bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Excess Deaths in Turin from COVID-19 and other causes, October to November 2020
Authors: Favaro E , Saugo C , Sandu B , DeMaria M , Gnavi R , Lefevre C , Costa G
Published: October 2021

Introduction

Understanding the effect of COVID-19 on mortality during this emergency and evaluating unexplained increases in deaths due to nonspecific outcomes can provide a more complete picture of this period and give better instrument to deal with the pandemy in the future.

Objective

The aim is to evaluate in the city of Turin the excess in the number of deaths from October to November 2020.

Methods

The number of excess deaths was defined as the difference between the deaths observed in the pandemic period of 2020 and the deaths expected for the years 2014-2019.

Results

There were approximately 2047 total all causes deaths in Turin October 1 to November 30 2020, representing 630 more deaths than would typically be expected at that time of year. This excess was higher between men than in women. The number of excess all cause death was higher in 80 years old, less evident between 60-79 years old and very few between under 60 years old. Regarding the place of death, the number of excess all cause death was higher in hospital or in some health institutions for old people. Regarding the causes of deaths the explanation of these excess of deaths was COVID-19 infection only for a part of deaths and there are some excess of deaths not caused by COVID-19. The cause of excess of death not COVID-19 seems to be due to cardiovascular diseases, respiratory diseases, psychiatric disorders, neurological diseases, diabetes or nephrological diseases and to other undefinited causes.

Conclusions

The results showed during pandemic an increase of mortality respect to the expected mortality. Only a part of this excess deaths is due to COVID-19 but there is a relevant percentage of excess of deaths apparentely not due to COVID-19 but probably due to other causes. A better knowledge of these phenomena could help to improve any gaps in territorial assistance and provide indications for the future management of the pandemic in Europe.

Key messages

Increase of mortality in pandemic respect to the expected mortality. There is an excess of deaths apparentely not due to COVID-19.
8.C. Round table: Round table: COVID-19: What have we learned? What are the public health challenges?
Authors:   Organised by: EUPHA,   Chair persons: Peter Allebeck (Sweden), Dineke Zeegers Paget (EUPHA)
Published: October 2021

If there ever was a public health problem where we could learn a lot about public health research, practice, policy and communication, it is the COVID-19 pandemic. With increased knowledge about the spread, the prevention measures, treatment and vaccination, a lot of research on COVID-19 has been and is being published. Looking for COVID-19 articles on google scholar leads to over 3.6 million articles found. Nearly all research published on COVID-19 has been made publicly accessible to allow the latest research to be available for politicians, policymakers, practitioners and laymen.

The quality of the research is sometimes good, sometimes less good (see our recent viewpoints https://academic.oup.com/eurpub/issue/30/5?browseBy=volume). But with the increase in research, it becomes more difficult to find which research is old, outdated and which is new.

Furthermore, all sorts of media have covered the pandemic extensively, in many journals one can find very good reviews and articles by serious journalists, but in many cases, also rumours, guesses and fake news. On top of becoming tired of information overload, it is also more and more difficult to keep track of the development of the research. EUPHA - therefore - decided to publish a supplement to the European Journal of Public Health looking at specific health issues and specific groups that were affected by the pandemic. The supplement aims to present short summaries and updates on some key issues of public health relevance. Topics included range from environment, mental health, legal and ethical issues, health workforce, health inequalities, accountability, opening up the economy and such.

In this Round Table, we will have a number of authors from the EJPH supplement to discuss their findings and find some common grounds on what we have learned from COVID-19 and how to move forward.

Speakers/Panelists

Martin McKee LSHTM, London, UK Elena Petelos Clinic of Social and Family Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece Julian Mamo Public Health Department, University of Malta, Valletta, Malta Ellen Kuhlmann Medizinische Hochschule Hannover, Hannover, Germany Els Maeckelberghe Wenckebach Institute for Medical Education and Training, University Medical Center Groningen, Groningen, Netherlands

Key messages

Learning from this pandemic for future planning is essential. Touching all fields affected by COVID-19 to plan for the future is necessary.
What does it mean to age in good health? An analysis of Time Use Survey data
Authors: Santos JV , Cylus J
Published: October 2021

Background

While there is intrinsic value of ageing in good health, there is little evidence of how the daily lives of older people differ depending on their health status.

Methods

We use Time Use Survey data from the United Kingdom to assess how people at different ages spend their time, conditional on their self-reported health.

Results

While results are preliminary, we find stark differences between people's time use dependent on their health. For example, older people who report good health are more likely than comparable older people to engage in paid work, volunteer, and participate in leisure activities.

