bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing COVID-19-related depression, anxiety and stress among European public health residents
Authors: Failla G , Peyre-Costa D , Croci R , Lo Moro G , Chen-Xu J , Ferreira MC , Jaquete A , Malcata F , Vasiliu A ,   ERG EuroNet-MRPH Research Group
Published: October 2021

Background

In Europe, Public Health Residents (PHR) have participated in the response against COVID-19.The pandemic has had a profound mental health (MH) impact on healthcare workers, but little evidence has been accrued about the Public Health (PH) workforce.The current study aims at assessing prevalence and risk factors for pandemic-related depression (D), anxiety (A) and stress (S).

Methods

Between March 22 and April 11, 2021 we administered an online survey to PHR from France, Italy, Portugal and Spain, recruited through the national associations of PHR.We collected socio-demographic data and assessed changes in the working conditions due to COVID-19.We used the Depression Anxiety Stress Scales-21.Cut-off scores for D, A and S were: 9, 7, and 14.Multivariable logistic regression models were applied to determine risk factors for pandemic-related MH outcomes.Data analysis was performed with SPSS version 27.

Results

443 out of approximately 2000 PHR completed the survey, response rate: 22.15%. Most responders (n = 226; 51%) were from Italy, 87 (19.6%) from Portugal, 74 (16.47%) from Spain and 56 (12.6%) from France. Median age: 29 years (IQR 25 - 33). Female/male ratio: 1.6. PHR above the cut-offs for D, A and S were: 60.5%, 43.1%, 61.2%.DASS-21 scores were 13.3 (± 10.27), 8.13 (± 7.79), 19.06 (± 9.71), respectively.Across the multivariable logistic regression models, the main identified predictors were: for D - the COVID-19 impact on PH training (OR 1.78, 95% CI [1.12-2.80], p = 0.014); for A - the loss of research opportunities (OR 1.94, 95% CI [1.28-2.93], p = 0.002) and for psychological S - the year of residency (last year vs other years of residency: OR 2.3, 95% CI [1.20-4.38], p = 0.012).

Conclusions

Our sample featured mild-to-moderate levels of prevalent D, A and moderate levels of psychological stress.Overall, the main risk factors associated with negative psychometric outcomes were training challenges, loss of research opportunities and residency seniority.

Key messages

During the pandemic it is vital to increase knowledge and awareness about the impact of the health emergency on mental health in the Public Health workforce. It is important to deploy concrete efforts into building healthy work environments, guarantee adequate training and research opportunities for Public Health Residents.
Health and social care near the end of life: Can policies reduce costs and improve outcomes?
Authors: Normand C , May P , Cylus J
Published: October 2021

Background

A key concern related to population ageing is how it will impact on health and social care use and expenditure trends. The belief that older people are more costly for health and social care systems than younger people is pervasive, and so the logic goes that having a larger share of the population at older ages may unsustainably accelerate growth in public health spending. In reality, the evidence suggests that the effects of ageing on health care costs will be modest and growth will be slow, but there will naturally be some additional care needs. Health and social care costs can nevertheless be particularly high for people near the end of life. In fact, the costs associated with end of life care largely explain why health and social care expenditures per person, on average, are higher for older people than for younger people, since most people die at older ages.

Methods

Literature review of patterns of service use and costs of care at the end of life; how needs for end of life care are likely to change with population ageing; and effects of end of life care interventions on patterns and costs of care.

Results

The evidence suggests that costs near the end of life vary greatly, and high overall costs are driven by service use by a small proportion of decedents.

Conclusions

Although the numbers of people with needs for palliative and end of life care will rise with population ageing, a review of the literature indicates that it is possible to reduce use of services and costs, and to improve patient experiences with well-designed palliative and end of life care interventions.
The politics of ageing: how to get policymakers to support lifecourse policies
Authors: Falkenbach M , Greer S , Lynch J , Gingrich J , Reeves A , Bambra C , Cylus J
Published: October 2021

Background

Given that there is not much evidence that ageing imperils the finance and provision of health care, why do so many policymakers act like it does?

Methods

We break conventional wisdom down into myths and realities, identifying the evidence against them.

Results

A first myth is that ageing produces unsustainable health care costs, which in turn, creates intergenerational conflict over public policy. A second myth is that older people behave as a single group, always pursuing policies that benefit themselves. The final myth is that decisions about policy are made by politicians who pander to that elderly block. The first reality is that most of the problems ascribed to inequality between generations (intergenerational equity) are actually problems of inequality within society as a whole that span across age groups (intragenerational equity). The second reality is that policies that address these broader inequalities are built on the life-course perspective, which focuses on identifying the policies which can make people happier and healthier at all ages by drawing on the context and circumstances under which aging occurs. The third reality is that it is possible to construct coalitions of politicians and interests that can develop and support sophisticated life-course policies that lessen the burdens of ageing and health on everybody.

