bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaccination coverage trends in European Union from 1980 to 2020: A joinpoint Regression Analysis
Authors: Causio FA , Villani L , Mariani M , Pastorino R , De Waure C , Ricciardi W , Boccia S
Published: October 2022

Vaccinations are successful, cost-effective public health interventions; nevertheless, vaccine hesitancy represents a concern and several EU countries have implemented mandatory vaccinations to counteract it. The assessment of vaccination coverage data is helpful to clarify the reason behind this choice better and assess its impact. Data were extracted from the WUENIC database as of July 2021. All the 27 EU countries were included, considering the period from 1980 to 2020 (depending on data availability). Coverage indicators on seven vaccinations scheduled during the first year of life to prevent nine vaccine-preventable diseases were considered. Joinpoint regression was run using Joinpoint Trend Analysis Software 4.9.0.0. For each coverage indicator, the last two trends in time identified by the joinpoint regression were considered to identify countries with a positive vaccination coverage trend (having either the last trend significantly positive or the second last significantly negative but followed by a trend reversal) or a negative coverage trend (having either the last trend significantly negative or the second last significantly positive but followed by a trend reversal). To assess each country, we collated together information on each coverage indicator. A total of 180 jointpoint regressions were run. At least one joinpoint was observed in 144 cases: 39 (27.1%) showed a significant positive trend, and 49 (34%) had a significantly negative one. In 36 cases, there was a single trend lacking a joinpoint, either positive (21, 58.3%), negative (8, 22.2%), or not showing a change (7, 19.4%). Overall, 14 countries had mostly negative vaccination coverage trends, whereas 13 had mostly positive vaccination coverage trends. Systematised data collection and analysis of vaccination coverage trends are needed to support public health systems. EU countries differ broadly, but the overall situation shows that coverage trends are a key issue to be addressed.

Key messages

• Vaccination coverage in the EU shows a general negative trend. The assessment and comparison of coverage trends across EU countries could make policymakers able to respond to critical issues timely.

• Mandatory vaccinations have been issued in different countries to prevent vaccination coverages from decreasing. Some countries have not issued any mandate but show high vaccination coverages.
Menstrual inequity in Spain: a cross-sectional study
Authors: Medina-Perucha L , López-Jiménez T , Jacques-Aviñó C , Holst AS , Valls-Llobet C , Munrós-Feliu J , Martínez-Bueno C , Pinzón-Sanabria D , Vicente-Hernández MM , Berenguera A
Published: October 2022

Background

Menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity. The aim of this study was to assess menstrual inequity and its associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain.

Methods

A cross-sectional online survey-based study was conducted in Spain in March-July 2021. Data were analysed through descriptive statistical analyses and multivariate logistic regression models.

Results

22,823 women and PWM participated (Mean age=33.2, SD = 8.7). Over half had accessed healthcare services for menstruation (61.9%) and had partial/no menstrual education pre-menarche (58.4%). Lifetime menstrual poverty was 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). In turn, menstrual poverty protective factors were having completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and not experiencing financial hardship in the last 12 months (aOR: 0.06, 95% CI, 0.06-0.07). Besides, 75.2% of participants indicated having overused menstrual products because of not having access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.0% of women and PWM. Menstrual discrimination risk was higher among non-binary menstruators (aOR: 1.88, 95% CI, 1.52-2.33). Menstrual-related work (20.3%) and educational (62.7%) absenteeism was reported.

Conclusions

Our study suggests that menstrual inequity in Spain is widespread, especially among those more socioeconomically deprived, vulnerable migrant populations and non-binary and trans menstruators. Findings from this study are being useful to inform future research and menstrual (health) policies.

Key messages

• Menstrual inequity especially impacts socioeconomically deprived, gender nonconforming menstruators and vulnerable migrant populations in Spain.

