bluuebunny/crossref_metadata_2025 huggingface dataset:
HTA and National Immunisation Program: an overview of competent bodies and of the impact of HTA on the decision-making process
Authors: Ricciardi W
Published: October 2022

Issue/problem

The WHO has recommended for many years to adopt transparent and standardized methods to decide upon the introduction of vaccines at national level. For this purpose, the Global Vaccine Action Plan has envisaged the establishment of National Immunization Technical Advisory Groups (NITAGs) to issue independent advice relied on the assessment of vaccines efficacy and safety and health technology assessment (HTA).

Description of the problem

So far, 172 countries worldwide have a NITAG. Despite the growth in the number of NITAGs worldwide and their strengthening following process indicators identified by the WHO, the way how NITAGs issue recommendations and how they are considered in the development of vaccine policy still represent a matter to the attention of the scientific and policy community.

Results

The evidence shows that assessment frameworks vary across countries. Furthermore, the legal basis and the authority, namely binding or advisory, recognised to them could influence the way how NITAGs work and impact on vaccine policy. Eventually, the final decision is also led by other aspects, including financial and contextual factors that are less standardizable but should be always taken into consideration in health policy. In fact, the final decision on the inclusion of a vaccination into the national immunization program is made by the Ministry of Health also based on the evaluation of HTA bodies working in the country.

Lessons

Considering the central role of NITAGs in vaccine policy, some efforts should be done in order to make NITAGs more authoritative and collaborative. This could help, from one side, to make the relationship between final decision and NITAGs recommendations clearer and, on other one, to make it possible to have shared and timely evaluations. In this respect, Joint Clinical Assessment envisaged by the new EU regulation on HTA could prepare the way for a more transparent and timely vaccine policy at European level.
Needs for a thorough Joint Clinical Assessment of vaccines within the HTAR: perspectives of NITAGs
Authors: Wichmann O
Published: October 2022

Issue/problem

NITAGs are independent expert advisory committees that provide evidence-based recommendations to the Ministry of Health to guide the introduction of new vaccines and formulate national immunization plans.

Description of the problem

The evaluation of vaccines has become more and more complex. This is not only because the number of vaccines on the market and the diseases they target has increased, but also because a much wider range of population subgroups can be targeted, and for some diseases several vaccines are available and need to be compared. In addition, vaccines not only have an impact on individual well-being, but can also induce population-level effects and broader socioeconomic value.

Results

NITAGs consider to a large extent similar key factors in their evaluation processes. These can be divided into context-free and context-specific aspects. Context-free aspects include effectiveness and safety. Local disease epidemiology, potential vaccine impact at population-level, cost-effectiveness and societal or cultural values and preferences are context-specific aspects. Collaboration is possible when jointly assessing the evidence related to context-free aspects, since this is usually easily transferrable across countries. In 2019, a network of NITAGs in the European Union and Economic Area countries was established under the coordination of the European Centre for Disease Prevention and Control. Within this network, working groups have been established and either performed themselves or supported external contractors in conducting systematic reviews on vaccines effectiveness and safety.

Lessons

The increasing workload of NITAGs and the prospect of joint clinical assessments draw the attention to a number of practical issues to be solved, e.g., consensus on methodological guidelines for systematic reviews, processes to ensure that the products meet NITAGs expectations (content, quality, timing), and approaches how to consider unpublished data.
Bottlenecks to child health service delivery – how can Health System Performance Assessment help?
Authors: Shuftan N , Rajan D
Published: October 2022

Health System Performance Assessment (HSPA) is an established tool that can help identify issues with the way health systems work to achieve their intended goals, improve transparency and account-ability, and provide stimulus for reform. However, HSPA frameworks tend to be adult-centric and therefore not generally sensitive to child health challenges. Using a new HSPA framework for Universal Health Coverage, we show how child health tracer conditions can be used to pinpoint system under-performance and flag major bottlenecks impeding service delivery overall. Based on the HSPA framework, health system bottlenecks can be traced backwards to explore possible origins (areas to be targeted for improvement) or forwards to understand potential implications for the achievement of health system goals. The following qualitative and quantitative data are used to highlight major bottlenecks to child health service delivery: eight health system-focused child health assessments which show that one of the main bottlenecks is weak primary care coverage of sexual, reproductive, maternal, newborn, child, and adolescent health services, leading to parents bypassing PHC in favour of hospitals; results from WHO missions (e.g. in Romania and Tajikistan) showing that paediatric patients were often admitted to hospitals for treatment, even for conditions that could be safely managed in the outpatient setting; quantitative data on responsiveness, user experience, client satisfaction and people-centredness from publicly available datasets and national datasets obtained in collaboration with WHO Country Offices for national level data, to contextualize the aforementioned findings.
Long-term psychosocial response in Belgium after the 22/03/2016 terrorist attacks
Authors: Van Overmeire R , Vesentini L , Vanclooster S , Muysewinkel E , Bilsen J
Published: October 2022

Introduction

While many studies have shown how terrorist attacks can have a mental health impact, there currently is little insight into how governments try to aid victims of terrorist attacks. In this study we viewed the long-term governmental psychosocial care response after the attacks of 22/03/2016 in Belgium, from both the level of the policy, as well as from the perspective of victims.

