bluuebunny/crossref_metadata_2025 huggingface dataset:
Public health and broader economic benefit of treating autoimmune and respiratory diseases in Greece
Authors: Stratopoulos A , Rigopoulos P , Kougioumtzoglou I , Chatzigeorgiou L , Kotsopoulos N , Kapaki V , Lagiou A
Published: October 2024

Background

The increasing prevalence and incidence of autoimmune and respiratory diseases is a leading public health concern. This study aims to quantify the public health and broader economic gains from treating autoimmune and respiratory diseases in Greece.

Methods

A decision-analytic model was constructed evaluating the socioeconomic and fiscal gains of established standard of care treatments against 4 autoimmune disorders namely, rheumatoid arthritis, psoriatic arthritis, psoriasis, ankylosing spondylitis and against the respiratory diseases of asthma, and COPD. Morbidity reductions from treatment were translated into averted loss of income and absenteeism and averted tax revenue loss and prevented disability pensions. Targeted literature reviews were conducted to obtain the effectiveness of treatments on productivity-related outcomes. Economic data were obtained from official sources.

Results

Treating 1,000 patients for the autoimmune and respiratory conditions is estimated to generate annual gains of 196.3 productive life years (PLYs), to avert 48,547 absenteeism days and to prevent 1.2 disabilities. The annual socioeconomic and fiscal gains of treatments against autoimmune disorders are estimated at €6.5 million and €1.3 million, respectively. Preventing asthma and COPD-related morbidity, among 1,000 patients, is estimated to yield annual socioeconomic gains of €1.2 million and fiscal gains of €0.4 million.

Conclusions

Effective treatment of autoimmune and respiratory diseases may generate substantial public health, socioeconomic and fiscal gains, simultaneously promoting population’s health and the sustainability of the healthcare system.

Key messages

• It is the first study carried out in Greece aimed to assess the positive impact on public health and the broader economic value of treating autoimmune and respiratory diseases.

• Therapeutic value of pharmacological interventions transcends the potential benefits to patients and public health.
Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria
Authors: Simon J ,   on behalf of STREAMLINE Consortium
Published: October 2024

Objectives

The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria.

Methods

We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses.

Results

We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented.

Discussion

STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF

Key messages

• New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing.

• Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.
Using advanced computing to improve outcome monitoring in substance use disorder treatment in Alaska
Authors: Ray R , Madison Pohl A , Licht P , Crews W
Published: October 2024

Issue

In Alaska, crime associated with substance misuse is a massive public health and safety concern costing over $2.3 billion annually. Government officials make substantial investments to address this challenge but have little ability to monitor the long-term effectiveness of these interventions. Treatment providers are also stifled by minimal feedback regarding their lasting impact. While government databases exist that contain relevant information related to long-term treatment outcomes, low knowledge transfer continues to occur between these big data systems and treatment providers.

Description

To determine if emerging database technology can effectively monitor long-term recidivism outcomes, a prototype was implemented by Alaska’s leading treatment provider, Set Free Alaska. The Recidivism Tracking Interface is an innovative database system that strategically connects treatment records with the criminal justice system database. While maintaining high confidentiality and security standards, the first-of-its-kind interface assessed long-term recidivism outcomes of Set Free Alaska’s former clients from 2010 to 2023.

Results

Of those who successfully completed treatment (n = 970), only 12.06% were convicted of a new crime with an average of 1,167 days between discharge and new criminal charges. The current recidivism rate in Alaska is 66.3%. In addition to recidivism outcomes, the interface also revealed data incredibly useful for informing treatment services and relapse prevention practices. The Recidivism Tracking Interface effectively demonstrated that advanced computing systems can be utilized to monitor long-term outcomes in a manner that was previously unavailable to treatment providers.

Lessons

In the age of advanced cloud computing and generative AI, treatment providers around the world and their government partners can overcome current knowledge transfer barriers to monitor long-term outcomes in a manner that is automated, inexpensive, and easy to use.

Key messages

• Advanced computing offers new opportunities to improve long-term outcome monitoring.

• Expanding secure access to relevant government databases can ultimately improve treatment outcomes and advance outcome-based funding models.
Fall risk factors and prevention among older adults in primary care in Belgium, 2019-2021
Authors: Moreels S , Bensemmane S , De Schreye R
Published: October 2024

Background

Falls are a major public health problem and ageing populations further increase the burden of fall-induced injuries. Falling among older persons is a multifactorial health condition needing multifactorial care. General practitioners (GPs) are well placed to implement a multifactorial management. A surveillance study of accidental falls studied characteristics of falls, risk groups and fall risk factors as well as fall prevention by GPs.

