bluuebunny/crossref_metadata_2025 huggingface dataset:
Unintended perinatal health consequences of a Swedish family policy: A population-based study
Authors: Juárez S , Debiasi E , Honkaniemi H , Aradhya S , Hjern A , Duvander A-Z
Published: October 2023

Background

Family policies can influence parents’ fertility behaviors, with consequences for perinatal health. The 1980 and 1986 Swedish speed premium policies aimed to protect parents’ income-based parental leave benefits within birth intervals shorter than 24 and 30 months, respectively, but additionally encouraged shorter birth spacing and childbearing at older ages - both risk factors for several perinatal health outcomes. This study evaluates the association of the 1980 and 1986 speed premium policies with perinatal health outcomes.

Methods

We used information on all singleton births in Sweden from 1974 to 1991 (n = 1,762,784) to calculate rates of preterm birth, low birthweight (LBW), small for gestational age (SGA) at preterm and stillbirth, by month and year of birth. Changes in outcomes at reform periods were evaluated with interrupted time series analyses.

Results

The 1980 speed premium policy was linked to a monthly rate increase in preterm births relative to the pre-reform period (0.013 [95% CI 0.0061-0.0200] percentage points), equivalent to a 24% increase from 1980 to 1986. After the 1986 relaxation of the policy, the trend in monthly rates reversed (-0.025 [95% CI -0.033--0.018] percentage points). LBW displayed a similar pattern over both reform periods, which was attenuated when considering LBW at term. Rates of SGA at preterm and stillbirths did not change following either reform. Further analyses suggested that changes in perinatal health were restricted to births among native- and Nordic-born mothers, i.e., the primary groups to adjust their fertility behaviors to the reforms.

Conclusions

Despite its economic advantages for couples, especially mothers, the introduction of the speed premium policy had adverse perinatal health consequences particularly for preterm births. Family policies should be carefully designed with a ‘Health in All Policies’ lens to avoid possible unintended adverse repercussions for perinatal health.

Key messages

• Family policies can have unintended, adverse perinatal health effects if their eligibility requirements encourage individuals to make fertility decisions that are associated with health risks.

• Policymakers should adopt a ‘Health in All Policies’ approach for developing and evaluating family policies to avoid unintended public health harms.
Hypertensive disorders of pregnancy and long-term risk of maternal stroke - a systematic review
Authors: Brohan M , Daly F P , Kelly L , McCarthy F P , Khashan A S , Kublickiene K , Barrett P M
Published: October 2023

Hypertensive disorders of pregnancy (HDP) are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether HDP are associated with an increased risk for ischaemic stroke (IS) or haemorrhagic stroke (HS) in later life. This systematic review aimed to synthesize the available literature on the association between HDP and the long-term risk for maternal stroke. PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022. Studies included were case-control or cohort studies, conducted with human participants, available in English, measuring the exposure of a history of HDP (preeclampsia (PE), gestational hypertension (GH), chronic hypertension (CH), or superimposed preeclampsia) and the outcome of maternal IS or HS. Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale. The primary outcome was any undifferentiated stroke (AS) and secondary outcomes included IS and HS. The protocol for this systematic review was registered on PROSPERO (CRD42021254660). 24 studies were included (10,632,808 study participants). HDP were significantly associated with AS (aRR, 1.74; 95% CI, 1.45-2.10). PE was significantly associated with AS (aRR, 1.75; 95% CI, 1.56-1.97), IS (aRR, 1.74; 95% CI, 1.46-2.06), and HS (aRR, 2.77; 95% CI, 2.04-3.75). GH was significantly associated with AS (aRR, 1.23; 95% CI, 1.20-1.26), IS (aRR, 1.35; 95% CI, 1.19-1.53), and HS (aRR, 2.66; 95% CI, 1.02-6.98). CH was associated with IS (aRR, 1.49; 95% CI, 1.01-2.19). In conclusion, exposure to HDP, including PE and GH, seems to be associated with an increased risk for AS and IS among parous patients in later life. Preventive interventions may be warranted for patients who experience HDP to reduce their long-term risk for stroke.

Key messages

• Hypertensive disorders of pregnancy appear to be associated with an increased risk of maternal stroke in later life.

