bluuebunny/crossref_metadata_2025 huggingface dataset:
Heat Waves and occupational injuries: the importance of a consistent working definition
Authors: Riccò M , Balzarini F , Mezzoiuso A G
Published: November 2019

Introduction

Heatwaves (HWs) have been linked with increased risk of occupational injuries (OIs). As no consistent definition of HW is globally acknowledged, also the actual impact of HWs on the workplaces is not well defined.

Background and aims

Daily numbers of workers compensation claims from all Northern Italy (2013 to 2017, warm season: April to September) from Agricultural and Industry economic sectors (n = 1,907,122) were associated with daily weather data. The impact of average (Tday) and maximum (Tmax) daily temperatures on the risk of OIs was assessed using a time-stratified case-crossover study. HW was defined by 3 or more days having Tday > 97.5th percentile or by Tmax exceeding 5 °C or more historical reference.

Results

A total of 1161205 OIs were retrieved (94.4% from industrial sector). Assuming Tday < 90th percentile as the referent category, the risk for OIs was higher for Tday exposure 95 to 97.5th percentiles (OR 1.43, 95%CI 1.09-1.20 for agriculture; OR 1.40, 95%CI 1.03-1.05 for industry) and for exposures exceeding 97.5th percentiles (OR 1.14, 95% CI 1.09-1.20, OR 1.02, 95%CI 1.01-1.03, respectively), and for days characterized by Tmax > 35 °C (OR 1.27, 95%CI 1.21-1.33; 1.03 95%CI 1.02-1.04). An increased risk for OIs was similarly identified during HWs defined by Tday (OR 1.15, 95%CI 1.08-1.23 for agriculture; OR 1.06, 95%CI 1.05-1.08 for industry), while HWs defined by Tmax were characterized by increased risk only for agricultural workers (OR 1.14, 95%CI 1.12-1.16).

Discussion

Days characterized by very high temperatures were associated with the greatest risk of OIs in the industrial and agricultural settings. As a working definition for HW based on maximum temperatures apparently missed a possible increased risk for OIs in the industrial sector identified by average daily temperatures, our results stress the urgent need for a common and shared definition of HWs, allowing potential stakeholder to put in place appropriate prevention strategies.

Key messages

High environmental temperatures are associated with an increased risk of occupational injuries. Different working definitions of Heat Wave may lead to missing the actual risk for occupational injuries. A shared definition is therefore strongly needed.
Google Trends and forecasting of influenza epidemics in Lithuania
Authors: Austys D , Burneikaitė M
Published: November 2019

Background

Influenza epidemics are a major public health concern, causing hundreds of thousands of deaths worldwide each year. Studies suggest a possible beneficial use of online activity monitoring in influenza epidemics surveillance and forecasting. Until the present time Google search user activity has not been assessed for forecasting of influenza epidemics in Lithuania. Though this country has 2.8 million residents and mother language of majority of them is Lithuanian. Thus, we assessed a possible use of Google Trends for forecasting of influenza epidemics in Lithuania.

Methods

We translated Google queries most commonly analyzed for forecasting of influenza epidemics by other researchers to Lithuanian language and used Google Trends to retrieve data about frequency of their usage in Google Search during the period of last 5 years. We assessed cross-correlation between usage frequency of each query with an incidence rate of acute upper respiratory tract infections (AURTI) and influenza. Providing data available 2 weeks before the first announcement of influenza epidemic, for the query with the strongest correlation we constructed the autoregressive integrated moving average (ARIMA) model and used it to make a forecast for upcoming 9 weeks. Then we assessed the cross-correlation between the forecast and incidence rate of AURTI and influenza.

Results

We found the strongest correlation with an incidence rate of AURTI and influenza for a keyword ‘gripas’ (correlation coefficients were 0.805 and 0.803 for lags of 0 and 1, respectively, p = 0.001). 75% true values of the query usage frequency fell into 95% confidence interval of the forecast by ARIMA(1,0,0)(0,1,0)[52] model. Incidence rate of AURTI and influenza correlated with the forecast having coefficients of 0.902 and 0.733 for lags of 0 and 1, respectively (p = 0.007).

Conclusions

Query ‘gripas’ demonstrated the possible beneficial use in forecasting influenza epidemics 2 weeks before their onset.

