bluuebunny/crossref_metadata_2025 huggingface dataset:
Suggestions for a gender-sensitive and intersectional practice of health monitoring and reporting
Authors: Mena E , Jaehn P , Merz S , Pöge K , Strasser S , Saß A C , Rommel A , Holmberg C , Bolte G
Published: October 2020

Background

Health reports summarize the evidence basis on disease burden and its causes and are intended to inform decisions of policy makers. By focusing on health needs of social groupings according to sex/gender or race/ethnicity, PHMR crucially contributes to achieving health equity. In order to realise its aims, PHMR relies on the availability of high-quality data, appropriate analysis methods and intuitive presentation of results.

Methods

The joint project AdvanceGender used mixed methods to translate principles of intersectionality into new methods for recruitment, data analysis and health reporting. A review of descriptions of representativeness in epidemiological studies was conducted to investigate how an intersectional perspective can inform recruitment. To evaluate intersectional and gender-sensitive data analysis, we reviewed and applied recently developed methods such as classification and regression tree analysis (CART) and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Findings

An intersectional perspective on representativeness unravelled that study participation of women and men might be differential according to further social categories such as civil status or educational level. CART analysis might help to identify intersectional groupings differing in health behaviours or outcomes by exploring a multitude of social dimensions without facing the risk of stereotyping with predefined categories. MAIHDA depicts an alternative method that is suited for descriptive analyses of health-related outcomes among intersectional strata. In contrast to analysing supposedly static features such as sex, a focus on solution-linked variables like social support might be a fertile ground to identify areas for public health action.

Discussion

Principles of intersectionality open up new perspectives for recruitment and data analysis that might be fruitful for population health research and ultimately for PHMR.

 

Greta Bauer

Schulich School of Medicine & Dentistry, Western University, London, Canada

Contact: gbauer@uwo.ca

Olena Hankivsky

University of Melbourne, Centre for Health Equity, Melbourne, Australia Institute for Intersectionality Research, School of Public Policy, Simon Fraser University, Burnaby, Canada

Contact: o.hankivsky@unimelb.edu.au

Nicole Rosenkötter

NRW Centre for Health, Division of Health Reporting, Bielefeld, Germany

Contact: Nicole.Rosenkoetter@lzg.nrw.de
Health reception policies for asylum-seeking and refugee children in the Nordic countries
Authors: Michaëlis C
Published: October 2020

Background

Health reception policies of asylum seekers have become an important part of welfare policy in the Nordic countries. The reception phase seems to have important consequences for the asylum seekers' future health, and addressing health needs early on is instrumental in facilitating individual rehabilitation, integration, educational achievement and labour market participation. Offering health assessment upon arrival may not only benefit the individual but also the society at large.

Methods

The material used in the study was obtained through desk research and combines national laws, acts, regulations, policy documents, national guidelines, research papers and evaluation reports to outline and compare Nordic reception polices and policy development from 1980-2018.

Results

Health reception of asylum seekers has changed considerably over time and varies according to national and local policies of the receiving country. There have been significant differences across the Nordic countries both with respect to coverage and type of health assessments. However, findings suggest a common overarching focus on infectious disease control and acute healthcare needs. Infectious disease control still seems to be a major component of today's health reception, whereas mental health has been a less frequent component in the reception.

Conclusions

The Nordic countries share similarities and differences in their development and implementation of health reception policies. Health reception policies and initiatives in the Nordic countries have changed considerably over time in relation to several factors, including perceived risk of infectious diseases, number of asylum seekers, as well as economic, political and societal factors. Further research is needed on whether and how these policies are carried out in practice, and to explore the effects and outcomes of these policies.
Solidarity and regulatory frameworks in (public health) Big Data
Authors: Puyol A
Published: October 2020

The question of governing medical data use has become very important. The traditional way of governing it is through data protection (e.g. General Data Protection Regulation in EU). However, Prainsack and Buyx (2016, 2017) rightly point out that the strictly regulation approach is insufficient for dealing with all abuses related to the use of big data: excessive control can curb the opportunities and benefits of digital technologies for users and society, and control and regulation may be insufficient in controlling all risks associated with the use of big data. In opposition to the strict regulation approach, they propose a new one, based on solidarity. The solidarity approach entails the acceptance of the impossibility of eliminating the risks of modern data usage, and it implies a formula for compensating those affected by possible abuses: harm mitigation funds. Such funds would help to ensure that people who accept those risks and are harmed as a result have appropriate support. I do not question the adequacy of harm mitigation funds, but rather the conception of solidarity that they choose to justify them. I argue that this conception of solidarity, based on psychology and moral sociology, has less normative force than exists in the strict regulation approach, which is based on the defence of fundamental rights. If we want the policy of harm mitigation funds to have a normative force similar to that of the strict regulation approach, then we must choose a conception of solidarity based on respect for fundamental rights.
13.D. Workshop: SDGs in the focus of environmental and health issues
Authors:   Organised by: EUPHA Environment and health section,   Chair persons: Marija Jevtic – EUPHA-ENV, Peter Van Den Hazel – EUPHA-ENV
Published: October 2020