Methods

This study employed a qualitative design. First, we studied guidelines, reports, policy documents and other relevant grey literature concerning the governmental psychosocial care response to the terrorist attacks. Second, we interviewed 27 victims of the terrorist attacks on their experiences with terrorist attacks for the micro level. We analyzed these interviews using a reflexive thematic analysis.

Results

On the policy level, a problem occurred in the transfer from responsibilities from the federal level to the community's level. Furthermore, there was no proper psychotraumatology network of therapists, which did not allow for the proper therapy to be easily sought by victims. This was noticed also by the victims, who had issues finding a therapist that fitted their needs and could help with their trauma-related disorders. Furthermore, on both policy level and victim level, a reoccurring problem is the lack of recognition and knowledge of the mental health issues occurring after disasters such as terrorist attacks.

Conclusions

The Belgian long-term psychosocial care response to the terrorist attacks of 22/03/2016 was not well organized and left some victims without proper aid. To improve the psychosocial response after terrorist attacks in the long-term, a combination of both more knowledge and recognition is needed.
New frontiers in risk assessments related to diets, health and the environment
Authors: Springmann M
Published: October 2022

Based on the sustainable development goals agenda, public health experts should approach the study of planetary diets, environment, and health with a holistic approach that includes both human and planetary health. Modelling studies help in estimating priorities while attaining differences across countries. Future scenarios vary according to priorities to be set. When aiming only at fulfilling food-security objectives, studies suggest that reductions in premature mortality have few environmental co-benefits. In contrast, modelling studies that include environmental goals indicate the potential for reducing environmental impacts while improving diet quality and overall health outcomes, especially in high-income countries. The scenarios indicate that focusing on dietary changes towards healthy and balanced dietary pattern seems an ideal strategy to improve both mortality risk and the environmental impact, although the magnitude of the effects may vary across countries. Weight and dietary risk factors have traditionally been considered separate categories. A new approach can be proposed for attributing weight-related risks to food intake at global, regional, and national levels. When comparing current consumption patterns to diets that for each country minimise diet and weight-related risks, a total of 5 million weight-related deaths in 2019 were attributed to the overconsumption of refined grains, dairy, red and processed meat, sugar, and eggs, and to the underconsumption of oils, and legumes, among others. A large share of deaths attributable to high intake of animal source foods and imbalanced grain intake occurred in countries with the higher high human development index, while more than a third due to imbalanced sugar and oil intake occurred in medium ones. Attributing weight-related risks to food intake can inform food-based interventions for reducing the burden of preventable deaths associated with imbalanced weight levels.
Creating a German “StadtRaumMonitor” with a climate lens - The approach and design of the piloting
Authors: Tollmann P , Mekel O , Mensing M , Claßen T , Sammet T , Boos R , Köckler H , Plantz C
Published: October 2022

Based on the Scottish Place Standard tool (PST), the Federal Centre for Health Education (BZgA) adapted and piloted a German version called ‘StadtRaumMonitor’ from 2019-2021 as part of a Joint Action ‘Health Equity Europe’ (JAHEE) funded by the EU Commission. The ‘StadtRaumMonitor’ was developed in cooperation with the NRW Centre for Health Nordrhein-Westfalen and the Ministry of Social Affairs, Health and Integration Baden-Württemberg under the leadership of BZgA and with scientific support from the University of Applied Sciences in Bochum. Based on the piloting and the findings of the accompanying scientific research, some adjustments were made to the PST and the website was relaunched offering extended functionality to users. Building on the successes of the ‘StadtRaumMonitor’, a follow-up project started in 2021: Recognising the health impacts of climate change and the need to include climate change issues when assessing the quality of places, the BZgA started a pilot project with the same project partners to adapt the tool to the context of climate change. The “StadtRaumMonitor” with a climate lens aims to address municipal climate adaptation for health promotion. The tool is inspired by the Scottish PST with a climate lens and was developed based on a systematic literature research, focus groups with experts and with actors in municipalities, as well as in participative cooperation with municipal stakeholders. After pre-test and subsequent adjustments, the tool is currently being piloted in four German municipalities, and an evaluation of the application of the tool is taking place. This part of the workshop aims to provide an example of the approach to the further development of an existing tool, here within the context of municipal climate adaptation and on the basis of the “StadtRaumMonitor”, and thereby build competencies in this field. Furthermore, early insights into the piloting of the German PST with a climate lens will be given.
6.F. Skills building seminar: Digital health and communication
Authors:   Organised by: EUPHA-DH,   Chair persons: Stefan Buttigieg (EUPHA-DH), Anthony Staines (Ireland)
Published: October 2022