Key messages

Google Trends has a potential to be used for forecasting influenza epidemics in Lithuania. Google Search query ‘gripas’ proved the most beneficial for forecasting incidence rate of upper respiratory tract infections and influenza in Lithuania.
Antonovsky meets Honneth or: The sense of coherence and intersubjective forms of recognition
Authors: Rosenlechner-Urbanek D , Garstenauer U
Published: November 2019

Persons who flee their home country are confronted with innumerous stressors. The action research project PAGES (Participation and Health Literacy of Asylum Seekers and Recognised Refugees in Salzburg) asked how their subjective health can be supported - despite experiences of uncertainty and inactivity in the asylum process. In the two yearlong accompanying qualitative research the project investigated into the role of participation, consistency and un-der/overload balance - as defined by (Antonovsky 1979, 1987) - for the well-being of 20 refugees from Syria, Iran, Iraq, Afghanistan, Pakistan, Somalia and Venezuela, aged between 17 and 58 (two thirds thereof were women). The analysis of empirical data showed that the subject-oriented dimensions (Antonovsky 1979, 1987) need to be complemented by intersubjective forms of recognition. First, findings stress the importance of support by “legitimate others” (e.g. social workers) in order to develop a sense of manageability, only briefly mentioned by Antonovsky (1987). Second, the experience of emotional closeness (Shagy/Antonovsky 2000, sphere of love in Honneth 1995) is essential for a person’s well-being, which is often hindered by isolation in refugee camps, relationships under distress or denied family reunification. A third crucial intersubjective dimension is legal recognition and the protection of one’s human dignity (Honneth 1995), which is often violated by racism and other forms of discrimination. Fourth, refugees seek the opportunity to rally for social esteem for their capacities and particularities (Honneth 1995), which is - at least in Austria - hindered by the denial of access to educational institutions and gainful work.

According to these findings, health promotion for refugees in welcoming countries needs to enable positive life experiences regarding participation, comprehensibility, manageability/support by “legitimate others” and emotional closeness, legal recognition and social esteem.

Key messages

For a deeper understanding of salutogenesis, the subject-oriented elements of the sense of coherence (Antonovsky 1987) need to be complemented by intersubjective forms of recognition (Honneth 1995). Health promotion means enabling experiences of participation, comprehensibility, manageability as well as support by “legitimate others”, emotional closeness, legal recognition and social esteem.
Workshop: Population attributable fraction: methodologies, utilization and translations into public health messages
Authors:   Organised by: International Agency for Research on Cancer (IARC), INCa, France Chair persons: Julie Gaillot - France
Published: November 2019

The aim of this session is to give an overview of the methodology, applications, and translations of studies where population attributable fraction is estimated. This session will go through the methodologies of basic population attributable fractions and also further utilization of its method beyond common application today. It will therefore go through best practices and also show case how such estimates can support assessment of prevention programs and also setting up public health messages.
Dietary patterns and gestational weight gain: evidence from the “Mamma & Bambino” cohort
Authors: Maugeri A , Barchitta M , Favara G , Rosa MC La , Mastra C La , Magnano San Lio R , Agodi A
Published: November 2019

Background

In 2009, the Institute of Medicine (IoM) revised the guidelines on recommended gestational weight gain (GWG), taking into account pre-pregnancy body mass index (BMI) independent of age and ethnicity. However, more than half of mothers does not meet these guidelines with adverse outcomes for themselves and for newborns. Here, we used data of 232 women from the “Mamma & Bambino” cohort (Catania, Italy) to investigate the association between maternal dietary patterns, pre-pregnancy BMI and GWG.

Methods

Pregnant women were enrolled during the prenatal genetic counselling, at 4-20 gestational week. Dietary patterns were derived by food frequency questionnaire and principal component analysis. Self-reported pre-pregnancy BMI and GWG was calculated according World Health Organization and IoM guidelines, respectively.

Results

Adherence to the “western” dietary pattern - characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks - was associated with increased GWG (β = 1.217; SE = 0.487; p = 0.013), especially among obese women (β = 7.363; SE = 1.808; p = 0.005). In contrast, adherence to the “prudent” dietary pattern - characterized by high intake of potatoes, cooked vegetables, legumes, rice and soup - was associated with reduced pre-pregnancy BMI (β=-0.651; SE = 0.308; p-trend=0.035). Interestingly, the adherence to this pattern was positively associated with GWG among underweight (β = 4.127; SE = 1.722; p = 0.048), and negatively among overweight and obese (β=-4.209; SE = 1.635; p = 0.016 and β=-7.356; SE = 2.304; p = 0.031, respectively).

Conclusions

Our findings encourage further studies to evaluate potential preventive strategies against inadequate weight gain, including the promotion of healthy dietary habits even during the periconceptional period.

Key messages

Adherence to diet rich in red meat, fries, dipping sauces, salty snacks and alcoholic drinks increases GWG, especially among obese women. Adherence to diet rich in potatoes, vegetables, legumes, rice and soup was associated with lower pre-pregnancy BMI, increased GWG among underweight, and decreased GWG among overweight/obese women.
Trends of diabetes-delated preventable hospitalizations in an italian region from 2006 to 2015
Authors: Cedrone F , Di Giovanni P , Di Martino G , Meo F , Scampoli P , Staniscia T
Published: November 2019

Background

Diabetes-related preventable hospitalizations (DRPHs) are indicators of primary care effective services. The aim of this study is to compute the trends of DRPHs, and to assess the risk factors for increased in-hospital length of stay (LOS) and costs in an Italian region.

