bluuebunny/crossref_metadata_2025 huggingface dataset:
7.C. Workshop: Towards a true European Health Union: milestones, drivers and barriers
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Matthias Wismar (European Observatory)
Published: October 2022

European health system responses to the COVID-19 pandemic have also demonstrated that European integration in health and health systems add value beyond what individual Member States can do: ranging from the joint purchase of medicines to providing large budgets for building back better. With a true European Health Union we will strengthen our health systems beyond crisis preparedness and response, which is necessary as we are facing the evolving perma-crisis, We will need to strengthen our health systems in general always with a view to Universal Health Coverage and improving health system performance. The European Health Union can work to help strengthen health systems, which may include support for Member States research, learning from best practices, investment but also common solutions including new or extended EU mandates, new arms-length bodies, as well as more coordination or harmonization. It has also taught us that we cannot wait to strengthen our health systems as we are in Europe in a perma-crisis.

The panel will address the following questions:

• Where are we with our progress towards a true European Health Union?

• What policy change is needed to create a true European Health Union?

• What would be the role of the true European Health Union strengthening and supporting Member States?

We will zoom in on the 1) existing public health mandate of the EU, 2) the impact of other EU-policies on health and health systems, 3) the new economic governance and, 4) the role of the EU in global public health

Key messages

• A true European Health Union will strengthen universal health coverage and health system performance.

• A true European Health Union goes beyond crisis-preparedness and respons.

Speakers/Panellists

Scott Greer

University of Michigan, European Observatory on Health Systems and Policies, Ann Arbor, USA

Anniek de Ruijter

University of Amsterdam, Amsterdam, Netherlands

Eleanor Brooks

University of Edinburgh, Edinburgh, UK

Thibaud Deruelle

University of Lausanne, Lausanne, Switzerland
Gender and socioeconomic inequalities in changes in a Mediterranean lifestyle among elderly Italians
Authors: Bonaccio M , Gianfagna F , Stival C , Amerio A , Bosetti C , Cavalieri d'Oro L , Odone A , Zucchi A , Gallus S , Iacoviello L
Published: October 2022

The COVID-19 pandemic and the adoption of restrictive measurements to control the SARS-CoV-2 spread disrupted general population lifestyles including dietary behaviours. However, there is poor knowledge on potential socioeconomic and gender disparities in dietary changes. We conducted a telephone-based survey during fall 2020 on a sample of 4,400 participants representative of the population aged 65-99 years living in Lombardy, Italy. Changes in a Mediterranean lifestyle were assessed retrospectively by asking participants to report modifications in the consumption of nine food groups and five diet-related behaviours (e.g., consumption of organic and local foods) compared to the previous year (2019). We then computed a Mediterranean COVID-19 Pandemic Score (MedCovid-19 Score), reflecting changes during pandemic, ranging from -14 to 14, with increasing values indicating improvements in line with a Mediterranean lifestyle. Overall, 18.3% of the study participants worsened their Mediterranean lifestyle (MedCovid-19 Score <0), 35.1% remained stable (MedCovid-19 Score = 0), while 46.6% reported improvements (MedCovid-19 Score ≥1). Predictors of favourable changes toward a Mediterranean lifestyle were educational level (OR = 1.52; 95% CI 1.19-1.95 for postgraduate vs lower education), wealth (OR = 1.52; 1.14-2.02 for high vs low wealth), and skilled manual occupations (OR = 1.57; 1.28-1.92 vs white collars). Women were more likely than men to move away from a Mediterranean lifestyle (OR = 1.86; 1.58-2.21). In conclusion, improvements in line with a Mediterranean lifestyle prevailed in almost half of a large sample of elderly Italians surveyed during the COVID-19 pandemic. However, changes towards a Mediterranean lifestyle were disproportionately distributed across gender and socioeconomic strata. These findings were similar to those from the general population of the Moli-sani study, where it was observed that healthful dietary changes were associated greater wealth.
Improving nutrition through carbon reduction policies: an online randomized experiment
Authors: Law C , Berger N , Faccioli M , Caine CA , Bateman IJ , Smith RD
Published: October 2022

Background

There has been increasing policy interest in changing dietary patterns to reduce diet-related diseases and improve population health. Meanwhile, the food choices people make every day have a determining impact on the climate change, with food systems responsible for a third of global greenhouse gas emissions. Current policies focused on dietary health are designed, implemented and evaluated in relative isolation, and there is a critical open question concerning the extent of possible synergy with an additional focus on carbon removal.