Conclusions

There are many benefits to supporting healthy ageing. By considering how time spent differs between those in good and poor health and attributing value to that time, one can take a more holistic perspective when conducting cost-benefit analysis of policy interventions.
A liquid biopsy model to detect eventual pollutants as “one health” tool
Authors: Pepe F , Scotti G , Barbieri O , Vozzella EA , Iervolino A , Malapelle U , Troncone G
Published: October 2021

Environmental pollution (EP), defined as the unfavorable chemical and physical alterations of our surroundings, still represents a relevant issue of this century. In this scenario, several changes may directly or indirectly impact on human health by promoting neoplastic cell transformation due to DNA damage in human tissue. The identification of a specific molecular signature observed in people exposed to environmental contaminants could improve risk calculation of exposition. As regards, DNA methylation is considered an epigenetic modification that could play a pivotal role in the risk calculation of patients under EC exposure. This mechanism, based on the introduction of methyl groups on cytosine's in CpG islands, is carried out by methyltransferases enzymes able to activate this modification in promotor region by influencing regulation process. Several studies demonstrated that methylation pattern is drastically alterated in subjects under EC exposure. To date, several approaches for the early detection of contaminants in biological fluids are under investigation. Liquid biopsy consists in a peripheral blood withdrawn where several biomolecules [cell-free DNA (ccfDNA), circulating tumor cells (CTCs), circulating cell-free RNA (ccfRNA) and exosomes] may be isolated. Students participate to the validation of a LP assay for the evaluation of environmental determinants with the Lab Residents. They assessed the cost-efficacy and the minimally invasive approach in order to construct a reliable model to be exported for the identification of epigenetic changes in the early stage of contamination process in high risk people. The young students role was also to create an informative schedule in order to explain the role and the potential of Liquid biopsy as a non-invasive tool that could allow the analysis of nucleic biomarkers as circulating cell-free DNA (ccfDNA), a potential stable biomarkers of diverse disease conditions in humans and animals.
An overview of AI and Machine Learning methods: motivations, concepts, and examples
Authors: Assouline D , Le Pogam M-A , Pittet V
Published: October 2021

What is artificial intelligence? Big Data? Machine learning? It may seem very difficult to define these terms and identify their use in real life, aside from the hype surrounding them over the past ten years. All of these terms are interconnected - sometimes they intersect, often they are included in each other. The main focus of this presentation is to present ‘Machine learning' methods, which can be defined as algorithms that learn patterns (a function) about a particular phenomenon (an output variable), based on examples (training data), often without any a priori on the shape of these patterns. Therefore, they are a broad family of methods that include traditional statistical methods such as linear regression models, but which often offer more flexibility in terms of hypothesis and complex data settings. Multiple frameworks exist, based on how many examples are available (size of the training data) and the kind of modeling application one wants to perform (e.g., classification, regression, clustering). Many different families of methods exist for each modeling application, which offers a tremendous amount of different algorithms, each having advantages and drawbacks. In practice, easy-to-use libraries were developed in popular programming languages such as Python and R, offering implementations of the majority of essential algorithms.
An introduction to Random Forests for modeling tasks - theory and practice in python with public health case studies
Authors: Assouline D , Le Pogam M-A , Pittet V
Published: October 2021

RFs are a powerful, volatile, and easy to use method, making it an excellent benchmark method for different types of analysis, notably in the public health domain. RFs offer outstanding performance with minimal effort from the user (given its low sensitivity to its hyperparameters) and can be used for many different modeling tasks (classification, regression, clustering, outlier detection). In practice, RFs are easily applicable through libraries in Python and R languages, allowing users to benefit from their capabilities with minimal coding knowledge. In addition to their pure performance abilities, RFs have some practical advantages when compared to many classical statistical models: it does not require any normalization of the data, handles very large datasets (in population or variables) and all kinds of data types (e.g., binary, categorical, continuous); it handles outliers and is insensitive to multicollinearity within the input variables. Their main limitation is their less straightforward interpretation of the final model they build. However, they offer additional tools, such as variable importance and proximity metrics, that improve the understanding of their results and potentially provide insights that traditional models cannot. Finally, its construction based on decision trees grants it additional capabilities, notably the possibility to extract prediction intervals and to handle efficiently imbalanced data problems with a variant of the algorithm called Balanced Random Forests.
Association between economic growth, mortality and healthcare spending in 31 high-income countries
Authors: Sanmarchi F , Golinelli D , Esposito F , Toscano F , Fantini MP , Bucci A
Published: October 2021

Background

During the last decades, countries' healthcare spending has grown continuously, becoming a major expenditure item and threatening the overall sustainability of healthcare systems. Plenty of literature shows conflicting evidence about the relationship between economic variations and measurable health outcomes. This study aims to investigate the association between GDP, population mortality and healthcare spending in OECD high-income countries.