Methods

A 3-year retrospective population-based study by the Belgian network of Sentinel General Practitioners (SGP) on all patients aged ≥ 65 years consulting their GP for new fall-related injuries.

Descriptive statistics were used to characterize falls, fallers, fall risks and preventive measures. Logistic regression analyses were performed to identify factors associated with a multifactorial fall risk profile.

Results

During 2019-21, 1138 accidental falls were registered. Medical and/or nursing intervention was required for 24% and 22% had a severe injury. During consult, 30% was referred to hospital. 61% of patients showed at least one of the four most prevalent fall risks, i.e. deficits of mobility or balance, polypharmacy, cognitive impairment or psychotropic medication. A multifactorial fall risk profile was observed in 45% of fallers and was associated with recurrent falling (p < 0.001), fall location (p < 0.05), activity when falling (p < 0.01) and pandemic year 2020 (p < 0.05). Addressing surrounding and walking problems were the most frequently delivered preventive measures. For 28% of patients, other primary care providers (mainly nurse and physiotherapist) were involved in preventive care.

Conclusions

This study highlights the importance of identifying fall risk factors among fallers in primary care. Preventive fall measures, taken in about one in four general practice patients in collaboration with other healthcare providers, are crucial for preventing accidental falls in older persons in Belgium.

Key messages

• A multifactorial management of fall risk factors by GPs is crucial for preventing accidental falls in older primary care patients.

• Strengthening collaboration between primary healthcare professionals is needed for improving fall prevention in Belgium.
Assessing the severity of COVID-19 waves: beware of surveillance bias
Authors: Tancredi S , Cullati S , Chiolero A
Published: October 2024

Background

Indicators to assess the severity of epidemic waves during the COVID-19 pandemic were influenced by differences in detection modalities over time, leading to surveillance bias. We compared four indicators across three pandemic periods to assess surveillance bias.

Methods

We used data from one region of Switzerland. We compared seroprevalence, cases, hospitalizations, and deaths during three periods (period 1: Feb-Oct 2020, including the 1st wave; period 2: Oct 2020-Feb 2021, including the 2nd wave; period 3: Feb-Aug 2021, including the 3rd wave and after the start of the vaccination campaign). Data were retrieved from the Swiss Federal Office of Public Health or population-based studies. We compared each indicator to a reference indicator (seroprevalence during periods 1 and 2 and hospitalizations during period 3). We also assessed the timeliness of the indicators, i.e., the duration from data generation to the availability of the information to decision-makers.

Results

According to seroprevalence estimates, the severity of the 2nd wave was slightly larger (by a ratio of 1.4) than the severity of the 1st wave. Compared to seroprevalence, cases largely overestimated the 2nd wave severity (2nd vs 1st wave ratio: 6.5) while hospitalizations (ratio: 2.2) and deaths (ratio: 2.9) were more suitable to compare the severity of these waves. According to hospitalizations, the 3rd wave severity was slightly smaller (by ratio of 0.7) than the 2nd wave. Compared to hospitalizations, cases or deaths slightly underestimated the 3rd wave severity (3rd vs 2nd wave ratio for cases: 0.5; for deaths: 0.4) and seroprevalence was very biased due to high vaccination rates. Across all waves, timeliness for cases and hospitalizations was better than for deaths or seroprevalence.

Conclusions

To assess the severity of pandemic waves accounting for surveillance bias, different types of indicators must be used across time.

Key messages

• Differences in detection modalities over time can skew the assessment of the severity of COVID-19 pandemic waves, leading to surveillance bias.

• The effectiveness of indicators in describing the severity of COVID-19 pandemic waves depends on the type of indicator used and the stage of the pandemic.
Quality indicators of long-term care for older people in OECD countries; a rapid scoping review
Authors: Ordonez Cruickshank A , Zanuzdana A , Marujo V , Heldt K , Fuchs J , Gaertner B , Hasseler M , Eckmanns T , Scheidt-Nave C
Published: October 2024

Background

The COVID-19 pandemic has exposed the vulnerability of older people living in long-term care facilities (LTCF), highlighting the urgent need for research on the quality of care for this group of the population. There is no universal definition for quality of care in LTCF, and yet, multiple tools and indicators have been developed to measure it. In this rapid scoping review, we aim to provide a comprehensive overview of the current knowledge on quality of care concepts and indicators for older people in LTCF in OECD countries.

