bluuebunny/crossref_metadata_2025 huggingface dataset:
4.A. Workshop: Developing a European planetary health curriculum model. Can we adapt Ireland's approach?
Authors:   Organised by: Royal College of Surgeons in Ireland,   Chair persons: Callum Swift (Ireland)
Published: October 2021

The climate crisis is reaching an irreversible tipping point. If the planet continues on its current trajectory of rising global temperatures and increasing ecological instability, then humans will be faced with catastrophic environmental and health effects. In acknowledgement of the interface between environmental change and human health, there is an increasing international mandate to integrate themes of sustainability, climate change and ecological instability into the health professional curriculum. As a result, planetary health is a growing field in health and medicine, but despite this, those working in the field are facing a number of challenges to its implementation that need to be overcome. The aim of this workshop is to explore examples of planetary health curricula development and to examine how best to implement such curricula for undergraduate health professionals across Europe. The workshop will open with a brief overview of the concept of planetary heath and the role of the health professional in responding to the climate crisis, summarising the current evidence in the field, before participating panellists each present the work they are undertaking in their own universities to develop planetary health curricula for undergraduate health professionals. Firstly they will briefly describe material covered in the curriculum before identifying any barriers and facilitators to implementation they have encountered. The panel discussion will then focus on the potential to develop shared undergraduate curricula in planetary health across European countries. To conclude there will be an opportunity for the audience to participate in Q and A. Participating panel members include Dr Sofia Hammarstrand, Occupational and Environmental Medicine, Sahlgrenska University Hospital and Gothenburg University, Sweden, Dr Debbi Stanistreet, RCSI University of Medicine and Health Sciences, Dr Heather Baid, The University of Brighton, and Dr Peter Blankestijn, The University Medical Centre Utrecht.

Speakers/Panelists

Deborah Stanistreet Royal College of Surgeons in Ireland, Dublin, Ireland Peter Blankestijn University Medical Centre Utrecht, Utrecht, Netherlands Heather Baid University of Brighton, Brighton, UK

Key messages

Participants will become familiar with examples of planetary health curricula for student health professionals. Participants will be able to identify challenges to implementing planetary health curricula and opportunities for an integrated approach across Europe.
Developing a planetary health curriculum for undergraduate medicine in Ireland
Authors: Hammarstrand Sofia
Published: October 2021

This presentation will describe the process and outcome of developing a planetary health curriculum for undergraduate medicine across the island of Ireland through cross-collaboration with all the island's Medical Schools. It will also present the final agreed curriculum content to participants before moving into the main workshop activities where participants will consider the potential to adapt this medical undergraduate curriculum in planetary health to other European countries and also to other health professions.
4.B. Workshop: Data collection during COVID-19 pandemic and its policy impacts
Authors:   Organised by: EUPHA-PMH,   Chair persons: Jutta Lindert (EUPHA-PMH), Marija Jakubauskiene (EUPHA-PMH)
Published: October 2021

The workshop has the aims to review practices for reliable and robust data collection during disaster such as the COVID-19 pandemic and to develop implementation practices. Study conduct is even more necessary in times of crises and at the same time more challenging. We review existing practices by bringing together three aspects of study conduct in times of crises: 1) experiences with sampling methods, 2) experiences with exposure assessment and 3) development of evidence based policy guidelines. First, experiences with different sampling approaches to collect longitudinal data on in a multicentre study during the COVID19 pandemic are presented (Felix Sisenop). Second, exposure assessment methods in different cultural traditions are presented and reflected (Edvaldo Begotaraj). Third, the challenge of rapid evidence based policy development will be reviewed (Marija Jakubauskiene). It will be shown, how data gathered in an international consortium can have impact on a national level through policy advisory. Ensuring the ability to provide robust and reliable data on psychosocial and mental health service responses to crises is an important step for emergency preparedness. The lessons learnt will be discussed with workshop participants.

