bluuebunny/crossref_metadata_2025 huggingface dataset:
A composite index of avoidable hospitalization to assess primary care quality: an Italian experience
Authors: Damiani G , Cuomo M , Mencancini C , Burgio A , Solipaca A , Catania D , Heidar Alizadeh A , Arcaro P , Baglio G
Published: October 2022

Background

In Italy, primary care (PC) ensures universal health coverage while containing costs. However, the assessment of its quality still remains an issue. Evidence has shown that high-quality outpatient care, through timely interventions to prevent complications of “ambulatory care sensitive conditions”, may avoid hospitalization. Aim of the study is to analyse the performance of PC in the Italian regions, using a composite and synthetic index of avoidable hospitalizations.

Methods

Hospital discharge data from 119 Italian geopolitical areas were analysed for the 2017-2019 triennium and for 2020, separately. According to the “Italian National Outcomes Evaluation Programme” methodology, 9 avoidable hospitalization indicators covering 5 nosological fields (infectious, respiratory, metabolic, cardiovascular and mental diseases) were combined in a synthetic index, calculated as the weighted mean of their standardized scores (with equal weights for each field). Using “natural breaks” technique, the areas were grouped into 5 clusters: “high”, “medium-high”, “medium”, “medium-low” and “low”.

Results

The analysis showed a marked heterogeneity at intra-regional level for the pre-pandemic triennium, with areas of homogeneity in regions with higher levels of hospitalization. The “medium” cluster, which is the widest, included 36 areas variously distributed across regions. The comparison with 2020 confirmed the geographical patterns observed for the previous triennium, despite a general reduction in hospitalizations due to the pandemic.

Conclusions

As a proxy indicator of PC quality, this index can aid decision makers in prioritizing quality improvement actions. However, in order to obtain a comprehensive evaluation, a joint reading of this index with other healthcare indicators is recommended.

Key messages

• High-quality PC is essential in maintaining appropriate hospitalization levels.

• The composite synthetic index proposed could aid PC quality assessment.
The impact of SARS-CoV-2 on emergency health care in a referral acute-care center in northern Italy
Authors: Ferrari A , Parente F , Iudica G , Porretto M , Simonetta D , Minet C , Mosca S , Panatto D , Orsi A , Icardi G
Published: October 2022

To assess how SARS-CoV-2 has changed the demand for in-person health care, we retrospectively analyzed data on access to the emergency department (ED) of San Martino Hospital, the referral acute-care center in the Liguria region (Northwest Italy). 181,699 records of patients diagnosed with an ICD-9 code between 2019 and 2021 were considered. In comparison to pre-pandemic levels, following the introduction of social distancing measures, the median number of ED visits declined by 41.4% in 2020 and by 28.1% in 2021. The period of maximum drop in access (-58.6%) corresponded to the 2020 11-12th calendar weeks and coincided with the highest rates of COVID-like illness - defined as either ILI or LRTI cases - identified through an operator-dependent syndromic surveillance system (+340%; 19.5% of total ED attendances). In terms of relative impact, in 2020 and 2021 non-urgent ED codes decreased (by 6.7% and 7.3%) and both urgent and emergency ED codes increased (by 4.8% and 3.8% the former; 5.5% and 8.8% the latter), even so, the absolute number of ED access fell drastically for all codes. Urgent codes, in particular, experienced the most severe decrease, shifting from a pre-pandemic value of 25,009 to 18,826 in 2020 and 19,528 in 2021. With regards to diagnosis, in 2020, respiratory infections saw the highest increase (+3.3%) while traumas and eye diseases saw the highest decrease (-1.1% and -3.8%, respectively). This trend reversed in 2021 during which respiratory infections decreased (-2.2%) and traumas increased (+2.2%). Despite the admissions of males and the elderly being routinely lower, these categories experienced the greatest increase in access for respiratory infections: +3.9% and +10.1% in 2020; +2.8% and +7.4% in 2021. While reduction of non-urgent ED visits indicates that the high pre-pandemic access levels may have been avoidable, the significant decline in non-COVID-19 urgent accesses potentially points to an increase in delayed and missed care.

Key messages

• During the COVID-19 pandemic – possibly due to fear and underestimation of symptoms – there was an overall reduction in ED accesses that potentially points to an increase in delayed or missed care.

• The reduction in non-urgent attendances indicates that high pre-pandemic accesses may have been avoidable and that a reduction in unnecessary ED visits is an attainable goal for healthcare systems.
The top three causes of prematuremortality in Belgrade 2020
Authors: Rosić N , Šantrić Milićević M , Stevanović A , Bjegović Mikanović V , Terzić Šupić Z , Todorović J , Terzić N , Stojisavljević S , Albreht T
Published: October 2022

Background

Analysis of years of life lost (YLL) due to premature deaths during the COVID-19 pandemic can direct decision-makers towards specific public health recommendations in order to improve health and lives of people. Our study aimed to examine the existence of age- and sex-specific patterns of the three most common causes of premature death in Belgrade during the first year of the COVID-19 epidemic.