Methods

We conducted a cross-sectional study using panel data across 31 high-income countries from 2000 to 2017. Socioeconomic data for every year and each country were extracted from WHO and OECD Database. The association between current healthcare expenditure (CHE), GDP and mortality rate (MR) was investigated through a random-effects model. To control for possible reverse causality, we adopted a test of Granger causality for heterogeneous panel data models.

Results

The results of the random-effects model show that the MR has no statistically significant effect on CHE. We found no statistically significant association between countries' MR and GDP when the latter is the dependent variable. Our results show that an increase in GDP is associated with a significant increase of CHE (b = 0.066, p < 0.001) and CHE is significantly associated with an increase in GDP (b = 3.188, p < 0.001). The Granger causality analysis shows a unidirectional association between MR and CHE, with MR influencing CHE, albeit with a small statistical significance (p = 0.045). Between GDP and CHE, the causality is bidirectional, while between GDP and MR we found no causality.

Conclusions

In this study, we found a strong two-way relationship between GDP and CHE, both in the causality analysis and in the random-effect panel model. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources often resulting from economic crises, this evidence should be taken into due consideration.

Key messages

Policymakers worldwide need to recognize the economic impact of healthcare spending when allocating financial resources. Spending on health leads to economic growth. In light of the current health-economy dichotomy, it is important to produce robust scientific evidence supporting healthcare spending.
Internal communication within the healthcare system during the COVID-19 pandemic in Latvia
Authors: Kursite M , Stars I , Gobina I , Springe L , Villerusa A
Published: October 2021

Background

Effective communication among health care providers is a key for responding to the rapidly changing health care needs, improving work efficiency, and ensuring patient safety, particularly during the crisis of the COVID-19 pandemic. This study explores the communication-related experiences of healthcare professionals during the first wave of the COVID-19 pandemic in Latvia.

Methods

Semi-structured interviews with 7 chairman of healthcare facilities, 19 general practitioners, and 15 specialists were conducted from September to December 2020. Interviews were recorded and transcribed. Thematic analysis revealed five themes related to internal communication among health care providers. The study was a component of the National research programme VPP-COVID-2020/1-0011.

Results

The 1st theme, ‘Initial chaos paralyzing the system', illustrated the disorderly format of delivering the information that created confusion and anxiety. The 2nd theme, ‘Overwhelming amount of information', revealed the challenge to process new information received daily and from various sources. The 3rd theme, ‘Decentralized decision-making' highlighted the lack of clearly communicated algorithms for specific patients' groups, leaving the decision-making to the health care providers. The 4th theme, ‘Collegial support of the peers”, emerged as a crucial coping mechanism and information channel, substituting for the lack of official information. The 5th theme, ‘Opportunity for growth', consolidated suggestions from health care professionals for improving internal communication in future.

Conclusions

Internal communication as experienced among healthcare professionals was overwhelming and insufficient at the same time. It created an environment promoting closer collaboration among different specialists and suggestions for necessary improvements.

Key messages

Understanding and perception of communication among health care providers in different healthcare system levels were central that affected the health care actions tackling the COVID-19 emergency. Effective communication within the healthcare system is critical during the pandemic. Messages should be clear, evidence-informed, and transparent for targeted action of the health care workforce.
The politics of COVID-19 on the island of Ireland
Authors: Nolan A , Burke S , Burke E , Darker C , Barry J , Dempster M , Graham C , Crowley P , O'Connell N , Scally G
Published: October 2021

Background

Political systems are the means through which the science of public health achieves its objectives. This is a qualitative study of public health policies for COVID-19 in Northern Ireland and the Republic of Ireland that seeks to establish if inter-jurisdictional commitments have led to co-ordination and co-operation on the island of Ireland.

Methods

10 indicators from the OxCGRT codebook directed data collection with directed qualitative content analysis supporting comprehensive reading of policy documents. Cross-case and within-case analysis of policy alignment and divergence across ten OxCGRT indicators was undertaken.

Results

Closing Schools Republic of Ireland: 12th March 2020 Northern Ireland: 23rd March 2020; Workplace Closing - Republic of Ireland: 12th and 15th March and 24th March 2020. Northern Ireland: 20th March 2020 followed by mandatory closure on 28th March 2020. Cancelling events and mass gatherings (St Patrick's Day, 17th March)-Republic of Ireland: 9th March 2020-Northern Ireland: 9th March 2020;Lockdown/Shelter-in-place policies. Republic of Ireland: 27th March 2020- Northern Ireland: 28th March 2020; Restrictions on Internal Movement Republic of Ireland: 27th March 2020 Northern Ireland: 28th March 2020. Physical Distancing Measures -Republic of Ireland: 2-metres 24th March 2020 Northern Ireland: 2 metres 23rd March 2020. Mandatory Face Masks in Enclosed Spaces-Republic of Ireland: 10th August 2020 -Northern Ireland: 10th August 2020.