Methods

DRPHs were computed following the AHRQ definitions, which include four types: short-term complications (PQI-1), long-term complications (PQI-3), uncontrolled diabetes (PQI-14), lower-extremity amputations (PQI-16). Trends were direct standardized on in-habitants in 2006. Negative binomial regression model was used.

Results

In the study period PQI-1 increased +426.9 %, PQI-3 +175.5%, PQI-14 +231.7% and PQI-16 decreased -26.2%. Prolonged LOS was related to type 2 diabetes (p < 0.001), peripheral vascular disease (p = 0.045), uncomplicated hypertension (p < 0.001), liver disease (p < 0.001) for PQI-1; type 2 diabetes (p < 0.001), uncomplicated hypertension (p < 0.001), complicated hypertension (p < 0.001) for PQI-3; type 2 diabetes (p < 0.001 ), complicated hypertension (p = 0.001), metastasis (p = 0.042) for PQI-14; female gender (p = 0.001), congestive heart failure (CHF) (p = 0.001), valvulopathy (p = 0.024), BPCO (p = 0.028), renal failure (p < 0.001), liver disease (p = 0.015) for PQI-16.Considerable factors affecting the costs were female gender (p = 0.005), peripheral vascular disease (p = 0.006), renal failure (p = 0.050) for PQI-1; type 2 diabetes (p = 0.002), arrhythmia (p = 0.002), peripheral vascular disease (p < 0.001), BPCO (p < 0.001), renal failure (p < 0.001) for PQI-3; peripheral vascular disease (p = 0.004), uncomplicated hypertension (p = 0.005), BPCO (p = 0.011), renal failure (p = 0.009), liver disease (p < 0.001), psychosis (p = 0.027) for PQI-14; CHF (p = 0.014), arrhythmia (p = 0.001 ), uncomplicated hypertension (p = 0.003), renal failure (p = 0.008), deficiency anemia (p = 0.032) for PQI-16.

Conclusions

DRPHs has been increasing and some comorbidities need to be better managed in outpatient setting to reduce LOS and costs.

Key messages

This study addresses the effect of multimorbidity on the burden of diabetes-related preventable hospitalizations using administrative data from an entire italian region over 10 years period. This study uses Prevention Quality Indicators to measure their burden on regional public health and produces useful evidences for the improvement of diabetes management in outpatient setting.
Prevalence of hypertension and diabetes in Finland by different data sources
Authors: Koponen P , Reinikainen J , Tolonen H , Laatikainen T , Jousilahti P , Koskinen S
Published: November 2019

Background

Population level information on the prevalence of hypertension and diabetes is needed to support planning and evaluation of preventive activities and care. Population based health examination surveys (HES) can provide valid information, but they are time consuming and expensive. Administrative registers on hospitalizations and out-patient visits could provide information faster and at less cost.

The aim of this study is to estimate how comparable prevalence estimates of type 2 diabetes (T2D), hypertension and their combination are based on data from the Finnish national health examination survey (FinHealth 2017) and data from administrative hospital and primary care registers in Finland.

Methods

Survey data were linked to care registers using personal identity codes. Survey based hypertension was defined as SBP≥140 mmHg or DBP≥90 mmHg or self-reported use of antihypertensive medications; and T2D as HbA1c ≥48 mmol/mol or self-reported us of diabetes medications. Corresponding indicators from care registers were: hypertension and T2D as a reason for care or visit or having received prescription for diabetes medication (using ICD-10, ICPC and ATC codes).

Results

For hypertension, survey data provided the prevalence of 43 % while only 12 % of individuals were identified as hypertensives in the register data. The prevalence of T2D was 9 % in both data sources. The prevalence of having both hypertension and T2D was 7 % based on survey data and 3 % based on register data. Agreement between survey and register data was lower for hypertension (Cohen’s kappa 0.23) than for T2D (0.84).

Conclusions

Register data provided lower prevalence for hypertension than the survey data. For diabetes, similar prevalences were observed. As there are limitations in the coverage of register data more reliable population level information can be obtained from HES.

Key messages

Health examination surveys cover persons with undiagnosed problems and conditions omitted in national registers. Hypertension and T2D should be monitored with both register and survey data.
Increasing HPV vaccination uptake among adolescents: A Systematic Review
Authors: Acampora A , Grossi A , Barbara A , Colamesta V , Causio F A , Calabrò G E , Boccia S , De Waure C
Published: November 2019

Background

Human Papillomavirus (HPV) is responsible for the development of several pathologies besides the cervical cancer and HPV vaccination is a key strategy for primary prevention. The aim of this research was to identify strategies adopted to increase HPV vaccination coverage among the adolescents.