Key messages

Rapid study conduct is necessary in times of crises. Methods of rapid study conduct need further development.
4.C. Round table: Recovering from the COVID-19 Pandemic: Identifying and Acting Upon Lessons Learned
Authors:   Organised by: ECDC,   Chair persons: Jonathan Suk (Sweden), Paul Riley (Sweden)
Published: October 2021

The COVID-19 pandemic has revealed many gaps and vulnerabilities in health systems and pandemic preparedness in European countries. It has also led to innovation and rapid improvements in certain elements of public health practice. One defining characteristic of the COVID-19 pandemic has been the rapid advance of scientific knowledge, accompanied by high degrees of scientific uncertainty. Each phase (or “wave”) of the pandemic has presented unique challenges. This workshop involves public health practitioners from multiple European countries. They will reflect upon some over-arching lessons learned through their experiences in the field, while also alluding to important innovations in public health that should be safeguarded for the future. The panellists will also discuss how lessons learned can be systematically identified and acted upon, through approaches such as after-action reviews (AARs), in order to optimise the public health response to the ongoing COVID-19 pandemic as well as to future ones. The panel discussion format of this workshop adds value to EUPHA 2021 participant through hearing, in a relatively informal format, the experiences from senior staff at national public health agencies from a variety of European countries and contexts. This approach keeps a coherence between speakers will also highlighting the unique challenges posed by specific national contexts. This workshop will also consider how processes such as AARs can be formalised to become routine aspects of public health practice. Particular attention will be paid to challenges and solutions that are similar across national boundaries. During the workshop, the moderator will ensure that the panelists responses are short and succinct. The final 15 minutes will be dedicated to questions from the audience.

Speakers/Panelists

Flavia Riccardo ISS, Rome, Italy Ute Rexroth RKI, Berlin, Germany Tanya Melillo Directorate of Health Promotion and Disease Prevention, MSIDA, Malta Mario Fafangel National Institute of Public Health, Ljubljana, Slovenia

Key messages

In order to guide the public health response to the COVID-19 pandemic as well as to future pandemics, it is essential to systematically identify lessons learned as well as innovative good practices. Identifying lessons learned, however, is only a first step as it is essential to develop action plans that are supported and endorsed across a wide range of stakeholders.
Prevalence and control status of T2DM in Bangladesh: finding from a nationally representative survey
Authors: Sutradhar I , Ikpeme M , Weldegiorgis M , Hasan M , Mridha MK , Sarker M , Gregg E
Published: October 2021

Background

With around 10 million diagnosed patients, Bangladesh remains at the forefront of the global type 2 diabetes mellitus (T2DM) epidemic. A comprehensive understanding of the current T2DM scenario is required to curb the disease burden. In this study, we aimed to identify the prevalence, associated factors, and control status of T2DM in Bangladesh.

Methods

This cross-sectional survey was conducted in 15 randomly selected community-based clusters in Bangladesh. Around 1,000 adults aged ≥18 years from each cluster were selected. Face-to-face interviews, anthropometric measurement, biospecimen collection, and point of care blood test were performed. Individuals with Fasting Blood Sugar (FBS) ≥126 mg/dl or previously diagnosed with T2DM by a qualified health provider were considered T2DM cases. Multivariate logistic regression analysis was performed to identify factors associated with T2DM.

Results

Data of 13,674 individuals were analysed for this study. The overall prevalence of T2DM was 10.0%, among whom 29.2% were undiagnosed. Among previously diagnosed patients, 64.9% had uncontrolled diabetes (FBS≥126 mg/dl). The prevalence of uncontrolled diabetes was higher among elderly, female, and urban participants. Patients with hypertension, high waist-hip ratio and high serum cholesterol had 2.20 times (95% CI: 2.17-2.23, p < 0.001), 3.53 times (95% CI: 3.47-3.59, p < 0.001) and 2.53 times (95% CI: 2.48-2.59, p < 0.001) higher odds of having T2DM, respectively.

Conclusions

One out of every ten adults in Bangladesh had T2DM, and a substantial proportion of them had undiagnosed and uncontrolled diabetes. This finding indicates the lack of preparedness of the country's health system to address the problem. Pertinent stakeholders should adopt a multi-sectoral approach to develop comprehensive policies and implement target-specific interventions, e.g., population-based screening program, primary care based T2DM service, and community mobilisation to combat the T2DM epidemic.

Key messages

As the T2DM burden is high in Bangladesh, policy makers should adopt a collaborative approach to develop and implement effective public health programs for prevention and control of T2DM. As the burden of uncontrolled T2DM is high in Bangladesh, the country’s health system should ensure early diagnosis and provision of quality care at affordable cost for T2DM patients.
Multimorbidity patterns and its associations with health literacy in chronic kidney disease patients
Authors: Gurgel do Amaral M , Reijneveld SA , Meems LMG , Almansa J , Navis GJ , de Winter AF
Published: October 2021

Background

Health literacy is the ability to deal with information related to one's health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases.

Methods

We included adult patients with CKD stages 1-5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, overall and by age and sex, using multinomial logistic regression and latent class analysis, respectively.