Conclusions

The historical and constitutional politics of the island of Ireland is the obstacle to an all-island response to COVID-19 and this has almost certainly been compounded by Brexit. Defying the odds, however, this study has demonstrated substantial public health policy alignment brought about through ongoing dialogue and co-operation between the health administrations in each jurisdiction.

Key messages

Historical and constitutional politics of the island of Ireland is the obstacle to an all-island response to COVID-19. Even pandemics cannot overcome realpolitik.
Instrumental, structural & discursive power & the regulation of online advertising of unhealthy food
Authors: Carters-White L , Hilton S , Skivington K , Chambers S
Published: October 2021

Background

Examinations of corporate power demonstrate how Unhealthy Commodity Industries (UCIs) exert influence on the public and policymakers. For example, the High in Fat Sugar and Salt (HFSS) product industry exploit online environments to market their products to young people as a form of discursive power, and regulating this marketing can limit the power of those industries and is recognised as an important policy response. Here we address the gap in consideration of stakeholders' views of regulation of online advertising of HFSS products to young people to limit industry power.

Methods

We undertook primary analysis of 8 focus groups of parents, 11 stakeholder interviews and secondary analysis of 15 focus groups of young people (aged 12 and 15 years-of-age) in various community settings, with 5 individual interviews over the telephone. Focus group participants were recruited from a range of socioeconomic areas following the Scottish Index of Multiple Deprivation quintiles. Stakeholders were recruited from civil society organisations, government bodies and industry. Analysis employed Fuchs and Lederer's (2007) framework on instrumental, structural and discursive power.

Results

Stakeholders' views on the power of HFSS product industry appeared to predicate their views on regulation as an appropriate policy response. The majority of participants viewed regulation as a means to increase young people's and parents' autonomy over young people's diets by addressing the problematic power dynamic with industry at a policy level, yet concern remained about the adverse impact of regulation on individual autonomy.

Conclusions

Power is an important consideration when examining acceptability of To increase public support for regulation, it may be beneficial to emphasise the empowering effects of policy proposals. Advocates should shift their framing of regulation from focusing on restricting industry, to focusing on empowering the public.

Key messages

Views on power appear important when considering public acceptability of regulatory policy. Understanding views on power may improve public health messaging on policy interventions.
Managers’ sick-leave recommendations for employees with common mental disorders – a vignette study
Authors: Hultqvist J , Hensing G , Stansfeld S , Bertilsson M
Published: October 2021

Background

To better understand the initial phases of employee sickness absence due to common mental disorders (CMD), this study explores managers' recommendation for sick leave to a CMD-labelled video vignette case. The aim was to investigate the associations between sick leave recommendation and 1) managers' experience of persons with CMD, and 2) managers' previous recommendation of sick leave for employees with CMD, and 3) managers' attitudes toward employees with CMD.

Methods

An online survey was sent in 2017 to 4,737 Swedish managers, aged 20-65 years (71% participated, n = 3,358). The survey included two randomized video vignettes, one female and one male. The vignettes were two minutes long. For aims 1 and 3 a study sample consisting of 2714 managers were used. For the second aim a sub-sample (n = 1740) was used due to the design of the survey questions.

Results

The bi-variate analysis showed that personal experience of CMD was associated with managers' recommendation of employee sick leave. In the adjusted regression model, it became insignificant (p = 0.056). Having previous experience of recommending sick leave to one employee (OR 3.7, 95% C.I. 2.90-4.73), and to several employees (OR 7.1, 95% C.I. 4.27-11.82), were associated with recommending sick leave, adjusted for gender, level of education, years of managerial experience, and having had management training on CMDs. Finally, there was no significant association (p = 0.071) between negative attitudes towards employee depression and managers' recommendation of employee sick leave to the vignette case.

Conclusions

The likelihood of a manager recommending sick leave after watching a CMD-labelled video vignette was higher if the manager had previously experienced this situation in real life. We consider this study being important as a first study looking into managers' attitudes and personal experience and recommendations of sick leave.

