

Results

Participation rate was 38% (N = 459). Nearly all participants had taught at least 1 mentally burdened student in the past year (average 4.7). 77% felt experienced to very experienced regarding these students. Only 32% felt they had sufficient tools and teaching resources. Participants felt it was difficult to very difficult to find (47%), understand (53%) and appraise (90%) information on students’ mental health. Kindergarden teachers and teachers without class responsibility showed significantly lower MHL. Internal psychometric properties of the MHAC measure support the use of a 1-factor scale and indicates discriminant validity with respect to age; experience and school level, median score was high (P50 48, P25 44, P75 53), but single items, e.g. on suicide signs, were rated low.

Conclusions

While overall subjective MHAC are high, teachers are insecure regarding MHL and report a lack of tools and resources. Targeted training could strengthen surrogate mental health literacy with a focus on critical appraisal and certain action competencies.