Methods

We analysed the changes in UK households’ food purchases from an online, randomized control experiment (n = 3933) designed to contrast respondents’ current food purchase behaviour with that under a range of potential tax and labelling policies targeting improvement in dietary health, alone or combined with those designed to reduce carbon emissions. We assessed changes in the healthiness of food baskets between interventions through indicators of: i) purchase of calories; ii) % of calories purchased from 23 food groups; and iii) relative changes in nutrient composition of food purchased.

Results

Food labelling and fiscal measures for both health and decarbonisation have a positive impact on dietary health, by reducing the calorie content of food purchases (p < 0.001). Adding carbon reduction considerations into health policies achieves nutritional improvement by further reducing fat and increasing fibre, resulting in a reduction of up to 193 kcal/person/day (95%CI: 172-214).

Conclusions

With an additional focus on planetary health, the combined (health + carbon) tax and food labelling policies could achieve a reduction in calorie content at a magnitude close to the Public Health England's estimate of average excess calories consumed by adults (195kcal).

Key messages

• Policies focused on achieving both nutrition and carbon reduction goals could achieve greater improvements in food choices and produce win-win scenarios.

• There is a need for greater dialogue and policy development between public health and environmental researchers, practitioners and policy makers.
European HPC cloud infrastructure for managing SARS-CoV-2 data in compliance with GDPR
Authors: Dellacasa C , Ortali M , Rossi E , D'Antonio M , Osmo T , Prasser F , Puskaric M , Rinaldi E ,   Orchestra Working Group, Scipione G
Published: October 2022

The Connecting European SARS-CoV-2 Cohorts to Increase Common and Effective Response to SARS-CoV-2 Pandemic (ORCHESTRA) consortium, led by University of Verona (Italy), brings together key European academic experts and research institutions in infectious diseases, data management and High Performance Computing (HPC) from 26 organizations (extending to 37 partners) from 15 countries. The project aims to create a new pan-European cohort built on existing and new large-scale population cohorts in European and non-European countries to significantly impact on the responsiveness to SARS-CoV-2. The integration and analysis of the very heterogeneous characteristics of SARS-CoV-2 data coming from many different sources such as EHR, retrospective and prospective patient registries, and related ‘omics’ data (incl. genomics, proteomics and transcriptomics) can benefit of data analytics enabled by HPC, where both high compute performance and fast storage capabilities are immensely important. During the first year of the project, a dedicated HPC cloud infrastructure have been designed and partially deployed to fulfill the functional requirements for data management ensuring healthcare data confidentiality/privacy, integrity and security in compliance with the European GDPR regulations. The result is an infrastructure for Data Management composed by three main layers: National Data Providers; National Hubs (one for each HPC center involved: CINECA - Italy, CINES - France and HLRS - Germany), to centralize data at national level and to support data storage, sharing and analysis on data ingested from the National Data Providers; ORCHESTRA Data Portal: the pan-European portal for sharing aggregated data and results. Currently data collection is on going; at the end of the project, clinical centers are expected to have enrolled more than 10.000 patients with about 50.000 samples for the prospective studies.

Key messages

• The SARS-CoV-2 crisis made evident the need to manage and analyse very heterogeneous health data coming from many different resources across different countries.

• The HPC cloud infrastructure released for the Orchestra project can act as a model to manage future public health threats.
JAHEE internal evaluation
Authors: Vantarakis A
Published: October 2022

The evaluation of the project for both the intermediate and the final report was based on an internal evaluation conducted by Work Package on Evaluation and on an external evaluation conducted by the Center for Global Health Inequality Research (CHAIN). The project evaluation as based on systematic and continuous monitoring of processes, outputs and outcomes indicators aimed to guarantee the achievement of the planned objectives and the identification of the lessons learned for future health inequalities programs. The main results will be presented.
Workplace social support, mental health and work functioning among young workers
Authors: de Groot S , Veldman K , Amick BC , Bültmann U
Published: October 2022

Background

Young adults with a history of mental health problems (MHPs) report lower work functioning (WF) compared to their peers without a history of MHPs. The identification of modifiable, protective workplace factors, such as workplace social support, is needed to increase WF.We examined the moderating role of workplace social support from supervisors and co-workers in the prospective association between MHP trajectories from childhood to young adulthood and WF among young adults.