Methods

This review follows the World Health Organization (WHO) guide for rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) extension for scoping reviews, including protocol registration (https://doi.org/10.17605/OSF.IO/34B2S). The electronic bibliographic databases MEDLINE (PubMed), EMBASE, and CINAHL were searched in September 2023 for studies published between 2013 and 2023 for quality indicators in LTCF. Experts in quality of care in LTCF were contacted and consulted to retrieve sources of grey literature. Information on the definition or framework of quality of care, quality of care dimensions, measurement instruments, context and purpose of the measurement will be extracted.

Results

Of the 8,516 identified records, 6,449 were screened by title and abstract after removing duplicates. A total of 469 publications will be screened in full-text. Experts recommended 40 websites to be screened for quality indicators. The PRISMA flowchart diagram will be provided to describe the selection process.

Conclusions

This review aims to improve the quality of care for older people living in LTCF. Our results will identify which concepts and dimensions of care are currently being measured in OECD countries, whether they are backed by any definition and scientific framework of quality of care for older residents of LTCF, and whether there is consideration of closing gaps in quality measurement.

Key messages

• Quality of care is an understudied field in the context of long-term care facilities for older people.

• In order to further improve quality in long-term care for older people, it is necessary to systematically review the current state of knowledge on quality concepts and indicators.
Diabetes mellitus EU comorbidity index: using data from EHIS 2019 and GBD disability weights
Authors: Mahrouseh N , Kovács N , Varga O
Published: October 2024

Background

Individuals with diabetes mellitus (DM) exhibit several of comorbidity burdens, with lower perceived quality of life also being a factor. Literature on the impact of DM is available, including studies on the index devised by (A. Andreella et al., 2023) for the assessment of comorbidities of health conditions. This study aims to adapt and validate this index for use as a standardized DM comorbidity index within the EU.

Methods

A cross-sectional study was carried out using microdata from the European Health Interview Survey (EHIS) 2019. The study included adults aged 25 years or older who reported having DM (n = 20,042) from 27 EU member states. Comorbidity index was calculated to assess the comorbidity of having 9 non-communicable diseases using disability weights obtained from the Global Burden of Disease 2019 and self-perceived general health using multiplicative approach. Beta regression analysis was used to evaluate the association between comorbidity index and several demographic, socioeconomic and lifestyle variables. Comorbidity index was calculated for each nomenclature of territorial units for statistics (NUTS 2).

Results

The comorbidity index ranged from 0.049 to 0.993. The results indicated that having a higher education and residing in urban areas were less likely to have a high comorbidity index. Being unemployed or in other employment statuses demonstrated a significant, positive association with the index. Income exhibited a gradual, positive association with each quintile, while consuming fruits and vegetables less than once a week was found to be associated with an increased index. The highest comorbidity index was observed in Calabria (Italy), followed by Lubuskie (Poland), and the lowest was observed in Antwerp (Belgium), followed by Övre Norrland (Sweden).

Conclusions

By identifying comorbidity burden, targeted interventions and regional-specific strategies can be implemented to improve the quality of life for individuals with DM.

Key messages

• Quantifying the burden of comorbidities allows understanding of health status of DM patients.

• Comorbidity index shows geographic variation in the EU which contributes to tailored policy interventions.
Inclusion of Long Covid patients in the care trajectory post-Covid-19: evidence from Belgium
Authors: Moreels S , De Schreye R , Bensemmane S
Published: October 2024

Background

Evidence suggests that 10-30% of COVID-19 infected people develop persistent symptoms that can be diagnosed as Long Covid. Most Long Covid cases are in patients with a mild acute COVID-19 infection and are mainly treated in primary health care. In July 2022, a care trajectory (CT) post-Covid-19 was launched in Belgium, in which Long Covid patients can benefit from reimbursement of treatment costs when consulting health professionals in primary health care for their rehabilitation. Patients are included in this CT mainly through their general practitioner (GP) and depending on patients’ care needs, treatment is organized in a monodisciplinary or multidisciplinary way.

Methods

A population-based study on data collected by the Belgian network of Sentinel General Practitioners (SGP) on all Long Covid patients consulting their GP during March-December 2023. Information on inclusion in the CT post-Covid-19 was also registered. Descriptive statistics were performed.

Results

End of 2023 in Belgium, GPs initiated the CT post-Covid-19 for more than 1000 patients, this mainly for monodisciplinary treatment, less than 10% of included patients received multidisciplinary follow-up. By the SGP, among the registered Long Covid sufferers (N = 14), a total of six cases were included in the CT post-Covid-19. Of these cases, the majority were female, of older age, higher educated and had one or two chronic conditions. Most had a mild or moderate prior COVID-19 infection and all were vaccinated multiple times against COVID-19. Symptoms lasted one year or more for 83.3% of included patients. Treatment focused mainly on self-management, energy management and physical exercise programs, mainly in collaboration with physiotherapists.