Key messages

The odds for recommending sick leave to a video vignette case was higher if managers had this experience. This study highlights the importance of including managerial behaviors to understand the sick leave process for employees with CMD.
Sociocultural factors of cervical cancer screening uptake among migrant women: a mixed methods study
Authors: Marques P , Gama A , Geraldes M , Silva J , Vaccari N , Dias S
Published: October 2021

Cervical cancer has a high mortality in Europe despite being preventable by cervical cancer screening (CCS). Migrant women have a lower CCS attendance compared to non-migrants. This study aims to describe CCS uptake among migrant women in Portugal and explore sociocultural influences. Within a mixed-methods approach, an online survey and focus group discussions (FGs) were conducted. The survey included 655 migrant women and collected data on sociodemographics, attendance and attitudes toward CCS. Four FGs with 12 healthcare workers and a FG with 5 community workers were conducted exploring perceptions on CCS attendance and barriers among migrant women. Quantitative data was analyzed using descriptive analysis and Chi-Square test and qualitative data through content analysis. Survey data shows that 24.9% of women never had CCS or had it over 5 years ago, more Asian and African women (51.3% and 36.7%, respectively) (p < 0.001). Non-attenders reported significantly more often embarrassment towards CCS (21.7% vs. 18.8% of CCS attenders, p = 0.002) and being unaware of their risk of cancer and the relevance of CCS (28.8% vs. 12.5%, p < 0.001). Around 24% of non-attenders reported concern with having a consultation with a male doctor. For FGs participants, CCS is a taboo in some communities, particularly African, Asian and Muslim. Lack of information about CCS along with feelings of embarrassment and discomfort related to pap smear and with being seen by a male doctor were referred as reasons for avoidance of CCS. Participants also stated that some women have low autonomy and often their husbands have a key role in deciding whether they should attend CCS. Lack of a preventive mindset was also stated as reason for low CCS attendance. The sociocultural background can influence migrant women's attendance to CCS. A culturally grounded approach is needed to provide tailored information on CCS and to create opportunities to engage migrant communities on CCS and improve their uptake.

Key messages

Lack of information, embarrassment and low autonomy hinder some migrant women’s attendance to CCS. The sociocultural influences on CCS uptake call for a culturally grounded approach to provide tailored information and engage migrant communities on CCS.
Interventions aimed at improving health care equity for d/Deaf patients: a systematic review
Authors: Morisod K , Malebranche M , Marti J , Spycher J , Grazioli V , Bodenmann P
Published: October 2021

Background

d/Deaf people suffer from inequitable access to care and health information, which results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people exist in the scientific literature but have to be systematically analysed. The purpose of this systematic literature review was to obtain a global overview of what we know about these interventions.

Methods

Medline Ovid SP, Embase, CINAHL EBSCO, PsycINFO Ovid SP, Central - Cochrane Library Wiley and Web of Science were searched for relevant studies on access to health care, interventions and health education for d/Deaf people following PRISMA-equity guidelines. The outcomes of interest were interventions aimed at achieving equitable care access to health information for d/Deaf people.

Results

Forty-eight studies were analysed. Four main categories of interventions emerged: 1) interventions addressing direct clinical care, 2) health technology-based interventions, 3) interventions focused on patient education, and 4) interventions focused on health care provider education. Among them, access to sign language interpretation or to culturally and linguistically adapted means of communication, use of communication media such as sign language video for the dissemination of medical information, and increasing use of technology (telemedicine, videoconferencing) were effective to strengthen equity in the care of d/Deaf people. Moreover, involving d/Deaf individuals in the conceptualization, creation, implementation and evaluation of interventions seemed to be imperative.

Conclusions

A multi-pronged approach, using a combination of interventions that improve health literacy among d/Deaf patients and promote health care providers' awareness of communication barriers and cultural sensitivity show promise in achieving more equitable care for d/Deaf patients, but more widespread research is needed.

Key messages

The scientific literature has identified and analysed many tools for improving health care equity for d/Deaf people, but their implementation is lacking. The involvement of d/Deaf people in research and implementation processes is crucial for the development of appropriate interventions.
Improving access to health care for asylum seekers in Belgium: a national stakeholder consultation
Authors: Dauvrin M , Detollenaere J , De Laet C , Roberfroid D , Vinck I
Published: October 2021

Background

All asylum seekers (AS) in Belgium are entitled to health care coverage while awaiting a decision regarding a refugee status. However, in practice, numerous public institutions oversee the governance, the distribution of funding and the practical organisation of health care. As a result, AS have currently no guarantee of receiving the health care they need.