Information has always been central to public health practice. As digital health develops it becomes increasingly central to health care delivery, health system management, and population health monitoring. Despite enormous investment, and great effort in collecting these data, much of the potential value of health care information is lost because of poor data architecture. Good design and interoperability are sometimes seen as obstacles to implementation. but in fact they are key to getting value out of health data systems. Tools and ideas developed over the last thirty years by bioinformaticians may be quite unfamiliar to public health practitioners. The intention of this seminar is to introduce some of these ideas, specifically syntactic and semantic interoperability, ontologies, and terminologies, and to show, using case studies, how these may fit into public health practice.

Key messages

• It is necessary to have an excellent data architecture to get a good return on investment in healthcare ICT systems.

• Standards are key to interoperability, be that syntactic or semantic.
Terminologies matter - the case of ICNP and SNOMED-CT
Authors: Staines A , Hussey P , Das S
Published: October 2022

Terminologies can seem very abstract to end-users. While most health professionals will be familiar with some terminologies (for example MeSH (Medical Subject Headings), the controlled vocabulary thesaurus used for indexing articles for PubMed or ICD-10, WHO's terminology for disease coding), fewer will be aware of the depth and range of terminologies used in healthcare, nor of the central importance of multilingual standard terminologies in health care interoperability. Following a brief introduction to the use of terminologies, the integration of the International Classification for Nursing Practice (ICNP) the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) will be presented, as an example of the use of terminologies, and their ongoing curation, maintenance and development.
Barriers on cross-border sharing of health data for secondary use and options to overcome these
Authors: Richards R
Published: October 2022

Cross-border health data sharing is essential to facilitate vital health research into new treatments and to improve patient care and safety across Europe. The flagship European Health Data Space (EHDS) aims to promote better exchange and access to health data through the creation of a European-wide infrastructure. However, significant barriers to cross-border data sharing must first be resolved in order to fully ensure the successful functioning of the Data Space. To this end, the European Commission established a Joint Action (TEHDAS), as the policy development tool for the development of the EHDS. This presentation will be based around the findings of the recent TEHDAS report ‘Barriers to cross-border sharing of health data for secondary use and options to overcome them.’ The report draws on the results of a dedicated literature review, 133 case studies from across 23 countries and expert interviews to identify the primary barriers to cross-border data sharing and options to overcome these from the perspective of European data users (research and policymakers). The session will start with a concise presentation of the report methodology. The research team will then deliver an interactive presentation, in which they succinctly outline each barrier and policy option and ask participants to vote for their preferred policy option to overcome each barrier identified. EUPHA participants votes will inform the final TEHDAS recommendations on mitigations and solutions for barriers to cross-border data sharing which will be submitted to the European Commission for incorporation in the European Health Data Space legislative proposal.
The role of PHIRI in the EHDS2
Authors: Bernal-Delgado E , Gonzalez-Garcia J , Derycke P , Schutte N , Bogaert P , Saso M
Published: October 2022

The Population Health Information Research Infrastructure (PHIRI) is setting the foundations for the design, implementation and deployment of a fully operative European research infrastructure on population health research in the next few years. In a nutshell, this effort represents setting up the principles and instruments for the governance of the reuse of data for research purposes in a number of aspects - the legal and ethical foundations for the mobilization of data, including sensitive data; how the different nodes in the infrastructure organize to respond multiple research questions in a federated manner; how to ensure high standards of data quality and data interoperability; and, how technological solutions can preserve a safe use of the data while enabling sound scientific outputs. PHIRI has been challenged to provide real-life solutions to each of these aspects. Acting as a demonstration project, PHIRI is currently providing solutions to researchers that are trying to solve their research questions. Building on this experience, in the future, PHIRI is expected to provide support and services to population health researchers that build their research on the secondary use of health data. Among those services: data discovery; data harmonization services (e.g., discovery and use of common data models and interoperability standards); technological services (e.g., playgrounds with synthetic data, secure process environments); research outputs archival (e.g., maintenance and dissemination of the knowledge base generated in the infrastructure); and, training and capacity building. Interestingly, PHIRI can be seen as a primer for the upcoming European Health Data Space for secondary use (EHDS2). In this workshop will be discussing how to line up PHIRI's vision and role within the EHDS2.
Global public health must end the neglect of oral health
Authors: Benzian H , Loistl S
Published: October 2022