This workshop is dedicated on SDGs in the focus of environmental and health issues, as very important and actual topic.

One of the characteristics of today's societies is the significant availability of modern technologies. Over 5 billion (about 67%) people have a cellphone today. More than 4.5 billion people worldwide use the Internet, close to 60% of the total population. At the same time, one third of the people in the world does not have access to safe drinking water and half of the population does not have access to safe sanitation. The WHO at UN warns of severe inequalities in access to water and hygiene.

Air, essential to life, is a leading risk due to ubiquitous pollution and contributes to the global disease burden (7 million deaths per year). Air pollution is a consequence of traffic and industry, but also of demographic trends and other human activities. Food availability reflects global inequality, famine eradication being one of the SDGs. The WHO warns of the urgency. As technology progresses, social inequality grows, the gap widens, and the environment continues to suffer. Furthermore, the social environment in societies is “ruffled” and does not appear to be beneficial toward well-being. New inequalities are emerging in the availability of technology, climate change, education.

The achievement reports on the Sustainable Development Goals (SDGs), also point out to the need of reviewing individual indicators. According to the Sustainable Development Agenda, one of the goals is to reduce inequalities, and environmental health is faced by several specific goals.

The Global Burden of Disease is the most comprehensive effort to date to measure epidemiological levels and trends worldwide. It is the product of a global research collaborative and quantifies the impact of hundreds of diseases, injuries, and risk factors in countries around the world.

This workshop will also discuss Urban Health as a Complex System in the light of SDGs. Climate Change, Public Health impacts and the role of the new digital technologies is also important topic which is contributing to SDG3, improving health, to SDG4, allowing to provide distance health education at relatively low cost and to SDG 13, by reducing the CO2 footprint. Community Engagement can both empower vulnerable populations (so reducing inequalities) and identify the prior environmental issues to be addressed. The aim was to search for public health programs using Community Engagement tools in healthy environment building towards achievement of SDGs.

Key messages

Health professionals are involved in the overall process of transformation necessary to achieve the SDGs. Health professionals should be proactive and contribute to the transformation leading to better health for the environment, and thus for the human population.
Sustainable Development Goals and Global burden of disease stakeholders
Authors: Van Den Hazel P
Published: October 2020

The Global Burden of Disease is the most comprehensive effort to date to measure epidemiological levels and trends worldwide. It is the product of a global research collaborative and quantifies the impact of hundreds of diseases, injuries, and risk factors in countries around the world. The publication published in The Lancet on September 12, 2017, namely the study, “Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016,” is the starting point to discuss the health-related SDG indicators as develop by the Institute for Health Metrics and Evaluation (IHME) and Global Burden of Disease collaborators.

The projected increases in mortality are steep for chronic obstructive pulmonary disease and other chronic diseases. Non-communicable diseases are increasingly recognized as major causes of death and disability worldwide. The question is whether the targets in the SDGs are sufficiently addressing these increases. Or are demographic changes underlying the projected increases?

Health related SDGs have been addressed in a tool made by the Institute for Health Metrics and Evaluation (IHME).

Results on air pollution, smoking, unsafe water, sanitation and hygiene are presented by current and projected data in an interactive tool.
Community Engagement: Reducing inequalities acting on environmental health. A Systematic Review
Authors: Sapienza M , Riccardi M T , Nurchis M C , Pascucci D , Damiani G
Published: October 2020

Sustainability is one of the most important challenges for Healthcare Systems all over the world. According to the Sustainable Development Agenda, one of the goals is to reduce inequalities, and environmental health is faced by several specific goals. Community Engagement can both empower vulnerable populations (so reducing inequalities) and identify the prior environmental issues to address. The aim was to search for public health programs using Community Engagement tools in healthy environment building.