Conclusions

Intergenerational inequality is not, and need not be, a significant problem for rich countries. It is substantially a product of current and past intragenerational inequality, and in fact inequality between generations often goes with inequality within generations. Intergenerational conflict is a distraction from policies that promote greater equality within and between generations, and talk of an ageing crisis is frequently just another version of longstanding arguments against public social investment from cradle to grave.
8.E. Workshop: One health approach to gain Youth engagement toward environmental issues
Authors:   Organised by: EUPHA-ENV,   Chair persons: Fabiana Rubba (Italy), Vlatka Matkovic Puljic (Belgium)
Published: October 2021

Humanization of care is involved in promoting healthy behaviors including harmonization with environment, implementing an educational model of “one health” approach. A strong emphasis is placed in our project on strengthening environmental awareness of the young generation through education and other forms of youth engagement. We built an educational project that involved schools (almost 200 students). Students had a “one -health “core curriculum focused on Medicine and environmental issues; spill over and environmental issues; green economy end mathematical models affecting environmental changes; architectural issues involving environment. After skill building classes Young students focused on three main issues that will be presented during the workshop:

A liquid biopsy model to detect eventual pollutants A study concerning individual behavior impact A green sustainable architectural model

The three issues were developed as proposal for:

A model of Health vision based on multidisciplinary A Youth stand point concerning environmental actual proposal to implement the Green deal

Liquid biopsy is a new diagnostic concept useful to collect and analyze sample from different humans and animal matrices able to investigate the molecular features by blood, saliva, and any other body fluids which show a source of potential biomarkers. Further, particular strategies on the possible ways of regenerating the center of the cities to make it resilient to critical environmental impact, and models to redevelop the suburbs were developed. Finally, individual behaviors can affect either health care or environmental goals. The add value of this work may be to realize through citizen activism a powerful tool for climate action, sustainable development and environmental protection through Youth engagement toward an health model that include environmental determinants. Their stand point may be meaningful in order to gain proposals for the European Green Deal, according to the sub topic 1 objective: “specific educational programs, school curricula, trainings, networking activities and exchange of good practices in the area of climate change and education for sustainable development. Thus, it is becoming increasingly important to study and to derive from different approach results regarding the connection between environment, humans and animals and with a new diagnostic genomic not-invasive approach.

Key messages

Youth engagement toward health and environmental issues may contribute to citizen activism. One health model is consistent with a multidisciplinary approach to care and environmental goals.
Comparative study of nurses’ perception of barriers and facilitators for care coordination
Authors: Agerholm J , Koitzsch-Jensen N , Liljas A
Published: October 2021

Background

The hospital discharge process of older adults with complex health and social care needs requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals' views is crucial to show what efforts are needed to manage the discharge process, and to identify strengths and weaknesses of the care systems in which they operate. The aim of this study was to examine nurses' perceptions on barriers and facilitators of good care coordination for older patients with complex health and social care needs being discharged from hospital in Copenhagen (DK) and Stockholm (SE).

Methods

Semi-structured interviews were conducted with 27 nurses involved in the coordination of the discharge process at hospitals and home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the nurses' contributions, responsibilities and influence on the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed with a thematic content analysis approach.

Results

Main themes were communication ways, organisational structures and supplementary actions by staff. Preliminary findings include differences in the organisational structure of the two care systems in relation to integration between different actors and differences in how they consider access to patient information, which influences the coordination. There also seem to be discrepancies in care policies and outlined staff responsibilities compared to the actually work undertaken by the nurses in both care systems.

Conclusions

There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there is more sector-overlapping work which might secure a safer transition from hospital to home.

Key messages

The written e-communication between hospitals and home health care runs smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there is more sector-overlapping work than in Stockholm which might secure a safer transition from hospital to home.
Healthcare needs of young people transitioning back to the community after a custodial sentence
Authors: Biazus Dalcin C , Rodriguez A , Fernandes F , Swinney A , Bezerra Pinheiro AK , Rocha P , Lomba L
Published: October 2021

Background

People in prison have poorer health outcomes than the general population, added by the long-term impact of incarceration on mortality. Young people in custody face extra challenges associated with the stage of development. There is a lack of a tailored approach and policy to young people when transitioning back to the community. This paper draws from a PhD research that looked at the challenges to access healthcare during the transition back to the community. The specific question is: What are young people's healthcare needs when released from custodial sentences?