Methods

Mortality data disaggregated by age, sex and cause of death, as well as the estimated number of inhabitants and remaining life-expectancy by age-groups for Belgrade was provided by the Statistical Office of the Republic of Serbia. YLLs were calculated using the methods of the Global Burden of Disease Study, without garbage code redistribution. Mortality rates were standardized according to the European Standard Population. We acknowledge the support from the COST Action 18218 - European Burden of Disease Network.

Results

In 2020 in Belgrade, according to the share in all-cause YLLs, cardiovascular diseases ranked first (36.2%), followed by neoplasms (25.7%) and COVID-19 (11.1%). However, on average, COVID-19 generated higher number of YLLs per death case (11.9) than cardiovascular diseases (9.2), but fewer than neoplasms (13.9). In total of 31,943 YLLs due to COVID-19, men had 1.7 times more YLLs than women. By age groups, the highest YLL share due to COVID-19 was among men aged 45-49 (16%) and 70-74 (16%) and among women aged 20-25 (33%) and 25-29. years (29%). In men, COVID-19 YLL rate was 2,488 per 100,000 and was higher after standardization (2,714). In women, COVID-19 YLL rate was 1346 per 100,000 and was lower after standardization (1,245).

Conclusions

In Belgrade, COVID-19 was the third cause of premature mortality in 2020. The difference between COVID-19 YLL rates in men and women were even more prominent after standardization. Future research is needed to determine the synergistic impact of COVID-19 and other causes of premature death.

Key messages

• In 2020, COVID-19 was among the top three causes of premature mortality among male and female contingents of the Belgrade population.

• Assessing the causes of premature mortality is important for determining community health priorities.
Real-life effects of nudging and pricing strategies in the supermarket to promote healthy diets
Authors: Stuber JM , Mackenbach JD , Lakerveld J , Beulens JWJ
Published: October 2022

Background

Unhealthy dietary patterns pose a major public health challenge. Individual-level efforts to promote heathy diets (e.g. nutrition education) have limited effect on the long term. Context-specific interventions focussing on point-of-purchase may create opportunities for sustainable dietary changes. We evaluated real-life effects of nudging and pricing strategies in supermarkets on dietary intake.

Methods

In this parallel cluster-randomised controlled trial, we randomized 12 Dutch supermarkets in socially deprived neighbourhoods to a control group (n = 6), or intervention group (n = 6). Healthy food nudges were implemented in intervention stores across 13 food groups, combined with healthy product price decreases and unhealthy product price increases. Eligible participants were aged 30-80 years and regular shoppers at participating stores. The primary outcome was dietary guideline adherence measured via an index score (0-150), at baseline and after 3, 6 and 12 months. Secondary outcomes included parameters of cardiometabolic health (HbA1c, lipid profile, and waist circumference), the percentage of healthy food purchases in the supermarket, socio-cognitive factors, and supermarket customer satisfaction. Effects were analysed with linear mixed models.

Results

This study included 173 participants from intervention clusters and 220 from control clusters. Preliminary evaluation of the 3-month follow-up data revealed no effectiveness of the nudging and pricing strategies compared to the control supermarkets in terms of dietary guideline adherence (β -0.8, 95%CI -4.2; 2.7). Results on all outcomes will be available at time of the conference.

Conclusions

This novel supermarket trial is the first to evaluate real-life long-term effects of nudging and pricing strategies based on a comprehensive set of study outcomes and using a strong methodological design. Findings can direct future design of context-specific interventions focussing on the promotion of healthy diets.

Key messages

• Context-specific interventions focussing on point-of-purchase may create opportunities for sustainable dietary changes.

• Findings from this supermarket trial testing real-life and long-term effects of nudging and pricing strategies can direct future design of context-specific interventions focussing on healthy diets.
Circadian nutritional behaviours and risk of cardiovascular disease in NutriNet-Santé
Authors: Srour B , Palomar-Cros A , Andreeva VA , Fezeu LK , Julia C , Bellicha A , Kesse-Guyot E , Romaguera D , Kogevinas M , Touvier M
Published: October 2022