Conclusions

This study yields recent data on patients included in the CT post-COVID-19 in primary care in Belgium. It is important to focus on guidance, follow-up and rehabilitation of Long Covid sufferers by healthcare professionals in Belgium.

Key messages

• Long Covid patients included in the care trajectory post-Covid-19 in Belgium experience years of debilitating symptoms after their prior COVID-19 infection.

• The establishment of the care trajectory post-Covid-19 for Long Covid patients in primary care since July 2022 stimulated collaboration between care givers in Belgian primary health care.
The impact of fuel poverty on cold-related mortality in England and Wales: disentangling the effects of fuel price, income, and energy efficiency
Authors: Wan K , Taylor J , Hajat S
Published: October 2024

Cold temperatures have been widely acknowledged as an important burden of poor health in many parts of the world including the UK. Although the temperature is expected to increase in the future due to climate change, the latest UK Health Effects of Climate Change (HECC) report projected that the number of cold-related deaths in the UK is expected to be more than 2 times of heat in the 2070s even under a high emission climate change scenario (RCP8.5). Therefore, it is still imperative to take intervention to reduce the health impacts of cold. People spent more than 90% of their time indoor and hence being able to stay in warm homes is crucial for reducing the impact of cold. However, some people may not be able to warm their home enough, a problem known as fuel poverty. Multiple factors can contribute to fuel poverty, including low income, poor housing performance, high fuel price as well as competing interest in fuel consumption and other essential living expenses. These challenges have been witnessed markedly during the cost of living crisis since 2021. This research investigates the effect of fuel poverty on cold-related mortality risk in England and Wales using small areal data. The underlying contributing factors of fuel poverty are explored to study the main mechanisms. The findings can support the identification of those who may be mostly affected by fuel poverty, and hence improve policies and interventions on reducing fuel poverty and protecting the public health from low temperatures.
The impact of the COVID-19 pandemic on physical activity among primary school children in Ireland
Authors: Kilduff O , Slattery J , Lee C , Hunt E , Douglas A , O’Brien S , Murrin C , Kelleher C
Published: October 2024

Background

The containment measures implemented during COVID-19 to curb the virus’s spread disrupted family life globally and profoundly impacted children’s daily behaviours. A decrease in children’s physical activity during COVID-19 is one such health behaviour change that was observed in many European countries. This study aimed to understand the pandemic’s impact on primary school children’s physical activity in Ireland which is important given the epidemic of childhood obesity and chronic diseases in the long term.

Methods

All Childhood Obesity Surveillance Initiative (COSI) participating countries (n = 45) could voluntarily implement the COVID study as part of their COSI Round 6 (R6) data collection or separately. The parents of First and Second-class primary school children (n = 2,784) who consented to participate in COSI-Ireland R6 were invited to complete the family survey which included the standardised COVID study. The COVID module assessed children’s lifestyles and health behaviours before and during the pandemic through 12 questions. Consenting parents supplied their email or postal address and completed the survey in hardcopy or electronically using LimeSurvey. Descriptive statistics were then calculated on the cleaned pseudonymised dataset (n = 1,060) using IBM SPSS Statistics 27.

Results

The time spent playing actively outside school hours remained the same for some children on both weekdays and weekends (24.2% and 37.1%, respectively). An increase rather than a decrease in the time spent in active play was also observed among almost twice as many children across Ireland on both weekdays (47.3% and 24.2% respectively), and weekends (40.10% and 21.80% respectively).

Conclusions

The positive findings show that the public health messaging from the Irish Government which emphasized the importance of staying active during COVID-19 may have been effective. Further research to assess children’s physical activity during COVID-19 is warranted to inform future pandemics.

Key messages

• In Ireland, unlike in many European countries, a substantial number of primary school children increased their time spent playing actively during the COVID-19 pandemic.

• A unique trend in Irish children’s physical activity levels compared to their European counterparts.
Vaccination Coverage among Institutionalized Elderly Population: A Case Study in Cascais, Portugal
Authors: Quelhas C , Lopes M , Moniz C , Fernandes M
Published: October 2024