• The strength of association between exposures and outcomes varies by hypertensive disorder of pregnancy subtype and stroke subtype.
The Solution-focused Intervention for Mental health to promote adolescent mental well-being
Authors: Söderqvist F , Norling U
Published: October 2023

With its compensatory mandate, the school is essential for health-promoting interventions. There are evaluated programs available that prevent mental problems, mental illnesses and various risk behaviours. However, there is a dearth of evaluated interventions designed to promote mental well-being in adolescents, which are adapted for upper secondary school. It was against this background that the development and evaluation of the Solution-focused Intervention for Mental health (SIM) began in 2018. This presentation will briefly overview the intervention, its components, design and results from feasibility studies. As an intervention programme, SIM consists of group-based coaching that starts from the core components and indicators of mental well-being and enjoying school. Thus, the intervention is based on a normative model of mental well-being; however, the dialogue conducted during the nine two-hour weekly group sessions is based on the solution-focused approach and its techniques. Specially trained teachers facilitating the content and process during group sessions lead SIM. The SIM programme is manual-based and designed to help students discover, explore, practice and develop existing personal resources in order to strengthen hedonic and eudemonic well-being. The teacher uses solution-focused coaching techniques to encourage the students to practise and discover how to utilise their existing resources. By focusing on what works small steps can be taken towards a desired future using indicators of well-being and solution-focused techniques. SIM has so far been tested in feasibility studies in 2019 (n∼140), 2021 (n∼200) and 2023 (n∼50). Results from focus group interviews, session scales ratings and pairwise testing of changes in well-being after compared to before interventions show promising results with increased well-being and total effect sizes ranging from Coheńs d of 0.19 to 0.59. SIM is now ready to be properly evaluated in a randomised controlled trial.
Anti-discriminatory language in public health research and practice in Germany
Authors: Kajikhina K , Sarma N , Koschollek C
Published: October 2023

Anti-discriminatory language has long been an important topic in the education and media sector, and has also been discussed in international public health research since the 1980s. However, the topic has so far had little presence in public health in Germany. Therefore, a guideline on discrimination-sensitive language around migration and health was developed at the Robert Koch Institute within the Improving Health Monitoring in Migrant Populations project. The 5 basic principles together with an overview of relevant terms and concepts are an orientation for responsible communication in public health research and invites people to critically examine and reflect on their own use of language. Expertise from the education and media sector, as well as from our anti-racist network played a crucial role the creation of the guideline. We will present and discuss the guideline with the international public health community to continue the learning process initiated during the creation process.
Which policies have been implemented to achieve healthy diets from sustainable food systems at the local level across East and West Africa? Results from a policy mapping across 8 African countries
Authors: Burgaz C , Van Dam I , Vandevijvere S
Published: October 2023

Introduction

Policymakers make decisions that shape food systems (from production, to consumption, to waste). According to the United Nations a quarter of the global population by 2050 will be African, agriculture is the source of livelihood for 70% of the African population, and the continent faces multiple forms of malnutrition simultaneously. After having compiled an evidence-based list of 44 good practice policies with double- and triple-duty potential to address food systems, based on a scoping review and workshops with international experts, we aimed to identify the implementation level of those good practice policies at national and local levels across 8 African countries.

Methods

In October 2022, a detailed policy mapping started at national and local levels across two African regions, in 8 countries (Benin, Burkina Faso, Ivory Coast, Kenya, Senegal, Tanzania, Togo and Uganda). Evidence of policy development and/or implementation was gathered across those 44 good practice policies, including, among others, information on jurisdiction, responsible government departments and agencies, overarching strategies, regulatory objectives of the policies, and whether policies address nutrition inequalities and/or women's empowerment. The results from the mapping will be analysed using Excel and NVivo12 software program.

Results

The final results will be available by June 2023. Our results will provide information on the role and potential of local governments to address food systems across African countries. In particular, the results will offer insight on the policy stakeholders involved, on ongoing national, regional or local plans and priorities, and on best examples of local public policies that have positively impacted human or planetary health across different domains of the food system.

Conclusions

The results from the mapping could inform similar studies across European countries, or inspiration for actions by local policymakers across Europe.
Daily temperature variability in cities and mental health-related hospitalizations
Authors: Cohen Shimonovich G , Rowland S T , Benavides J , Lindert J , Kioumourtzoglou M A , Parks R M
Published: October 2023

Despite plausible behavioral and physiological pathways, limited evidence exists on how temperature variability is associated with acute mental health-related episodes. This analysis explored associations between daily temperature range (DTR) and mental health-related hospitalizations in New York State during 1995-2014. A case-crossover design with distributed lag non-linear DTR terms (0-6 days) estimated associations between ZIP Code-level DTR and hospitalizations for mood, anxiety, adjustment, and schizophrenia disorders, adjusting for daily mean temperature, and how associations varied by age, sex, admission type and season. For all outcomes, across most DTR distribution, divergence from the study period daily mean (7.7 °C) yielded a positive association to a threshold (5.2 °C, 25th percentile; 12.2 °C, 90th percentile), beyond which negative associations were observed. For mood disorders, an increase in DTR from 7.7 °C to 12.2 °C was associated with a cumulative 4.8% (95%CI, 4.0%−5.6%) increase in daily hospitalization rates. This increase was highest during transition seasons (6.0%, 4.5%−7.4%) compared with summer (1.8%, 0.6%−3.0%) and winter (-0.6%, -0.7%−1.9%). Evidence for effect-modification by age group and admission type was inconsistent across outcomes, without evidence for effect modification by sex. This study highlights potential impacts of increased temperature variability in a changing climate on mental health-related outcomes.
Focus on self-presentation on social media is associated with perfectionism and eating disturbance
Authors: Danielsen H E , Finserås T R , Andersen AIO , Hjetland G , Woodfin V I , Skogen J C
Published: October 2023