Meal timings and daily night-time fasting periods can synchronise the circadian system, which regulates the cardiovascular system. The present study aims to evaluate the prospective associations between circadian nutritional behaviours, defined by meal timing and frequency, and the risk of cardiovascular diseases. We used data from 103,389 adults (79% females) in the French NutriNet-Santé study, 2009-2021. Circadian nutritional behaviours were assessed using repeated 24h food records during the first two years of follow-up. We examined the associations between circadian eating behaviours and risk of cardiovascular, coronary heart and cerebrovascular diseases by multivariable Cox proportional hazard models. During a median follow-up of 7.2 years, 2036 incident cardiovascular diseases were diagnosed. A later first meal of the day was associated with a higher risk of cardiovascular diseases (HR per hour increase = 1.06, 95% CI 1.01 - 1.12). A later last meal of the day was associated with a higher risk of cerebrovascular diseases (HR per hour increase = 1.08, 95% CI 1.01 - 1.15). Among women, a later last meal was also associated with a higher risk of cardiovascular disease (HR per hour increase = 1.08, 95% CI 1.01 - 1.15). We found no evidence for an association between night-time fasting duration nor meal frequency, with risk of cardiovascular diseases. This study suggests that the habit of eating a later first meal, and a later last meal (in women) could be associated with a higher risk of developing circulatory diseases. These results need to be confirmed in other largescale studies before they can be transferable to clinical practice.

Key messages

• Beyond nutritional quality of meals, meal timing could also be a risk factor for cardiovascular disease.

• If confirmed in other largescale studies, early breakfast and dinner could be considered in preventive strategies of cardiovascular diseases.
Gambling disorder and chronic diseases in Finland: a nationwide register study
Authors: Grönroos T , Salonen AH , Latvala TA , Kouvonen A
Published: October 2022

Background

Previous register-based studies on comorbidity have mainly focused on gambling disorder (GD) and psychiatric disorders. However, knowledge on somatic health of persons with GD is also needed. This nationwide register-based study aims to examine the gender-specific prevalence rates of chronic diseases and conditions among the Finnish adults with GD.

Methods

This study utilizes aggregated data of persons aged 18 and over with GD diagnosis (corresponding to pathological gambling, ICD-10; F63.0) in 2011-2020. The data were retrieved from the Finnish nationwide health registers: Register of Primary Health Care visits and Care Register for Health Care, including specialised outpatient and inpatient health care, and inpatient social care. All diagnostic groups were included. Corresponding figures for the total population with same age range were presented as reference numbers.

Results

The preliminary results showed that 2,617 persons with the median age of 33.5-36.0 were diagnosed with GD (men n = 1,858; women n = 759). Despite the fact that the prevalence rates of the general population were not age-adjusted, many chronic diseases and conditions were more prevalent among persons with GD compared with the general population. The prevalence rates of psychiatric disorders (87.5% vs 29.2%) and nervous system diseases (23.9% vs 15.2%) were particularly high. Musculoskeletal diseases (61.6% vs 55.8%) and digestive diseases (30.2% vs 27.6%) were also slightly more prevalent. Memory disorders (1.1% vs 5.3%), cardiovascular diseases (25.3% vs 41.0%), and cancer (15.6% vs 24.4%) were less prevalent. Among persons with GD, all comorbid diseases were more prevalent among women than among men.

Conclusions

Psychiatric disorders and nervous system diseases are exceptionally prevalent in persons with GD. These findings highlight the need for health and social care professionals to recognize that persons with GD may additionally have other disorders that need attention.

Key messages

• Mental disorders are the most common comorbidity among persons with GD, however, many somatic chronic diseases are also common.

• Comorbidities are more common among women with GD than among men with GD.
Ethnic and socioeconomic inequalities in relation to air pollution exposure in the Netherlands
Authors: van den Brekel L , Lenters V , Mackenbach JD , Hoek G , Wagtendonk AJ , Lakerveld J , Grobbee DE , Vaartjes I
Published: October 2022

Background

Air pollution (AP) contributes to a large disease burden and some populations are disproportionately exposed. It is unclear to what extent AP exposure differs across ethnic groups in the Netherlands and how this intersects with socioeconomic position (SEP). First, we identified differences in AP exposures between ethnic groups in the Netherlands. Second, we examined the interrelationships between ethnicity and SEP in relation to AP exposures.

Methods

We assessed AP exposures for residents of the Netherlands in 2019 (N = 17,251,511). Home address AP levels were estimated by dispersion models of the National Institute of Public Health and the Environment (RIVM). We linked exposure estimations of particulate matter <10 or < 2.5 μm (PM10, PM2.5), nitrogen dioxide (NO2), and elemental carbon (EC) to demographic data gathered by Statistics Netherlands. Absolute and relative differences in AP levels across ethnic groups were assessed. We conducted multivariable linear regression analyses and estimated marginal mean exposures to evaluate differences by ethnicity, SEP, age and sex within urban and rural areas. We tested for interactions and stratified accordingly.

Results

For the 40 largest minority ethnic groups (N > 18,314 per group), exposure to all pollutants was higher than for ethnic Dutch, with up to 1.5-fold differences for NO2. After stratification for urbanity and SEP, ethnic exposure inequalities persisted. For ethnic Dutch and some migrant groups, we found the lowest AP exposures in the middle SEP group (i.e. U-shaped trends), while we found linear patterns in other large migrant groups, with higher exposures at lower SEP.