Oral diseases are among the most common health problems and constitute major public health challenges across countries and health systems worldwide. The main diseases dental caries, severe periodontal disease, oral cancer and toothlessness affect populations everywhere and show significant social gradients - poor, disadvantaged, rural, or otherwise vulnerable groups suffer from a much higher burden, while at the same time having more difficulties to access prevention and care. Similarly, low- and middle-income countries have the highest prevalence of oral diseases while their healthcare systems are ill-equipped to address the challenges. Due to the predominant clinical care model of dentistry that favours an interventionist approach requiring costly technology provided by a dentist, many health systems and large population segments are not able to afford even basic oral health care. Moreover, oral health has been largely absent from the global health arena for the last 20 years leading to faltering political priority and attention. This has changed recently with the convergence of several initiatives of global relevance, supported by advocacy of the wider oral health community. Following the first ever paper series on oral health in The Lancet, a Lancet Commission on Oral Health was established in 2019, which sparked a group of WHO member states to embark on a remarkable policy development process dedicated to oral health. We now have a Global Strategy for Oral Health and will soon have a Global Action Plan complemented by a comprehensive Monitoring Framework. In addition, work on defining Best Buys in Oral Health and other supportive workstreams are under way. The presentation will provide an introduction and overview to these global policy guidance frameworks that are shaping a new reform agenda for oral health as part of NCDs, Universal Health Coverage and the SDGs towards 2030. Particular implications for public oral health in Europe will be discussed.
Health protection policies for digital platform and low wage workers
Authors: MacEachen E
Published: October 2022

Background

In the context of the COVID-19 pandemic, shifting employment and occupational health social protections of low-wage and self-employed digital platform workers are described and compared. Specifically, we examine how, across advanced economy countries, laws, policies, and collective agreements protected the health of low wage (e.g., service workers) and digital platform workers (usually classified as self-employed) including during the first three waves (2019-2021) of the COVID-19 pandemic. The overall goal is to inspire conversation, comment, critique and new research questions to tackle the issue of the employment, work and health of low wage workers and self-employed digital platform workers.

Methods

Taking a comparative focus on eight advanced economy countries, this paper identifies legal efforts to address employment misclassification and challenges related to employee definitions that vary by the legal act. Debates about minimum wage and occupational health and safety standards as these relate to worker well being are considered. Finally, we discuss promising changes introduced during the COVID-19 pandemic that protect the health of low-wage and self-employed workers.

Results

Overall, we describe an ongoing “haves” and a “haves not” divide, with on the one extreme, traditional job arrangements with good work-and-health social protections and, on the other extreme, low-wage and self-employed digital platform workers who are mostly left out of schemes. However, during the pandemic small and often temporary gains occurred and are discussed.

Conclusions

In the context of an evolving social contract during the COVID-19 pandemic, this paper provides views on avenues for policy reform and research from employment and occupational health specialists across eight advanced economy countries.
6.K. Workshop: Health Literacy in Health Care Settings in Europe: Practice experience, challenges and future needs
Authors:   Organised by: Fulda University of Applied Sciences (Germany),   Chair persons: Katharina Rathmann (Germany)
Published: October 2022

Health care organizations (e.g., hospitals, nursing homes, facilities for people with disparities) are increasingly required to create health literate structures and processes, to train staff in such a way that they make it easier for their users to behave in a health literate manner, to deal competently with health information and to navigate competently through facilities and the entire health care system. This approach is known as the concept of organizational health literacy (OHL). Meanwhile, different standards (fields of action) of organizational health literacy and assessment tools to measure health literacy on an organizational level are available, which address, among other issues, health literacy as part of the quality management system, the development of health-related information by involving users, or to facilitate navigation within and to health care facilities and through the health care system. In order to assess and to strengthen OHL in health care settings, an increasing number of projects in Europe and internationally conduct needs assessments and interventions to implement tools to strengthen OHL at the patient-/client-, staff- and organizational-level. The assessment and implementation is accompanied by different requirements, challenges and needs at different levels (i.e. clients, staff, management).

Thus, the workshop emphasizes the following objectives:

1. to present findings from OHL projects in European countries (Austria, Belgium, Germany, the Netherlands, Switzerland).

2. to present and to discuss methodological issues (e.g., needs assessment),

3. to highlight practical experiences when implementing measures to strengthen OHL, and

4. to discuss beneficial factors, challenges and helpful approaches (e.g., participatory or co-creation setups) for the implementation of OHL.