Background

Social media use, perfectionism and eating disturbance has all increased over the last decades. Some studies indicate that there is a relationship between focus on self-presentation and social media, as well as how other present themselves on social media and eating disturbances. Nevertheless, no previous studies have investigated the link between focus on self-presentation and upward social comparison on social media, perfectionism and eating disturbances, which is the aim of the present study.

Methods

The present study is based on a cross-sectional survey from the “LifeOnSoMe”-study (N = 3725), conducted in 2020 and 2021. Respondents were high school students (mean age 17.3 years, 55% females) in Bergen, Norway. Multiple regression analysis was performed where SPAUSCIS, a measure of self-presentation and upward social comparison was the independent variable. Perfectionism and eating disturbance were dependent variables. Self-reported age, gender and subjective socioeconomic status were used as covariates, as well as frequency and duration of social media use. Regression models were performed to compare proportions across the median split of SPAUSCIS.

Results

The multiple regression analysis showed that increased focus on self-presentation and upward social comparison on social media were positively associated with both perfectionism (standard coefficient 0.28) and eating disturbances. A stronger association for girls than boys was found for eating disturbance (standard coefficient 0.39 for girls and 0.29 for boys). There was no gender moderation for perfectionism.

Conclusions

Findings suggests that focus on self-presentation and upward social comparison on social media is associated with perfectionism and eating disturbance. As such, promoting a healthy use of social media could be established through a focus on increasing adolescents’ ability to reflect on and think critically about self-presentation and upward social comparison on social media.

Key messages

• Focus on self-presentation and upward social comparison on social media is associated with perfectionism and eating disturbance among adolescents.

• Promoting healthy use of social media could be established through a focus on increasing adolescents’ ability to reflect critically on self-presentation and upward social comparison on social media.
Measuring Digital Health Literacy in Europe – Scope, determinants and consequences
Authors: Levin-Zamir D , Van den Broucke S , Schaeffer D
Published: October 2023

Background

Increasing access to health-related digital information/resources of varied quality warrants sufficient Digital Health Literacy (DHL) in the population. Public health researchers, practitioners, and policy makers need to consider DHL for improving people's ability to use digital resources. The M-POHL HLS19 study objectives were to construct and validate a DHL measure, and identify its determinants and consequences.

Methods

A scale was constructed with 8 items on dealing with digital health resources. Two additional items examined interactive use of resources. The scale was applied among a sample of 29,060 respondents in 13 countries using CAPI, CATI, CAWI, PAPI and mixed methods. A standardized score was calculated for DHL, range: 0-100.

Results

Appraising the reliability of digital resources was perceived particularly difficult. The scale showed acceptable reliability (Cronbach's α 0.7-0.87/country). A confirmatory factor model loading onto a single latent variable indicated an acceptable fit for all countries. The DHL scale was sufficiently unidimensional based on principal component analysis of Rasch model residuals combined with dependent t-tests. Linear regression models with 5 DHL predictors showed a social gradient with explained variance of 6% (2-23%/country). The highest predictor was financial deprivation: ß=−0.15 (0.08--0.27), then age: ß=−0.13 (0.15--0.26); self-assessed social status: ß=0.08 (0.05-0.13). General health literacy was a strong predictor: ß=0.51 (0.43-0.67). In linear regressions to explain variance in self-assessed health, the DHL coefficient was significantly different from zero in 9 countries (ß=−0.05-0.10).

Conclusions

The new DHL scale had acceptable psychometric properties. The relevance of DHL is reflected in the high proportions with lower DHL, a social gradient, and health consequences in most countries. The study offers an evidence base for tailoring DHL intervention strategies and organizational health literacy policy.

Key messages

• Digital Health Literacy of populations in Europe was estimated through a validated measure with associations that predict public health and healthcare consequences in most countries.