Conclusions

Exposure to PM10, PM2.5, NO2, and EC was consistently higher in minority ethnic groups compared to ethnic Dutch. The association between SEP and AP levels showed different patterns between the majority ethnic Dutch and some of the largest minority ethnic groups. Further research is needed to define the equity and health implications.

Key messages

• Minority ethnic groups in the Netherlands are consistently exposed to higher levels of air pollution (PM10, PM2.5, NO2, and EC) than the ethnic Dutch population.

• Depending on the ethnic group, the association between SEP and air pollution exposure was either linear (i.e. lower exposures at higher SEP) or U-shaped (i.e. lower exposures in the middle SEP group).
Exposure to phthalates, potential endocrine disruptors, in an infant cohort in Modena, Italy
Authors: Lugli C , Palandri L , Ferrari A , Barbieri R , Trevisani V , Passini E , Lucaccioni L , Facchinetti F , Righi E
Published: October 2022

Phthalates are pollutants ubiquitous in the environment. Human exposure to phthalates and their endocrine disrupting effects have been widely studied. Therefore, the European Union forbids phthalates in toys, cosmetic and kitchenware manufacturing. However, phthalate metabolites can still be found in human biological matrices. The purpose of this study is to investigate phthalate exposure over time in a group of Italian healthy newborns. In a prospective cohort study, we enlisted 187 women who gave birth in the University Hospital of Modena, Italy, between January 2019 and May 2020. Urine samples from women after delivery and from their infants at birth, 3 and 6 months were collected and 8 metabolites of 6 phthalates were analysed. Descriptive statistics were calculated and preliminary correlation coefficients tests were performed. Monoethylphthalate (MEP) was always detectable in urine samples. MEP, monomethylphthalate and diethylhexylphthalate metabolites showed an increasing trend over time, while monobutylphthalate and monobenzylphthalate showed decreasing levels over time. Associations between levels of phthalates metabolites in mother and infant pairs at birth were found for a few metabolites, while metabolites in infant samples at 3 and 6 months appeared often significantly associated. Infants’ phthalate exposure in Modena is still high and prolonged over time, even to those more toxic and strictly regulated. As phthalates presence in indoor environment can be a risk factor especially for the most fragile groups of population, such as children, public Health campaigns addressing childbearing age women should stress about the risk posed by these substances and how to avoid their exposure. Moreover, regulatory actions and a stricter legislation should be considered.

Key messages

• In Italy infant exposure to phthalates, including those strictly forbidden, appears still high and continuous over time.

• Public heath intervention and stricter regulatory actions should be considered.
Health in All policies: what do we mean and where are we now?
Authors: Green L
Published: October 2022

This presentation sets what HiAP is and is not, and its evolution since it was conceived. It also addresses how HiAP can be mobilised in practice via the use of tools such as HIA and the key role that enabling structures and contexts - both politically strategic and locally operational- to ensure that health, wellbeing and equity is promoted in the European region. It discusses the enabling context of Wales, with the Future Generations (Wales) Act 2015, which provides political leverage for the implementation of HiAP in practical terms, enabling addressing health considerations intersectorially by non-health policies and projects. This Act along with supporting documents, guidance and legislation implicitly incorporates the principles of HiAP so the rest of non-health sector understand (and also have the statutory obligation) to address the health considerations of policies and plans. It does this by requiring all public bodies in Wales to strive to maximise 7 Well-being Goals - which include ‘A healthier Wales’, ‘A more equal Wales’ - and requires that they do so by working with other agencies in order to prevent negative impacts and promote participation, long-term thinking and integration to ensure that inequalities are minimised. These are key public health principles from which to have conversations. Wales also provides a good example with its advocacy and policy in respect to Economies of Wellbeing - a critical challenge for HIAP is that HiAP is, by its nature, political, and may challenge some policy proposals. Although the focus is on identifying ‘win:wins’ and co-benefits, sometimes there is a conflict between health and other outcomes. There may be a need to balance health gains against economic growth or other policy aims. The following debate intends to discuss the challenges and enablers to achieve that aim, and how public health can make its voice heard.
Economics and health economics as a major determinant towards HiAP
Authors: Santos J
Published: October 2022

COVID-19 pandemic response was an opportunity to advocate for HiAP as everyone developed opinions on how policies could affect the different dimensions, including health and economy. Health planning, from the local to the international level, is the main setting where we still need to advocate for the inclusion of all political sectors and actors in order to ensure an effective HiAP implementation. From a more technical perspective, there is still a lot to do when it comes to implementing and improving economic evaluations, including on data on costs, valuing benefits or using cost-effectiveness approaches.