Results

Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25 to 2.33) for two comorbidities to 2.71 (2.00 to 3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16 to 2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, and slightly different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases.

Conclusions

This study showed that CKD patients have a high prevalence of comorbidities. Patients with low health literacy are more likely to have a higher number of comorbidities than patients with adequate health literacy. Moreover, the multimorbidity patterns are similar for both groups of health literacy, differing slightly at older ages. This age difference suggests that the negative effects of low health literacy develop when aging. Therefore, low health literacy could be an intervention target to decrease multimorbidity along the life course of CKD patients.

Key messages

Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy does not affect patterns of multimorbidity in younger patients, but it does slightly in older ones.
Climate Change influence in fungi
Authors: Viegas C
Published: October 2021

The International Panel on Climate Change (IPCC, 2013) and almost the entire scientific community agreed to consider the Mediterranean Area as one of the most vulnerable regions in the world to the impacts of global warming. In this scenario, heat waves, defined by the World Meteorological Organization as five or more consecutive days of heat reaching a daily maximum temperature at least 5 °C higher than the average maximum temperature, have been recently foreseen to be particularly frequent and intense in Portugal. As a consequence, agriculture constitutes one of the most sensitive sectors that could be affected by the climate change. Among the xenobiotics contaminating agricultural crops, mycotoxins (MY) are the most challenging since their presence represents an economic burden due to crops loss and a serious health effects related for animal and human with severe repercussions. Many fungal plant pathogens species from Aspergillus and Fusarium genera produce MY harmful to animal and human health. The contamination of cereals grains is commonly reported, and the climate change scenario can also influence significantly the contamination during postharvest phase having implications in food security and safety aspects. Additionally, it is foreseen that specific species increase due to climate change leading to higher use of azole-based fungicides. Azole-based fungicides are the most used antifungals to control fungi and MY production in crops. However, excessive and long-term use of azole fungicides in agriculture has led to the emergence of acquired azole resistance in some plant pathogenic fungi and also trigger in potential pathogenic fungi for humans and the toxigenic potential. Overall, climate changes can trigger crops contamination by toxigenic fungal species, increase human exposure to mycotoxins, promote the acquired azole resistance and, consequently, the occurence of life-threatening infections.
50 Global Actions to Manage the COVID-19 Infodemic: A WHO Framework
Authors: Mahajan A , Phuong L , Nguyen T , Czerniak C , Lamichhane J , Purnat T , Briand S
Published: October 2021

Issue

The World Health Organization describes an infodemic as an “overabundance of information - good or bad - that makes it difficult for people to make decisions for their health.”

Description of the problem

On April 7-8, 2020, the WHO Information Network for Epidemics (EPI-WIN) held a global online to crowdsource ideas from an interdisciplinary group of experts to form a novel COVID-19 infodemic response framework. The online consultation comprised of four plenary sessions and a brainstorming session conducted entirely online. Nearly 1500 individuals from over 100 countries and territories spanning social scientists, epidemiologists, staff from ministries of health and institutes of public health, registered for the consultation.

Results

A set of 50 proposed actions for a framework for managing infodemics in health emergencies was developed that will provide guidance for governments and public health institutions to take in five key areas of action that emerged from the consultation:

strengthening evidence and information simplifying and explaining what is known fact-checking and addressing misinformation amplifying messages and reaching the communities and individuals who need the information quantifying and analysing the infodemic, including information flows, monitoring the acceptance of public health interventions, and assessing factors affecting behaviour at individual and population levels strengthening systems for infodemic management in health emergencies

Lessons

Everyone has a role to play

Read the Call for Action Sign the Call for Action

https://www.who.int/news/item/11-12-2020-call-for-action-managing-the-infode

Key messages

The confusion due to Infodemic can lead people to ignore public health measures and take risks that can cause serious harm. Recognizing this WHO convened an interdisciplinary group of experts 7-8 April 2020 virtually to form a novel COVID-19 infodemic response framework.
A digital health intervention for young refugees: intervention development and initial dropout rates
Authors: Fischer L , Kölligan V , Klein M
Published: October 2021

Background

Digital health interventions (DHI) have the potential to increase access to health care for vulnerable and hard-to-reach populations. As such, many refugees are at high-risk for mental health issues as well as underserved by health care systems of receiving countries, such as Germany. Interventions, digital or not, have shown to be more feasible and accepted if adapted to the specific needs of the targeted group. While evidence for the feasibility of DHIs among refugees is spare, studies show high dropout rates in DHIs in the general population.