Methods

An ethnographic study conducted in Scotland in partnership with a community-based organisation. The participants were eight young people and ten practitioners that work in health and social care. Participatory observation and in-depth interviews were used to collect data during July 2019 and March 2020. Data analysis was conducted with Reflexive thematic analysis. NVivo supported data management.

Results

The identified needs were individualised issues, structural factors, mental health, substance use and geographical disposition of services. There is a need for mental support and continuity of care associated with substance use. The demand for local services is vital for healthcare provision. Healthcare needs go beyond the necessity of services and health issues. They are associated with stigma in the interaction with practitioners. Institutional practices and practitioners' attitudes reinforce non-explicit forms of discrimination and health inequalities.

Conclusions

Practitioners and policymakers need to focus on the person-centred approach. They need to listen to young people. Data showed a need for specific services, like mental health and drug use. Moreover, practitioners need to avoid stigmatisation and discrimination by a caring practice. Public health and social care policies need to address stigma and access to services for young people after a custodial sentence.

Key messages

It is necessary to avoid stigmatisation and improve access to services for young people transitioning back to the community after a custodial sentence. Public Health and social care policies need to address this marginalised group by offering person-centred approaches, continuity of care and support during re-entry.
9.B. Workshop: Burden of disease of COVID-19: strengthening the collaboration for national studies
Authors:   Organised by: COST Action CA18218-European Burden of Disease Network,   Chair persons: Sara Pires (Denmark), Elena von der Lippe (Germany)
Published: October 2021

The spread of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was categorized as a pandemic by the World Health Organization in March 2020. Since the outbreak was first identified in December 2019 in Wuhan, China, the public health impact of the disease globally has been enormous. Estimating the burden of the disease at national level is useful for comparing its impact with other diseases in the population and across populations. The disability-adjusted life year (DALY) is one of the most used summary measure of population health, and the key metric in the Global Burden of Disease study. The European Burden of Disease Network (burden-eu) was established in 2019 to act as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. It is structured in technical and disease-focused working groups focus. Since the start of the pandemic, burden-eu has developed tools and started initiatives to support countries in estimating the national burden of COVID-19. These include developing and harmonizing methodologies, disseminating technical materials, launching a working group and online forum, exchanging experiences and supporting capacity building, and planning future studies. This workshop consists of four presentations. In the first, we present a consensus methodology, data requirements and solutions to data gaps to estimate national-level burden of COVID-1. Next, we present as examples results of studies conducted in Germany and Scotland, and the status of an international effort to harvest real-world data derived from the health systems' response across Europe and internationally during the pandemic. The fourth presentation describes burden-eu's activities to promote capacity building to estimate the burden of COVID-19, and discusses the importance, needs and lessons learned of sharing experience and of communicating COVID-19 data. The workshop will end with ample time for discussions on current approaches and opportunities for methodological developments, challenges, possible solutions and potential for collaborations to increase implementation and utility of studies of COVID-19 burden globally.

Key messages

National burden of disease studies offer a means of monitoring the direct population health impact of COVID-19 infection in countries. International initiatives have emerged to promote harmonization of methods, share knowledge and support international collaboration across countries and public health authorities worldwide.
Building country-level capacity to estimate the burden of COVID-19
Authors: Pires S
Published: October 2021

The European Burden of Disease Network (burden-eu) joins 271 members from 50 countries. Upon the onset of the COVID-19 pandemic, several of these members started studies to estimate the burden of COVID-19 in their countries, and many others showed interest in taking steps to launch such studies. Capacity building is one of the key pillars of burden-eu, and the ultimate goal of several of its activities. In mid-2020, a group within burden-eu convened to establish an approach to support the network's members to establish national studies. First, the grouped discussed the methodology, data requirements and resources needed to implement a national study. Based on the output of these discussions, a comprehensive protocol was published on the network's website, and a scientific article was published in an open-access journal. To present this methodology, share already finalized studies, and discuss challenges and opportunities for future studies, in November 2020 burden-eu organized a public webinar, which was attended by over 100 participants. The network's website collects and continuously posts all published articles related to the burden of COVID Burden-eu. Burden-eu also formed the Burden of COVID-19 Working Group, which is open to all network members conducting or interested in implementing national studies. This group aims to share experiences in national burden of COVID-19 studies; support each other with calculations, model assumptions, data gaps; harmonize methodologies and align strategies for communicating results; and discuss research and upcoming evidence on long-COVID. The group meets regularly to achieve these aims. Lastly, the network launched an online discussion forum, where members can post questions and receive answers from peers in an interactive and rapid way. All these efforts have resulted in several studies being launched, and are allowing for harmonized approaches to be used and comparable estimates to be generated.
Urban Green Spaces and Public Health Outcomes: a systematic review of literature
Authors: Gianfredi V , Buffoli M , Rebecchi A , Croci R , Oradini-Alacreu A , Stirparo G , Marino A , Odone A , Capolongo S , Signorelli C
Published: October 2021