Methods

A systematic review was carried-out by searching electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords as “papillomavirus vaccine”, “vaccination strategy” and “efficacy”. Articles conducted in high-income countries and evaluating the impact of one or more strategies on vaccination coverage (initiation e/o completion) in adolescents were included.

Results

Out of 3571 single citations screened, 42 papers (2011-2018) were included. Study size ranged from 50 to 325229 individuals. The major part of the studies was from the United States (n = 35; 83,3%) and conducted with an experimental design (n = 17; 40,5%). The evaluated outcomes included first dose uptake, schedule completion, vaccination timeliness and the number of administered doses. Identified strategies included reminds (9), education activities (9), multicomponent strategies (22) and others (2) and were focused on adolescents/parents and/or healthcare providers. Significant positive results were reported in seven studies (77,8%) evaluating the impact of reminds, four studies (44,4%) on education strategies, and in 12 studies (54,5%) on multicomponent strategies. Offering vaccination in “bundle” or during any medical visit was also reported as significantly effective.

Conclusions

Increasing the vaccination coverage is essential to achieve HPV-related diseases control. Several types of strategies are available and showed a positive impact on vaccination uptake, in particular those relied on reminds. Nonetheless, the heterogeneity of interventions suggests the importance to adapt such initiatives to the specific context in order to maximize the improvement in vaccination uptake.

Key messages

Several types of strategies to increase vaccination uptake are available at international level and showed a positive impact among adolescents. These interventions are heterogeneous suggesting the importance of their adaptation to the specific context in order to gain the maximum improvement in vaccination uptake.
Combined healthy lifestyle factors and risk of all-cause and cardiovascular first hospitalization
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Persichillo M , De Curtis A , Cerletti C , Donati M D , de Gaetano G , Iacoviello L
Published: November 2019

Background

We aimed to explore the association of combined healthy lifestyles with risk of first hospitalization for all-cause, cardiovascular disease (CVD), ischemic heart disease (IHD) and stroke in a southern Italian population-based cohort. We also investigated several biological mechanisms possibly on the pathway between lifestyles and health outcomes.

Methods

Longitudinal analysis on 23,161 men and women (aged≥35 y) recruited in the Moli-sani Study (2005-2010). We defined 4 healthy lifestyle factors as abstention from smoking; high adherence to Mediterranean diet; physical activity; absence of abdominal obesity. First hospital admissions for any and CVD-related causes were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression.

Results

Over a median follow up of 7.2 y, we ascertained a total of 9,482 hospitalizations, 3,556 CVD, 939 IHD and 589 stroke-related hospital admissions.

Adherence to all four healthy lifestyles, compared with none or 1, was associated with lower risk of hospitalization for any cause (HR = 0.82; 0.74-0.90), CVD (HR = 0.81;0.69-0.95) and IHD (HR = 0.63; 0.44-0.90) and, to a less extent, with stroke hospitalizations. Inflammatory biomarkers (e.g. C-reactive protein) were likely to partly explain the association between lifestyles and all-cause (14%) or CVD (15%) hospitalizations, while inflammation played a leading role towards risk of IHD (30%) and stroke-related hospital admissions (21%).

Conclusions

The impact of combined 4 healthy lifestyles on first hospitalization risk was considerable. Inflammatory biomarkers explained a large proportion of this association.

Key messages

Improvements to lifestyle reduce the risk of hospitalizations in a general adult population. Achieving a greater number of healthy behaviours has the potential to reduce the burden of hospitalizations and the associated healthcare costs.
Skills building seminar: Innovative future meal services targeting old people in Europe
Authors:   Organised by: EUPHA (FN) Chair persons: Enni Mertanen - Finland, Lise Justesen - Denmark
Published: November 2019

Aging without appropriate nutrition and provision of food services increases risk of malnutrition, weight loss, sarcopenia and lower functional capacity, quality of life and contribute to higher health care costs. It has been found that appetite, functional capacity and quality of life are closely related. New research and recommendations have been published, projects and rehabilitation programmes have been funded and new service models have been suggested, however there is still a need for adapting and implementing further public health tools in order to prevent costly care, this include a need for developing and implementing innovative ways of providing food services in combination with rehabilitation programmes.

The aim of the workshop is collaborative learning, knowledge building and discussion on future actions that is needed in order to improve public health, quality of life among elderly and prevent rising costs of health, care by focusing on food and nutrition services. This include the opportunity to collect new ideas and experiences from audience cross-different countries. Furthermore, the aim of the workshop is to support future collaboration and project ideas as part of EUPHA Section on Food and Nutrition’s work on nutrition for aging people.

The discussion will be based on an introduction of three innovative projects from Scandinavian.

representing different groups of elderly. This include; 1) The young old, retired, home living, in good condition, and active elderly. 2) Community-dwelling frail old people, who need health care and meal services and 3) Residents in nursing homes with a high degree of lost food related functionality.