Methods

In a participatory and interdisciplinary approach, we developed a DHI for indicated addiction prevention, targeting young refugees from Syria, Iraq, Iran, and Afghanistan currently residing in Germany and with problematic use of alcohol and/or cannabis. This process consisted of a literature review, formative research, cultural adaptations of intervention elements, and ultimately the intervention's technical implementation following an iterative approach. The preliminary dropout rates immediately after download and during the baseline assessment were analysed using descriptive statistics.

Results

The DHI, in form of the BePrepared App, was successfully developed and launched in January 2021 for entering a single-armed feasibility study. Preliminary results show a dropout rate of 46,5% (n = 40) after download of the app and before entering the baseline assessment t0. Among the refugees reached and identified as such using the third item of t0, 73,3% (n = 11) completed t0 and started the intervention (compared to 83.3% (n = 25) of the users without a self-declared refugee status). The further intervention dropout is to be determined.

Conclusions

Adapting a DHI according to young refugees needs is to some extent possible. However, in accord with other DHI and regardless of the intervention content, dropout immediately after downloading the app (46.5%) and during the baseline assessment (58.1%) is high.

Key messages

Within a set of further urgently needed interventions, DHIs are a low-threshold service that can increase access for refugees to mental health and substance use services. Considering high and early dropout, further research on reducing dropout from app-based DHI for refugees and other specific target group is needed to increase the feasibility of digital interventions.
Combining digital trends and scientific literature: a case study on Social Determinants of COVID-19
Authors: Bettencourt-Silva J , Cullen C , Mulligan N , Di Bari A , Gleize M
Published: October 2021

Background

Digital sources such as Internet-based search tools have created prospects for augmenting traditional public health surveillance. These can support the identification of emerging public health concerns, intervention evaluation or policy making. Social Determinants of Health(SDoH) are key factors linked to health outcomes yet they are poorly recorded and seldom used. Scientific papers have reported SDoH impacts on various outcomes yet this data has not been explored for population trend analyses. We present an analysis of our approach to combining insights mined from PubMed with online search trends.

Methods

PubMed-2019 database was used to build a knowledge graph(KG) of connected health and social concepts based on relative co-occurrences found throughout the abstracts. We then observed Google search trends for 10 SDoH concepts at the outset of the 2020 pandemic (March-May) and compared them with the previous 4 years. For concepts with increasing trends, the KG was used to identify other potentially relevant concepts. Subsequently we continued observing online trends for a further 12 months in order to examine the KG concepts' trends.

Results

Our analysis showed Food Security and Unemployment trended the highest compared to previous years. These became the seed concepts used to traverse the KG, where the top 20 relevant concepts were identified for each seed. An analysis of the 8 concepts overlapping both seeds showed 6 with increasing trends during follow-up. Correlation coefficients were computed and positive relations observed (Unemployment+Anxiety, r=.72; Distress+Food Security, r =.62). Data will be discussed.

Conclusions

Positive correlations were observed between data from a 2019 PubMed KG and online search trends during COVID-19. These preliminary results suggest value in combining these digital sources to strengthen public health systems. This is important to understand the interactions between health and social factors and identify emerging trends.

Key messages

Combining data from scientific research papers with online search trends yielded interesting results that may further complement traditional surveillance systems and clinical case ascertainment. Social determinants of health data should play an increasingly important part in complementing public health surveillance systems and in strengthening population trend analyses.
Financing the COVID-19 response
Authors: Cylus J , Karanikolos M
Published: October 2021

The COVID-19 pandemic posed immediate and unprecedented financial challenges to health service providers and health systems more broadly. Providers were faced with additional expenditures, not only because many COVD-19 patients required intensive and costly medical care but also because they had to secure necessary supplies and equipment, such as personal protective equipment (PPE), testing supplies and ventilators; reshape facilities to implement new hygiene and safety measures and reorganise patient pathways; and pay health professionals for high-risk and overtime work. At the same time, providers faced sharp falls in revenues due to reduction in volume of non-COVID-19 services, both because people postponed seeking care as well as due to facilities temporarily postponing non-essential care in order treat COVD-19 patients or reorganise provision in a safe way. These increases in the financing needs of the public sector occurred in the context of pandemic-associated economic decline and sharply falling public revenues precipitated by the (sometimes multiple) national lockdowns and general anxiety about engaging in normal daily activities. This presentation will provide an overview of strategies that countries have used to raise extra funds for the health system, adjust payment and purchasing systems to meet changing needs, and ensure health coverage. A brief overview of key metrics to assess resilience in the area of financing will also be provided.
Effects of covid-19 on cognitive functioning
Authors: Kovacic V , Lavtar D
Published: October 2021