Methods

In 2017-2019, a 5-step approach was used. Firstly, 3 data sources were combined to identify major problems and possible options to solve it (literature, interviews, and existing databases). Secondly, these options were submitted to a large panel of Belgian experts, field workers and policymakers through an online survey (n = 171). Survey results and non-consensual results were discussed in a 3rd step with 35 field workers, experts, and policymakers. In a 4 step, individual interviews were conducted with stakeholders likely to be affected by the different options. In a final step, all stakeholders attended a final meeting following by an online consultation to validate the final options.

Results

Stakeholders agreed on 3 basic principles that should sustain a reform of health care for AS: respecting the current legal framework, ensuring equity among all AS and supporting administrative simplification. Three different models of access emerged with 2 options regarding the governance of health care for AS and 3 options for the distribution of the funding. Each model was assessed regarding its impact on the identified problems and the respect of the 3 basic principles. Besides, 8 quick-wins at the system level and 6 at the organisation level were proposed.

Conclusions

Despite the involvement of the policymakers, no consensus was found at the end of the research. Final decision will then remain in the hands of the policymakers.

Key messages

In Belgium, access to health care for asylum seekers is impeded by the numerous public institutions involved. Equity between asylum seekers should be guaranteed by an appropriate governance and an adequate distribution of funding.
Reproductive health services use by the Roma minority women in Romania
Authors: Nanu M , Stativa E , Moldovanu F , Nanu I
Published: October 2021

Backgound

In Romania Roma women are vulnerable to pregnancy-related events, unwanted pregnancies, stillbirth, abortion and cervical cancer. This paper aims to analysis the use of reproductive health services, family planning, prenatal care and screening for cervical cancer by Roma women.

Methods

A secondary analysis was performed on the data of the Reproductive Health Survey in Romania 2016, of a subsample of 314 Roma women, aged 15-44 years.

Results

2/3 of Roma women had their first pregnancy in adolescence, 66.9% between 15-19 and 8.4% under 15 years of age. 65.4% Roma adolescent girls had their first child at 15-19 years, and 2.8% at ages under 15 years. During pregnancy, 24.1% of Roma women do not use prenatal care services, three times more than the women from the reference population (7.1%) (p < 0.01). 73% of Roma women have never benefited from cervical cancer screening compared to 42.7% in the general fertile female population. 46, 7% of Roma women use any type of contraceptive method and 38.1% modern methods, a closed prevalence of contraception in the general population of fertile women (48.4% of any method and 38.7% modern methods)

Conclusions

Roma women have their first pregnancy in adolescence. There are inequalities in the use of preventive services for prenatal care and cervical cancer screening of the Roma female population compared to the reference female population in Romania. Public health policies should include specific active measures for Roma women to improve their access to preventive services. In order to prevent unwanted pregnancies, public health policies in Romania should include family planning measures addressed towards all women, but using methods culturally adapted to the Roma population.

Key messages

There are inequalities in sexual reproductive health services use of Roma minories women I Romania. Services and active preventive mesures should be adressed to Roma populationtion.
Unravelling data for rapid evidence-based response to COVID-19: the unCoVer project
Authors: Pires Sara
Published: October 2021

The unprecedented health system's response to the COVID-19 pandemic is generating a multitude of data that has enormous potential for informing policy and research at the national and international levels. The unCoVer project is a functional network of 29 partners that was established to bring together European and international expertise to monitor, identify, and facilitate the access and utilization of COVID-19 patient's data, to identify knowledge gaps, underrepresented populations, and proactively seek synergies with complementary clinical databases. unCoVer's members are capable of collecting and utilizing data derived from the response and provision of care to COVID-19 patients by health systems across Europe and internationally. These real world data comprise information from electronic medical records from front line hospitals, national surveillance data, and registries. Thus far, they integrate information from over 300,000 COVID-19 patients, which is anticipated to increase as databases are being continuously updated. These data may inform future burden of disease assessments, by gaining a deeper understanding on the disease model and variations among heterogeneous groups of patients, including COVID-19 manifestations in vulnerable population subgroups, and shedding light into post-COVID conditions that may add to the disability estimations. A federated learning platform integrating the characterization of ethical and data protection components from each dataset will be used for pooled analysis. unCoVer will develop a model for the use of dissimilar data sources capable of streamlining ethical and legal aspects for the correct use of data, complying with local and international regulations, and bringing together expertise on the use of advanced computational, epidemiological and biostatistical methods to handle heterogeneous, and multi-layered information aiming for significant medical and public health impact.
Strengthening community self-help clubs for health and wellbeing
Authors: Koot J , Nguyen Van M
Published: October 2021