The workshop is organized by the leaning café -method. This provides an opportunity for all participants to influence the outcome of the workshop. The topics will be:

Young old: How to keep food related functionality in new life situation after retirement? What new food and nutrition services are needed?

Frail old: How to improve food related functionality and prevent frailing? How to use meal services (Meals on Wheels) and nutrition services?

Residents in nursing homes: How to involve residents in meal activities in order to improve or maintain food related functionality in elderly home and quality of life. Which co-operational actions could be implemented.

Key messages

New innovative food and nutrition services design to address risk of malnutrition and loss of functionality among a growing aging population. Different age-groups of elderly need different food and nutrition services.
The Breakfast Club – co-creational meal practices as rehabilitation strategies in nursing homes
Authors: Justesen L , Walter U , Kristensen N H , Beck A M
Published: November 2019

Background

A growing aging population demands new welfare public health activities in nursing homes. Involving residents in meal activity through a co-creational approach as part of a rehabilitation strategy has been suggested as a solution, but knowledge is limited. This project explore how co-creational meal practices in a breakfast club might improve residents’ food related functionality and quality of life.

Methods

The project is designed as a three-year complex intervention study in a Danish nursing home. A breakfast club is held with 4-5 residents (16 all together) and 2-6 staff members on a weekly basis during a period of 10 month. Residents are on shift hosting the club and all members are preparing the meal together. The degree of food related functionality is assessed after each club and is analyzed through paired t-test on mean values. Semi-structured interviews in combination with Research Driven Photo-Elicitation is conducted with 16 residents and 8-10 staff members before, during and after holding the clubs in order to evaluate quality of life and potentials for implementing meal practices to everyday practices. A hermeneutic analysis strategy is applied.

Results

Preliminary results from 12 breakfast clubs finds an increase in residents food related functionality. Data will be presented in November 2019. All residents express impact on quality of life independent of physical or mental state. Improved functionality is not the main value for participation in the breakfast club. Staff became aware of utilizing residents food related functionality.

Conclusions

The study will contribute with new knowledge about whether co-creational meal activities could have a positive effect on functional abilities and improve health-related quality of life in residents in nursing homes. A meal practice based on co-creation has potential to become implemented as a public health activity in nursing homes and increase residents’ quality of life and food related functionality.
Health literacy and physical activity as buffers to counter act work related stress
Authors: Saboga-Nunes L , Madaleno P , Ferreira T , Guerra R , Mata I , Barros B
Published: November 2019

Background

Stress health problems affect 47.8% of the work force in Portugal. It is predicted that, in the next decade, these problems will overcome musculoskeletal disorders, the first cause of employee’s withdrawal from work. Research indicates connections between stress and dimensions of the work place (like job satisfaction). Nevertheless the conceptual understanding of these relationships is sparse. In order to better understand these relationships, this research focus on the use of job–specific models of stress, associating them with health literacy (HL) - in the context of the European Health Literacy Survey framework (HLS-EU) - and physical exercise.

Methods

A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores <30).

Results

Out of the 748 participants (58.7% males, average age of 39 years), 80.4% sometimes and very often experience stress and tension in the workplace. Less than one in every two (44.4%) practice physical activity several times a week. Of the participants, 7.1% have inadequate, 39.0% problematic, 36.6% sufficient and 17.3% excellent HL (HLS-EU-PT). Employees that are more active are those who experience lower levels of stress.

Conclusions

The research of the effects of HL combined with physical exercise, as buffer variables to problems related to the effects of work stress, is a new area of research that may help understand patterns of adherence to activities that can help workers deal with everyday working conditions. More research is needed to integrate HL strategies in the work place.
How does capacity building in public health work? Insights from the midterm evaluation of the CONFIDE project
Authors: Palianopoulou M , Eklund Karlsson L , Aro A R
Published: November 2019

Introduction

In an increasingly complex, rapidly changing world with a growing inequality gap, capacity building (CB) could function as an essential instrument for improving population health in a resilient and sustainable way. The PH community has been engaged in CB for decades, but there is little empirical evidence about the effectiveness of the efforts. Most evaluations focus on the individual level disregarding the complex, dynamic and multidimensional nature of CB. The aim is to provide an overview of CONFIDE’s 4-level evaluation framework - individual, organizational, network and system - and to share the findings and learning from the first 18 project months.

The progress

A participatory, multilevel evaluation approach is used in CONFIDE. Existing evaluation models/tools, adapted to the project needs, are used to evaluate the interventions; Kirkpatrick’s 4-level model guides the assessment of the training program’s effectiveness and impact, social network analysis for the networking interventions and organizational capacity and sustainability tools to evaluate the performance of the C4EHPs. Data collection has been conducted via surveys and document reviews at multiple time points.