Speakers/Panellists

Nikhil Gokani

EUPHA-LAW

School of Law, University of Essex, Essex, UK
A sport focus of ECEC centres appears especially health-promoting for boys from lower socio-economic background
Authors: Mayer A , Herr R , Wiedemann E , Diehl K , Blume M , Hoffmann S , Jepsen D , Sundmacher L , Schneider S
Published: October 2022

Background

Pediatric overweight is considered one of the 21st century's most serious public health challenges. Many studies investigated individual level determinants of children's body mass index (BMI), yet studies measuring determinants at the meso- level are sparse. As there is a lack of theoretical and empirical knowledge about the role of child care facilities, the aim was to examine the combined effects of family socio-economic position (SEP) and the meso-level variable early childhood education and care (ECEC) centre with sport focus on the BMI of pre-schoolers.

Methods

We used data from the German National Educational Panel Study (NEPS) and included 1,891 children from 224 ECEC centre groups. Multilevel mixed-effects linear regressions were applied to calculate the main association of ECEC centre focus and family SEP, as well as their interaction on children's BMI. All analyses were adjusted for age, migration background, number of siblings, and employment status of parents and were stratified by gender.

Results

Boys attending an ECEC centre with a sport focus have on average a lower BMI than boys from ECEC centres not having this focus. Interactive effects between family SEP and ECEC centre focus were found. Considering predictive margins, boys with low family SEP not attending a sport focused ECEC centre had the highest BMI while boys with low family SEP attending a sport focused ECEC centre had the lowest BMI. For girls, no association regarding ECEC centre focus or interactive effects emerged. Girls in the high family SEP tertile had the lowest BMI in both ECEC centre types.

Conclusions

Our analysis shows the social gradient towards a higher BMI for children from lower SEP families. Considering meso-level factors, we provide evidence for the relevance of ECEC centre characteristics for BMI in boys, whereas for girls the association of family SEP with BMI remains. The ECEC centre focus appears to lower the association of family SEP with BMI for boys.
A gamification-based intervention to encourage active travel
Authors: Harris M
Published: October 2022

Purpose

‘Beat the Street’ is a community-wide intervention which aims to increase active travel by turning an area into a 6-week game. Residents earn points and prizes by walking and cycling and tapping a smartcard on RFID readers called ‘Beat Boxes’ placed on lampposts at half-mile intervals. To-date, over 1 million people have taken part in the intervention, however, the impact of the program on adult active travel is yet to be explored.

Methods

In Autumn 2019, Beat the Street was delivered throughout the London Borough of Hounslow. Prior, and immediately following the intervention, residents were invited to complete a self-report questionnaire (Sport England Active Lives Survey-SF) to assess changes in physical activity. Time-stamp data generated through Beat Box activity provided an objective measure of intervention engagement and a traffic survey camera was used to measure the number of cars travelling along 1 target road between 1-week pre- and 1-week post-intervention.

Results

28,219 people took part in the six-week game. Between pre- and post-intervention there was 7% decrease in adults reporting less than 30mins of activity per week and a 13% rise in adults reporting 150+ mins (n = 346, p < 0.01). Beat box data ascertained that 25% of total taps at all Beat Boxes were made between 08:00-08:59am and a further 28% were made between 3:00-3:59pm, typical travel to school/work periods. Further, traffic camera data showed that between the week before and week following Beat the Street, 1199 and 705 fewer cars and 130 and 36 fewer vans were observed travelling along Cambridge Road between 07:00-09:30am and 2:00-4:30pm, respectively.

Conclusions

These data sources, in combination, suggest gamification may be an encouraging approach to increasing levels of active travel at a community-wide level.

Key messages

• Gamification based intervention increases physical activity.

• Gamification encourages active travel to school and work.
A systematic review of randomized clinical trials on quadrivalent influenza vaccines for adults
Authors: Pellacchia A , Mannocci A , Millevolte R , Chiavarini M , de Waure C
Published: October 2022

Background

Vaccination is the most effective intervention to prevent influenza. Adults at risk of complications are among the targets of annual vaccination campaigns and can receive different types of quadrivalent influenza vaccines (QIV). To assess the immunogenicity of different QIVs we performed a systematic review of available randomized controlled trials (RCTs) with the aim of indirectly compare them through a network meta-analysis.

Methods

The systematic review was conducted in accordance with PRISMA-NMA guidelines. We systematically searched RCTs conducted in adults aged 18-64 years that assessed the immunogenicity, namely seroprotection and seroconversion rate (SPR and SCR), of any QIV compared to any comparator. The literature search was performed on three databases (Medline, Cochrane Library and Scopus) until March 30th, 2021.