The SUNI-SEA project invests in community organisations in Vietnam, Myanmar and Indonesia. In Vietnam and Myanmar these organisations are called Intergenerational Self-Help Clubs and aim at strengthening the social cohesion in communities. The organisations stimulate mutual support of members in health, wellbeing and socio-economic sustainability. The SUNI-SEA project analysed relevant factors contributing to increase of self-reported health and wellbeing in the community groups. First of all, there are personal factors of motivation and perceived benefits, whereby members make a strong link between health and wellbeing. Feeling part of a group of like-minded persons is important for participation in group activities promoting health. The social benefit of jointly cooking or performing physical exercises is an important motivation. For many participants, improving health is a natural spin-off of mutual support, rather than a primary goal. Secondly, strong community organisations contribute to increased participation in health activities. When there is a continuous offer of health screening, health promotion activities and welfare activities, participation by members remains constantly high, with very low dropout. Investing in leadership skills, organisational strengthening and communication, pays off for achieving sustainable improvement of health in communities.
Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid
Authors: López-Bueno JA , Navas-Matín MA , Linares C , Mirón IJ , Luna MY , Sánchez-Martínez G , Culqui D , Díaz J
Published: October 2021

Backgraund

The objective of this study was to analyze and compare the effect of high temperatures on daily mortality in the urban and rural populations in Madrid.

Methods

Data were analyzed from municipalities in Madrid with a population of over 10,000 inhabitants during the period from January 1, 2000 to December 31, 2013. Four groups were generated: Urban Metropolitan Center, Rural Northern Mountains, Rural Center, and Southern Rural. The dependent variable used was the rate of daily mortality due to natural causes per million inhabitants (CIE-X: A00- R99) between the months of June and September for the period. The primary independent variable was maximum daily temperature. Social and demographic “context variables” were included: population >64 years of age (%), deprivation index and housing indicators. The analysis was carried out in three phases: 1) determination of the threshold definition temperature of a heat wave (Tthresold) for each study group; 2) determination of relative risks (RR) attributable to heat for each group using Poisson linear regression (GLM), and 3) calculation of odds ratios (OR) using binomial family GLM for the frequency of the appearance of heat waves associated with context variables.

Results

The resulting percentiles (for the series of maximum daily temperatures for the summer months) corresponding to Tthreshold were: 74th percentile for Urban Metropolitan Center, 76th percentile for Southern Rural, 83rd for Rural Northern Mountains and 98th percentile for Center Rural (98). Greater vulnerability was found for the first two. In terms of context variables that explained the appearance of heat waves, deprivation index level, population >64 years of age and living in the metropolitan area were found to be risk factors.

Conclusions

Rural and urban areas behaved differently, and socioeconomic inequality and the composition of the population over age 64 were found to best explain the vulnerability of the Rural Center and Southern Rural zones.

Key messages

Heat waves affect urban and rural areas differently. So results and conclusions from urban areas should not be extrapolated to rural population. Socioeconomic status and ageing are important variables which explain the different behavior of heat waves in different areas.
Childhood consumption of ultra-processed foods and adiposity trajectories: a UK birth cohort study
Authors: Chang K , Khandpur N , Neri D , Touvier M , Huybrechts I , Millett C , Vamos EP
Published: October 2021

Background

Worldwide consumption of ultra-processed foods (UPFs) is continued to rise. Growing evidence has linked higher consumption with elevated risks of obesity and non-communicable diseases in adults. However, the influence of UPFs on long-term adiposity trajectories have not been evaluated in children.

Methods

Prospective birth cohort data were obtained from the Avon Longitudinal Study of Parents and Children. English children with baseline dietary intakes from 3-day food diaries and repeated adiposity measures were followed up from ages 7-24 years. Outcomes included body mass index (BMI), weight, waist circumference (WC), fat mass index (FMI) and body fat percentage. UPFs were identified using the NOVA food classification. Child's consumption of UPFs was derived as a percentage of its weight contribution (gram per day) in the total diet and categorised into quintiles. Longitudinal associations were assessed using linear growth curve models and adjusted for study covariates.

Results

Of the 9025 children followed up over a median (IQR) of 10.2 (5.2-16.4) years. Trajectories of BMI, FMI, weight and WC increased by an additional 0.06 (95% CI, 0.04-0.08) kg/m2, 0.03 (0.01-0.05) kg/m2, 0.20 (0.11-0.28) kg and 0.17 (0.11-0.22) cm per year among those in the highest (vs. lowest) quintile of UPF consumption. Evidence of dose-response relationships were consistently observed with those in the two highest quintiles of UPF consumption showing significantly more rapid progression of BMI, weight, and WC.

Conclusions

Radical and effective public health actions that reduce children's exposure and consumption of UPFs are urgently needed to address the obesity epidemic in England and internationally.