A systematic review was conducted searching on Scopus, MEDLINE and Cochrane databases. The search string was created according to the Population-Intervention-Context-Outcome model. The Risk Of Bias In Non-randomized Studies-of Interventions tool was used to assess quality. Data analysis was based on descriptive statistics and a Chi-Square test was performed to compare studies in which the community carried out engagement interventions with or without the direction of public health institutions (p < 0.05).

Of 182 articles, 11 were eventually included. Risk of Bias was moderate in 70% of the articles.

7 studies were conducted in rural areas, while 4 in urban contexts. Target populations were children in 20%, adults in 50% and elderly in 30% of the articles. Concerning the intervention design, 9 studies included the research of local leaderships, and in 7 there were both context study (to identify the main barriers and facilitators) and the active planning of motivational meetings by public health professionals. We found that the level of engagement reached is highly correlated with the presence of public health professionals acting as engaging coaches (p = 0.007).

Community engagement allows Public Health to carry out promotion and prevention programs by leveraging community forces. This study shows that one of the most important ingredients to make it work is the active presence of the Public Health professionals acting as community coaches.
Dissemination strategies: experience and lessons learned
Authors: Arwidson P , Verry-Jolivet C
Published: October 2020

The French national public health agency is building a portal of evidence-based and promising interventions. The aim of this project is to improve the effectiveness and the efficiency of public health interventions. The portal currently contains around 80 descriptive files. But this portal is only part of a system. Each decision maker or project manager interested in an intervention must be able to have access to qualified trainers, to manual and have assistance in quality assessment.

It is also necessary to adapt the interventions to each local context without losing the effectiveness demonstrated in the evaluation or initial research. It is essential to document all the local adaptations in a centralized information system and to compare them with a fidelity measure or a monitoring tool. David Chambers has named this type of system an Adaptome (AJPM 2016; 51: S124-S131).

Several programs, adapted from international programs (Strengthening families' program, Good behavior game, nurse family partnership), or based on French research (Tabado, ICAPS), are being deployed. The challenges and difficulties of these deployments will be discussed.
Evaluation of hazardous alcohol consumption prevalence of university students in Turkey
Authors: Çam C , Kılınç A , Ahmet A , Önsüz M F , Metintaş S
Published: October 2020

Background

The aim of the study was to determine the prevalence of hazardous alcohol consumption (HAC) according to gender among university students and associated factors.

Methods

The study is a cross-sectional study conducted on undergraduate students who were studying at Eskisehir Osmangazi University in 2019. To ensure a representative sample of 26036 students from all grade levels, we used a stratified sampling technique from 11 faculties at the university and the questionnaire was applied to 2349 undergraduate students. The prevalence of HAC was determined with the Alcohol Use Disorders Identification Test (AUDIT). HAC was defined as getting 8 points or more from the AUDIT. Multivariate logistic regression analyzes were performed to examine HAC related factors in males and females.

Results

1250 (53.2%) of the participants were male. The age of the study group ranged between 18 and 35, and the mean (SD) was 21.04 (2.07) years. The prevalence of HAC in the study group was 13.5% (18.8% male and 8.2% female), and lifetime prevalence of alcohol use was 65.3% (74.5% male and 54.8% female). In males; those whose fathers [OR = 1.74; 95% CI: (1.18-2.55)], mothers [1.52; (1.04-2.22)], best friends [2.57; (1.35-4.88)] use alcohol and those who smoke [3.11; (2.06-4.71)], use illicit drugs [2.42; (1.68-3.47)], have depressive disorders [1.68; (1.06-2.68)] were more likely to report HAC. Meanwhile in females, those whose fathers [OR = 1.93; 95%CI: (1.03-3.62)], best friends [6.21; (1.83-21.05)] use alcohol and those who smoke [4.82; (2.53-9.17)], use illicit drugs [4.79; (2.52-9.10)] have depressive disorders [2.96; (1.63-5.39)] were more likely to report HAC.

Conclusions

HAC prevalence is high among university students. The risk of HAC increases with the use of alcohol in family and circle of friends, smoking, illegal substance usage and depressive disorders. The factors associated with the risk of HAC in males and females are similar.

Key messages

The university students are at a higher risk for HAC than the general population. Strategies should be developed to identify and prevent university students who are more likely to use hazardous alcohol and the situations that trigger this consumption model.
Mental Health Comorbidity In HIV-positive Zambian Adults Who Consume Alcohol
Authors: Kanguya T , Vinkoor M , Sharma A , van Wyk S , Paul R , Mayeya J , Murray L K , Sikazwe I , Kane J C
Published: October 2020

Background

Alcohol abuse is common in Zambia and a growing threat to achieving the 90 90 90 treatment target to ending the HIV epidemic. Brief counselling is offered but has limited effectiveness possibly because it does not address the mental health issues that underpin drinking behavior. We assessed the frequency and nature of comorbid mental health issues in HIV-positive drinkers in Zambia.