A total of five experts on the topic of ‘health literacy in health care settings’ will present and discuss the implementation of health literacy in health care settings in Central European countries.

Key messages

• The Workshop highlights a synthesis of challenges and future needs that are evident for organizations and users at different levels (management, staff, clients).

• Beneficial factors are a supporting management and leadership staff, participatory approaches, communication tools, training staff in health literacy skills as well as clients/patients.
COVID-19 vaccination in prison settings: a model to design tailored vaccine delivery strategies
Authors: Tavoschi L , Mazzilli S , Petri D , Busmachiu V , Stylianou I , Meroueh F , Stöver H , Rosello A , Ranieri R , Baglietto L
Published: October 2022

Introduction

Vaccinations are one of the most powerful preventive tools discovered by modern medicine. Although expanded programmes of immunization are well established in EU/EEA, significant immunity gaps and suboptimal coverage are registered among specific populations, including people living in prisons (PLP). PLP are also at increased risk to vaccine-preventable diseases (VPD) with potential outbreak in prison, e.g. flu, COVID-19, as well as other VPDs such as HBV. The EU-funded project RISE-Vac, aimed at collecting models of care developed during the pandemic to design tailored vaccine delivery strategies that could be extended beyond the sole COVID-19 vaccine.

Methods

Through a survey to healthcare staff working in prisons in six countries of the EU/EEA (Cyprus, France, Germany, Italy, Moldova, UK) we collected information on the implementation of COVID-19 vaccination program. The following areas were investigated: challenges & barriers encountered, workload distribution, education & training activities for prison staff and PLP, referral strategies after release, immunization information system.

Results

The respondents reported that in prisons COVID-19 programs have been implemented efficiently. Strategies for optimal management of the vaccination campaign included: week-day dedicated to vaccination services when vaccines were delivered and immediately administered to overcome cold chain challenges; new staff recruitment & task shifting; administration of booster doses within prison premises for released individuals; distribution of informational material both to PLP & prison staff.

Conclusions

Our results show that universal immunisation campaigns are feasible, acceptable and effective in places of detention when there is commitment to implementing them. Evidence from the pandemic situation may inform future provision of expanded immunization programmes.
Preventing HIV infection in pregnancy: a comprehensive ANC-based intervention in Western Uganda
Authors: Theuring S , Jahn LS , Kengonzi A , Kabwama SN , Rubaihayo J
Published: October 2022

Introduction

Pregnant women in sub-Saharan Africa represent a high-risk group for HIV infection, but most endemic countries including Uganda do not engage specific HIV prevention measures in pregnancy. This longitudinal study aimed to assess outcomes of a comprehensive, ANC-embedded strategy to prevent seroconversions during pregnancy in Western Uganda.

Methods

HIV-negative ANC clients were administered an HIV risk assessment tool, followed by individual risk counselling. They received a fixed appointment for repeat HIV testing after three months. Those attending ANC without partners obtained formal partner invitation letters. At follow-up after three months, women not attending repeat testing were reminded via text message. Post-intervention risk behavior engagement was captured. We analyzed uptake of the intervention, HIV incidence rate, and associations with risk behavior.

Results

Of 1081 participants, 116 (10.7%) reported risk behavior engagement at first ANC visit, 148/1081 (13.7%) were accompanied by partners. The repeat test visit was attended by 848/1081 (78.5%) women, 42 (5.0%, p < 0.001) reported post-intervention risk behavior engagement, and 248 (29.4%, p < 0.001) were accompanied by partners. Seroconversion occurred in two women. In multivariable logistic regression, rural facility clients compared to urban ones (aOR 3.96; 95%CI 1.53-10.26), and women with positive or unknown partner HIV-status (aOR 2.86; 1.18-6.91) and partner alcohol abuse (aOR 2.68; 1.15-6.26) had increased odds for engagement in risk behavior despite the intervention.

Conclusions

After our intervention, risk behavior in pregnancy was reduced by half, and partner attendance had doubled compared to baseline. Our cohort showed a 0.76/100 women-years HIV incidence rate compared to 2.85 in pre-intervention data from the same setting. Clients from rural settings and women experiencing precarious partner situations require special attention to reduce risk behavior engagement during pregnancy.

Key messages

• HIV incidence in pregnancy in Western Uganda can be significantly reduced through a comprehensive, ANC-based counselling intervention.