• Public health practitioners and policy makers should be aware of populations with lower Digital Health Literacy (DHL), and both promote DHL while also adjusting interventions/services to DHL needs.
Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care
Authors: Hengel P , Haltaufderheide M , Blümel M , Achstetter K , Busse R
Published: October 2023

Background

HSPA is a tool to monitor, evaluate, and improve health systems based on their achievements within different dimensions, e.g., access to care, quality, and population health. Next to the overall system, HSPA also allows to analyze its performance for specific groups across dimensions. In a pilot for a German HSPA, a conceptual framework was developed, and indicators for every dimension were selected and analyzed. This presentation illustrates the results of the German HSPA pilot using the example of access to and quality of care for ischemic stroke.

Methods

Selected indicators include stroke unit (SU) density, availability of a SU within 30 minutes by car, share of inpatient cases treated in a hospital with a SU, and inpatient mortality from 2014 to 2020, respectively. Indicators were analyzed based on nation-wide hospital discharge data. Travel time was computed and provided by the Federal Institute for Research on Building, Urban Affairs and Spatial Development.

Results

About 475 SU were identified in hospital data (2014: 463), compared to 350 certified SU in Germany. In 75% of Germany's 11,000 municipalities, 100% of the population could reach a SU within 30 minutes by car. Number of inpatient ischemic stroke cases was about 250,000 per year. Of the 215,000 cases without transfer from another hospital, 93% were treated in a hospital with a SU in 2020 (2014: 88%). Inpatient mortality was about 6,4% for all ischemic stroke cases and 6,1% for cases without transfer, varying only slightly over time. SU treatment showed large, and inpatient mortality minor regional variation.

Conclusions

Access to and quality of inpatient stroke care seems comparatively good in Germany, as SU density is high and mortality low in the European context. However, regional variation should be further tackled. The example shows how HSPA can be used to assess different strands of care by connecting health system dimensions, to produce actionable evidence for policy.

Key messages

• Health system performance assessment (HSPA) is a tool for the evaluation and improvement of the overall system but also of the care for specific groups or diseases across health system dimensions.

• The results of the German HSPA pilot show a good access and quality for the case of inpatient stroke care. Regional variations might be further reduced via improvements in hospital planning.
Implementability of multicomponent interventions in Primary Care: an overview of systematic reviews
Authors: Renzi E , Covelli A , Abbatecola G , Innocenzio M , Parrinello E , Baccolini V , De Vito C , Marzuillo C , Villari P , Massimi A
Published: October 2023

Background

Literature defines “implementability” as the likelihood that a given evidence-based intervention (EBI) will be adopted into routine practice. As time goes by, EBIs delivered in Primary Health Care (PHC) increasingly consist of multicomponent interventions aimed at promoting active ageing in the elderly. The aim of this review is to identify a conceptual framework that uses implementation outcomes (acceptability, fidelity, feasibility, implementation cost, appropriateness, and sustainability) to guide the implementability of multicomponent PHC interventions in the elderly population.

Methods

An overview of systematic reviews was conducted through PubMed, CINAHL, Scopus, Web of Science, PsycInfo, Conchrane Library including articles based on the following criteria: (1) individuals ≥65 years; (2) including multicomponent PHC interventions (3) including a framework to assess implementability. Methodological quality of systematic reviews was evaluated using the AMSTAR 2.

Results

Of the 14,984 articles identified, twenty-six reviews met the inclusion criteria. The characteristics of the identified conceptual frameworks included multicomponent PHC interventions based on the use of technology (n = 16) and aimed at preserving cognitive function (n = 12); The most considered implementation outcomes were: feasibility (n = 21) and implementation costs (n = 17). The RE-AIM and PRISM integrated framework were identified in five systematic reviews used to implement preventive interventions (cognitive function and physical activity) for community-dwelling older adults.

Conclusions

RE-AIM and PRISM are a widely used model for assessing the impact of EBIs on public health and policy. The use of this framework occurs after EBI realization, so the next steps of our research will aim to test this framework on an elderly-focused health intervention delivered in Italy through the Next Generation EU fund and to develop a revised version for use in multicomponent PHC interventions.

Key messages

• Identifying a framework to help guide the implementation of multicomponent PHC interventions facilitates the application of evidence-based intervention in routine practice.

• RE-AIM and PRISM are a widely used framework that may help evaluate implementation outcomes.
Scoping review of transport workforce exposure to COVID-19 and other respiratory pandemic diseases
Authors: Qureshi M , Seale H , Chughtai A , Jegasothy E , Quinlan M , Harris P
Published: October 2023

Background

Transport workers may be at heightened occupational risk during pandemics. However, there is a lack of research that specifically focuses on understanding the factors contributing to this risk and the strategies that can reduce their risk. This study aimed to understand the current state of research regarding the transmission of respiratory pandemic diseases for transport workers and to identify any existing evidence-based recommendations that can help mitigate the risks associated with these diseases in the transport industry.