Methods

The most recent 2019/2020 data of N = 861 young workers, participating in the 18-year follow-up Dutch TRAILS (TRacking Adolescents’ Individual Lives Survey) cohort study, was used. MHP trajectories for internalising and externalising problems included measurements at ages 11, 13, 16, 19, 22 and 26. Supervisor and co-worker social support were measured at age 29. WF was assessed at age 29. Logistic regression analyses were conducted to examine the moderating role of workplace social support in the association between MHP trajectories and WF.

Results

Four trajectories were identified for both internalising and externalising problems. Young adults with high-stable MHP trajectories reported more often low WF (ORs 3.73 (95% CI 2.28-6.12) and 2.88 (1.78-4.65) for internalising and externalising problems respectively) than those with low-stable trajectories. Higher supervisor and co-worker social support were associated with a lower odds for low work functioning (adjusted ORs ranging from 0.67 (0.54-0.83) to 0.84 (0.71-1.00)). No moderating effect of workplace social support was found for the association between MHP trajectories and WF.

Conclusions

Both supervisor and co-worker support were shown to be important for all young workers, regardless their history of mental health problems. Occupational health professionals should create awareness among employers and employees that workplace social support is beneficial for young adults’ work functioning.

Key messages

• Both supervisor and co-worker social support are important for all young workers’ work functioning, regardless of their history of mental health problems.

• Creating awareness of the impact of workplace social support on young adults’ work functioning among employers and employees should be a priority area for occupational health practice and policy.
Implementation strategies to integrate academically qualified nurses in German innovator hospitals
Authors: Köppen J , Kleine J , Maier CB
Published: October 2022

Background

In Germany, the number of Bachelor and Master programs for nurses has increased significantly over the past 20 years but the recommended target of 10%-20% of academically qualified nurses has not yet been reached. In university hospitals, it was 3% in 2018. Major challenges for hospital managers are to attract and retain academically qualified nurses in clinical practice, with some hospitals doing better than others.

Methods

In 2020, semi-structured interviews (n = 18) were conducted with chief nursing officers, nurse managers, nurses, and physicians working in five innovator hospitals, characterised by a high willingness to change the work environment, improve quality of care, and increase the number of academically qualified nurses. The interviews were recorded, transcribed, and analysed using Atlas.ti. Mayring's qualitative content analysis method was applied.

Results

Recruiting, retaining, and integrating academically qualified nurses varied in the five hospitals studied but all provided time and/or financial support for nursing students. Those with a longer tradition of attracting academically qualified nurses were following a hospital-wide strategy. CNOs or other leaders motivated nurses to enrol in a degree program, provided close support for clinical projects (e.g., on the ward) and when starting a career (e.g., coaching), and fostered individual career planning. Specialised tasks for nurses with a master's degree were leadership roles or specialised patient care. Taking over additional clinical or scientific activities according to their qualification was seen as beneficial to integrate the nurses. Barriers were the limited acceptance of graduated nurses by nurses with a vocational training, low staffing levels, and limited political support.

Conclusions

Recruiting and retaining graduated nurses takes efforts by hospitals in the current situation of a nation-wide nursing shortage. A hospital-wide approach can be a way to overcome this challenge.

Speakers/Panelist

Inge Rinzema

V&VN VS, Dutch Association of Nurse Practitioners, Utrecht, Netherlands

Johanna Heikkilä

JAMK University, Jyväskylä, Finland

Sabine Valenta

Department of Nursing Science, University of Basel, Basel, Switzerland
Family factors contribute to mental health conditions – a systematic review
Authors: Marth S , Cook N , Bain P , Lindert J
Published: October 2022

Background

Family functioning can have positive and negative mental health consequences. Positive relationships can boost mental health, the opposite is true for negative relationships. 1 in 4 individuals are affected by at least one mental health condition in their life. Family-based interventions can help prevent the onset of mental health conditions and mitigate its consequences.

Methods

Following databases were systematically searched: Medline; PsychInfo, Web of Sciences and Cochrane, resulting in 3719 hits. After removing 12 duplicates, 3707 studies were screened. After exclusion of irrelevant studies, 362 studies were assessed for eligibility and 40 studies were included. Inclusion criteria were original studies with ≥100 participants, ≥18 years, general population, and family members. Exposure had to be family social cohesion or conflict, or social capital. The outcome had to be a mental health condition.

Results

Most studies (n = 37) used a cross-sectional design. 37 studies included a measure of family functioning and 3 studies used one of family structure. Most used was the Family Adaptability and Cohesion Evaluation Scale (n = 17), followed by the Family Functioning Scale (n = 5). Family relationship quality was related to depression, anxiety, and substance use. All aspects family cohesion were related to mental health outcomes. Family conflicts are associated with an increase in mental health conditions.