• Pregnant women from rural settings and those experiencing precarious partner situations require special attention regarding sexual risk behavior.
Inequalities in the disease burden in Scotland: an area level analysis
Authors: Grant I , Fletcher E , McCartney G , Thrower M , Wyper G , Stockton D
Published: October 2022

In the context of increasing demand for evidence-based policy, attempts to address or mitigate the effects of disadvantage have been usefully informed by comprehensive indices of multiple deprivation. These indices combine indicators on a range of dimensions of deprivation to classify neighborhoods or localities. Through combining information on fatal and non-fatal health loss, burden of disease studies allow planners and policy-makers to have a better understanding of the contribution of different diseases and injuries to the total burden of disease. These estimates can be augmented through studies, stratified by investigating inequalities in the burden of disease due to area-based deprivation. Doing so, helps contribute to discussions about where prevention and service activity should be focused to address health inequalities. The Scottish Burden of Disease study uses the Scottish Index of Multiple Deprivation (SIMD) as means to report on of the extent of inequality in the burden of disease in Scotland between people living in the areas of greatest, and of least, multiple deprivation. The SIMD quantifies deprivation based on data zones, a geographical unit comparable to a postcode. Using pooled and weighted data from seven domains (employment, income, crime, housing, health, education and geographic access), each data zone is given a composite rank out of 6,505 data zones. The composite rank was then converted to a decile, with 1 assigned to the 10% most deprived data zones and 10 to the 10% least deprived. In this presentation we will show the key steps involved in undertaking an area-based analysis of health inequalities in the burden of disease in Scotland using results from the Scottish Burden of Disease 2019 study, and from our monitoring of COVID-19 disability-adjusted life years.
Essential EU mobile workers in the Dutch food supply chain: occupational safety and health policies during and after the Covid-19 pandemic
Authors: deLange T , Mantu S , Skowronek N , Berntsen L
Published: October 2022

The pandemic has revealed the dependence of many labour markets on EU mobile ((im)migrant) workers, particularly in sectors designated as essential for national economies. Despite many EU workers falling under the label of ‘essential workers’, they are nonetheless vulnerable to unhealthy and unfair working and living conditions linked to the type of work they perform (manual), the conditions of their employment (highly flexible) and their lack of social networks that makes them dependent on their employers for housing and health. Taking EU mobile workers in the meat and distribution sectors, two specific Food Supply Chain sectors in the Netherlands, as a case study, this contribution discusses how in the Netherlands protection during the Covid-19 pandemic was organized for this group of workers in relation to protective measures at the work place, quarantining, pay during periods of quarantine and protection against job loss, and access to public health services (testing, vaccines), topics that generated a great deal of insecurity among EU mobile workers. The analysis is based on data provided by a survey among 153 EU mobile workers (May-July 2021), 35 interviews with Polish and Romanian workers, and 50 interviews with national stakeholders. The aim is to problematize the disjuncture revealed by the pandemic between an EU legal regime that prioritizes mobility and national arrangements around welfare and social protection that leave many mobile workers vulnerable. We argue that EU free movement of workers needs to be flanked by measures to ensure that the people who move do so under decent and fair conditions.
Healthcare services access during the COVID-19 pandemic among older people
Authors: Bertuccio P , Vigezzi GP , Signorelli C , Zucchi A , Cavalieri d'Oro L , Stuckler D , Iacoviello L , Gallus S , Odone A
Published: October 2022

The COVID-19 pandemic strongly impacted older people, not only in terms of clinical outcome but also in care provision. Investigating trends of changes in healthcare services access among older subjects during the pandemic, along with studying potential determinants, is of utmost interest to identify the most at-risk individuals. We used data from LOST in Lombardia, a cross-sectional study conducted on a representative sample of 4,400 older adults (aged 65 or more) in autumn 2020. Data were collected about lifestyles, mental health, and access to healthcare services before and during the pandemic. To investigate potential determinants of changes in healthcare access, we presented prevalence ratios (PRs) estimated through multivariable log-binomial regression models. Twenty-one per cent of the participants increased telephone contacts with general practitioner (GP), 9.6% specialist visits for a fee, while 22.4% decreased GP visits, 7.5% ED access, 6% hospitalisations, 12.3% outpatient visits, 9.1% diagnostic exams. The prevalence of the cancellation or delay of medical appointments by the patient's decision was 23.8%, with higher proportions among men, among individuals aged 75 or over as compared to those aged 65-74, and among individuals with a higher self-reported economic status (p-value<0.05). People with comorbidities more frequently cancelled or postponed visits, reduced ED access or hospitalisations. Moreover, individuals with worsened mental health status showed a higher prevalence to cancel or delay visits and to reduce ED access. The decrease in healthcare provision and consultations could result in mortality and morbidity excess. Our results should inform targeted intervention to bridge the gaps and overcome the health inequalities that the pandemic has deepened. Exploring the underlying reasons and determinants for healthcare avoiding or delaying among the most vulnerable groups is crucial for epidemic preparedness and planning future interventions.
Changes in retail food environments around schools over 12 years in Flanders, Belgium
Authors: Smets V , Vandevijvere S
Published: October 2022

Background

Food environments influence food preferences, in particular among children. Besides their homes, children spend most of their time in and around the school. This study mapped changes in retail food environments around primary and secondary schools in Flanders between 2008 and 2020. In addition, associations between those indicators and children's weight status were assessed.