Methods

As part of an ongoing randomized control trial (NCT03966885), we recruited HIV positive adults on ART who reported at least 1 alcoholic drink in the previous 3 months from two clinics in Lusaka, Zambia. Using audio computer assisted self-interviewers, we captured demographic information and screened for unhealthy alcohol use (AUDIT), depression (CES-D), trauma (HTQ) and other substance abuse (ASSIST). These instruments have previously been validated in Zambia. Established cut-offs were used to define unhealthy alcohol use (AU), depression (DEP), post-traumatic stress disorder (PTSD) and substance abuse (SU).

Results

Among 300 individuals reporting any alcohol use, 165 agreed to screening. 155 participants were recruited, including 93 men and 62 women. Nearly all screened 146 (94.2%) had unhealthy alcohol use and 9 (5.8%) had low to moderate alcohol scores. Comorbid mental health issues were present in 72 % of unhealthy drinkers, most commonly depression 46 (31.5 %) and trauma 35 (24 %). Non-alcohol substance use (7.6 %) comorbidities where less prevalent than mental health comorbidities among those with unhealthy alcohol use.

Conclusions

Among urban Zambian adults living with HIV who reported alcohol consumption at their ART clinic, unhealthy use was the norm; moderate alcohol use was rare. Comorbid mental health issues (particularly depression and trauma) are highly prevalent among unhealthy drinkers with HIV. These data suggest that all unhealthy drinkers should be screened for mental health issues.

Key messages

Alcohol Abuse In HIV Patients Is Common In Zambia. HIV Patients Abusing Alcohol Suffer From Depression and Trauma.
Can digital technology help reduce smoke exposure and protect health in extreme air quality events?
Authors: Campbell S L , Jones P J , Wheeler A J , Lucani C , Williamson G J , Bowman D M J S , Johnston F H
Published: October 2020

Background

In the southern hemisphere summer of 2019-2020, Australia experienced its most severe bushfire season on record. Smoke from fires affected 80% of the population, with large exceedances of the Australian National Air Quality Standard for particulate air pollution recorded in all major population centres during this period. We examined if emerging and innovative digital technology can assist extreme smoke-affected populations to reduce their exposure and protect their health.

Methods

AirRater is a free smartphone app that tracks air quality and user symptoms in near real-time. We distributed an online survey to over 13,000 app users to assess how they used this information during the 2019-20 bushfire season, and if the app was helpful in decision-making around reducing personal smoke exposure.

Results

We received responses from 1732 users (13.3%). Respondents reported that the app was highly useful, supporting informed decisions regarding daily activities during the smoke-affected period. Commonly reported activities supported by information provided through the app were staying inside (76%), rescheduling or planning outdoor activities (64%), changing locations to less affected areas (29%) and informing decisions on medication use (15%).

Conclusions

Smartphone apps enable users to reduce smoke exposure and protect their health by providing individual-level and location-specific data. Furthermore, digital technology such as AirRater provides the potential to provide insight into the community impacts of environmental hazards such as bushfire smoke.

Key messages

Smartphone apps enable users to reduce their smoke exposure and protect their health. These emerging technologies can help public health authorities to understand the community impact of environmental hazards.
Ways of exposing the sexuality of university students in digital media
Authors: Sousa M A , Lima M D O , Oliveira P A
Published: October 2020

Background

Due to social and technological developments, experiences related to relationships between people express changes, which can be observed in social media, especially in social networks and dating and sexual apps. The use of social networks is growing among people of all age groups, which facilitates the maintenance of interpersonal contact and allows some people to get to know each other digitally, in addition to assisting in the search for information about sexuality and making it possible to meet with women. loving or sexual purpose.

Objective

to understand the means that university students express their sexuality in digital media.

Methods

This is a research with a qualitative approach, based on the Theory of Social Representations. University students from Belo Horizonte participated in the study. Data collection took place through a structured questionnaire with open and closed questions made available via the internet. The data were interpreted based on the Structural Analysis of the Narration, proposed by Demazière; Dubar.