Results

Twenty-four RCTs were included in the systematic review. A network meta-analysis was not possible: the assumption of transitivity was not satisfied. Therefore, we decided to combine data on immunogenicity and efficacy of each QIV through single meta-analyses in the presence of at least two studies. Live attenuated QIV showed the worst results in terms of both SCR and SPR. Standard dose egg based, low dose adjuvanted, cell based, recombinant and intradermal QIV showed similar SCR in respect to influenza strain A, whereas low dose adjuvanted QIV showed an overall better profile in respect to B lineages. Regarding SCR, the better results were issued by standard egg based, cell based, recombinant, and low dose adjuvanted QIVs.

Conclusions

Albeit an indirect comparison among different QIVs was not possible, the assessment of SCR and SPR provided an overview of their respective potentiality and criticality in adulthood. In particular attention should be paid to new generation influenza vaccines that can have an antigen sparing effect and to the collection of real world data to make comparison among different QIVs possible.

Key messages

• Available evidence does not allow to perform indirect comparison of the quadrivalent influenza vaccines for adults.

• Some QIVs, including new generation ones, elicit a better antibody response.
Self-cutting in bullying victimized adolescents is mediated by depression and dissociation
Authors: Hamal M , Kekkonen V , Kraav S-L , Kivimäki P , Rissanen M-L , Hintikka J , Tolmunen T
Published: October 2022

Background

Bullying victimization is a universal public health threat with numerous negative mental health consequences, including anxiety, depression, and dissociation.

Aims

We explored 1) firstly whether bullying victimization is associated with self-cutting in Finnish adolescent population and, 2) if the possible association is mediated by dissociation and/or depression.

Methods

We used cross-sectional questionnaire data from 13-18- year-old Finnish students (N = 4214; boys n = 1942; girls n = 2229).

Results

Bullying victimized adolescents were older, more likely to come from single-parent families and to take drugs and drink alcohol, had a poorer relationship with parents and siblings, as well as poorer school performance compared to non-bullied adolescents. According to logistic regression analysis the association between bullying and self-cutting remained significant despite adjustments for age, gender, fear of going to school, school performance, social network-related factors, family-related factors, lifestyle related factors, and dissociative symptoms, but not for depressive symptoms. In mediation analyses we found that both depression and dissociation mediated the effect of bullying victimization on self-cutting.

Conclusions

Self-cutting is more common in adolescents who have been bullying victimized. The association is mediated by depressive and dissociative symptoms. More studies are needed to clarify the exact mechanisms how of depressive and dissociative symptoms interact with the association between bullying and self-harm.

Key messages

• Bullying victimized adolescents are associated with self-cutting.

• Depression and dissociation mediate the mentioned association.
Low-quality employment trajectories and mental health disorders among Swedish and migrant workers
Authors: Pollack R , Kreshpaj B , Jonsson J , Bodin T , Gunn V , Orellana C , Östergren P , Muntaner C , Matilla-Santander N ,   PWR Consortium
Published: October 2022

Aim

This study aims to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background.

Methods

This is a longitudinal study based on Swedish population registries (N = 2,703,687). Low- and high-quality employment trajectories observed across five years (2005-2009) are the exposure with severe CMD as outcome (2010-2017). Adjusted hazard ratios (HR) were calculated using Cox regression stratified according to background (first-generation (i) EU migrants, (ii) non-EU migrants, (iii) second-generation migrants, (iv) Swedish-born with Swedish background) and sex. The reference group were Swedish-born with Swedish background in a Constant high-quality employment trajectory.

Results

Second-generation migrants had an increased risk of CMD compared to Swedish-born with Swedish background when following low-quality employment trajectories (e.g., male in Constant low-quality HR: 1.53, 95% CI: 1.41-1.68). Female migrant workers, especially first-generation from non-Western countries in low-quality employment trajectories (e.g., Constant low-quality HR: 1.65, 95% CI:1.46 - 1.87), had a higher risk of CMD compared to female Swedish-born with Swedish background. The confidence interval for CMD risk showed little differences between migrant groups (1st and 2nd generation) compared to the reference group.

Conclusions

Low-quality employment trajectories appear to be determinants of risk for CMD, having a differential impact according to background of origin and sex. We observe a higher risk for severe CMD across migrant groups, especially second-generation migrants, compared to Swedish-born with Swedish background. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background.

Key messages

• First and second-generation migrants in low quality employment have higher risk of severe common mental disorders compared to Swedish born with Swedish background workers in low quality employment.