Background

As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity.

Methods

In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included.

Results

Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects.

Conclusions

To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity.

Key messages

Urban green spaces are important factors, impacting on both physical and mental health. Policymakers involved in urban planning should pay more attention in urban green spaces.
Body weight, body composition and risk of SARS-CoV-2 infection in a large population-based sample
Authors: Deschasaux-Tanguy M , Bourhis L , de Lamballerie X , Carrat F , Touvier M ,   SAPRIS-SERO study group, Paris, France
Published: October 2021

Background

Obesity has been identified as an important risk factor for COVID-19 severity. Besides, several reports also suggested that obesity (or a higher BMI) may also be associated with a higher susceptibility to SARS-CoV-2 infection although this remains unclear. Going beyond BMI, our objective was to study several anthropometric characteristics in relation to the seroprevalence of SARS-CoV-2 infection in a large population-based sample.

Methods

21,376 participants from the French NutriNet-Santé cohort study were included in the main analyses. An ELISA assay was used to detect anti-SARS-CoV-2 antibodies: 1027 participants were positive and 20,349, negative. Associations between a wide range of anthropometric characteristics (body mass index but also waist and hip circumference and body composition) and the seroprevalence of anti-SARS-CoV-2 antibodies were investigated using multi-adjusted logistic regressions.

Results

A positive yet unclear association was observed between BMI and SARS-CoV-2 seroprevalence in women (positive linear trend (P = 0.07) that was significant using restricted cubic splines (P = 0.04), but no association with standard categories of BMI). No association was observed in men. Waist circumference (P = 0.04) and waist-to-hip ratio (P = 0.01) associated with a higher seroprevalence in women while opposite trends were observed in men (P = 0.08 and 0.03 respectively). Body, trunk and visceral fat (all P < 0.05), but not lean or muscle mass, associated with higher seroprevalence, especially in women.

Conclusions

Our results highlight a higher susceptibility to SARS-CoV-2 infection in women with higher body fat, suggesting that central adiposity may be an important factor to consider for risk stratification in the population.

Key messages

A higher seroprevalence of SARS-CoV-2 infection was observed in women with a higher body fat, but not in men. Central adiposity may be a risk factor for SARS-CoV-2 infection and not only for COVID-19 severity.
The new map of injuries in the aftermath of the COVID-19 pandemic: examples from north with south Europe
Authors: Alves T , Lund J , Papadakaki M
Published: October 2021

The aim of this paper is to describe the impact of the pandemic on injuries. Data from National Injury Surveillance System of Norway and Portugal during Covid-19 period were analyzed. In Norway hospital data on injury diagnoses were collected from a national emergency preparedness register established during the pandemic. The number of injured patients per day in the period 1 January-30 June 2020 were identified. The change in patient volumes over two three-week periods before and during the lockdown by sex, age, level of care, level of urgency, type of contact and type of injury were analysed. In Portugal we described the temporal trend in 2020 of the Home and Leisure Accidents(HLA) among vulnerable groups(0-19years, 65years+), who needed attendance in Emergency Department(ED) of the National Health Service Hospitals. In 2019 and 2020, 240 538 HLA episodes were recorded in the age groups of interest. In Norway, there was an overall reduction of 43% in injured patients during the first three weeks of lockdown. The decrease in patient contacts did not differ by sex, but was most pronounced among young people. Substantial reductions were observed for both acute and elective treatment and across all levels of care and types of contact, with the exception of indirect patient contacts. The change in patient contacts varied considerably by injury type, with the largest reduction observed for dislocations/sprains/strains and a lower decrease for burns/corrosions/poisoning. Similar trend was observed in Portugal on home and leisure accidents episodes rate registered in children and young people up to 19 years decreased by 24,0% during the 2020 year. In groups of 10-14 years the greatest significant decrease of 35,2% was observed, followed by groups of 5-9 years with a decrease of 24,1%. In 65-74 years an increase of 13,2% was recorded, with the highest increase(19,1%) among people aged 75+. Implications for the health systems and health policy planning will be discussed.
When childbirth turns red: the post-partum hemorrhagic emergency
Authors: Lorenzini C , Napolitani M , Rosano G , Alaimo L , Nante N
Published: October 2021

Background

WHO affirms that post-partum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide. The first step to recognize, prevent and diagnose this complication is to define it. The aim of this work is to identify risk factors for PPH.