Results

Two theoretical categories were listed. Use of digital media for sexual and amorous encounters - university students reveal the use of apps for casual encounters, where they use photos considered sensual to get a date outside the digital medium. Use of digital media as a source of information - the research subjects say they use the internet as a source of information about sexuality, as they still consider this issue difficult to approach with parents. These students also share the acquired information and personal experiences with friends.

Conclusions

In the digital environment, social relations are based on a hypervisibility of personal life on social networks, where intimate, private and especially sexual and body issues are exposed.

Key messages

Understanding how university students express their sexuality in digital media is an important step towards promoting the health of this population group. Social media can be of great value, but it can also present risks. Thus, university students are susceptible to these two factors, especially when it comes to topics such as sexuality.
Urbanization and greenness in HBSC survey: association with overweight and obesity in adolescents
Authors: Bellisario V , Bono R , Squillacioti G , Caputo M , Gintoli I , Borracino A , Lemma P , Dalmasso P
Published: October 2020

Background

Childhood obesity is an important public health issue worldwide and includes different risk factors, such as environmental pollutants exposure or physical activity. Neighborhood composition and green spaces availability could contrast obesogenic lifestyles and promote healthy habits, whereas, urbanization and traffic volume exposure are inversely associated with physical activity and worsen effects on childhood health.

Methods

This project analyzed students involved in the HBSC survey from the Piedmont Region. Data were collected in 2018, following the protocol. All the subjects were georeferenced within buffers around schools. Green-spaces availability was measured by Normalised Difference Vegetation Index (NDVI-satellite images) while urbanization was calculated by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations).

Results

Overall, the sample included 3022 subjects, with amount 50% male/female and 30% for each age group (11-13-15 years old). Concerning weight status, above 14% of the all sample is obese or overweight, with, respectively, 20% among boys and 11% among girls. Preliminary analyses showed an association between weight status and population density (rural vs urbanized areas). Currently, we are analyzing the association with greenness and the other measures of urbanization.

Conclusions

Our preliminary findings suggest that high urbanization levels impact health implementing weight in children. We are testing the hypothesis that greenness positively influences weight status and reduce negative effects of urbanization and air pollution. The managing of these risk factors must be deepened and corroborated by active preventive Public Health strategies for improving children health.

Key messages

Urbanization and greenness may influence weight status in children. Public Health strategies must be improved for children health.
What is the role of community fridges in the UK? An exploratory mixed methods study
Authors: Visram S , Brown E
Published: October 2020

Background

More than one-quarter of the world's population is experiencing severe or moderate food insecurity, yet one-third of all food produced is lost or wasted. In response to this paradox, countries such as Spain, Germany and the UK have introduced community fridges: 'a public space where organisations and households can make perishable foods that would have been wasted available to the community'. The UK is home to the world's first national community fridge network, comprising 90 operational fridges that have so far redistributed 780 tonnes of surplus food. Other fridges exist outside of this network but little is known about what they do or who they serve. The objective of this study was to explore the role of community fridges in the UK.

Methods

A mixed methods approach was used, involving an online survey of community fridge organisers and telephone interviews with a purposively selected sample of respondents. The survey was piloted before being distributed via email and social media. Forty-seven responses were received from individuals representing 42 community fridges, and in-depth interviews were conducted with eight respondents. Data were analysed using thematic analysis.

Results

Three main roles fulfilled by community fridges were identified: reducing food waste; helping those in need; and building a sense of community. Some participants were reluctant to describe their work as being linked to food insecurity, citing the potential for stigmatisation. Others indicated that their primary goal was to tackle hunger in a non-stigmatising way, by providing free access to nutritious foods. A minor theme involved creating opportunities to build community cohesion.

Conclusions

Community fridges may form part of efforts to reduce food waste and tackle growing levels of food insecurity in the UK. This is an area ripe further for research, given the potential to promote sharing and social cohesion but also the risks in terms of stigma, hygiene and food safety.

Key messages

The UK is home to the world's first national community fridge network, but little is currently known about what these fridges do or who they serve. Community fridges have a role in reducing food waste, addressing food insecurity and building community cohesion, although stigma remains a concern.
14.G. Workshop: Teaching ethics in public health and medicine – International experiences, concepts, challenges
Authors:   Organised by: UK Faculty of Public Health, EUPHA Ethics in public health section, DGPH WG Public-Health-Ethik (Germany), SESPAS WG Ethics in Public Health (Spain),   Chair persons: Ilona Koupil - Sweden, Els Maeckelberghe – EUPHA-ETH
Published: October 2020

To conduct good public health practice and research, ethical standards and reflection are essential. Therefore, ethics education rightly plays an increasing role in the training of the public health workforce. The organizers of this workshop all have the theme of ethics education for the public health profession as a priority in their activities. In this workshop, we present recent research findings, lessons learned and challenges in a European and global perspective. The aim of this workshop is to present and discuss these to help public health organizations and institutions of higher education to improving their public health ethics education. The added value of this workshop is to engage - personally - during the conference in Rome with senior public health professionals and researchers and to continue the dialogue on this important issue - a key mission of the EUPHA Ethics in Public Health section.