We were interested in whether the covid-19 pandemic affects cognitive functioning in addition to emotional responses. To this end, we applied four questions related to everyday activities that inevitably involve fluid cognitive abilities, e.g., problems concentrating, remembering, and switching between different mental activities. Respondents self-assessed their cognitive abilities during the covid-19 pandemic compared to the period before the pandemic on a 7-point scale (1 - much easier than before, .. 4 - the same as earlier, .. and 7 - much harder than before). The results showed that, on average, respondents estimated slightly more cognitive problems during the covid-19 pandemic period than before the pandemic (4.21, where 4 means that the respondent does not notice changes). Nearly three-quarters of the respondents(72%) did not report changes in cognitive abilities. In comparison, 7% reported improved cognitive abilities, and as many as 21% of respondents self-assessed that their cognitive abilities deteriorated during the covid-19 pandemic. There were no differences between men and women in terms of self-assessment of cognitive abilities. More significant problems with their cognitive abilities during covid-19 pandemic reported younger as compared to older respondents, students as compared to other employment groups, less educated as compared to more educated, those living alone as compared to those living in the family, those whose financial situation had deteriorated, and, as expected, those with chronic illnesses, and those who also reported depressive and mental health symptoms. The results of the survey indicate the interdependence between different demographic factors, mood and mental health problems, and self-assessed changes in cognition. Therefore, interventions to mitigate the covid-19 pandemic should include peoples' emotional response and their cognitive problems.
Seeking help by parents for care regarding the socio-emotional development of preschool children
Authors: Luo J , Raat H , Franse CB , Bannink R , Bai G , van Grieken A
Published: October 2021

Background

Timely parental help-seeking regarding their child's socio-emotional development is associated with a lower rate and lower severity of psychosocial problems in later life. This study aimed to examine factors associated with parental help-seeking for the socio-emotional development of 3-year-old children.

Methods

Data of parents and children (n = 1507) from a community sample was analyzed. Thirteen potentially related factors were assessed at baseline at child age 2 years, and classified according to Andersen's Behavioral Model: predisposing, enabling, and need factors. Parental help-seeking and 14 formal and informal care (e.g. General practitioner, internet) used in the past 12 months were measured at follow-up at child age 3 years. Logistic regression was applied.

Results

In total, 22.6% of parents reported help-seeking for socio-emotional development of their 3-year-old child; 6.8% addressed formal care and 17.5% addressed informal care. General practitioner (2.7%) and family (12.5%) were the most frequently used formal and informal care, respectively. Among predisposing factors associated with a higher odds of parental help-seeking were child's other western background (OR = 1.66, 95%CI: 1.02-2.68) and parental age = < 29 years old (OR = 1.71, 95%CI: 1.01-2.92). No associated factors were found among enabling factors. The need factors associated with a higher odds of parental help-seeking were having previous help-seeking (OR = 2.52, 95%CI: 1.83-3.48) and discussing child's socio-emotional development in the well-child visit (OR = 2.47, 95%CI: 1.73-3.53).

Conclusions

Predisposing and need factors were associated with parental help-seeking for socio-emotional development of 3-years-old child. The findings can be used to further develop support for parents accessing adequate information, prevention and anticipatory care with regard to the child's socio-emotional development.

Key messages

The study longitudinally investigated parental help-seeking for socio-emotional development of their 3-year old children in a large community sample. The study makes an important contribution to the existing literature on this topic because of its particularly young sample of 3-year-old children.
Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood
Authors: Schmengler H , Peeters M , Stevens GWJM , Kunst AE , Hartman CA , Oldehinkel AJ , Vollebergh WAM
Published: October 2021

Background

Social causation as well as health-related selection may contribute to educational gradients in adolescents' attention problems (AP) and externalizing behaviour (EB). From past studies it is unclear which of these mechanisms predominates, as AP and EB have the potential to disrupt adolescents' educational careers, but may also be affected by differences in their social environment. Furthermore, gradients in AP and EB may reflect ‘third variables' already present in childhood, such as parental socioeconomic status (SES) and IQ. We investigated social causation and health-related selection in the development of educational differences in EB and AP.