Methods

A case-control study was conducted at the Hospital of Siena (Italy), including all females who have given birth from 2016 to 2018. In relation to presence of PPH (blood loss of ≥ 500 ml), the sample was divided into two groups. Analyzed variables were: age, parity, use of epidural, stimulation of labour with oxytocin or prostaglandins, episiotomy, manual removal of the retained placenta, medically assisted procreation (MAP), fetal weight, pre-pregnancy BMI (body mass index), placental localization and gestational age (GA). Statistical analysis was carried out using Stata 14.

Results

The sample was composed of 1490 women: 56% nulliparas, 18% had epidural, 34% had broken membranes, 22.6% had stimulation of labour, 1.5% had MAP. 8% older than 40 years, 32% of babies were ≥3500g; 5.1% had BMI ≥30; 11.2% had episiotomy; 2% had manual removal of the retained placenta, 3% had lateral placenta, 47.5% had GA ≥ 40th weeks. PPH occured in 15%; mostly in nulliparas (17.7% vs.12.4% p < 0.01), those that used epidural (20% vs. 14.5%¸ p < 0.05), MAP (32% vs.15.2%; p < 0.05), those had manual removal placenta (71.9% vs.14.4%, p < 0.05)in mothers of babies ≥3500g (21% vs. 13%; p < 0.05), in those with BMI ≥30 (27% vs. 15%; p < 0.05), those with lateral placenta (26% vs. 12.3%; p < 0.05), and GA ≥ 40th weeks (17.3% vs. 13.6%; p < 0.05).

Conclusions

PPH is one of the most studied obstetric emergencies being the leading cause of maternal mortality in the world. It is important to closely monitor during labour and childbirth to modify risk factors where possible.

Key messages

Postpartum bleeding is an obstetric emergency that causes mortality and morbidity in pregnant women. There are no effective treatments yet, so it is important to recognise the associated risk factors and prevent them.
9.P. Workshop: Impact of COVID-19 pandemic and containment measures on the mental health in youth
Authors:   Organised by: EUPHA-PMH, EUPHA-CAPH,   Chair persons: Jutta Lindert (EUPHA-PMH), Lourdes Cantarero Arevalo (Denmark)
Published: October 2021

The Coronavirus pandemic is an unprecedented public health crisis impacting all age groups and all areas of society, irrespective of the risk of exposure or disease severity. In fact, containment measures put into place, such as social distancing, limiting mobility or closing of schools, carry risks for health, especially for mental health. This is particularly true for youth, defined as the age-group that spans from adolescence into young adulthood (15 - 24 yrs.). In this life phase youth are expected to acquire important social and intellectual skills, make decisions on their professional path, as well as master the transition from adolescence into young adulthood. It is further characterized by increasing independence from family and a high relevance of peer-groups. While this age group is so far not considered to be at high risk for serious SARS-CoV 2 disease, the epidemiological data indicating high incidence, but mostly mild symptoms and a low mortality risk, they are impacted by containment measures and concern for their parents and grandparents. First evidence indicates a rise in mental health problems with potential long-term impact. We present four studies with data collected during the lock-down or pandemic, of which three are set in the setting “tertiary education”. The workshop presents data from four European countries. While the first three studies present cross-sectional and longitudinal data on mental health outcomes in students during the pandemic and the uptake of treatment, the fourth presents qualitative data on coping mechanisms applied by youth.

Key messages

Young people are at risk to develop short and long-term mental health conditions due to the abrupt changes and challenges in their lives due to the Corona pandemic. Academic institutions offer a setting to reach young people, to provide low-threshold support and strengthen resilience to reduce the pandemic impact on young peoples’ health.
Spanish adolescents’ and young adults’ coping strategies under severe lock-down due to COVID-19: a dialogical research study
Authors: Arevalo L Cantarero
Published: October 2021

Background

During spring of 2020, millions of young adults throughout the world were sent home as a measure to contain the spread of COVID-19. In March 2020, Madrid became the city of the world with the highest incidence and mortality rates. By applying a phenomenological approach, this study aimed at gaining in-depth understanding of the subjective mental health experiences lived by Spanish young adults.