Conclusions

Family cohesion shows an association with positive mental health while conflict is associated with negative mental health. This is an indication, that interventions at the family level are useful to help prevent/mitigate mental health conditions over the life course. Main message: As mental health conditions are a big public health issue affecting at least 1 in 4 individuals, family-based interventions for mental health condition prevention could not only help individuals but the whole family to strengthen and maintain positive mental health.
Health empowerment and access to health coverage among immigrants in France: the Makasi intervention
Authors: Bousmah M , Gosselin A , Coulibaly K , Ravalihasy A , Desgrées du Loû A
Published: October 2022

Background

The Makasi community-based research project offered an innovative health-related empowerment intervention to immigrants from sub-Saharan Africa living in precarious situations in the greater Paris area, to reduce their social vulnerability and their exposure to HIV. Our objective is to evaluate the impact of the intervention on access to health coverage in this population.

Methods

Participants were recruited based on precariousness criteria in public places in Ile-de-France (squares, railway stations, markets, etc.) by mobile teams of social workers and health mediators. Following a stepped-wedge design, participants were randomised into two groups receiving the intervention sequentially (immediately in one group and 3 months later in the other). We evaluated the impact of the Makasi intervention on access to health coverage among 821 individuals observed at 0, 3, and 6 months, between 2018 and 2021. We implemented random-effects panel models - allowing for unobserved heterogeneity - using a Heckman selection approach to correct for attrition. Finally, we used seemingly unrelated regressions (SUR) to examine the extent to which the effect of the intervention was mediated by health-related empowerment.

Results

Participants - 77% of which were men - had been living in France for 4 years on average. 44% of them had no health coverage at the time of inclusion. Our results provided evidence for a significant impact of the Makasi intervention on participants’ access to health coverage, with an 18 percentage-point increase in the probability of accessing health coverage 6 months after having received the intervention (p < 0.01). The mediation analysis revealed that this effect operated partly through an empowerment process in terms of knowledge of social and health resources.

Conclusions

We showed that a health empowerment intervention provided by social workers and health mediators largely favours access to health rights for immigrants in precarious situations.

Key messages

• A health empowerment intervention improved access to health coverage among immigrants from sub-Saharan Africa living in precarious situations in France.

• Improvement in access to health coverage was found to be partly mediated by reinforcement of participants’ health literacy in terms of social and health resources.
National taxation on sugar-sweetened beverages: a scoping review and time series analysis
Authors: Villani L , Sassano M , Castagna C , Quaranta G , Pastorino R , Boccia S
Published: October 2022

Background

The intake of Sugar-Sweetened Beverages (SSBs) has increased around the world, leading to a growing burden of disease due to these beverages, such as obesity, diabetes, and heart disease. Taxation is a major action for comprehensive programmes aimed at reducing consumption of sugars. For these reasons, the aims of our study were to systematically summarize national tax legislation on SSBs and to assess the impact of these laws on the prevalence of overweight, obesity, and diabetes.

Methods

We conducted a scoping review to summarize the landscape of national tax laws on SSBs implemented worldwide. We included any document reporting both currently into force and past national tax laws addressing SSBs. As to the time series analysis, data regarding the national prevalence of obesity, overweight, and diabetes were retrieved from WHO Global Health Observatory data repository.

Results

As of July 2020, 34 countries worldwide implemented SSB taxation (amount-specific and ad valorem tax design), of which 17 (50.0%) in high-income countries, 12 (35.3%) in upper-middle income countries, and 5 (14.7%) in low-income countries. As for overweight, Hungary was the only country showing a slower rate of change after the taxation. Regarding obesity, France, Guatemala, Hungary and Panama showed a deceleration of the rates of change after the intervention. Eventually, Hungary and Tonga exhibited a one-time decrease of diabetes prevalence at the intervention point. Decelerating rates of change in the post-intervention period was also found for Guatemala and Fiji.

Conclusions

Laws targeting SSBs showed, at least in part, to be an effective measure to reduce the prevalence of overweight, obesity, and diabetes. Less than one fifth of worldwide countries have implemented national taxation policies. Finally, while taxation might be effective to reduce SSB consumption, other types of Public Health interventions, such as educational initiatives, should not be neglected.

Key messages

• Sugar-Sweetened Beverages (SSBs) are associated with obesity, diabetes, and heart disease. Taxation can be an important tool to reduce the consumption of SSBs.