Vaccination stands as a cornerstone of public health, significantly reducing the morbidity and mortality associated with infectious diseases. However, the aging demographic, with declining homeostasis and immunosenescence, presents new challenges. Those residing in nursing homes face heightened risks of infectious diseases due to proximity and interactions with multiple staff members. In Portugal, elderly vaccination against tetanus/diphtheria (Td) is integrated into the National Vaccination Program, with additional official recommendations for pneumococcal (Pn), seasonal influenza, and COVID-19 vaccinations. Specific vaccination campaigns in nursing homes for influenza and COVID-19 are coordinated by Public Health Units. This study aimed to assess the vaccination coverage for these vaccines among the institutionalized elderly in Cascais municipality and evaluate the implementation of official recommendations. A survey of nursing homes in Cascais was conducted, and the vaccination status of residents was assessed through electronic records in February 2024. Statistical analysis was performed. Vaccination status for each vaccine was considered valid if individuals had received at least one dose of Pn13 or Pn23, a Td vaccine dose within the last 10 years, and vaccinations against influenza and COVID-19 within the last 6 months. Among 2189 institutionalized elderly in Cascais, 87% were vaccinated against both influenza and COVID-19, 39% against Td, and 17% against pneumococcal disease. While influenza and COVID-19 vaccination coverage is high, the tetanus/diphtheria vaccination rate is low, and pneumococcal vaccination is very low, despite official recommendations. This population remains at increased risk for preventable diseases. Monitoring vaccination status and implementing targeted vaccination campaigns are crucial for increasing coverage, realizing health and economic benefits and preventing severe diseases.

Key messages

• Vaccination is essential for safeguarding the health of institutionalized elderly populations. There is a need for targeted interventions to address preventable diseases and protect these individuals.

• Monitoring vaccination status and implementing targeted campaigns are critical for increasing coverage and realizing health and economic benefits among elderly populations in nursing homes.
How Avoidable Mortality is influenced by health expenditure: an Italian 14-year panel data analysis
Authors: Sanna A , Guarducci G , Golinelli D , Nante N
Published: October 2024

Background

Avoidable Mortality is a widely used public health indicator to assess the quality of healthcare systems. The aim of this study was to investigate how the allocation of private and public health expenditure (PHE) could influence avoidable mortality (AM), treatable mortality (TM) and preventable mortality (PM) of Italian citizens.

Methods

A pooled cross-sectional time series study was conducted. Italian healthcare data from 2009 to 2019 was extracted from ‘Health for All’, a WHO-related database released periodically by the Italian National Institute of Statistics. PHE was divided by providers area (directly provided services (DPS), general and specialist medicine, pharmaceutical, rehabilitation). Data about private health expenditure, gross domestic product per capita (GDPPC), level of education, medical drug consumption per capita (MDCPC), general practitioners per capita (GPPC), physical exercise, tobacco use, and obesity were collected. AM was divided into TM and PM using OECD/Eurostat lists of causes of death (2022). A fixed-effects regression was used to assess the effects of economic and social variables on AM, TM and PM.

Results

Higher spending on DPS (-0.027), higher MDCPC (-0.859) and higher GDPPC (-0.001) were associated with lower rates of AM. Higher sport activity (c -0.673) was associated with lower rates of TM. Higher levels of private health expenditure (0.022) and higher number of GPPC (0.023) were associated with higher rates of PM; these counterintuitive results could be caused by the inappropriateness of medical treatment directly requested by patients. Other variables were not significantly associated with AM, TM or PM.

Conclusions

The results highlight the importance of medical DPS by NHS (emergency departments, hospital care, specialized care, primary care, etc.). Analyzing health data divided by areas of NHS we could help policy makers to allocate human and economic resources more efficiently.

Key messages

• The allocation of public health resources could influence the health status of the polulazion.

• Italian National Health System could reduce avoidable mortality through the use of directly provided services.
Comprehensive sexuality education: indicators to evaluate interventions in Italian schools
Authors: Paparatto G , Martinelli D , Suligoi B , Nardone P , Silvestri C , Bonaldo L , di Nino M G , Ubbiali M , Chinelli A , Tavoschi L
Published: October 2024

Background

Comprehensive sexuality education (CSE) is globally acknowledged as the most effective approach to promoting sexual health and preventing Sexually Transmitted Infections (STIs). However, in Italy, CSE is not consistently part of the school curriculum. The EduForIST project, funded by the Ministry of Health, introduced and tested a unique CSE model in a sample of secondary schools across six Italian regions, aiming to develop an evaluation model for potential nationwide implementation.

Methods

The EduForIST partnership, comprising experts from various institutions, devised a framework for monitoring and evaluating CSE interventions. Through monthly focus group discussions from April 2023 to February 2024, they established indicators for short-, medium-, and long-term evaluation of clinical and behavioral outcomes, as well as process indicators to assess intervention implementation.