Methods

dialogical research was used to interact with AYA and young adults. AYA were recruited using the network of networks and snowball strategies. 36 were initially contacted and 35 decided to participate. All participants were informed of their right to stop the dialogue at any time without providing any further explanation to the researcher, and were informed of the data protection rules of the University of Copenhagen. All signed an informed consent. The 35 dialogues were held online using Zoom, recorded and saved in a secured folder.. The dialogues lasted on average 55 minutes, were transcribed with Nvivo Transcription software. The sociological theory on Resonance was used to shape specific segments of the dialogues and to analysis the data.

Results

35 online dialogues with 20 adolescent girls and 15 adolescent boys aged from 17 to 23 were held from the second to the 28 of April 2020. The majority of youth did not leave their residences for 2 months. Three of them lost relatives due to COVID-19, one was admitted at the hospital and seven had relatives who contracted the disease. Different themes were brought up: 1) AYA' relations with their physical spaces and with time. 2) Relating with others. 3) Strategies to overcome sense of alienation, loss and fear and to re-find resonance. AYA living with chronic or mental diseases realized the importance of developing supportive habits and of adhering to treatments.

Conclusions

Dialogical research allowed youth to reflect upon their experiences and abilities to cope with the shock a provoked by COVID-19.
Pharmaceutical expenditure: what has changed in ten years in Italian Health Care System?
Authors: Scattaglia M , Lenzi J , Gianino MM
Published: October 2021

Introduction

In the last 20 years, Italian pharmaceutical policies have moved to contain public expenditure. This study analyses the trajectory of retail pharmaceutical expenditures to investigate whether there has been a switch from public to private expenditure, how the composition of private and public expenditure has changed, and whether there are correlations with supply/demand variables. These research questions have received little attention in the literature.

Methods

This study used secondary data from Italy covering the period 2010 to 2019. A time-trend analysis was performed using the average annual percent change (AAPC) as the summary measure for the rate of change over the period 2010/19. The AAPC was estimated by fitting a linear regression model for the logarithm of each aggregate indicator. Kendall's τ coefficient investigates the correlation between the 2010-19 pharmaceutical expenditure items and other relevant health statistics (ages, categories of practising physicians, Gini coefficient, etc.).

Results

Italy's public pharmaceutical expenditure did not change significantly between 2010 and 2019 (AAPC = +0.03%, 95% CI = -1.4% to + 1.4%), nor did private spending (AAPC = +0.6%, 95% CI = -0.2% to + 1.3%). Public expenditure without the direct distribution of drugs in class A experienced a slowdown (-3.9%), and public expenditure with the direct distribution of drugs in class A exhibited a significant increase (+8.4%). The regression analysis evaluates the relationship between supply/demand variables and pharmaceutical expenditures. A significant result relates to the positive correlation between income inequality and out-of-pocket expenses for over-the-counter drugs (τ = 0.62, p-value = 0.046).

Conclusions

Pharmaceutical spending has increased over time, especially for drugs reimbursable by the NHS but paid for by citizens. This could be an alarm for a public healthcare system that should be able to guarantee healthcare services to all citizens.

Key messages

Public expenditure with the direct distribution of drugs in class A exhibited a significant increase (+8.4%). There has been increasing expenditure on drugs reimbursable by the NHS but paid for by citizens.
Comparing provider payment adjustments across 20 countries during COVID-19
Authors: Waitzberg RW , Quentin W , van Ginneken E ,   HSPM Network
Published: October 2021

COVID-19 has affected health providers economically in two main ways. First, some providers lost income due to postponed services or patients refraining from seeking care. Second, other providers took on new tasks by treating (high volumes of) COVID-19 patients. All providers faced higher costs due to new hygiene and distance requirements. We reviewed if and how countries have adjusted payments to health providers during 2020 using an analytical framework and data from 20 countries. The analysis is based on information collected in the COVID-19 Health System Response Monitor (HSRM) and complemented by grey literature by country representatives who are experts on health policy and have reported the developments and responses to the pandemic since is very onset.