The preliminary findings show that, on the individual level, the trainees perceived increased knowledge and skills in the three PH fields. On the organizational level, human resources to deliver PH-related training in the participating Tunisian universities have been developed. On the network level, challenges have been encountered in building partnerships beyond the medical field. On the system level, significant delays have occurred in the establishment of the C4EHPs mainly due to the centralized administrative processes in Tunisia.

Conclusions

While the project’s CB process is still at an early phase, the current findings indicate that the diversity of the activities used has contributed positively to the enhancement of the beneficiaries’ existing capacities in PH.
Workshop: Screening infectious diseases amongst migrants in Europe: The diversity of policies
Authors:   Organised by: French National Institute of Health and Medical Research Chair persons: Martin Duracinsky - France, Manish Pareek - UK
Published: November 2019

In Europe, the prevalence of several infectious diseases such as HIV, hepatitis B, hepatitis C and tuberculosis is higher amongst migrants. Late diagnosis of HIV, hepatitis B and C is a health issue that thwarts prevention efforts. Early diagnosis has obvious benefits, both for the individuals (i.e. earlier access to care with a better life expectancy) and for the community. As regard for HIV, treated patients with an undetectable viral load do not transmit the virus. This is in line with the UNAIDS 90-90-90 target that in every country 90% of people living with HIV should be aware of their positive status, 90% of them should be treated with antiretroviral and within 90% should have an undetectable viral load.

Widespread testing of HIV, HBV and HCV is recommended by European guidelines, such those from European Centre for disease Prevention and Control (ECDC). The ECDC recommends that screening for HIV, hepatitis B, hepatitis C and tuberculosis should be offered to every migrant from countries with a high prevalence (≥1% for HIV and ≥2% for hepatitis B and C). Other recommendations include ensuring that screening and vaccination is voluntary and confidential, that migrants have a quick access to care, addressing barriers to screening, and taking into account the particular issues and needs of migrants. However, European countries have developed diverse guidelines and initiatives to address the issue of screening infectious diseases amongst migrants.

The objective of this workshop is to present several European initiatives to improve the screening of infectious diseases amongst migrants. Four initiatives will be presented and discussed: screening of active tuberculosis amongst asylum seekers with the use of a questionnaire in Switzerland; replacing the systematic chest X-ray with a screening questionnaire for active tuberculosis and introducing rapid tests for HIV, HBV and HCV for all legal migrants at entry point in France, adding HIV, HBV and HCV testing to the compulsory targeted tuberculosis test in the Netherlands and offering targeted tests for latent tuberculosis, HBV and HCV to migrants registering for primary care in the UK.

Key messages

Screening of infectious diseases should be targeted to migrants from high-incidence countries. European practices should be harmonized.
Screening TB in asylum seekers in Switzerland: comparing chest X-ray and interview-based system
Authors: Jackson Y , Zellweger J P
Published: November 2019

Setting

Mandatory initial screening of asylum seekers for tuberculosis (TB) in Switzerland, 2004-2005 and 2007-2008.

Objective

To compare the yield of screening by chest radiography with an individual assessment based on geographic origin, personal history and symptoms.

Design

Cross-sectional retrospective comparison of two 2-year periods.

Results

The prevalence of detected TB cases was defined as the proportion of screenees starting antit tuberculosis treatment for culture-confi rmed pulmonary TB within 90 days. TB prevalence was 14.3 per 10 000 asylum seekers screened (31/21 727) using chest radiography and 12.4 (29/23 402) using individual assessment. The sensitivity of radiography was 100% vs. 55% for individual assessment, but its specifi city was lower (89.9% vs. 96.0%, respectively). The higher sensitivity of radiography meant shorter delays between screening and start of treatment (median 6 vs. 25 days). Its lower specifi city led to a larger proportion of screenees needing further investigations for suspicion of TB (12% vs. 4%).

Conclusions

The interview-based system initially missed more cases, but the ultimate 90-day yield was comparable for the two periods. The main difference is the delay until start of treatment, which potentially increases transmission and secondary cases. The radiograph system was more burdensome to both the health care system and the screenees, as more suspects required further investigations.
Using HBSC data as part of Ireland’s key policy documents: the example of wellbeing
Authors: Molcho M
Published: November 2019

This paper examines the importance of understanding wellbeing in childhood and adolescence, and will present Ireland’s efforts to develop a set of national indicators of wellbeing that are published every two year in the State of the Nation’s Children Report. One of the main source of population based indicators of wellbeing in Ireland is the Irish Health Behaviour in School-Aged Children (HBSC). The HBSC Study in Ireland collects data from 10-18 year olds children since 1998, using a self-completion questionnaire. Data are collected every four years using standardised procedures for sampling and data collection. The same procedures are used since the initiation of the study in Ireland allowing for both cross-country comparison and time trend analysis. As part of the efforts to develop the Irish set of indicators of wellbeing, the HBSC group used a participatory research with children to identify what makes children happy, and the indicators identified by children are now routinely collected. The paper will present these indicators and how they were developed. Most recently, the HBSC study group was asked to develop indicators to the new National Policy framework for children and young people, Better Outcomes Brighter Future, to fill in the gaps in existing knowledge. This further expands the role that the HBSC study in Ireland has in informing policy and in providing data for assessing its success. The paper will present the indicators that are currently used for both national documents, as well as how these were developed.
Using data from the HBSC study for evidence-based suicide prevention in Luxembourg
Authors: van Duin C , Catunda C , Heinz A , Willems H
Published: November 2019