Four presentations in different formats are planned, a mixture of “Research Abstract” and “Training and Education Abstracts” and presentations respectively are foreseen. The first presentation gives an assessment of how ethics is (or is not) taught in schools of public health and to the public health workforce in Europe. It shows, for the first time, the results of two surveys, among EUPHA and ASPHER members on ethics education. The second presentation gives examples of a university in Barcelona (Spain) on innovative teaching methods at master level and thus gives impulses on how education can be integrated and improved in public health education. The third presentation reflects on the competencies in public health ethics that are aimed at with innovative and traditional teaching methods. Finally, a presentation from Nigeria contrasts educational experiences of low- and middle-income countries with high income countries and shows challenges and collaborative solutions to improved ethics education in the health field. This perspective is especially suitable to be integrated in this workshop given the global character of this year's “World Conference on Public Health”. Mutual learning and support within Europe and globally is key to develop and promote the field of public health ethics education further. A fifth timeslot for a presentation would be possible in this workshop but is not filled on purpose to have sufficient time for a structured debate on challenges and opportunities with the audience and speakers.

Key messages

Public Health Ethics education remains key for professional education; more awareness of ethical competences has to be raised. The diversity of experienced ethics trainings offers a challenging but also promising context to develop and integrate better ethics education.
Responding to COVID19 in Russia
Authors: King E
Published: October 2020

While it is hard to predict what will have happened by the time of the conference, this round table will be tightly templated and coordinated. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened in order to draw comparative lessons about public health politics and governance.
Creating healthy places with the Place Standard Tool – An introduction
Authors: Hasler K , Howie J
Published: October 2020

This presentation will give an overview of the evidence around 'place' - the social AND physical environment - and how it impacts on lifelong health and wellbeing and health inequalities.

It will provide a comprehensive introduction to the innovative Place Standard tool (PST) developed in partnership in Scotland - and how it translates complex health and place-making relationships into a simple set of questions. The resulting tool allows participants to identify strengths and weaknesses and begin to develop a shared understanding of place from which to take collaborative action to improve places and the lives of the people that use them.

It will give a practical guide to how, when and where the PST can be deployed to support the delivery of healthy and equitable places, illustrated by real-life examples of use in a range of scales and contexts by the public sector and by communities across Scotland (and beyond) since its launch in 2015.

It will also draw out the lessons learned during the first phase deployment and showcase the resultant versions that have been developed by the Scottish team to address identified gaps in a changing climate. These new versions, which will be launched in 2020, are: improvements to the main PST intended amongst other things to better enable place-based conversations to address health impacts of climate change; versions for children to support children's rights and participation; and a Design version aimed at architects and planners to support the design process to deliver healthier places.

Key messages

The Place Standard tool is adaptable, easy-to-use and distils complex health evidence into simple questions relevant to a range of scales and types of real-life 'place'. As a practical, accessible framework for place-based conversations to support communities and agencies to together identify priorities for action to deliver high quality, sustainable places, it has proved highly transferable to a variety of contexts and countries.
The US health system: on the brink of major change?
Authors: Rice T , Rosenau P , Barnes A , Unruh L
Published: October 2020

The US system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program, and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditures levels per person far exceeding all other countries, poor objective and subjective indicators of quality and outcomes, and an unequal distribution of resources and outcomes across the country and among different population groups. Because of the adoption of the Affordable Care Act in 2010, and subsequent revisions to it, the US is facing a period of enormous change. There is a great need to improve coverage and improve equity, better ensure quality outcomes, and find ways to better control expenditures.
Factors related to tuberculosis delays: Evidence from nationwide retrospective study in Portugal
Authors: Lutfor Rahman M , Nunes C , Aguiar P
Published: October 2020

Background

Globally, tuberculosis (TB) remains one of the top 10 causes of deaths and the leading cause from a single infectious agent. Delayed TB diagnosis and/or treatment may result in the transmission of bacilli, increasing infectivity, the risk of severe disease states, morbidity and mortality. It is essential to identify the factors that prolong delays in TB services so that health planners can initiate necessary measures to control TB infections.