We found that payments were not adjusted for many providers whose income did not depend on activity such as salaries, capitations and budgets. Most of the compensatory payments were in the form of new salaries and budgets that substituted activity-based payments, and some higher fees to compensate for activity shortfalls. New FFS payments were created to incentivize virtual services. Payments for COVID-19 related costs included mainly new fees for services. Hospitals also received new budgets to cover the costs of adjusting wards, creating new (ICU) beds, and hiring more workforce. Some countries also created new per diem and DRG tariffs to pay for COVID-19 patients. Consumables such as personal protective equipment and hygiene material were provided in-kind or reimbursed in-cash. Overall, governments bore many COVID-19 financial risks. Payment adjustments should be carefully designed in order to protect providers from income shortfalls without undermining productivity, access or quality of care. Payments for COVID-19 services should promote provision without leading to overtreatment or overspending.
Social Health Insurance country responses to the COVID-19 pandemic
Authors: Schmidt A , Winkelmann J , Merkur S
Published: October 2021

Background

Pandemic response is largely also driven by organization and governance of health systems. In countries with social health insurance (SHI) systems, pluralism of actors and decentralisation may represent a particular challenge in crisis times.

Objectives

We aim to present a comprehensive analysis of the health system responses during the COVID-19 pandemic of eight SHI countries: Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland. The question at the centre of the analysis is how SHI funds and defining characteristics of SHI systems have shaped pandemic response and which lessons to draw from the experiences of the first wave (spring to autumn 2020).

Results

Our analysis highlights key characteristics driving pandemic response common across SHI countries, particular the level of (de)centralization of responsibilities and providers and the role of SHI funds (compared to other actors). Five key themes emerged: governance, SHI fund sustainability, the role of GPs, surveillance strategies and (essential) health service provision. We found that SHI funds were not represented in crisis management teams during the pandemic in the majority of countries analysed. Responsibility partly shifted towards central government and away from the SHI funds.

Conclusions

Decentralization may pose significant challenges among local authorities with regard to the coordination of policies and information system flows. At the same time, decentralized pandemic management may be favourable as it supports bottom-up self-organization of ambulatory care providers. In fact, coordinated ambulatory care often helped avoid overburdening hospitals in the countries analysed.
Economic evaluation of the LTVEEG-m for refractory epileptic patients
Authors: Garcia-Lorenzo B , Becerra-Cuñat JL , Rocamora R , Dávalos A
Published: October 2021

Long-term video-EEG monitoring (LTVEEG-m) is the diagnostic test of certainty of epilepsy. The European Commission recommends one epilepsy unit with LTVEEG-m for every 3,000 patients with refractory epilepsy. In Spain, there was one center accredited every 10,600 patients with RE in 2019. There are different publications on LTVEEG-m about clinical effectiveness; however, very scarce scientific evidence has been shown on the efficiency of using of LTVEEG-m. This study aims to conduct an economic evaluation of the LTVEEG-m versus no LTVEEG-m (continuing with anti-sei¬zure drugs) in RE patients, which should support funding decision-making of the LTVEEG-m in Spain. Based on a prospective cohort of patients referred for refractory epilepsy for LTVEEG-m in the epilepsy unit of the Germans Trias i Pujol Hospital, a cost-effectiveness analysis was conducted using a decision tree followed by a Markov model which simulated the costs and health outcomes of individuals treated under both alternatives (LTVEEG-m vs. no LTVEEG-m) for a lifetime horizon from a hospital perspective. The effectiveness measure was quality-adjusted life years (QALYs). An extensive sensitivity analyses was run, including a probabilistic sensitivity analysis. In the base case analysis, the LTVEEG-m led to higher QALYs and health care costs with an estimated mean incremental cost of 17,472 EUR and an incremental effectiveness of 8 QALY s, generating an incremental cost effectiveness ratio of 2,175 EUR per QALY, a lower figure than the cost effectiveness threshold of 20,000 EUR per QALY in Spain. The sensitivity analysis showed the robustness of the results. The probability that LTVEEG-m is a cost-effective technology against the no LTVEEG-m was 100%. LTVEEG-m is an efficient diagnostic test compared to not use the LTVEEG-m and continuing with anti-sei¬zure drugs. This is a pioneering study in Europe and scalable to other similar economic contexts to Spain.