Methods

A scoping review was undertaken which adhered to the PRISMA guidelines, and a comprehensive search was conducted in English-language databases for peer-reviewed research articles. Our search across multidisciplinary databases returned a total of 12540 sources, with 39 articles included in the final review. The results were summarized, coded, and thematically categorized.

Results

Most studies employed quantitative methodologies (24/39) and reported high percentage of male participants. Spatial distribution analysis demonstrated that the coverage of the literature was uneven across different continents. Findings revealed that transport workers faced a heightened risk of exposure due to crowded work settings, job demands, and inadequate use of personal protective equipment. Systemic and structural inequalities were identified among transport workers.

Conclusions

This study provides insights for policy and practice interventions that address the unique needs and challenges faced by workers in the industry, including how to promote social equity and justice during pandemics. There is a need for more qualitative and mixed-methods research approaches to obtain a more comprehensive understanding of the topic. Given the global nature of risks for respiratory infections and the global transport sector (which is a significant transmission point for societies), more research is required in non-traditional contexts outside US, Canada, EU, and UK.

Key messages

• During respiratory pandemic diseases transport workers face heightened risk of infection, inadequate resources, and systemic inequalities. Need for focus on certain regions, and policy interventions.

• Respiratory pandemic diseases impact on transport industry & workers reviewed, revealing geographic disparities in focus of literature, & socio-economic challenges. Policy interventions needed.
Violence against children and substance abuse: A pooled study of 8 low- and middle-income countries
Authors: Puno A , Kim R
Published: October 2023

Introduction

Violence against children (VAC) has been linked to substance abuse later in life. However, most evidence of this association comes from high-income countries (HICs) and is understudied in the context of low- and middle-income countries (LMICs).

Methods

This study used the latest Violence Against Children Surveys (VACS) data from 2017-2019 across eight LMICs. The main exposure variable was defined as having experienced at least one type of violence (physical, sexual, or emotional) from any perpetrator before age 18. With the pooled dataset of 32,326 adolescents aged 13-24 years, a series of logistic regressions with country-fixed effects were estimated to examine the association between VAC and three substance abuse outcomes: smoking daily, binge drinking (i.e., more than four drinks a week) and use of illegal drugs in the last 30 days. Further, analyses based on the types of violence and whether the association differs by sex were performed.

Results

After adjusting for all covariates, any VAC experience was significantly associated with all three substance abuse outcomes: daily smoking (OR: 1.5, 95% CI 1.2,1.8), binge drinking (OR: 1.8, 95% CI 1.5, 2.2), and drug use (OR:1.9, 95% CI 1.5-2.3). Sexual violence, in particular, had the strongest association. Sex-stratified analyses revealed that women who experienced sexual violence in childhood were more likely (OR range 3.3-3.7) to engage in substance abuse than sexually abused men (OR range 1.2-2.1).

Conclusions

The findings highlight the need for interventions to prevent childhood violence and to address its consequences on substance abuse in LMICs.

Key messages

• Experience of any type of violence during childhood is significantly associated with daily smoking, binge drinking of alcohol, and drug use in later life.

• Women who experience sexual violence in childhood are more likely to abuse substances than men who were sexually abused.
Effectiveness of community care for patients with severe mental disorders in Italy
Authors: Monzio Compagnoni M , Corrao G , Saponaro A , Carle F , Scondotto S , Barbato A , D’Avanzo B , Gaddini A , Di Fiandra T , Lora A
Published: October 2023

Background

The quality of care provided to patients with severe mental disorders (SMD) often does not correspond to the standards set by the recommendations. In addition to monitoring the coverage rate achieved by services, the evaluation of the effectiveness of interventions provided by mental health services for the treatment of SMD, in preventing an exacerbation of psychiatric symptoms, becomes of relevant importance.

Methods

Data were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly referred cases of depression, schizophrenia, bipolar and personality disorder were included. A variant of the self-controlled case series method was adopted to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contact with outpatient services, psychosocial intervention, psychotherapy) and relapse (emergency hospital admissions for mental illness).

Results

11,500 relapses occurred. Relapse risk was reduced during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI: 0.49-0.91) and bipolar disorder (0.64; 0.29-0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68-0.99) and bipolar disorder (0.55; 0.36-0.84), (iii) pharmacotherapy for patients with schizophrenia (0.58; 0.49-0.69) and bipolar disorder (0.59; 0.44-0.78). Coverage with generic care, in absence of psychosocial/psychotherapeutic interventions, did not affect relapse risk.