• Policies targeting working conditions in low-quality employment and promoting workers mental well-being are essential to reduce this higher risk for developing CMD, especially for migrant populations.
9.Q. Skills building seminar: Redistribution of ill-defined deaths: a methodological conundrum
Authors:   Organised by: COST Action CA18218– European Burden of Disease Network,   Chair persons: Brecht Devleesschauwer (Belgium)
Published: October 2022

Today, several countries are conducting national burden of disease (BOD) studies, calculating Disability-Adjusted Life Years (DALYs) for a variety of diseases, injuries and risk factors. The DALY metric is composed of a morbidity component, the Years Lived with Disability (YLDs), and a mortality component, the Years of Life Lost (YLLs). The calculation of YLLs typically starts from national cause of death data, which are coded using the International Statistical Classification of Diseases and Related Health Problems (ICD). National BOD studies however often follow (a modified version of) the cause hierarchy of the Global Burden of Disease (GBD) study, which applies coarser categories, and does not contain unknown or ill-defined causes. This implies that not all ICD codes can be mapped to one specific BOD cause, giving rise to so-called “ill-defined” or “garbage” codes. To include all deaths in a national BOD study, it is therefore necessary to redistribute the ill-defined deaths to specific BOD causes. Several methodological approaches exist for redistribution of ill-defined deaths, ranging from the use of fixed redistribution proportions to advanced redistribution algorithms based on multiple cause of death data. The choice of the methodology needs to depend on the nature of the available cause of death data, and as a consequence, methodologies are typically tailored to the specific data at hand. The absence of a single best methodology, and the methodological heterogeneity across applications, has made redistribution of ill-defined deaths into a methodological conundrum. This skills building workshop will present the redistribution methods applied in different national burden of disease studies, including a discussion of their strengths and weaknesses. By providing a step-by-step presentation of how the methods have been applied, attendees will gain unique insights in the different redistribution methods currently applied.

Key messages

• Redistribution of ill-defined deaths is an essential part of national burden of disease studies, but is methodologically challenging.

• Attendees will receive an overview of the redistribution methods applied in different national burden of disease studies, including a discussion of their strengths and weaknesses.
Primary health care reforms in Estonia: using financial incentives to encourage multidisciplinary care
Authors: Habicht T , Kasekamp K , Webb E
Published: October 2022

Estonia has a historical legacy of large hospital networks and municipality-owned specialist clinics, with a low emphasis on primary health care (PHC). Since the 1990s, a transition towards PHC has occurred, delivering PHC in family physician practices rather than in specialist clinics. The transition has been underpinned by a series of comprehensive healthcare system reforms starting in the late 1990s. The most recent reforms, although lacking a legal basis, have been accompanied by financial incentives including EU structural funds to encourage change. These financial incentives were designed to improve quality of care, encourage working in remote areas, and more. A key focus of PHC reforms has been an emphasis on multidisciplinary care, and the reforms have aimed at increasing the involvement of home nurses, midwives, and physiotherapists in PHC. The reforms have also prioritized PHC centres, with multiple practicing physicians, over single physician practices. Although EU structural funds have supported building the infrastructure for expanded scope of services at PHC level, the uncertainty of long-term funding of expanded services remained a key challenge limiting the success of the reform. Further, the supply of family physicians will be problematic in the future, as the number of permanently vacant positions has quadrupled in the last five years and almost half are 60 years of age or older. As the PHC reform process in Estonia continues until today, it can serve as a case study for other countries interested in strengthening their PHC systems.
10.C. Round table: Is public health just science?
Authors:   Organised by: UK Faculty of Public Health, EUPHA-ETH, EUPHA-PHPP,   Chair persons: Farhang Tahzib (EUPHA-ETH)
Published: October 2022

Politicians and policy makers often assert that they are following the science and the evidence in their decision making. Public health is proud of its rigorous scientific and evidence-based approaches and providing the numbers and facts. It is clear though that such numbers and facts, as during the pandemic, have resulted in diverse policies in different countries. Some commentators have noted that public health has lost its way, arguing that its leadership is failing, lacks courage and not sufficiently concerned with issues about social reform and political accountability and change. Is providing facts and the science sufficient to fulfil our mandate and obligations in public health? What should be our role in advocacy and engagement in politics and policy-making to promote and protect the public's health and tackle health inequalities? The purpose of the roundtable is to explore questions of whether public health is “just science”: is it built merely on a scientific skillset; or is it about justice-promoting science? This question goes to the heart of public health's mandate, with direct implications for public health practice. The questions will be considered largely from the perspective and evidence from the Covid pandemic. There will be presentations by senior distinguished academics and public health practitioners and leaders who have been researching and advising policy makers on wide range of public health issues. They will share their research and experience in particular from membership of the UK Independent Scientific Advisory Group (Indie_ SAGE) for the pandemic and on the Pandemic Ethics Accelerator, as well as other groups advising the government and public organisations on the analysis and implementation of policy options during the pandemic. This will be followed by reflections and discussion with the workshop participants and their reflections and insights on these critical questions.

Key messages

• Public health is not merely a technical, scientific discipline; it incorporates norms and values, and operates in a political environment where value-judgments are fundamental to decision making.

• Public health practitioners and leaders need to consider advocacy and engagement, and the moral foundations of public health, as key to their mandate and professional obligations.