Methods

The food environment near primary and secondary schools was mapped using three spatial indicators: 1) The density of different types of food retailers within 1000m road distance from the school entrance, 2) the percentage of schools with at least one food retailer of a certain type within 1000m road distance from the entrance, and 3) the median walking distance from the school entrance to the nearest food retailer of a certain type. Associations between the density of convenience stores, as well as fast food outlets around the schools and the weight status of the schools’ children were assessed using generalized linear models adjusted for level of urbanization, socio-economic status of children at school level and sex.

Results

Food environments near schools in Flanders were found to be unhealthy, with a significant increase in fast-food outlets and convenience stores between 2008 and 2020. Food environments near schools with a higher proportion of children from a poor socio-economic background were found more unhealthy than those near schools with a lower proportion of such children, regardless of the urbanization level. A significant positive association was found between the density of fast food outlets as well as convenience stores around primary schools and the weight status of children aged <6 years and 6-12 years.

Conclusions

Food environments around schools in Flanders became more unhealthy over time and were associated with children's weight status. The government therefor has the responsibility to create healthy food environments near schools to protect children's health.

Key messages

• The food environment near schools became more unhealthy between 2008 and 2020.

• The food environment near schools was associated with younger children's weight status.
Validity of self-reported diseases from health surveys: comparisons with registry data in Denmark
Authors: Rosendahl H , Lau CJ , Davidsen M , Ekholm O , Christensen AI
Published: October 2022

Background

The validity of self-reported disease prevalence estimates in health surveys may be low when compared to data from medical records in administrative registers. Such discrepancies reflect a low content validity of the survey question, which may ultimately compromise the application of these survey data for public health purposes. The aim of the present study was to examine the agreement of self-reports of seven diseases with data from administrative registers, both overall and by sociodemographic characteristics.

Methods

Prevalence estimates of self-reported current and/or previous diabetes, asthma, rheumatoid arthritis, osteoporosis, myocardial infarction, apoplexy, and cancer, respectively, were derived from the Danish National Health Survey in 2017 (n = 183,372 adults aged ≥16 years). Individual-level data were linked to registry data on the same diseases. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), kappa, and total agreement between self-reported and registry-documented prevalence estimates were examined.

Results

For all included diseases, the specificity was >92%, and the sensitivity varied between 59% (cancer) and 95% (diabetes). NPV was >94% for all diseases and PPV varied between 13% (rheumatoid arthritis) and 93% (cancer). Total agreement varied between 91 % (asthma) and 99% (diabetes), whereas kappa was lowest for rheumatoid arthritis (0.21) and highest for diabetes (0.88). Sociodemographic variables were significantly associated with total agreement with sex, age, and educational level exhibiting the strongest associations.

Conclusions

Overall, total agreement, specificity, and NPV between self-reported and registry-documented disease prevalence estimates are high, but PPV and kappa vary greatly between diseases. The latter findings reflect a low content validity of the applied survey question for specific diseases. This should be taken into account when interpreting similar results from surveys.

Key messages

• The validity of self-reported disease prevalence estimates may be low when compared to data from medical records. We found positive predictive values and kappa to vary greatly between diseases.

• Future studies should aim at designing survey questions properly in order to ensure a high content validity of the applied question.
Universal screening for postpartum depression? Inequalities and barriers among immigrant mothers
Authors: Marti Castaner M , Hvidtfeldt C , Møller Olsen JM , Nørredam M , Fredsted Villadsen S
Published: October 2022

Background

Postpartum depression (PPD) is a serious public health concern affecting 12% of women globally. Early detection is necessary to provide timely support. In Scandinavian countries, universal screening is recommended. However, migrant women, who are at increased risk of PPD, seem to be screened less often. Still, there is limited knowledge about 1) how acculturation relates to screening, and 2) how healthcare providers navigate PDD screening with migrant women.

Aims and methods

We used a mixed-methods approach to explore whether and why inequalities in PPD screening using the Edinburgh postpartum depression scale (EPDS) may exist in the context of universal PPD screening within the free home-visiting program in Denmark. Data from 77,694 infants and their mothers participating in the Danish home-visiting program (2015-2018) was used to examine the prevalence of participation in PPD screening and its association with migrant status and acculturation factors. We interviewed 16 health visitors to examine qualitatively challenges and strategies used when assessing PPD among immigrant mothers.