• Menstrual inequity research is crucial to address social inequities of health and develop menstrual policies.
Associations between perceptions and sick leave duration in dyads of workers and significant others
Authors: Snippen NC , de Vries HJ , Roelen CAM , Hagedoorn M , Brouwer S
Published: October 2022

Background

Dyadic processes of workers and significant others like partners, family members and friends can play an important role in adaptation to chronic disease, thereby influencing health and work outcomes. This study aimed to increase our understanding of dyadic processes in sick leave duration of workers with chronic diseases. We examined illness perceptions, return to work expectations (RTWE) and perceptions about significant other responses (i.e., engagement, buffering and overprotection) of workers and their significant others in relation to sick leave duration.

Methods

This study used survey and registry data of 90 dyads of sick-listed workers with a chronic disease and their significant others. Simple and multiple regressions in which perceptions of workers and significant others were included simultaneously were used to examine associations with sick leave duration.

Results

Workers’ and significant others’ perceptions were moderately to strongly correlated (r ranged from .46 to .80). Sick leave duration was associated with illness perceptions of both workers (b = 8.58, p=.001) and significant others (b = 6.46, p=.008), with more negative illness perceptions associated with a longer sickness absence. In the multiple regression, illness perceptions explained 12.3% of the variation in sick leave duration. Sick leave duration was also associated with RTWE of workers (b=-76.87, p<.001) and their significant others (b=-92.47, p<.001), with more positive RTWE associated with a shorter sickness absence. The RTWE of dyad members accounted for 24.5% of the variance of sick leave duration.

Conclusions

Illness perceptions and RTWE of workers and their significant others are strongly interdependent and associated with sick leave duration of workers with chronic diseases. A dyadic approach targeted at improving illness perceptions and RTWE of both workers and significant others might be more effective than an individualistic approach in preventing long-term sickness absence.

Key messages

• Return to work expectations and illness perceptions of workers and their significant others are associated with the duration of sickness absence of workers with chronic diseases.

• A dyadic approach targeted at both workers and their significant others might be more effective than an individualistic approach in the prevention of long-term sickness absence.
Health literacy among adolescents: summary of some key findings from ten European countries
Authors: Paakkari L , Lahti H , Kulmala M , Paakkari O , Lyyra N
Published: October 2022

Introduction

In research on disparities, the concept of health literacy (HL) as a set of competencies to promote and sustain health may help in understanding the disparities better and in addressing avoidable and unfair health disparities. The presentation will present some key findings on adolescents’ HL levels in ten European countries, and how HL mediates and moderates between various background factors and health outcomes.

Methods

Data consisted of cross-sectional data from Health Behaviour in School-aged Children (HBSC) study from year 2017/18 of ten European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia). Data (n = 14,590 - 22,291) of 13- and 15-year-old pupils were used. Indicators include background variables (e.g. age, gender), Health literacy, Health indicators (e.g. self-rated health (SRH) and problematic social media use (PSMU)). Analysis include (1) Mediator analysis (with Mplus): pearson correlation coefficients, path models (Mplus 7.3 and Maximum Likelihood estimator) and (2) random effects models and moderator analyses (with R-sofware).

Findings

HL is an independent factor explaining disparities in health (e.g. SRH), and a mediator as well as a moderator between health outcomes and background factors. Based on the national analyses HL had significant main effects in every country, but group level differences emerged only in some countries. For instance, in Finland and Belgium, among girls HL lowered the likelihood to problematic social media use, but not among boys.

Discussion

HL is of use in understanding and tackling health disparities among adolescents. Results confirm the need to adopt the principles of proportionate universalism when promoting HL among adolescents to avoid widening the disparities within population groups. Also, country-specific health literacy interventions are needed to secure equity in opportunities of different population groups to benefit from the HL interventions.
Training health professionals in infodemic management to mitigate the harm caused by infodemics
Authors: Purnat TD , Bertrand-Ferrandis C , Yau B , Ishizumi A , White B , Briand S , Ngueyn T
Published: October 2022

Background

Due to their multifaceted impacts on health and society, understanding and controlling infodemics to support uptake of vaccines, public health and social measures, treatments, and health behaviours is rapidly becoming a priority for many health authorities. WHO has developed a comprehensive training programme to support health professionals in the new field of expertise of managing infodemics.