Methods

A nationwide retrospective study was conducted from 2010 until 2013 to analyze tuberculosis delays under the setting of the Portuguese National Tuberculosis Control Programme. There were 16824 participants who were from 25 administrative districts under 7 regions and were originated from 70 countries in the world. The log-rank test, Cox's regression, and the Kaplan-Meier method have employed to analyze TB delay data.

Results

The median of patients` delay was 34 days with interquartile ranges (IQR) 50 days. Alcohol addicted people with TB infection were delayed by 40 days with 95% CI 37.73-42.28 whereas the non-addicted people took 33 days with 95% CI 32.35-33.65. The median diagnostic delay was 12 days with an IQR of 38 days. The female participants were delayed more than that of male (median delay for female 17 days with 95% CI 15.80-18.19) in TB diagnosis. Further, comorbidities e.g. lung cancer affected TB candidates were delayed more than their counterparts (median delay 37 days with 95% CI 23.29-50.70). The median of public health delays was 63 days with IQR 72 days. The females were delayed more than that of males (median delay 68 days with 95% CI 66.06-69.94). The adjusted Cox's regression identifies the features - older age, female, drug addiction, and community residence as potential factors that might affect TB delays.

Conclusions

It is essential to emphasize on the influencing dynamics - older age, female patients, HIV patients, alcohol addiction, and comorbidities to minimize TB delays.

Key messages

To minimize spreading risk of TB infections the dynamics of TB delays e.g. older age, female patients, drug, and alcohol addiction, comorbidities should be prioritized in the TB control programs. Special attention should be given to other lung diseases while diagnosing TB infections.
Legitimising a ‘Zombie idea’: childhood vaccines and autism
Authors: Rizzi M , Attwell K , Casigliani V , Taylor J , Quattrone F , Lopalco P
Published: October 2020

Background

In June 2017 the Italian government made childhood vaccination mandatory following a drop in immunization rates. In the years preceding, two court judgments affirmed a causal link between vaccines and autism. Studies have linked these decisions to internet searches about vaccine-autism, the popularity of 'no-vax' theories, and drops in immunization rates. This paper provides an in-depth case study of both decisions and their impact.

Methods

We use a synthetic research design reliant on: (i) a systematic collection of primary sources (publicly available and obtained via official access to information requests); (ii) interviews with key actors prominently involved in the two cases or privy to the Italian vaccine-injury compensation regime (iii) a systematic analysis of media coverage.

Results

Circumstantial and systemic flaws enabled these decisions. Poor trial strategies, insufficient resources and laborious communication practices between arms of government were facilitators. Lack of awareness of the social sensitivity of vaccine issues, underestimation of the phenomenon of vaccine hesitancy, and a tendency to 'think in silos' informed the lack of attention dedicated to the cases. The decisions created false expectations of economic benefits and vindication for families with autistic children, resulting in increased litigation. Systemic flaws exist in the process of appointment of expert consultants acting for the court leading to judicial reliance on false data.

Conclusions

Lessons learned include greater levels of attention to vaccine cases by the administration and a matured attitude of adjudicating bodies. Two issues remain: (i) the inability of government lawyers to disseminate positive results to counteract unfounded narratives; (ii) flaws in the process of appointing expert consultants advising courts, which remains focused on the fiduciary nature of the relationship, rather than scientific authority.

Key messages

The Milan and Rimini decisions that directly affected vaccine governance stemmed from a combination of circumstantial decision-making and systemic flaws that still lurk in public health governance. Strategic decision-making that overlooks lower levels of the adjudicative system can lead to significant public health consequences as courts of law and courts of public opinion obey different logics.
Dynamics of multimorbidity in England between 2004 and 2019: a descriptive epidemiology study
Authors: Head A , Fleming K , Kypridemos C , Schofield P , O'Flaherty M
Published: October 2020

Background

An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence.

Methods

We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time.

Results

Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430).

Conclusions

The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends.

Key messages

The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.
Access to healthcare and self-rated health among refugees in transit and after arrival in Norway
Authors: Haj-Younes J , Strømme E , Hasha W , Igland J , Abildsnes E , Kumar B , Diaz E
Published: October 2020

Background

Lack of basic infrastructure and poor provision of health services in conflict settings and during flight can have a negative impact on health. The overall health status of refugees seems to improve after arrival at a safe destination. This may be related to a safer environment and better access to health care services, but prior studies on this topic are limited. This study aims to assess self-perceived access to healthcare and its relationship with self-rated health (SRH) among refugees in transit and when settled in a host country.