Issue

As suicide is the second leading cause of death for young people, WHO aims to reduce the suicide rate with 10% by 2020 worldwide. In Luxembourg, organization D’Ligue coordinates suicide prevention. Since suicide research has been carried out in the country for a few years only, data on adolescent suicidal ideation is lacking. Therefore, D’Ligue has contacted the Luxembourg team of the international Health Behaviour in School-aged Children (HBSC) study, to identify risk factors for suicide behaviour and derive recommendations from them.

Description of the problem

First, our practice partner wanted us to provide them with basic data on the suicidal ideation of adolescents: How many adolescents are suicidal and what are risk factors? Second, recommendations for practice should be derived from the results. To this end, the HBSC data (2014) of 5262 pupils aged 12-18 were analysed.

Results

15.1% of adolescents thought about suicide last year and 7% attempted suicide. Of the 24 risk factors examined, 12 were found to be significant, with three being particularly important: multiple health complaints (OR: 1.3 for each health complaint, p < 0.001, CI: 1.18 - 1.33), lower life satisfaction (OR: 1.3 for the loss of each life satisfaction point, p < 0.001, CI: 1.17 - 1.33) and frequent physical fighting (OR: 2.4, p < 0.001, CI: 1.57 - 3.74).

Lessons

Risk factors for suicide behaviour known from research have been confirmed for Luxembourg. What is new is that the number of health complaints is the most important risk factor for Luxembourgish adolescents. Therefore, a list of 8 health complaints was validated as a screening tool for suicidal thoughts. In a further step, this tool could be used, for example, by school nurses. The HBSC data can be used to update the national suicide prevention plan.

Main messages

HBSC data are used to: update the Luxembourgish national plan for suicide prevention.investigate a screening tool for adolescents at risk for suicide.
Workshop: Implementing cost-effective policies to reduce the burden of alcohol in the European region: national and local experiences?
Authors:   Organised by: MILDECA, WHO EURO Moderators: Carina Ferreira-Borges - WHO EURO, Nicolas Prisse - MILDECA
Published: November 2019

Countries across the European region have very different approaches to alcohol policies and to their implementation. Presentations by different countries/local authorities will illustrate different interventions taken to reduce alcohol consumption and attributable harm, the effective operational strategy, and the various actors mobilised to promote the coherence and efficiency of inter-sectorial public action (i.e education, health, law enforcement, private sectors). This workshop will contribute to further enabling its participants to set or contribute to set efficient policies aimed at reducing the risks and damages related to alcohol consumption. Moreover, the workshop could result in triggering European synergies and contribute to the promotion and effectiveness of such initiatives.
Daniel Lopez-Acuña
Authors: Lopez-Acuña D
Published: November 2019

Dr Lopez-Acuña will present opportunities to advance health equity by making health systems more accessible for people in situations of heightened vulnerability, including due to irregular status, through actions at the local, regional and international levels.
Role of the health sector in EIA
Authors: Martuzzi M , Nowacki J , Cave B , Mekel O , Silva F , Martin-Olmedo P , Xiao Y , Claßen T h
Published: November 2019

EIA is an obligation for many projects in many countries. Consideration of human health within EIA is also an obligation. This results in an invaluable opportunity for early consideration of a variety of environmental health determinants, leading to minimization of noxious exposures and promotion of the salutogenic factors involved in plans and projects in many sectors. In other words, EIA can be an extremely powerful vehicle to scaling up primary prevention - by far the most effective strategy in public health. This opportunity is further enriched by the recent revision of the EU Directive on EIA, which makes better provision for human health considerations in EIA, in particular referring to the need to address “significant” health effects of plans and projects - without elaborating further.

The health sector can play a key role in EIA by: recognizing the opportunity and its potential, so far under-exploited; engage in dialogue with other sectors, on specific applications; make institutional arrangements so as to secure manpower and competences to contribute to EIA; advocate for a high level of human health consideration in EIAs on the ground.

This process requires careful consideration of needs and constraints of EIA, including a need to establish a common language with other sectors, the identification of realistic, achievable goals, as well as long-term objectives, the consolidation of available methods and tools and a need to engage in possibly unfamiliar conversations. A pragmatic, operational decision on what constitutes significant health effects in the context of EIA may be a good starting point to measure the readiness of the health sector to undertake this journey.
Development of a French ecosystem to support cohorts
Authors: Durrleman S D
Published: November 2019

For a long time, the usual research funding mechanisms in France limited the development of very large databases (funding too low or too short for example). Over the past decade, new measures provided unprecedented momentum in our country to structure large cohorts.