Objectives

The WHO infodemic management multiformat and transdisciplinary training program builds the skills and knowledge needed to prepare for and respond to infodemics. The trainings are built on WHO competency framework for building an infodemic response workforce. The methodology used relies on human-centred and emotional design evidence and practice and uses evaluation for continuous learning design improvement.

Results

Since November 2020, three WHO global trainings organized online with US Centers for Disease Control and Prevention, UNICEF and other partners, including four-week-long simulation exercises, creating a network of 772 infodemic managers in 133 countries. A “train-the-trainers” companion package was prepared and by April 2022 delivered in Iran and Malaysia. Deep dive training modules on specialist infodemic management practice topics have been prepared for use at country level. In addition, a comprehensive set of self-paced free online courses enhances infodemic literacy and resilience to misinformation. Between December 2021 and April 2022, the OpenWHO Infodemic Management 101 course reached over 17 000 enrolments. The training programme will be updated based on evaluations, the feedback from field responders and the updated to the WHO competency framework for infodemic management workforce.

Conclusions

The WHO multiformat blended training program allows an efficient and rapid dissemination of infodemic management skills and knowledge.

Key messages

• A global network of trained infodemic managers is ready to support national preparedness and response planning.

• Skills and knowledge in infodemic management are accessible to all thanks to free online courses.
Impact of Sugar-Sweetened Beverage Taxation Scenarios in Germany: A Comparative Modelling Study
Authors: Emmert-Fees KMF , Felea A , Kypridemos C , Scarborough P , Laxy M
Published: October 2022

Objectives

Taxing sugar-sweetened beverages (SSBs) is recommended to reduce the burden of obesity, cardiovascular disease (CVD) and type 2 diabetes (T2DM). The objective of this study was to quantify the potential long-term health and economic impact of different SSBs taxation scenarios in Germany using simulation models with different granularity.

Methods

We used a multi-state life table Markov cohort (MSLT) and a microsimulation (IMPACT) model to simulate the impact of different SSB taxation assumptions and scenarios on CVD and T2DM in the German population aged 20 years and older over 20 years. Data sources included official population counts, anthropometric and dietary intake data from national surveys and published meta-analyses. Change in beverage consumption by sex and age under different taxation scenarios was estimated using de-novo national price elasticities and changes in body weight were based on an energy equilibrium model. We projected incremental disability-adjusted life years (DALYs) and healthcare costs, comparing results between both models.

Results

Preliminary results from the MSLT model show that a 20% SSB excise tax in Germany could lead to moderate body weight reductions across all age-sex groups. Over 20 years, the tax would reduce healthcare costs by €753 million [95% CI: 527; 1,021] and save 24,380 DALYs [18,460; 33,900] from T2DM alone. Health and economic gains largely depend on the relevance of substitution effects, tax amount and taxed beverage categories. Results including CVD and comparisons with the IMPACT model are work-in-progress.

Conclusions

We show that SSBs taxation in Germany has the potential to reduce healthcare costs and improve population health. The impact of any SSB tax depends on its implementation scenario, which behavioural assumptions hold, and the obesity-related disease outcomes considered for its evaluation. Further research should compare various obesity prevention approaches to support health policy priority setting.

Key messages

• Taxation of sugar-sweetened beverages can reduce healthcare costs and improve population health in Germany.