Results

Immigrant women were 80% more likely to lack screening (adj. RR 1.81-1.90). All factors indicating lower acculturation, such as shorter length of residence, older age at migration, and having studied abroad were independently associated with increased risk of lack of screening. Thematic analysis of qualitative data showed how cultural and linguistic differences and organizational constraints limit health visitors’ ability to assess immigrant women's mental health needs. Although health visitors often used EPDS as an opener to talk about mental health, they did not use it as an ‘assessment’.

Conclusions

This study shows inequalities in PPD screening than may result in reduced use of mental health services among immigrant women. The experiences of health visitors shed light on how to improve the identification of PPD among immigrant mothers.

Key messages

• Migrant women in Denmark, even those who have migrated as children, are at risk of being left out of PPD screening programs.

• Limited organizational support and cultural competences makes PPD screening among immigrant women not feasible for maternal health visitors.
The consequences of the COVID-19 pandemic on the health and wellbeing of the youth: a systematic review
Authors: Bosmans M , Marra E , Baliatsas C , de Vetten-Mc Mahon M , Dückers M
Published: October 2022

Introduction

The coronavirus outbreak and resulting restrictive measures have a major impact on population health. Research results suggest that the impact on the youth is especially great. In this review of international literature we investigated the impact of the COVID pandemic on the health and wellbeing of the youth, with a special emphasis on identifying vulnerable groups.

Methods

This review looked at the impact on five domains; physical health, (health)care needs, mental health, social effects and other effects. We also identified protective and risk factors. We searched the databases of Pubmed, PsychInfo and Embase for longitudinal empirical studies in May 2021.

Results

For all topics together, 145 papers were included. Results show that the corona crisis had a negative impact on the physical and mental health of the youth. Many young people exercised less, ate less healthy and suffered more from depression, anxiety and loneliness. Young people who already had mental or physical health problems were more vulnerable and experienced more negative results of the corona crisis. The crisis worsened existing problems. Other factors that exacerbate problems are poverty and poor family functioning. The impact is the largest for youths with multiple problems. At the same time, young people seem resilient. Many had no or few health problems during the studied period (roughly the first year of the pandemic), or their health problems decreased when restrictions were lifted.

Discussion

More attention is needed for preventive interventions that prevent health problems, promote health and that support the youth to maintain and build their resilience. Special attention should be paid to vulnerable groups when targeting these interventions.
Multimorbidity, low income and unmet need for healthcare: a national study of 41,135 older adults
Authors: Alemu F , Thornton J , Ali S
Published: October 2022

The aims of this study were: (1) to identify the determinants of unmet need for access to primary care in middle-aged and older adults; and (2) to examine the reasons for unmet need. We used data from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative survey of adults aged 45 to 85 years. Respondents were asked if they ‘needed health care during the last 12 months but did not receive it’. For those who replied ‘Yes’, the survey asked for the reason(s) for not receiving the needed care. Out of 41,135 respondents, 3,468 had unmet need for healthcare in the last 12 months. Among respondents with 0, 1, 2 and ≥3 morbidities, the proportion reporting unmet need was 2.5%, 5.3%, 5.1% and 9.1% respectively. After adjusting for covariates, the odds ratios (ORs) for unmet need for 1, 2 and ≥3 morbidities (compared to no morbidity) were 1.25 (95% CI: 0.87 to 1.78; p = 0.23), 1.57 (95% CI: 1.13 to 2.17; p < 0.05) and 2.03 (95% CI: 1.51 to 2.73; p < 0.05), respectively. For income groups, the ORs for unmet need (compared to >$150,000/year) were 0.94 (95% CI: 0.79 to 1.12) for $100,000-$150,000, 1.02 (95% CI: 0.87 to 1.20;) for $50,000-$100,000, 1.30 (95% CI: 1.09 to 1.55) for $20,000-$50,000, and 1.39 (95% CI: 1.08 to 1.78) for < $20,000. Other statistically significant determinants of unmet need included age (older adults were less likely to have unmet need), sex (females were more likely), having a family physician (less likely) and perceived physical and mental health (poor health more likely to be associated with unmet need). The most common reasons for unmet need were: ‘long wait time’ (52.1%) and ‘doctor did not think it was necessary’ (16.7%). Multimorbidity and low-income are associated with higher odds of unmet need among older adults. This disparity is partly due to not having a regular family physician and long wait time to see a doctor. Reducing these barriers are critical to reducing inequalities in health outcomes.