Methods

We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level, EB, and AP at ages around 14, 16, 19, 22, and 26 years. First, we evaluated the directionality in longitudinal associations between education, EB, and AP with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of parental SES and IQ in childhood both as confounders in longitudinal associations, and as predictors of AP, EB, and educational level around age 14.

Results

In fixed effects models, AP, but not EB, consistently predicted decreases in educational level throughout all of adolescence and young adulthood. Regarding social causation, differences in parental SES contributed to increases in EB amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent AP and EB.

Conclusions

We found health-related selection attributable to AP throughout all phases of adolescence and young adulthood. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, AP, and EB.

Key messages

AP have the potential to negatively impact adolescents’ educational careers and may trigger downward mobility in the educational system in all phases of adolescence and young adulthood. The results of this study call for actions to reduce the impact of AP on education. Further, it is essential to address the effects of insufficient economic resources on education and mental health.
Effectiveness and safety analysis of home-treatment models in child and adolescent psychiatric care
Authors: Wolf S , Grössmann N , Zechmeister-Koss I
Published: October 2021

Background

The Austrian child and adolescent psychiatric care landscape is characterised by substantial deficits on the intramural and extramural level. To overcome these supply shortfalls alternative outreach approaches, such as home-treatment (HT) can be introduced, which shall facilitate the reduction of hospitalisations. Thus, we aimed to systematically characterise international HT models considering their efficacy and safety in the area of child and adolescent psychiatry.

Methods

A systematic literature search in six databases, as well as an extended hand search, was conducted. Taking into account the predefined inclusion criteria, six HT studies were eligible for the qualitative synthesis; comprising two randomised controlled trials (RCTs), two non-randomised controlled trials (NRCTs) and two observational studies.

Results

The following four effectiveness measures were investigated: change in symptoms, hospitalisation, treatment satisfaction and need for further treatment. A benefit of HT models compared to stationary care could be identified considering patient symptoms, espeicially psychopathological symptoms; however, solely in the longer-term treatment. Studies have also shown that HT is associated with fewer days of hospitalisation, but with a higher need for further treatments. Inconclusive evidence was identified considering treatment satisfaction. Safety endpoints were not evaluated by any included study.

Conclusions

The results are limited by a moderate to high risk of bias due to several factors (e.g. small sample sizes, various assessment instruments). However, the evidence indicates that in long-term, HT can lead to an improvement in psychopathological symptoms and supports the transition from inpatient to outpatient care. Therefore, HT may be considered as an alternative or supplement to the stationary child and adolescent psychiatric care. However, further evidence is needed considering safety outcomes.

Key messages

In the long-term, home-treatment can lead to a bigger improvement in psychopathological symptoms for the children and adolescent compared to stationary care. Further evidence is needed especially regarding possible adverse events of home-treatment in the field of child and adolescent psychiatry.
5.A. Workshop: Transforming health and care systems - building a European Partnership under Horizon Europe
Authors:   Organised by: EUPHA-HSR,   Chair persons: Johan Hansen (EUPHA-HSR), Chiara de Waure (EUPHA-HTA)
Published: October 2021

Health and care systems have been facing increasing challenges. The COVID-19 pandemic has highlighted that improvements are urgently needed to reach high quality, efficient, accessible, health promoting, people-centred, resilient, health and care systems for all EU citizens. The workshop will be built around the preparations for a proposed EU Partnership on Transforming health and care systems as part of the new Horizon Europe Programme. In a first presentation, the Partnership will be clarified in more detail, including its main objectives to be achieved by 2030. The presentation will also share the outcomes of a consultation process among European stakeholders, among others involving decision makers and research funding bodies to identify common goals and priorities, which will feed into a Strategic Research and Innovation Agenda. Second, the work of the Expert Panel on effective ways of investing in Health (EXPH) will be presented, and in particular its Opinion on the Organisation of Resilient Health and Social Care Following the COVID-19 Pandemic. One of its main recommendations has been the need for investment in the development and implementation of health systems data collection methodologies to generate meaningful, actionable results for health system transformation. Similarly, it is important to establish corresponding learning communities within and across Member States to share lessons learned through this process. What does this mean for a future Partnership and what should be its priorities? As third presentation, the Partnership is evaluated from the context of the EU Presidency by Slovenia in the second half of 2021. What are the goals of the EU Presidency and how can a Partnership facilitate alignment with the overall EU political ambition to accelerate the transformation towards sustainable health and care systems? The last element also opens the floor to workshop participants. What health systems research pirorities are key to address from their perspectives and how would workshop audiences prefer to enhance synergies between EU and national level initiatives, including those from within the EPH conference community.