Results

A total of 35 indicators were developed, including clinical and behavioral ones for medium and long-term outcomes, short-term behavioral outcomes, and process indicators. Data for clinical and behavioral indicators can be obtained from administrative sources like the Ministry of Health and Regional Health Authorities. The National Institute of Health provides data from relevant surveillance programs. However, many process indicators require specific data collection and calculations. Challenges such as under-reporting and underestimation persist, especially in regions with limited CSE implementation.

Conclusions

Creating an effective monitoring system for CSE interventions necessitates integrating diverse data sources, including health records, administrative data, and behavioral assessments. The proposed model’s effectiveness will be fully assessed by comparing pre- and post-intervention after widespread implementation in secondary schools. Meanwhile, the selected indicators serve as a foundation for evaluating baseline status of STIs and behaviors in Italy.

Key messages

• The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation.

• By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy.
Radiation exposure of patients undergoing multiple-slice CT scans in Romania
Authors: Prejbeanu I , Assani M Z , Niculescu F , Prunariu L A , Prejbeanu R G
Published: October 2024

Ionizing radiation is largely used in medicine due to its role in the diagnosis and treatment of patients. In the past 50 years computed tomography (CT) has become indispensable for medical practice because it offers sub-millimeter cross-sectional imaging of any region of the body. New CT scanners use thinner slices, providing more accurate results, but also an increased radiation exposure with possible long-term harmful effects for the patients. The parameter used as an indicator of radiation dose in CT is the dose-length product (DLP). The study included 4507 patients who were CT scanned using a 16, 32, 64 or 128-slice CT machine. DLP was measured for head, sinuses, thorax, abdomen, pelvis, abdomen+pelvis, and trunk scans - regions for which the health authorities have established national diagnostic reference levels (DRL - the expected radiation dose received by a patient in CT). One-way ANOVA was used to analyse data considering the use of contrast agents, the gender, age, and weight of patients. Average DLP values were higher (up to 80%) than national DRL for all regions in 64 and 128-slice scans. The highest DLP values were registered in contrast CT for all scanners (p < 0.01); the maximum average (a threefold increase compared to DRL) was measured in the 32-slice sinuses contrast CT. Average DLP correlated with patients’ gender and weight (p < 0.01), but the influence was lower compared to the use of contrast agents. In conclusion, CT scans acquired using thinner slices lead to more accurate results and high-quality images, but the study suggests an increased radiation exposure. CT has an uncontestable contribution to a precise and rapid diagnosis, but more attention must be given to the stochastic effects risks associated with the radiation dose received during a CT scan. Are all scans necessary? Do all patients really need to receive high doses? The role of the practitioner is decisive, and the justifiable process is “a must” in all radiodiagnosis practices.

Key messages

• CT doses must be kept “as low as reasonably achievable” while maintaining diagnostic image quality.

• Justification, dose limitation, and optimisation are fundamental principles of radioprotection.
Integrating environmental sustainability within national food-based dietary guidelines: a qualitative analysis from five case study countries
Authors: Hadida G , Turner G , Alae-Carew C , Ann Brown K , Nájera Espinosa S , Curtin E , Picetti R , Scheelbeek P , Green R
Published: October 2024

Background

The incorporation of environmental sustainability principles into national food-based dietary guidelines (FBDGs) has gained prominence as a strategy to address both human health and environmental concerns. This study aims to identify and explore the processes and considerations to integrate environmental sustainability in food-based dietary guidelines.

Methods

Countries that have integrated environmental sustainability in FBDGs since 2016 were identified from the UN FAO website. Background documents and interviews with key stakeholders involved in the development of FBDGs from case study countries (The Netherlands, Denmark, Chile, France and Belgium (Flanders)) were thematically analysed using the Framework Method. A coding framework explored the rationale for integration, data sources and analysis methods, stakeholder and expert engagement, synergies and trade-offs, translation into public messaging, and key learnings.

Results

Eight background documents and six interviews were analysed. Approaches to integrating environmental sustainability varied, from inclusion in dietary modelling optimisation to changes to consumer messaging. Nearly all countries adjusted guidelines to reduce red and processed meat and emphasise the role of plants in diets. However, issues of cultural significance, affordability, and access limited ambitions to reduce overall meat intake. Novel plant-based alternatives remain contentious due to concerns about their ultra-processed nature and potential nutrient inadequacies as substitution foods. Key barriers to integrating environmental sustainability into FBDGs include consumer acceptance, data quality and availability, stakeholder involvement and conflict, timelines, and resource constraints.