Key messages

There is a huge lack of epilepsy units using the LTVEEG-m as a diagnostic test of certainty of epilepsy for refractory epileptic patients in Spain, disregarding the European recommendations. LTVEEG-m is an efficient diagnostic test compared to not use the LTVEEG-m and continuing with anti-sei¬zure drugs. This is a pioneering study in Europe and scalable to similar Spanish economic context.
Trajectories of sickness absence and disability pension by type of occupation in multiple sclerosis
Authors: Bosma A , Murley C , Aspling J , Hillert J , Schaafsma F , Anema J , Boot CRL , Alexanderson K , Machado A , Friberg E
Published: October 2021

Background

Multiple sclerosis (MS) can impact working life, sickness absence (SA), and disability pension (DP). Different types of occupations involve different demands, which may be associated with trajectories of SA and DP among people with MS (PwMS). We aim to explore if annual levels of SA and DP differ according to type of occupation among PwMS and references. Further, we aim to gain knowledge of how trajectories of SA and DP are associated with type of occupation among PwMS.

Methods

A nationwide Swedish register-based prospective cohort study with six-year follow-up was conducted, including 6,100 individuals with prevalent MS and 38,641 matched population references. Mean annual SA and DP net days during follow-up years were calculated and stratified by type of occupation. Trajectories of SA and DP were identified with group-based trajectory modelling. Multinomial logistic regressions were estimated for associations between identified trajectories and different types of occupations.

Results

An increase of SA and DP over time in all types of occupations was observed in both PwMS and references, with higher levels of SA and DP among PwMS. Managers had the lowest levels of SA and DP in both groups. Three SA and DP trajectory groups were identified: Persistently Low (55.2%), Moderate Increasing (31.9%), and High Increasing (12.8%). Managers (Odds Ratio [OR] 0.37, 95%CI 0.26-0.52) and those working in Science & Technology (OR 0.64, 95% CI 0.50-0.82) had less probability of belonging to the Moderate Increasing group. Similarly, Managers (OR 0.52, 95%CI 0.30-0.89) and Science & Technology (OR 0.58, 95%CI 0.39-0.88) had also less probability of belonging to the High Increasing group.

Conclusions

Our findings suggest that the type of occupation plays a role in the level and course of SA and DP among PwMS.

Key messages

Over time SA and DP levels increased among PwMS regardless of type of occupation. PwMS in Managers or Science and Technology had less probability of belonging to the increasing trajectories.
Portuguese validation of the Adult Carer Quality of Life Questionnaire (AC-QoL)
Authors: Teixeira F , Moura A , Alves E
Published: October 2021

Background

Assuring informal carers' quality of life (QoL) must be a priority for public health policies and practices. The Adult Carer Quality of Life Questionnaire (AC-QoL) is a recent and valid instrument, overpassing limitations of previous tools, and being already used among informal stroke carers. This study aimed to assess the feasibility, reliability and validity of the AC-QoL among Portuguese informal carers of stroke survivors.

Methods

The linguistic adaptation of the AC-QoL was performed. Informal carers (n = 212) of stroke survivors hospitalized between September 2018 and August 2019 in all Stroke Units of the North of Portugal (n = 12) were invited to participate, 18 to 24 months post-stroke. Data on sociodemographic characteristics, psychological profile, burden and QoL were collected using a structured questionnaire. The psychometric properties of the AC-QoL were investigated through exploratory and confirmatory factor analyses. Cronbach's alpha was used to measure internal consistency. Construct validity was assessed through the association of the overall score of AC-QoL with anxiety and depressive symptoms, burden and sociodemographic characteristics.

Results

Exploratory factor analysis supported the original eight-factor structure of the AC-QoL, revealing an adequate goodness of fit to the study sample (X2(674)=1145.926; CFI=0.916; TLI=0.908; RMSEA=0.058). The AC-QoL showed a high degree of reliability, with Cronbach's scores for the subscales ranging from 0.64 to 0.97 and a Cronbach's alpha of 0.91 for the overall score. Anxiety symptoms (p < 0.001), depression symptoms (p < 0.001) and burden (p < 0.001) were inversely associated with the overall score of AC-QoL. Younger (p = 0.032) and employed (p = 0.021) informal carers presented more frequently higher scores of overall QoL, than those older and unemployed.

Conclusions

The Portuguese version of the AC-QoL is a comprehensive, simple, reliable and valid instrument to assess informal stroke carers' QoL.

Key messages

The Portuguese version of the AC-QoL is a comprehensive and valid instrument with a high degree of reliability, that can be briefly and easily applied to informal carers of stroke survivors. A comprehensive and brief assessment of informal carers’ QoL will contribute to devise strategies to promote well-being and social integration of stroke survivors and their informal carers.
COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease
Authors: Cardwell K , O'Murchu E , Byrne P , Broderick N , O'Neill S , Smith SM , Harrington P , O'Neill M , Ryan M
Published: October 2021

Background

This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.

Methods

A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.

Results

In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.

Conclusions

At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.