Funding: CM and EV are funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR), Grant Reference Number PD-SPH-2015. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Key messages

Children with highest (vs. lowest) quintile of ultra-processed food consumption had more rapid regression of BMI, FMI, weight and waist circumference from ages 7-24 years. Dose-response relationships were consistently observed in the two highest quintile of ultra-processed food consumption showing more rapid progression of BMI, weight and waist circumference.
What health systems do? Functions as a starting point to assess health systems performance
Authors: Papanicolas Irini
Published: October 2021

Health system assessment (HSA) tools are often built around static health system building blocks, which lead to largely descriptive narrative and lack of linkages to health system outcomes. The development of a common framework that would also focus on performance outcomes is long overdue. We analysed the key HSA frameworks and tools based on them, with the purpose of identifying a common approach that would allow to link health system components to specific outcomes. The presentation will focus on using the health system functions as the basis of conducting the performance assessment. In a second step, the presentation will elaborate on the intermediate and final health system goals as part of the HSPA framework. It will explain their links to the four functions and thus, discuss their relevance for performance assessment.
Quantification of injury burden and barriers in maintaining quality data
Authors: Haagsma J
Published: October 2021

For policy-makers, quantification of the burden of injury and the determination of the relative attributes of avoidable risk factors to this burden are vital tools for priority-setting purposes. This is particularly important in the case of a rapidly changing injury landscape due to effects of the COVID-19 pandemic. Following the 1996 Global Burden of Disease study the disability adjusted life year (DALY) is widely used to assess the burden of injury. The DALY is a population health metric that expresses health loss due mortality, morbidity and disability into a single number. This allows comparisons of distinct health outcomes across subgroups of a population and over time. In addition, cost-of-illness studies can be used to assess the societal burden of injury. Cost-of-illness studies may vary with regards to the time horizon that is used as well as the cost components, which may include intramural and extramural costs as well as productivity loss due work absenteeism due to injury. Essential for the calculation of injury DALYs and cost-of-illness is relevant data on the occurrence of injury, injury deaths, data on exposure to risk factors for injuries, health care consumption and return to work. However, each phase of the pandemic posed different barriers maintaining collection of quality data which may subsequently jeopardize accurate injury DALY calculations and determination of the relative attributes of avoidable risk factors during the COVID-19 pandemic.
9.N. Round table: The comparative politics and policy of Covid-19
Authors:   Organised by: EUPHA-HP, UNESCO Chair GHE, University of Michigan (USA),   Chair persons: Luís Saboga-Nunes (EUPHA-HP), Elize Fonseca (Brazil)
Published: October 2021

The COVID-19 pandemic created unprecedented and turbulent mixtures of political, social, economic, and epidemiological forces. In this workshop the participant will be invited to interact & explore with panelists and other participants on how and why some countries have fared worse than other countries in addressing the threat of SARS-CoV-2, and in many cases fared far worse than expected. The objectives of the workshop are twofold: i) how & why different political systems that were put to the test engage and did what they did; ii) how health promotion in this pandemic play its role to ease the burden of populations. As of this writing, the pandemic is far from over. Therefore the added value of organizing this workshop is to help draw the many lessons that might need to be learned in a shared environment. The politics of COVID-19 during the pandemic warrant a multidisciplinary and multinational analysis. This knowledge can be useful as the world continues to fight COVID-19 and is equally important for thinking about other ongoing and future infectious disease pandemics and the role that health promotion can play.

The round table will include 5 presentations intertwined with discussion grouped by geographical regions. The first presentation will launch the discussion on how The European Union Confronted COVID-19. The second will explore findings of the three approaches to handling the COVID-19 crisis in federal countries (e.g. Germany, Austria, and Switzerland). The third presentation will consider how peripheral countries managed their crisis (e.g. Portugal, Spain, and Italy). The fourth will look at how large countries dealt with the complexity of their territory and population diversity (e.g. Russian Federation Government Control during the Epidemic). Finally a theory-driven perspective on social justice and inclusion based on the salutogenesis approach will propose some discussion points as a take home message.

This round table offers a forum for researchers, practitioners and policy-makers interested in policy analysis. By dialogue and two-way communication lively interaction and vivid discussions will be facilitated. This will allow discussing results regarding their benefit for improving policy research, practice, and policy-making, support further synergies, facilitate networking and collaboration, and support international capacity building

Key messages

Although COVID-19 is effectively unprecedented in the modern world, political systems responding to it need to move from hazard mitigating responses to comprehensive health promotion strategies. We need to maximize a salutogenesis approach since historical continuities, as well as novelties in dealing with pandemics are often political arenas of improvisation focusing the disease realm.