• The estimated health and economic impact of sugar-sweetened beverage taxation critically depends on tax design and behavioural modelling assumptions.
Measuring Health Insurance Literacy in the Netherlands – first results of the HILM-NL questionnaire
Authors: Holst L , Rademakers JJDJM , Brabers AEM , de Jong JD
Published: October 2022

Background

Many Western countries have healthcare systems that expect their citizens to make critical, well-considered decisions about which health insurance policy best fits their needs and preferences. There are indications that citizens struggle to fulfil this role due to the complexity of the healthcare systems and lack of skills, support or motivation. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. To understand how citizens choose and use a policy, the health insurance literacy measure (HILM) was developed in the US. It seems valuable to investigate the concept of Health Insurance Literacy (HIL) in other countries. This study aims to examine how HIL is distributed among citizens in the Netherlands; and to find out whether certain groups have more difficulty choosing and using a health insurance policy.

Methods

We measured HIL using the HILM-NL questionnaire, a validated and translated version of the HILM. In February 2020, the HILM-NL was sent to 1,500 members of the Nivel Dutch Health Care Consumer Panel. The response rate was 54% (n = 806). Higher HILM-NL scores imply a higher self-assessed ability in choosing and using health insurance.

Results

There is a wide variation in HIL among citizens in the Netherlands. The average total HILM-NL score is 55.14 (ranging from 21-84). Lower-educated citizens (p<.04) and citizens with lower income (p<.01) are relatively more likely to have lower HIL, than, respectively, higher-educated citizens and citizens with higher income.

Conclusions

Citizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing and using a health insurance policy. It is important to support these vulnerable groups, so that Dutch citizens in general will be better able to choose a policy that fits their needs and preferences. This should ensure that citizens are less likely have to deal with inadequate coverage and unexpected costs.

Key messages

• There is a wide variation in HIL among citizens in the Netherlands.

• Citizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing and using a health insurance policy.
Case based approach to the application of standards and Interoperability in practice
Authors: Hussey P , Das S
Published: October 2022

Digital infrastructure and connectivity is layered and requires a number of defined viewpoints in order for safe data flow and use to occur. To address context specific challenges to support communication in health and social care, health informatics standards supporting interoperability are key. In this skills building seminar we will introduce participants to a standards based roadmap for interoperability. We will provide examples of projects and resources detailing the process of engagement to optimise system design for sustainability through a use case based approach.
How ontology can be used to achieve semantic interoperability in healthcare
Authors: Das S , Hussey P
Published: October 2022

Semantic interoperability allows machines to share, interpret and use data without ambiguity. Semantic Interoperability is a major concern in healthcare (c.f. the EU commission 2021 report on electronic record exchange formats). The lack of interoperability with regard to electronic health record (EHR) leads to fragmentation and a lower quality of cross-institution and cross-border healthcare. The simple choice of an interchange language (HL7, FIHR etc.)is not sufficient to ensure interoperability. Healthcare interoperability is associated with multi-level and multi-sectoral complexity, and this cannot be addressed without consideration of a range of people and needs, from application design to knowledge sharing. Each transaction needs to be defined in unambiguous details as part of a complete, consistent, coherent, and machine-readable set of specifications for interoperability between the machines to minimize any potential error. We propose a systematic process to achieve healthcare interoperability, working with healthcare professionals starting from design level to implementation level. In our seminar we will explain with examples how ontology can be used to achieve semantic interoperability in healthcare. Technical requirements, including the choice of tools (e.g. Protégé); data base (e.g. GraphDB); data model (i.e. Web Ontology Language 2 (OWL2); formal specification (i.e. Description logics (DL)); and the right syntax (RDF/XML). Will be introduced.
Oral Health Care in Europe: Financing, Access and Provision
Authors: Winkelmann J , van Ginneken E , Gomez Rossi J
Published: October 2022