Methods

We used data from the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), which includes a cohort of 353 Syrian refugees who were contacted in 2017-2018 in Lebanon while waiting for relocation, and one year after their arrival to Norway. Information on self-perceived access to healthcare and its association with SRH was analyzed separately at each time-point. Data analysis was performed with STATA using logistic regression adjusting for age, gender, ethnicity and years of education and presented as adjusted odds ratios (AOR) with 95% CI.

Results

Fifteen percent reported good access to healthcare and 62% reported good SRH in Lebanon vs. 91% and 77% respectively, in Norway. Measures in Lebanon showed no association between access to healthcare and good SRH (AOR: 1.2 (0.6-2.2)), and men reported worse access to healthcare than women (AOR: 0.5 (0.3-1.0). In Norway, access to healthcare was strongly associated with good SRH (AOR: 4.7 (2.1-10.7) and was negatively associated with belonging to one specific minority group (AOR: 0.1 (0.0-0.3)).

Conclusions

Both SRH and perceived access to care improved from being in transit to being settled in Norway, the latter substantially more. There was a significant association between access to healthcare and good SRH after the refugees' arrival to a safe host country but not in transit.

Key messages

Refugee’s self-reported health and access to healthcare seem to improve shortly after arrival to a host country. To ensure that the UN’S Sustainable Development Goals concerning health equity are reached, refugees’ access to healthcare in transit and its impact on overall health needs to be addressed.
Cross-border value-based innovation procurement in health systems: the Euriphi Project
Authors: Fera F , Di Ciano M , Gorgoni G
Published: October 2020

The EU Coordination and Support Action, under Horizon 2020 “Innovation in Healthcare”, aims at the adoption of innovation in health and care systems and advancing procurement of innovation practices. In response to this initiative, a consortium of 25 leading organizations in procurement and health care has been created. Among the project partners, AReSS Puglia, in collaboration with InnovaPuglia (public provider of Apulian system), analysed and exploited the best integrated solution to adopt in the Health and Care system.

The EURIPHI project has successfully contributed to address common unmet needs and shortcomings in the current care delivery by using value-based innovation procurement for Public Procurement of Innovation Solutions and Pre-Commercial Procurement in the field of rapid-diagnosis of infectious diseases and integrated care.

Regions, providers and procurers joined the effort to map the unmet needs and to have a broader view on demands for innovative solutions for rapid diagnosis for infectious disease and integrated care. After the definition of unmet needs and, therefore of procurement objectives, the EURIPHI consortium organized two Open Market Consultations with the industry, one in the field of rapid diagnosis and in integrated care.

Two ecosystems have been created to ensure the sustainability of the project's

results

the EURIPHI Health & Social Care Regions Network and Value Based Procurement Community of Practice. Puglia Region is at the forefront of the two, together with other relevant healthcare stakeholders across Europe.

The needed reform of health and care systems in Europe requires the adoption of innovation and integrated solutions. One way forward is to rethink procurement policies. A positive transformation in this area definitively is to elevate procurement practices towards an approach that awards the value offered by innovation or integrated solution.
Burden of non-communicable diseases and behavioral risk factors in Albania
Authors: Burazeri G
Published: October 2020

About 85% of the overall burden of disease in Albania is attributable to non-communicable diseases (NCDs) including cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Furthermore, NCDs account for about 94% of proportional mortality in the Albanian population. The three main risk factors responsible for the disease burden in the Albanian population include arterial hypertension, nutritional-related risks, and smoking. High systolic blood pressure accounts for about one-third of the overall mortality rate in Albania. In turn, dietary risks account for about 30% of the total mortality rate and about 15% of the overall burden of disease in Albania. Conversely, the proportional mortality attributable to smoking is about 16%. Smoking epidemics affects predominantly Albanian males and this trend is likely to increase. The proportion of Albanian females who smoke is still quite small (less than 10%) compared with other countries in the region, but female smoking is considered be steadily increasing.

Differences in smoking prevalence amongst males from different socio-economic strata are not significant, whereas among females significant socio-economic differences are noted. Smoking epidemics in the future are expected to demonstrate large socioeconomic differences with lower social classes in both sexes smoking the most. Similar to other countries, actions and measures for tackling NCDs in Albania should include promotion of healthy nutrition; promotion of physical activity; and antismoking policies starting with school age children and have a gender specific component targeting different settings, enhanced by the intensive use of social media.