Conclusions

Several countries have successfully integrated environmental sustainability into their dietary guidelines, but there is still variation in the integration and acceptance of FBDGs including environmental sustainability.
Maximising the potential of National Cancer Mission Hub-like structures: A SWOT analysis approach
Authors: Ghattas J , Delnord M , Abboud L ,   ECHoS WP 2.3 KEP participants
Published: October 2024

Cancer is a significant and urgent concern in public health, particularly in the context of an aging population like in Europe. It is estimated that new cancer cases will increase by 21% by 2040 in Europe. With the ambition of improving the lives of 3 million people by 2030, the European Commission launched 2 major initiatives: Europe’s Beating Cancer Plan (EBCP) and the Mission on Cancer (MoC). The EBCP is a policy-driven initiative aimed at supporting Member States in addressing the whole cancer continuum. It is supported by the MoC, a research driven initiative. Member States are implementing the EBCP and MoC in a way that fits their national contexts. This can take different forms, such as ‘cancer hub,’ ‘mirror group,’ or other similar structures. The role of these entities can vary, ranging from purely coordinating activities to involving more technical work. We performed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis with different national mission-hub-like (NCMH-like) structures to explore their strategic positioning. We collected results from 6 countries (Belgium, Italy, the Netherlands, Portugal, Poland, and Sweden) as part of the EU project ECHoS on setting NCMHs. Participants perceived that formal government endorsement, existing stakeholder mapping, and good stakeholder engagement as strengths for the structure. Whilst, they identified overlap with other ongoing initiatives and low stakeholder engagement as weaknesses that need to be addressed, the future of existing structures could be threatened by financial and human resources as well changing political landscape. National, regional alignment and the leverage of EU funding were recurrent opportunities to build on. Ultimately, NCMH-like structures can be leveraged to achieve national and European alignment on cancer initiatives, if they succeed in building a sustainable financial and governance structure.

Key messages

• National Cancer Mission Hub-like structures can build on existing initiatives to support the implementation of EU cancer initiatives if they achieve sustainable financial and governance structures.

• SWOT framework is a good tool for a comprehensive overview of the strategic positioning of National Cancer Mission Hub-like structures in different European countries.
A comparative analysis of national dementia plans: preventive strategies in five European countries
Authors: Blandi L , Clemens T , Brand H , Odone A
Published: October 2024

Background

About 8.5% of people aged +65 live with dementia in Europe. Preventive measures can avert up to 40% of cases. The aim of the study is to analyse National Dementia Plans (NDP) in Europe, to elicit how much dementia prevention is considered a priority and whether policies are evidence-based.

Methods

A qualitative comparative analysis was performed between NDPs of countries with the best healthy life expectancy in the elderly in Europe. The NDPs of France, Ireland, Italy, Spain, and Sweden were included. The consensus on actions and elements of prevention policies was evaluated, according to the WHO recommendations and to Cheung’s framework designed for evaluating chronic diseases policies.

Results

All the NDPs prioritised early diagnosis, public awareness, and community engagement for dementia risk reduction. They fostered the development of information system for data collection and established committees for progress monitoring. However, not all NDPs defined timelines for policy implementation and most of them expired years ago. NDPs included prevention research agenda, but their preventive actions did not address alcohol consumption, traumatic brain injury, and air pollution, representing 3 well-known risk factors attributable for the 15% of preventable cases. Neither integration of dementia with other chronic disease preventive strategies was present and a clear allocation of funds for NDPs always missed.

Conclusions

NDPs partially address risk factors of preventable cases. All countries need to update their NDPs, integrating new scientific evidence and allocating clear financial funds. This can potentially prevent millions of new cases, decreasing the burden of disease and improving the sustainability of health systems.

Key messages

• NDPs do not target adequately dementia in Europe.

• New evidence-based preventive policies, including most recent identified risk factors, would have a clear impact on burden of disease and health systems’ sustainability.
Exploration of research projects on personalised prevention supported by the European Commission
Authors: Maio A , Farina S , Di Grande S , Osti T , Pastorino R , Boccia S
Published: October 2024