Conclusions

Psychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study showed that real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.

Key messages

• Real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.

• To evaluate the effectiveness of interventions provided by mental health services in preventing an exacerbation of psychiatric symptoms becomes important in the transition to community mental health.
The burden of dietary risk factors in the Nordic and Baltic countries
Authors: Knudsen A , Clarsen B , Blomhoff R , Baravelli C
Published: October 2023

Background

The Nordic Nutrition Recommendations (NNR) gives the scientific basis for national dietary guidelines for the Nordic and Baltic countries. The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) provides comparative estimates of the disease burden related to suboptimal diet in 195 countries. The aim of the study was to employ data from GBD 2021 to improve the knowledge base for NNR.

Methods

A comparative risk assessment approach was used to estimate the proportion of disease-specific burden that could be attributed to fifteen dietary risk factors in the population aged 25 and older in the Nordic and Baltic countries. The analyses included four steps: (1) estimating dietary intake on a population level; (2) determining the relative risks of dietary factors on disease endpoints; (3) determining the level of exposure with minimum risk; and (4) estimating the final disease burden, defined as disability-adjusted life-years (DALYs), attributed to each dietary risk.

Results

A suboptimal intake was found for all dietary risk factors in all countries. A total of 60 350 deaths and 1 079 087 DALYs were attributed to dietary factors. The highest age standardised mortality rates attributed to diet were found in Lithuania (371 per 100 000), and lowest in Norway (101 per 100 000). Low intake of whole grains was the largest dietary risk factor for mortality and DALYs in all countries except Estonia. Other highly-ranked factors in all countries included a diet high in processed meat and low in fruit. The results are preliminary, with final GBD 2021 estimates expected to be published medio 2023.

Conclusions

GBD offers a powerful resource to model trends in diet-related burden of diseases in the Nordic and Baltic countries. Estimates from GBD can provide countries with insight into the potential of reducing disease burden by targeting specific dietary risks.

Key messages

• Suboptimal diet leads to a substantial and avoidable mortality and disease burden in the Nordic and Baltic countries.

• Detailed and comparative estimates from GBD can help countries identify their most important dietary risk factors.
6.C. Workshop: Monitoring progress towards the SDGs: are we leaving someone behind?
Authors:   Organised by: WHO/ Europe, EMCDDA, EUPHA-PHPP, EUPHA-IDC,   Chair persons: Lara Tavoschi (Italy), Sofia Ribeiro (EUPHA-PHPP)
Published: October 2023

People in vulnerable situations such as people in contact with the justice system and people living in prison (PLP) are characterized by exclusionary processes such as stigma and discrimination; restrictions on basic freedoms or rights (e.g., voting, privacy, and liberty); or barriers to accessing public services (e.g., health care). Exposure to incarceration is associated with higher rates of ill health and premature death compared with unaffected peers, even after accounting for the socioeconomic position. Evidence suggests that experience of detention frequently co-occur with other well-known vulnerabilities, such as social marginalisation and substance use disorders, although the extent of this overlap varies by context. These experiences and their co-occurrence might influence health through multiple and complex pathways. For instance, their harmful effects might combine or even synergise. An accurate understanding of the burden of ill health in people living in prison is essential to inform the development and implementation of services and policies that meet their needs and tackle inequities in health. Unfortunately, the information richness resulting from the data science revolution is not equally distributed within and across human populations. Vulnerable populations, including PLP, remain both under-studied and under-consulted on the use of data derived from their communities. Strategies to improve the use and integration of data designed for the general population may not be accessible to or as effective in disadvantaged groups and may lead to an exacerbation of health inequities. In the analysis of social science and health data, the global consequences of social exclusion are costly, including exacerbating poverty and reducing human capital. It also hampers the design of culturally coherent solutions which could be more easily adopted in specific communities. This is not only relevant at local/national level, but it has implications at regional and global level. Inclusion of health data on PLP into routine public health monitoring processes is scarce due to poor data availability, parallel and often unlinked data collection tools, as well as organizational and political reasons. Efforts have been made in Europe through dedicated monitoring initiatives led by EMCDDA and WHO, however large scope for improvement and scale-up do exist. This workshop aims at exploring the current landscape and deriving implications of prison health monitoring in Europe and beyond.

Key messages

• Despite efforts, availability of comparable and comprehensive information on prison health in Europe is scarce/suboptimal.