Due to their very broad scope, cohorts are one of the reference instruments for epidemiological and public health research. Cohorts also help to inform decision-making on risk prevention action, enhance the health system or patient care. For these reasons, the French Ministry of Research identified in 2008 cohort as research infrastructures. With this decision, the Ministry recognizes their usefulness for the public health research community, and more broadly for biomedical research. To fund this ambition, a call for proposal was launch in 2010 by the government as part of the ‘Investments for the Future >>. A dozen patient or general population cohorts are funded through this process, such as Constances, E4N or others.

The creation of the National Health Data System in 2017 also reinforces the strategic aspect of cohorts. This system is unique in Europe. He allows cohort data to be linked with data from health insurance, hospital data, causes of death, disability data and supplementary health insurance organizations. The challenge of artificial intelligence also follow the analysis of this data flow.

This model is part of a national strategy with several initiatives: joint coordination, shared services (France Cohortes), the France Médecine Génomique plan and the Health Data Hub, as well as the recently announced launch of 4 Institutes for Artificial Intelligence, three out of them having exploitation of health data at the heart of their development strategy. The objective of this intervention will be to present this french integrated model, and mechanisms developed, in terms of tools, resources or staff, at the service of cohorts and researchers.
Health literacy policy to promote public health in Europe
Authors: Rowlands G
Published: November 2019

Background

Health literacy is gaining increasing attention as a means of promoting individual- community- and population-level health, and is key to delivery of the European Health 2020 policy. European policy frameworks promote a holistic approach to policy at multiple levels in society and across multiple arenas in every-day life.

Methods

An evidence synthesis was undertaken to describe health literacy policies in the WHO European Region: their distribution, organizational levels, antecedents, actors, activities and outcomes, along with the factors influencing their effectiveness. Evidence was obtained by a scoping review of academic literature in English, Dutch and German and of grey literature in English, Dutch, German and Italian, supported by a Region-wide expert enquiry. Emerging findings were presented to representatives from 19 Member States of the Region to check for accuracy and omissions.

Results

The report highlights much good health literacy policy-related activity, mostly in the health and education sectors. Fewer policy-related activities were identified in other areas, such as the lived environment, employment, the media, and digital health. Robust evaluation of policy-related activities was identified in some, but not all, policies.

Conclusions

Suggestions are made for policy-makers to share good health literacy policy practice, and to further develop policy aims and activities across all societal areas. An additional need is the development of robust health literacy metrics to direct resources and monitor the effectiveness of policy activities.
Round table: Academic institutions and regional governments: two worlds apart?
Authors:   Organised by: WHO RHN, Østfold University College, Norwegian University for Life Sciences,   Chair persons: Francesco Zambon - WHO EURO
Published: November 2019

Partnerships can be described as voluntary, equal and binding agreements between different stakeholders about cooperation and efforts towards a common goal. Partnerships are especially seen as a necessary and important factor within governance and for solving complex “wicked problems”. This is reflected both in the European health policy framework Health 2020 and in the 2030 Agenda for Sustainable Development, where the development of partnerships is described as an important tool for achieving goals and obtaining sustainability. Partnerships between regional governments and academic institutions could be especially important, as many countries in Europe delegate power and responsibility for public health to the regional and local level. As regional academic institutions have local knowledge, they might be in a better position for adding more value into collaboration with the health professionals and policy makers working in regional governments.

However, public health partnerships between regional governments and academic institutions are not straight forward, as the operationalization, conceptualization, and prioritization of public health issues varies across sectors. Several pitfalls for successful partnerships have also been identified, such as hidden unwillingness to share information or resources, rapid policy and organizational shifts, resistant ‘silo mentality’, and difficulties to establish evidence of impact. When partnerships are made between academic environments and the practical level in the public sector, different views upon what is actually knowledge and evidence, and how to translate knowledge into practice, lead to challenges.

In this workshop, the complex relationships between academia and practice are discussed, both by examining advantages and by taking a critical stance. The results from a survey of 31 regions within the WHO Regions for Health (RHN) on partnerships will be presented, describing the occurrence of partnerships, how public health partnerships are formalized and organized, important enablers, how collaborations are carried out in practice, perceived benefits and success, and experienced challenges. This will further be elaborated on in a panel discussion between representatives from four regions with longstanding experience with public health partnerships between regional government and academic institutions, sharing examples, experiences and good advice.

Key messages

Despite representing different worlds, partnerships between regional governments and academic institutions are powerful and effective structures to address public health challenges. Sustainable partnerships should patiently be developed through building mutual understanding and trust between motivated individuals representing both academia and regional governments.