Key messages

An EU Partnership can help transform health and care systems to become more sustainable, efficient and resilient. Consultation of workshop participants is key to identify synergies at EU and national level and specific priority areas within such a Horizon Europe Partnership.
Value of integrated mandatory national surveillance data and literature reviews to inform public health policy in the child care sector
Authors: Buchholz U , Lehfeld A-S , Lindahl M , Otte im Kampe E , Lewandowsky M , Haas W
Published: October 2021

Background

Epidemiological properties of children have been a matter of debate during the entire duration of the SARS-CoV-2-pandemic. To inform public health policy two instruments were used that stemmed from mandatory national surveillance data as well as continuous, up-to-date literature screening. We report how these two instruments complemented each other in the first/second (before the advent of the VOC Alpha (B.1.1.7)) and the 3rd wave (dominated by VOC Alpha (B.1.1.7)) in Germany.

Methods

We monitored and analysed continuously data reported from local health departments via state health departments to the Robert Koch Institute. In addition, we reviewed peer-reviewed, pre-prints and grey literature on key epidemiological parameters in children, such as susceptibility, infectiousness and viral load.

Results

After the 1st wave in March-May 2020 the 2nd wave started in early autumn and lasted until the first weeks in 2021. The proportion of cases among 0-5 year old children stayed mostly below the corresponding population proportion, and was always lower than that of older age groups. Reported outbreaks in child care centres were small (median 4 cases). Primary cases were mainly adults. Among the cases reported from child care centre outbreaks the proportion of 0-5 year old children was only 35%. Information from the literature indicated lower susceptibility of children, lower viral load, but provided equivocal information about infectiousness. In the 3rd, B.1.1.7-dominated wave the number of outbreaks increased rapidly and exceeded the highest number in the 2nd wave. In addition, the proportion of 0-5 year old children involved in the outbreaks increased to 45%.

Conclusions

During the 1st and 2nd wave susceptibility and likely also infectiousness of 0-5 year old children was limited allowing broad opening of child care centres. In contrast, in the 3rd wave affectedness of children increased leading to recommendations to scale-up prevention efforts in child care centres.
SARS-CoV-2 infections in day care centres in Germany: social, structural, and hygiene determinants for infection among children and staff in the second and third wave of the pandemic
Authors: Neuberger F , Grgic M , Diefenbacher S , Spensberger F , Lehfeld A-S , Buchholz U , Kuger S
Published: October 2021

Background

During the SARS-CoV-2 pandemic, German early childhood education and care (ECEC) centres organized children's attendance variably (i.e., reduced opening hours, emergency support for few children only or full close-down). Further, protection and hygiene measures like fixed children/staff groups, ventilation and surface disinfection were introduced among ECEC centres. To inform or modify public health measures in ECEC, we investigate the occurrence of SARS-CoV-2 infections among children and staff of ECEC centres in light of social determinants (socioeconomic status of the children) and recommended structural and hygiene measures. We focus on the question if the relevant factors differ between the 2nd (when no variant of concern (VOC) circulated) and the 3rd wave (when VOC B.1.1.7 (Alpha) predominated).

Methods

Based on panel data from a weekly online survey of ECEC centre managers (start August 2020, ongoing) including approx. 8500 centres, we estimate the number of SARS-CoV-2 infections in children and staff using random-effect-within-between (REWB) panel models for count data in both waves.

Results

Centres with a high proportion of children with low socioeconomic status (SES) have a higher risk of infections in staff and children. Strict contact restrictions between groups like fixed group assignments among children and fixed staff assignments to groups prevent infections. Both effects tend to be stronger in the 3rd wave.

Conclusions

ECEC centres with a large proportion of children from a low SES background and lack of using fixed child/staff cohorts experience higher COVID-19 rates. Centres should be supported in maintaining recommended measures over the long run. Preventive measures such as vaccination of staff should be prioritised in centres with large proportions of low SES children.
The implementation of protective and hygienic measures in day care centres in Germany
Authors: Diefenbacher S , Grgic M , Spensberger F
Published: October 2021

Background

Since the beginning of the COVID-19 pandemic, day care centres in Germany needed to implement protective and hygiene measures (e.g., care of children in fixed groups). Our research questions are: To which extent can day care centres implement protective measures in daily practice? Which difficulties and needs regarding the implementation of these measures do they report?