• Integration of prison health into current and future developments in public health monitoring is essential to achieve equity in health.
Gaps in monitoring global progress toward universal health coverage among disadvantaged populations: the case of people living in prison
Authors: Winkelman TNA , Kinner S
Published: October 2023

The United Nations’ Sustainable Development Goals (SDGs) represent a sweeping initiative to create a sustainable and equitable global future. SDG 3 focuses on the health and wellbeing of the world. Expanding universal health coverage is a central component of SDG 3 and has been a focus area of the World Health Organization (WHO), which aims to expand universal health coverage to an additional 1 billion people by this year (2023). The WHO developed an index (indicator 3.8.1) intended to monitor coverage of essential health services across the globe. However, this indicator fails to incorporate health coverage for people in prisons. People incarcerated in prisons across the globe have high rates of physical health, mental health, and substance use conditions compared with the general population, and they are frequently excluded from policies and services available in the general population. For example, in some countries, like Australia and the United States, people in prison are legislatively excluded from the public health insurance programs available to the general population. Exclusion of prison health coverage from the WHO's universal health coverage indicator likely results in overestimation of health coverage in most countries and fails to identify gaps in care during and after periods of incarceration. We believe prison health coverage should be incorporated into the WHO's 3.8.1 indicator, which would more accurately capture a country's health coverage among its most disadvantaged populations. Monitoring of prison health coverage will require improved measurement of quality and service availability in prisons, which is sorely lacking in most countries.
Monitoring health status of people living in prison in Europe: insights from HIPED
Authors: Alves da Costa F
Published: October 2023

Aiming to improve the information available about the health status of people living in prisons in the WHO European region, a survey was sent to Member States (MS) in the Region whose Ministry of Health nominated a focal point. The survey used was derived from the operationalization of the WHO Prison Health Framework which contains 8 domains that characterize the population, the health system, the healthcare services available and the health outcomes at the individual level, in addition to influencing factors and cross-cutting principles. Data from 613 497 people living in prison establishments in 2020 was obtained from 36 MS and suggested the most common way of delivery of prison health care to be shared between the Ministry of Health and the Ministry of Justice. Many MS (⅔) experienced difficulties reporting individual data that would allow the quality of primary care to be characterized. Only 4-10 MS (11.1-27.8%) could provide data on health behaviours and 14- 28 figures on the number of individuals with diagnoses on record (except for oral health status; only 4). The most prevalent condition was mental health disorders (32.8%) and 2.6% of individuals were reported to be living with HIV; in both cases suggesting severe underreporting. Weak links with community care were obvious (e.g. 47.2% of MS had a support service to register people with community health services upon release; and 11.1% did not provide any medication upon release), and possibly aggravated by poor health information systems, where most countries still keep paper-based records and among those with electronic records, most did not have interoperable systems. Even death data was poorly linked with national surveillance systems and only 18 MS had a formal data transfer system in place. Investments are needed so that prison health may be fully integrated into public health to be able to monitor progress in SDGs.
Subnational inequalities in YLLs and associated socioeconomic factors: a disease burden study
Authors: Baravelli C M , Chen-Xu J , Varga O , Grad D A , Mahrouseh N , Charalampous P , Unim B , Economou M , Badache A C , Haneef R
Published: October 2023

Background

Health inequalities are an unjust and avoidable problem. This study examines subnational geographical inequalities in all-cause years of life lost (YLLs) and the association of socioeconomic factors in pre-coronavirus European Economic Area (EEA) countries.

Methods

In this ecological study complimented with a longitudinal analysis, demographic and socioeconomic data for 1390 small regions and 285 basic regions of 32 EEA countries were extracted from Eurostat. Age-standardised YLL rates per 100,000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease Study. Inequalities were assessed using the Gini coefficient (GC) and slope index of inequality (SII). The association between socioeconomic factors by YLLs were assessed using negative binomial mixed models in 2019.

Findings

Over the period 2009-2019, YLLs have decreased in almost all subnational regions. The GC of YLLs across EEA regions was 14% for females (95% CI = 13·5 to 14·6%) and 17% for males (CI = 16·1 to 17·5%). Greece (GC = 10·1%, CI = 7·8 to 2·5%) and Belgium (GC = 10·8%, CI = 9·5 to 12·0%) had the highest relative inequalities in YLLs for women and men, respectively. Subnational regions with the lowest income (incident rate ratio (IRR)=1·39, CI = 1·23 to 1·58) and levels of educational attainment (IRRfemales=1·19, CI = 1·13 to 1·26; IRRmales=1·22, CI = 1·16 to 1·28), and highest poverty risk (IRR=1·18, CI = 1·12 to 1·25) were associated with increased YLLs, with stronger associations observed in Central and Eastern Europe.

Interpretation

Differences in YLLs remain within and between EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing specific health inequities to improve overall disease burden within the EEA.

Key messages

• The study highlights the need for public health policies targeted at the subnational level to reduce health inequalities in the EEA.