Speakers/Panellists

John Coggon

University of Bristol, Bristol, UK

Martin McKee

LSHTM, London, UK

Marleen Bekker

Wageningen University & Research, Wageningen, Netherlands

Farhang Tahzib

Faculty of Public Health, Haywards Heath, UK
Methodological considerations when assessing the Burden of Disease due to injuries
Authors: De Pauw R
Published: October 2022

Measuring the burden of disease due to injury is a similar process compared to the disease burden. However, burden calculations for injuries impose an extra complexity for the non-fatal burden, as it is important to consider both the ‘cause’ and the ‘nature’ of the injury. Cause of injury (e.g., road injuries, falls, drowning) have historically been used for assigning cause of death as opposed to the ‘nature’ of injury, which more directly specifies the pathology that resulted in death or disability. However, precisely estimating the disability as a result of an injury requires a mapping of, for example, individuals that have suffered a fracture hip (‘nature’ of the injury) because of falling (‘cause’ of the injury). This process would require a matrix of the nature-cause relation of injuries, which are only scarcely available, because they required dual-coded data registers. The presentation will zoom into the differences between disease and injury estimations and will appraise the methodological considerations for the estimations of injury-related burden of disease estimates.

References

James, S. L., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., Liu, Z., ... & Fomenkov, A. A. (2020). Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study. Injury Prevention, 26(Suppl 2), i125-i153.

Haagsma, J. A., James, S. L., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., ... & Mahotra, N. B. (2020). Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017. Injury prevention, 26(Suppl 2), i12-i26.
The risk and safety profile of electronic nicotine delivery systems (ENDS): An umbrella review
Authors: Asfar T , Maziak W
Published: October 2022

Background

Balancing electronic nicotine delivery systems (ENDS) health communication between limiting the harm for new users while offering current smokers the benefits of reduced-risk products is challenging. This umbrella review aims to summarize the evidence about ENDS risk and safety health profile to inform ENDS health communication strategies.

Methods

Six databases were searched for systematic reviews presenting evidence on ENDS health effects. Ninety reviews divided into 5 categories were included: toxicity = 20, health effects = 40, smoking cessation = 24, transition to combustible cigarettes (CCs) = 13, and industry claims = 4. Findings were summarized narratively. Meta-analyses were conducted when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine's Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive, and limited-not-conclusive.

Results

We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of asthma; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CCs initiation; and exposure to ENDS marketing increases its use/intention-to-use. Evidence was moderate for ENDS association with mental health and substance use, and limited-not-conclusive for its association with cardiovascular, cancer, ear, ocular, and oral diseases, and pregnancy outcomes.

Conclusions

Currently, ENDS communication can focus on high-level evidence related to ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning), and anti-ENDS industry sentiment. Further research is needed to assess the full spectrum of ENDS health profiles.

Key messages

• Further research is needed to establish the risk and safety health profile of ENDS with consideration of the wide variety of ENDS, their frequency of use, and different segments of the population.

• More prospective cohort studies that take place over longer time periods and with larger sample sizes are necessary to gauge accurately the short- and long-term health-related risks of ENDS.
Improving the quality of translation for patients with language barriers
Authors: Newell R , George S , Patel M , Dawe H , Roelas M , Wedmore F , Morris M
Published: October 2022

Background

Patients with language barriers have worse health outcomes. To promote equitable care, efforts must be made to ensure effective communication with patients, including providing professional translation. In a busy, overstretched health service this can be difficult to achieve. Language translators can reduce barriers, improve safety and ensure impartiality.

Description of the Problem

Aims - To understand the quality of translation and explore interventions that could improve this in a busy diverse hospital in East London.

Methods

A quality improvement project in the Medical Admissions Unit of the Royal London Hospital was completed over two years. Patients with language barriers were identified, methods of translation were analysed and interventions to improve access to independent translation were introduced.

Results

Cycle 1- All medical admissions over a two-week period were analysed. 36 patients had documented evidence of a language barrier with 7 (19.4%) having independent professional translation. 20 (55.6%) patients had family members providing translation, for 4 patients limited English was used and previous documentation was used for 3 patients.

Cycle 2- Posters and information leaflets were disseminated regarding how to access translation services. There was no improvement in the types of translation used. Only 1 patient had impartial professional translation, out of 43 patients identified.

Cycle 3- Advocates (Bengali speaking professional translators) were made available on the ward twice a week. Results showed no significant improvement, with only 6 (10%) identified having impartial professional translation. However staff and patient feedback has been positive.

Lessons

Impartial professional translation is essential in reducing barriers and delivering equitable health care. This can be difficult to achieve in busy healthcare services. Education alone is not enough. Good accessibility to translation services is paramount in promoting usage.

Key messages

• Healthcare services often fall short of providing impartial professional translation.

• Education alone is not enough. Good accessibility to translation services is paramount in promoting usage.