• Prevalence of obesity, overweight and diabetes decreased in countries that adopted taxation. However, other strategies such as educational programs should be implemented to reduce the intake of SSBs.
7.Q. Workshop: What population health researchers’ need and how PHIRI federated research infrastructure can help
Authors:   Organised by: PHIRI, EUPHA-PHMR,   Chair persons: Enrique Bernal-Delgado (Spain), Martin Thißen (Germany)
Published: October 2022

What population health researchers’ need? The population health research community has a vast experience in the reuse of data for health monitoring and surveillance or healthcare performance assessment. However, there is a gap in the extensive reuse of individual sensitive data, particularly when mobilising these data requires the linkage of multiple data sources curated in different sites. The gap is greater when it comes to using sensitive data in cross-national research. The usual arguments to explain the scarce extensive and continuous mobilisation of sensitive data are data privacy and safety issues, the difficulty to discover data sources of value, complex accessing rules, uneven data quality (particularly, non-harmonized data), and limited capacity (personnel and dedicated resources). In InfAct Joint Action, Information for Action, we demonstrated at a very small scale that mobilising individual sensitive data is possible, it is compliant with the legal and ethical requirements, and it yields the expected outputs. The instrument used for such an achievement was the design, implementation and deployment of a very small-scale federated infrastructure, where we could pilot all the legal, organisational, data quality and technological issues related to the mobilisation of individual sensitive data. (https://doi.org/10.1186/s13690-021-00731-z). Building on those achievements In PHIRI (see here https://www.phiri.eu/wp7) we are paving the way for a large-scale research infrastructure where multiple population health researchers with multiple research questions will need the mobilisation of multiple data sources from multiple sites across Europe. The PHIRI enhanced infrastructure will have to be prepared to provide a variety of services for data discovery, data access, data analysis and research outputs FAIR publication, while improving the capacity of population health researchers community in the use of advanced computing tools. In this workshop we will start describing the PHIRI federated research infrastructure achievements, the governance step-wise approach and the technological solutions provided. The workshop will discuss how an enhanced PHIRI could improve its services for the community of population health researchers; in particular improving the analytical capacity and the associated technological solutions. Finally, the workshop will touch ground on the future developments, in particular, the interaction of the PHIRI infrastructure with existen European-wide services providers, as EGI, and research infrastructures.

Key messages

• In the domain of population health sciences, the reuse of individual sensitive data for research purposes is very limited.

• The PHIRI federated research infrastructure is paving the way for population health researchers to enhance their research when reusing individual sensitive data.
Cardiometabolic dysregulation and cognitive decline: potential role of depressive symptoms
Authors: Schmitz N , Deschenes S , McLeish J
Published: October 2022

Background

Previous studies have examined associations of cardiometabolic factors with depression and cognition separately.

Aims

To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies.

Methods

Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940), the Whitehall II study, UK (n = 4469) and the Canadian Longitudinal Study on Aging, Canada (n = 13,720).

Results

Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of -0.15 and -0.41, respectively).

Conclusions

Evidence from three independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline.

Key messages

• Cardiometabolic dysregulation and depression might increase cognitive decline.

• The association between cardiometabolic dysregulation and cognitive decline might be mediated by depression.
How life course socioeconomic conditions shape multimorbidity in old age – a scoping review
Authors: Wagner C , Carmeli C , Chiolero A , Cullati S
Published: October 2022

Multimorbidity is the co-existence of two or more chronic conditions in the same individual and is highly prevalent in ageing populations. Inequity in multimorbidity in old age could have socioeconomic roots that can be traced across the life course. It is, however, unclear if adverse socioeconomic conditions (SEC) at different periods of the life course predict the occurrence of multimorbidity in later life. We reviewed, therefore, studies assessing the association between life course SEC, measured at min. two time points, and later-life multimorbidity. We identified four studies (25,209 participants) with the first measure of SEC in childhood. In these four studies, childhood SEC was associated with multimorbidity in old age, and the associations were partially or fully attenuated upon adjustment for later-life SEC. We identified five studies (91,236 participants) with the first measure of SEC in young adulthood, and the associations with multimorbidity in old age as well as the effects of adjustment for later-life SEC differed from one study to the other. In conclusion, SEC in early life could have an effect on multimorbidity, attenuated at least partly by SEC in adulthood. Our results suggest that interventions and health promotion aiming to reduce the risk of multimorbidity in old age should target early-life socioeconomic conditions.
Challenges in transferring GP to heterogeneous contexts: the JADECARE Joint Action
Authors: Txarramendieta J
Published: October 2022

In this first presentation of the workshop, Jon Txarramendieta, the Project Manager at the Coordination team of JADECARE will present the Joint Action and the challenges in transferring the good practices to the heterogeneous context of the Next Adopters. It will give context to the workshop and introduce good practices that are transferred into action.
Consumption of legumes in children from 3 to 6 years – evaluation of an intervention program
Authors: Amaral A , Carvalho A , Lima J
Published: October 2022

Introduction

Eating habits are a key aspect of a healthy lifestyle. This study focuses on the importance of consuming legumes - rich and accessible source of protein, and a healthy and sustainable option, in environmental terms - contributing to increment health literacy levels at the population level.