With growing awareness of the large burden of oral diseases and how limited coverage affects both access and affordability, oral health policy has been receiving increased attention in recent years. This culminated in the adoption of the WHO resolution on Oral Health in 2021, which urges Member States to better integrate oral health into their universal health coverage and noncommunicable disease agendas. This study investigates major patterns and developments in oral health status, financing, coverage, access, and service provision of oral health care in 31 European countries. While most countries cover oral health care for vulnerable population groups, the level of statutory coverage varies widely across Europe resulting in different coverage and financing schemes for the adult population. On average, one third of dental care spending is borne by public sources and the remaining part is paid out-of-pocket or by voluntary health insurance. This has important ramifications for financial protection and access to care, leaving many dental problems untreated. Overall, unmet needs for dental care are higher than for other types of care and particularly affect low-income groups. Dental care is undergoing various structural changes. The number of dentists is increasing, and the composition of the health workforce is starting to change in many countries. Dental care is increasingly provided in group practices and by practices that are part of private equity firms. Although there are early signs of a shift towards more prevention of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care and impede to inform policy-making on the underlying causes and the prevalence of oral disease, as well as the effectiveness of community preventive activities and oral health services.
Horizon Europe: the DELIVER (DELiberative ImproVEment of oRal care quality) project
Authors: Vassallo P
Published: October 2022

Oral diseases and conditions affect more than 3.5 billion people worldwide. They are the 3rd most expensive diseases to treat in the EU and disproportionally affect vulnerable groups. In deviation from the UN and WHO goal of Universal Health Coverage, many EU citizens do not have access to quality oral care without financial hardship. To this end, the DELIVER (DELiberative ImproVEment of oRal care quality) project aims to enhance the quality of oral care through deliberative dialogue and action involving citizens, patients, providers, payers and policymakers. DELIVER will create a synergistic problem-solving ecosystem to convert deliberative dialogues into meaningful improvement of oral care quality. Using a mixed-methods research approach, DELIVER will co-develop and co-produce new quality improvement approaches in three phases. The 1st phase involves situational analysis, consenting of core quality indicators, and development of a EU-wide monitoring framework. The 2nd phase involves in-depth analysis of select quality improvement approaches: (i) PROMs/PREMs-based quality improvement in dental practices; (ii) community-based quality improvement for vulnerable groups; (iii) quality-oriented commissioning of oral health services. The regulatory determinants of oral care quality improvement will be scrutinized. In the 3rd and final phase, the knowledge gained in the 1st and 2nd phases will be merged into the DELIVER Quality Toolkit with manuals and digital tools for concretely actionable and context-adaptive approaches for oral care quality improvement. This presentation will give an overview of the DELIVER project and discuss how it can contribute to improving oral health systems.
What matters to families about the healthcare of preterm or low birth weight infants
Authors: Odd D , Mann M , Beetham H , Dorgeat E , Isaac T , Ashman A , Wood F
Published: October 2022

Introduction

Preterm and low birth weight (LBW) infants have complex long-term healthcare needs. The impact on families of caring for a sick infant is increasingly understood, with consequences for attachment and bonding and parental health and wellbeing immediately after birth and beyond. In this qualitative evidence synthesis, we aimed to understand what matters to families about the care provided to preterm or LBW infants in hospital and the community.

Methods

We searched nine databases and the reference lists of included studies for eligible studies using qualitative methods examining the views of families on healthcare for preterm or LBW infants. We used the Critical Appraisal Skills Programme checklist for qualitative studies to assess study quality and the GRADE-CERQual approach to assess confidence in each review finding. Studies were sampled after data saturation, and thematic synthesis techniques were used for analysis.

Results

203 studies were eligible for inclusion. We selected 49 studies from 25 countries for the analysis, based on methodological quality, data richness and on ensuring representation from settings with varying resources. Eight analytical themes were identified. Confidence in most results was moderate to high. What mattered to carers was a positive outcome for the child; active involvement in care; support to cope at home after discharge; emotional support for the family; the healthcare environment; their information needs were met; logistical support was available; and positive relationships with staff.

Conclusions

Enabling a positive post-natal period for families of small and sick infants is difficult. Experiences of care for preterm or LBW infants vary, but we found high consistency in what matters to families. This information can be used to shape global recommendations on support for infants and carers. More research is needed on what matters to parents who receive community-based care, especially in low resource settings.

Key messages

• We found high consistency across settings in what matters to families in the care of preterm infants.