Methods

We draw on data from a nationwide survey (October 2020-June 2021) of approximately 3,000 centre managers in Germany. Measures are clustered in four categories: reducing (1) contact opportunities, (2) airborne transmission (where social interaction cannot be avoided), (3) contact transmission, and (4) handling (the lack of) symptoms. To analyse implementation of protective measures in daily practice, we compute indices for different contact situations based on the persons involved: contact situations between (1) staff and parents), (2) staff and children of own group, (3) staff and children of other groups, and (4) the different groups of children.

Results

Day care centres increasingly implemented protective measures during the second wave. Yet, all four categories showed room for improvement, especially reduction of contact opportunities and handling (the lack of) symptoms. Our data suggests higher implementation of protective measures in contact situations among adults compared to contact situations between staff and children. Additionally, staff report high uncertainty regarding the attendance of children with mild symptoms (e.g., head cold), difficulties regarding the parental acceptance of the new organizational rules and a need of training.

Conclusions

Implementing protective measures between staff and children is seemingly difficult, likely due to pedagogical and developmental reasons. Staff's and parents' compliance with protective measures becomes all the more important within day care settings.
Design primes to change health behaviour - Using aesthetic features for health behaviour change
Authors: Rehn J , Schuster K
Published: October 2021

Health behaviour is a crucial aspect regarding overall health and well-being. However, the role of aesthetics and the built environment in relation to this is often neglected. Disciplines such as consumer psychology use aesthetic features of objects and environments such as colour, lighting and haptic structures to increase sales, customer loyalty and brand awareness in various contexts. In many cases these designs prime a certain mental concept to influence subsequent thoughts, feelings and behaviours. While there is a growing body of literature regarding the profound effect these design decisions can have from a consumer perspective, this knowledge is hardly used in the context of health promotion. In contrary, in settings such as schools, universities and hospitals, the built environment does prime specific mental concepts however often randomly and without designers being aware of it. In a series of experiments in (a) a university (n = 83) and (b) a clinical context (n = 36), participants were confronted with primes (positive vs. negative) in the shape of lecterns that were supposed to prime health related mental concepts such as sense of control and health-related behaviour. In the clinical context participants confronted with positive primes mentioned significantly more sport-related words in an association task. Furthermore, the primes seem to influence whether participants choose healthy vs. unhealthy rewards after the task. In the university setting, for some resiliency related items (e.g. motivation regarding planned behaviour) students answered significantly more positively standing at the lectern resembling the positive prime. Although, only mild effects could be found, these results indicate that objects and interiors might influence health behaviour by priming certain mental concepts. More research is needed especially on the role of duration, intensity and extent of the design intervention for using objects to prime health behaviour change.

Key messages

The design of the built environment can be seen as a prime that might influence health behaviour change. In the context of public health, evidence-based and research driven design can be an effective tool for health behaviour interventions.
The Role of Community Health Workers in the COVID-19 Response in the Caribbean, an exploratory study
Authors: Rise N
Published: October 2021

Background

Pandemics begin and end in communities and to manage them, community engagement must be a priority. The use of community health workers (CHWs) during the COVID-19 response is key to engaging communities and strengthening their capacity to limit the spread of disease. Integration of CHWs into health systems is a key enabler and integral to their success and requires inclusion of CHWs into health policies. This thesis aims at exploring the role of CHW in the COVID-19 response in the Caribbean countries to identify practices which can potentially form basis for subregional policy and contribute to capacity building within human resources for health and health system strengthening in the subregion.

Methods

An exploratory study using a mixed-methods approach of reviewing policies and grey literature detailing COVID-19 community health initiatives, and key-informant interviews (KIIs) in the Caribbean.

Results

Preliminary results from the policy review finds that CHWs have been widely used in infection prevention and control, as well as for providing psycho-social support to vulnerable populations and supporting the delivery of basic health services. However, few formal policies on the work of CHWs are available. KIIs are yet to be conducted and may yet contribute new knowledge.

Conclusions

While CHWs have been widely used during the COVID-19 response in the Caribbean, the apparent lack of formal policies may be a barrier to their success. Developing such policy will not only strengthen community health interventions against COVID-19, but also support Caribbean countries in how to strengthen their post-COVID-19 health workforces and improve sanitary emergency response preparedness. The findings of this exploratory study can contribute to developing health policy guidelines on CHWs in the Caribbean.

Key messages

Community health workers are key for engaging and supporting communities and vulnerable populations during the COVID-19 pandemic. Lessons learned on community health workers during the COVID-19 pandemic should be integrated into health policies to strengthen the health workforce and improve sanitary emergency preparedness.