Objectives

To design, implement and evaluate a program to promote the consumption of legumes - Beans4Life. Specifically, to assess its impact on the knowledge and frequency of consumption of the eight legumes (beans, grain, peas, beans, beans, lentils, chickpeas and lupins).

Methods

Pre-test post-test analytical study, with three evaluation moments: 1) before the intervention; 2) after the intervention with the children and 3) after the intervention with the guardians (end of the intervention). Participants: 90 children from 3 to 6 years old (54.4% male) and their guardians. Instruments: questionnaire to assess knowledge and food preferences, questionnaire on eating habits and a questionnaire to evaluate sessions. The intervention had two components, the first with the children (4 food education sessions) and the second with the families (activities that facilitate the inclusion of recipes with legumes in the family's daily life).

Results

Before the intervention, the results obtained show low levels of knowledge and frequency of consumption of legumes, influencing low health literacy. Peas and beans are the best known legumes (81.1% and 55.6%) and also preferred (77.8% and 73.3%). The results obtained in the second and third assessments show that there was a significant increase (p < 0.05) in the knowledge and frequency of consumption of most legumes.

Conclusions

The objectives initially proposed were achieved and it will be pertinent to continue the present study, with larger samples, in order to increase health literacy awareness and the consumption of this food group in childhood, and provide more robust results that help to clarify the relationships found.
Suicide Trends during the COVID-19 pandemic and the International COVID-19 Suicide Prevention Research Collaboration
Authors: John A , Pirkis J , Gunnell D , Spittal M , Del Pozo Banos M , Arya V , Shin S
Published: October 2022

Introduction

There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world.

Methods

We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference.

Results

Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas.

Conclusions

This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.
The WHO initiative to measure the effectiveness and impact of PHSM – key activities in 2022
Authors: Ludolph R , Takahashi R , Nguyen T , Briand S
Published: October 2022

The presentation will focus on two main outcomes of the WHO initiative: a global research agenda to steer future evidence generation on PHSM, and a central monitoring system for PHSM research. In September 2021, a global technical consultation with over 60 global experts was organized to review the existing evidence on PHSM and identify the initiative's priorities. The consultation provided an opportunity to have an initial discussion on potential research priorities. This became the basis for an iterative online consultation process. The draft research agenda includes seven main research themes including effectiveness, unintended consequences, methodological challenges and implementation considerations affecting the uptake of and adherence to PHSM. Workshop participants will be invited to comment on the suggested themes and propose additional priority questions for the research agenda. The central research monitoring system will consist of a global repository of primary studies and reviews investigating the effectiveness and broader multisectoral impact of PHSM. Indexed studies will be mapped against the key themes of the research agenda, facilitating real-time monitoring and evaluation of its progress. An AI-based mechanism for automated updating of systematic reviews will complement the database. This one-stop shop will allow researchers and decision-makers worldwide to access the latest evidence on PHSM and keep track of the synthesized effectiveness and impact of different interventions and combinations. The platform will further provide a protected working interface. This monitoring system for PHSM research enables timely access to and utilization of evidence indecision-making processes during health emergencies and fosters international collaboration on the analysis and interpretation of data. Workshop participants will be invited to review the alpha version of the platform.
The health system and health impacts of primary healthcare reform in China: A systematic review
Authors: Cai C , Xiong S , Millett C , Tian M , Hone T
Published: October 2022

Background

China has undergone a comprehensive primary healthcare(PHC) reform since 2009 aiming to deliver accessible, higher-quality, and equitable healthcare. However, there is limited understanding of the effectiveness of this reform. This systematic review synthesizes evidence on health system and health impacts of this reform.

Methods

We searched 13 international databases and three Chinese databases for quantitative studies assessing the impacts of this reform published between January 2009 and March 2020. We searched for studies in English or Mandarin. Eligible study designs were RCTs, quasi-experimental studies and controlled before-after studies. We included studies that: assessed PHC policies since 2009; had geographical, temporal or population comparators; and assessed any outcome measures of health expenditures, health service utilisation, quality of care or health outcomes. Study quality was assessed using ROBINS-I, and results synthesized narratively. PROSPERO: CRD42021239991.