• The study describes the effect of existing public health policies targeting socioeconomic factors.
Longitudinal clustering of risk behaviours and their association with multimorbidity in older adults
Authors: Suhag A , Webb T L , Holmes J
Published: October 2023

Smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (SNAP risk behaviours) are leading risk factors for multimorbidity and tend to cluster within specific subpopulations. Little is known about how these clusters change with age in older adults and their association with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess eight body system disorders, multimorbidity, and complex multimorbidity. Logistic regressions examined how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11·4%), Abstainer yet inactive (20%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10·9%). There was little evidence these clusters changed with age. Clusters characterised by physical inactivity (in combination with other risky behaviours) were associated with lower levels of education and wealth. The heavy drinking clusters were predominantly male. Compared to other clusters, Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all diseases studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and ought to be addressed early. By identifying seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics, and disease prevalence, our study provides valuable information for identifying high-risk subpopulations and tailoring interventions to their behaviour patterns and socio-demographic profiles.

Key messages

• We identified seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics and disease prevalence.

• Health-risk behaviours tend to be stable as people age and ought to be addressed early.
Cost-benefit assessment of health benefits of local climate action: scoping review
Authors: Kovats S , Turner G , Connor L O , Connell E O , Hajat S , Cairns J
Published: October 2023

Background

Local climate strategies are often linked to current priorities for transport, housing and planning but the health benefits of these strategies are often neglected in decision making. Economic information on the health benefits of climate action, including return on investment (RoI), would help support adaptation in Local Government.

Aim

To review methods for economic evaluation of the health benefits of local climate action (adaptation and mitigation) in high income countries.

Methods

We undertook a scoping review of full economic assessments that considered the health impacts of local climate action. We first reviewed climate actions and strategy documents to identify climate policies, practices and measures. We searched four electronic databases (Global Health, Web of Science, ECONLIT, and MEDLINE via OVID) for studies published from 2000 to 2022.

Results

26 studies were identified. The economic assessments covered a range of interventions, mostly for mitigation objectives: active travel (n = 10); housing (n = 6), green infrastructure (n = 4), heatwave warning systems (n = 3), transport (n = 1), and food waste (n = 1). A limited range of economic methods were used, with most using benefit-cost ratios (BCR) as a measure of cost effectiveness (n = 14). The range of health outcomes that were monetised was even more limited, either benefits from reduction in indoor or ambient heat and/or air pollutants (PM) on mortality or increased physical activity.

Conclusions

Currently there is limited economic evidence to support decision-making for local climate action that takes health into consideration. Climate actions may also incorporate nature-based solutions but these have specific challenges for evaluation and valuation. There is a need to develop standard methods to allow decision makers to evaluate the most appropriate strategies.
Digital Public Health in Slovenia
Authors: Hrzic R
Published: October 2023

The digitalisation of the Slovene healthcare system began in the mid-2000s with the publication of the eHealth 2010 strategy. However, it was not until 2016 that the digitalisation process gained significant momentum with the adoption of the Resolution on the National Health Care Plan 2016-2025 and the conclusion of the pilot phase of the eHealth project. These resulted in a unified health data infrastructure that links various health databases and telemedicine services, including the central registry of patient data, ePrescriptions, eReferrals, eConsultations, and the electronic registry of vaccinations (eRCO). Slovenia's eHealth capacity proved critical in enabling continuity of care during the pandemic, with more than 60% of the population consulting their physician or receiving a prescription remotely. This was enabled by the national patient portal, zVEM, which created a one-stop- shop for health services and information and the changes in the reimbursement rules of the national health insurance institute during the pandemic, which enabled the reimbursement of teleconsultations. Crucial for public health and health research, the current health data infrastructure links various national databases, including national cancer and central population registries. However, gaps remain in the health information system. For example, data from long-term healthcare services are inadequately captured, and there is currently no scope for linkage between health and the social welfare system datasets. In November 2022, the government unveiled a new healthcare digitalisation strategy for 2022-27. Its key objectives include streamlining the governance of eHealth services, infrastructures, and health data, implementing a standardised electronic patient record supporting medical imaging, and creating a national framework for telemedicine. The strategy also aims to enable the secondary use of health data in preparation for participating in the European Health Data Space.
The role of WHO in alcohol control
Authors: Ferreira-Borges C
Published: October 2023

The second presentation explores the role of WHO and the work it is undertaking, as well as the interventions envisaged by the WHO Global strategy, Global action plan and the European framework.
States’ action in international trade
Authors: Garde A
Published: October 2023

The third presentation will discuss the various policies which have been discussed in international trade law forums by States, and the roles some States have played in promoting or challenging proposals by other States.