The interaction between environmental exposures, lifestyle factors, and genetic predisposition affect individual susceptibility to chronic diseases. Personalised Prevention (PP) has emerged in the recent years as potential approach to integrate traditional public health approaches in prevention. The implementation of PP into national health systems so far has not realized its full potential due to a number of obstacles including scanty evidence from research. Within the project “PROPHET: A Map for Personalised Prevention in the Future of Healthcare”, we conducted an extensive mapping of currently active research projects in the field of PP. We carried out a scoping review according to Arksey and O’Malley methodology, followed by consultations with experts in personalised medicine and prevention. We included 45 ongoing research projects on PP, of which 57.8% were funded by Horizon Europe, 35.5% by Horizon 2020, and 6.7% by Eu4Health. Regarding disease types, 40% of the projects were about cancer, 20% on cardiovascular and 20% on neurological and psychiatric diseases, followed by metabolic diseases and other chronic conditions. Overall, the EC allocated approximately €160 million to cancer personalised prevention projects, roughly double of the funding dedicated to cardiovascular, neurological and psychiatric diseases. The emphasis on cancer projects is noteworthy, with Horizon Europe emerging as the main funding programme aligned with the ongoing Cancer Mission. Regardless of the disease, most of the projects addressed primary and secondary personalised prevention research. This is in line with the limited approaches in PP in the setting of primary and secondary personalised prevention (e.g., genetic testing to identify high risk subjects for breast cancer) compared to tertiary prevention (e.g., pharmacogenomics). This comprehensive mapping underlines the EU’s continued commitment to promoting PP, which is fundamental to the future of healthcare.

Key messages

• The EC prioritises significant financial resources towards cancer personalised prevention research projects, highlighting Cancer Mission as a focal initiative in the personalised prevention field.

• European-funded projects focus on primary and secondary personalised prevention strategies. This suggest that we currently miss evidence in these areas.
Alcohol-related premature mortality in Northern Dimension partnership countries 2003-2021
Authors: Jousilahti P , Harald K , Vienonen M , Laatikainen T
Published: October 2024

Background

Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration. Iceland is not included in the analyses due to too small number of events.

Methods

Premature mortality was defined as a death before the age of 70 years. Alcohol-related deaths included the following ICD-codes: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, Q86.0, R78.0, X45, X65, Y15, K73, K74.0-K74.2, K74.6, O354, P043 and G4051. PYLL-rates per 100,000 population are presented separately for men and women in four time points: 2003, 2013, 2017 and 2021. Data were obtained from Eurostat and analyses are standardized to EU standard population.

Results

In the whole NDPHS area, alcohol related PYLL-rates declined between 2003 and 2017: from 527 to 458 in men, and from 159 to 134 in women. However, between 2017 and 2021 the rates increased: to 509 in men and to 154 in women. In 2021, the highest alcohol-related PYLL-rates were in Latvia (1696 in men and 530 in women) and the lowest in Norway (94 in men and 43 in women). Thus, the differences between countries in alcohol-related PYLL-rates were 20-fold in meles and 10-fold in females. In all countries the rates were 2-3 times higher in men compared to women.

Conclusions

Alcohol use is an important cause of premature mortality and disease burden in NDPHS area. There are marked differences in alcohol-related PYLL-rates between sexes and countries. The increase in alcohol-related PYLL-rates between 2017 and 2021 may be related to the Covid-pandemic.

Key messages

• Alcohol use is an important cause of premature mortality and disease burden in NDPHS countries, and there are marked differences in alcohol-related mortality between sexes and countries.

• Reduction of total alcohol consumption is an evidence-based most effective public health measure to reduce alcohol-related health harms.
Everyday household costs of raising a child with cerebral palsy
Authors: Roos G , Alecu A I , Austgulen M H
Published: October 2024

Background

Caring for a child with a disability can be costly in terms of time and energy, and it is also associated with lower incomes and higher direct costs, such as costs for assistive technologies, transport, food, clothing and leisure activities. However, few studies that have focused on households’ everyday costs associated with raising a child with disability. This study is based on the capability approach. The economic costs of a child with cerebral palsy are defined as the economic costs associated with achieving the same capabilities, or functionings, as a child without cerebral palsy. The purpose of this study is to explore the needs and economic costs in households raising a child with cerebral palsy. The results are important to inform, plan and justify targeted policies and interventions.

Methods

Digital in-depth interviews with caregivers from 15 Norwegian households raising children with cerebral palsy (aged 4-17 years, GMFCS levels 1-5). 12 women, 2 men and a couple were interviewed two times (1-2 hours each).

Results

The caregivers who took part in the interviews described their demanding role and that they spend a lot of time organizing daily routines, activities, health services, assistive technologies and assistants. Many of them initially reported that they do not have many daily extra costs, but when discussing the different areas of consumption, it emerged that households have extra housing costs because they need to make adaptations, remodeling and maintenance to their homes. An adapted car, which requires service, insurance and fuel, is often used for transport. The washing machine runs regularly and towels, sheets and clothes need to be frequently changed. Sometimes they also end up buying food, clothes or toys that are not used.

Conclusions

Households caring for children with cerebral palsy have additional costs for several types of expenses, including especially high costs for housing and transportation.

Key messages

• Households raising a child with cerebral palsy have needs that generate additional costs.

• The costs vary and it is important to cover a broad range of cost areas.