Results

Of 35,480 titles, 37 studies were included (27 in English and ten in Mandarin). Eight were considered at low risk of bias. The 37 studies covered all major PHC policies since 2009, but mostly focused on the essential medicine (N = 15) and financing (N = 10). The quantity and quality of studies on service delivery policies(e.g., family physician and essential health services), were low(N = 3,with moderate or serious risk of bias). 17 studies found that the PHC reforms promoted primary care utilisation. Its impacts on quality and health improvement appear limited to people with chronic diseases(N = 11). Evidence on primary care costs and OOPs were not clear. Some evidence showed that the reforms were pro-equity with benefits accrued in disadvantaged regions and groups.

Conclusions

Comprehensive PHC reforms can deliver some benefits related to utilisation and health for high-risk and vulnerable populations. Policymakers should continue to prioritize PHC to achieve Universal Health Coverage.

Key messages

• The finding suggests that large-scale and comprehensive primary healthcare reforms can deliver benefits related to utilisation and health for high-risk and vulnerable populations.

• Future research should include more robust study designs and seek to better understand the impact of major PHC reforms on quality of care, health outcomes and equity.
Covid-19 pandemic in north-west Italy: the potential role of meteorology, air pollution and pollens
Authors: Squillacioti G , Scaioli G , Cassardo C , Arduino G , Siniscalco C , Siliquini R , Bono R
Published: October 2022

Background

Italy was the first western country severely affected by the Covid-19 pandemic attesting more than 16 million cases since the outbreak began. Po Valley regions have been most afflicted, with Piedmont ranking sixth at 25,899 cases/100,000 inhabitants. Within this area, air dispersion is hampered making Po Valley a recognised air pollution hotspot. We aimed to explore the potential association between the environment and Covid-19 incidence.

Methods

Daily key air pollutants (NO2, NO, CO, O3, PM10, and PM2.5), meteorological parameters (temperature, %humidity, wind speed and solar radiation), pollens and Covid-19 cases were collected from 01/01 to 31/12/2021 in Turin, Italy. This ecological study preliminarily tested correlations (Spearman) between air pollutants and Covid-19 cases.

Results

The Covid-19 pandemic followed a seasonal trend with the highest number of cases (/100,000 inhabitants) in winter and spring (3.1) followed by autumn (1.3) and summer (0.5) (KW test p < 0.0001). Likewise, all air pollutants showed peaks in winter and autumn and sensibly decreased during spring and summer apart from pollens and O3. O3 follows the photochemical processes reaching its peak in the sunniest periods, while pollens undergo their natural vegetative process. Daily Covid-19 cases were positively correlated with daily-averaged NO2 (0.50, p < 0.0001), NO (0.48, p < 0.0001), CO (0.81, p < 0.0001), PM10 (0.36, p < 0.0001), PM2.5 (0.39, p < 0.0001), pollens (0.15, p = 0.073) and inversely with O3 (-0.44, p < 0.0001). We plan future analyses to test the hypothesized association by enhanced models with lagged air pollution variables, with demographic characteristics and meteorological data as potential confounders.

Conclusions

Results from ecological studies may support researchers’ preliminary understanding of the interplay between environment and Public Health issues, including pandemics. A multidisciplinary approach is mandatory to deepen the complexity of this topic across European regions

Key messages

• The Covid-19 pandemic may be associated with environmental conditions and air pollution but further research is needed.

• Atmospheric particulate matter, including aeroallergens, can favour many airborne-related diseases by acting as immune suppressor and/or carrier, but these hypotheses deserve future research.
Specchio-COVID19: a digital cohort study to improve public involvement in epidemiological research
Authors: Baysson H , Pennacchhio F , Bal A , Pullen N , Lamour J , Semaani C , Zaballa ME , Graindorge C , Guessous I , Stringhini S
Published: October 2022

Background

To manage the sanitary crisis and rapidly assess the seroprevalence of anti-SARS-CoV-2 antibodies in the canton of Geneva, we invited previous participants of an annual health survey of the general population to a first serological test. As the pandemic progressed, it become clear that there would be a significant longer impact on health and wellbeing of population. Moreover, there was a need to assess the adherence of the population regarding COVID-19 prevention measures, over time, as well as to provide scientific knowledge about antibodies dynamics and protection from new infections. For all these reasons, a long-term follow-up has been settled via the dedicated digital platform Specchio-COVID19 and on-line questionnaires and repeated serological tests.

Methods

Several measures were designed to maintain high retention and involvement, including regular electronic newsletters with links to a “News” webpage, a “Research” webpage for dissemination of publications and the organization of webinars specifically dedicated to participants. A specific email address and a dedicated hotline were set up so that participants can get in touch with the Specchio-COVID19 team.

Results

Specchio-COVID19 was launched in November, 2020. Up to February 2022, 10'946 individuals (57% women, median age 48) joined the project. Over time, participation rate remains around 65% for each release of questionnaire. 550 participants (5%) definitely dropped out.

Conclusions

Our digital cohort facilitates participants’ involvement, allowing participation from remote locations, organizing webinar, promoting news and scientific information via newsletters and specific webpages and enabling interaction between researchers and participants.

Key messages

• When designing the Specchio-COVID19 digital cohort, the purpose was not only to collect data.

• But to establish a reciprocal exchange of information between researchers and participants, fostering long-term involvement and health empowerment.
The impact of the school-to-work transition on self-rated health & subjective well-being in Germany
Authors: Reuter M , Herke M , Richter M , Diehl K , Hoffmann S , Pischke CR , Dragano N
Published: October 2022

Background

During the school-to-work transition (STWT), young people enter different states as vocational training, university or unemployment that may have immediate or long-term effects on health. Since research has not paid much attention to this, we investigate the development of self-rated health (SRH) and subjective well-being (SWB) during the STWT.

Methods

We used data from Starting Cohort 4 of the German National Educational Panel Study (NEPS), a nationally representative cohort of 11,098 ninth graders (50.5% girls) followed over nine years. Linear panel regression analysis with fixed-effects (FE) was used to explore intra-individual changes in SRH and SWB when moving between different STWT states (school, prevocational program, vocational training, university, employment, unemployment, inactivity). FE impact functions were used to compare trajectories of SRH and SWB by states reached after school-leave. Time-varying control variables were age, household composition, and residential area.

Results

School-leave was linked to increases in SRH and SWB, whereas no impact was found for job entry after vocational training or university. Upward transitions (e.g. from a prevocational program to vocational training, from vocational training to university or from unemployment to employment) increased SRH or SWB, while downward transitions (e.g. from vocational training or employment to unemployment) were related to decreases. Over the years after school-leave, we found a decline in SRH and SWB, which was faster in case of transitions to unemployment or prevocational programs directly after school.

Conclusions

Findings suggest that a smooth STWT is key for good health in youth and adulthood. Health and labour market intervention programs should focus on the time after school-leave, especially on those who are not able to find an academic or vocational training position.
Leo&Giulia: a cartoon series to promote health and prevention in primary school-aged children
Authors: Vecchio R , Meloni A , Gentile L , Gaeta M , Signorelli C , Odone A
Published: October 2022

Background

Coronavirus (COVID-19) pandemic control measures actively involved people who were called to adopt new and unusual lifestyles. In this context, children had to stay home from school for weeks, had to adapt to new teaching methods and give up socializing. In many countries, not much attention was paid to the educational sector, and, ultimately, to children's physical and psychological well-being.

Objectives

In this context, we developed an innovative health education audio-visual model to teach children about public health, empower them to adopt preventive behaviours and limit the risk of infection transmission in schools and in the community.

Results

We designed and produced the animated cartoon series “Leo&Giulia” to convey solid scientific content and key public health messages related to the ongoing COVID-19 pandemic to primary school-aged children. Contents and dialogues were validated by a scientific committee composed of experts in the fields of public health, paediatrics, infectious diseases, and neuroscience, as well as communication experts. The first episode of Leo&Giulia focused on COVID-19 and explained to children what SARS-CoV2 was, its transmission and why schools were closed. Endorsed by the European Commission, it was broadcasted by national public and private television channels and went viral on social media. The second episode of Leo&Giulia, funded by the Italian Ministry of Research, was launched in April 2022 and focused on vaccines and immunization explaining to children how vaccines work and why herd immunity is important for collective health.

Conclusions

Leo&Giulia is an innovative health education project to help children to better understand how to cope with COVID-19 as a public health challenge. More broadly, the series aims to increase youth engagement by promoting public health values and healthy behaviours.

Key messages

• Health promotion targeting children is important and contributes to societal health and wellbeing.

• Cartoon series are an innovative digital health education tool that effectively increase youth engagement on public health values.