• Understanding carers views and values ensures that care can be planned to meet the needs of infants and families.
Design strategies to influence health behaviour and mental wellbeing in the urban setting
Authors: Rehn J , Müller H , Wasmer A , Chrysikou E
Published: October 2022

The design of objects, spaces and systems can have a profound influence on the behaviours as well as emotional and cognitive states of the people confronted with it. With regards to health behaviour, elaborating on Schwarzer's HAPA model (1992), the Design Model for Health Behaviour Change - DMHBC (Rehn, 2018) proposes the use of the built environment to act as situative barriers or opportunities to change health behaviours and overall health promoting mindsets. Regarding urban space and mental health, most environmental stimuli and related behavioural patterns focus on consumption (e.g. retail stores) or daily routines (e.g. commuting). Using objects such as specifically designed furniture, installations and other elements to act as perceived affordances and stimuli can affect both cognitive-emotional states as well as specific behavioural responses. For instance, based on the research on mindfulness, drawing people's attention towards their own bodily sensations (e.g. breath) by playful interactive installations or information signs can increase feelings of calm, appreciation and contentment. The same applies to design interventions that guide one's view towards otherwise overlooked urban features (e.g. natural scenery). While mindfulness and relaxation are powerful techniques for increasing mental health, many other approaches (such as physical activity, social interactions etc.) can be found to have similar benefits. In fact, the orchestrated combination of various forms of stimuli might prove to be more effective than the sum of the individual interventions as they create a subsequent chain of stimuli that form a coherent experience. This approach poses particular potentials to foster mental health in vulnerable groups that usually suffer most from urban environmental risk factors. Thus, providing public and open access stimuli and affordances in this way, can have a significant effect on overall urban public health and reduce social inequalities at the same time.
Using individual-level stratification as an approach to integrating social inequalities into the burden of disease
Authors: Baravelli CM , Eikemo TA , Klitkou ST , Kinge JM , Clarsen BM , Bølling AK , Balaj M , Knudsen AKS
Published: October 2022

Substantial social inequalities in almost all non-fatal and fatal health outcomes are one of the most consistent and universal epidemiological findings. Therefore, monitoring social inequalities in health is considered a key priority for researchers and policy makers. The Global Burden of Disease Injuries, and Risk Factors Study (GBD) is the most comprehensive worldwide observational epidemiological synthesis of data to date. However, currently, the GBD Study does not include the potential to stratify associated metrics, such as the disability-adjusted life years metric, by different socioeconomic factors, such as education or income level. Although The GBD Study does include the Socio-Demographic Index, this measure is only useful when comparing between, and not within, countries or regions. We conducted a Cox regression analysis using a national longitudinal prospective cohort study design and registry-based data linked at the individual-level. We stratified on educational groups and investigated cause-specific mortality rates over a 30-year period, adjusting for age, sex and 5-year age cohorts. We also calculate years of life lost (YLLs) stratified by educational groups, standardised by age, and presented for specific years - to investigate trends over time. We discuss the benefits and limitations of this “individual-level” stratification approach as one possible solution to the integration of social inequalities into the GBD study or when using a burden of disease framework approach more generally.
Labor migration, the food supply chain and the COVID-19 syndemic: Germany, Netherlands, and the USA
Authors: Jungwirth I , Glassner M
Published: October 2022

In Germany, the COVID-19 syndemic has brought questions regarding precarious labor migration in the food supply chain (FSC) to the forefront of the public debate. An analysis of responses to COVID-19-related challenges in agriculture and meat-processing pinpoints similarities and differences between the two industries, offering lessons for workers’ health and safety, and for the improvement of the FSC's systemic resilience. Agriculture and meat-processing were highlighted as “essential” during the COVID-19 syndemic in Germany. In agriculture, amidst lockdowns and border closures, special arrangements allowed permits for migrant workers to harvest seasonal and perishable produce, thus ensuring food supply and mitigating economic loss. Bilateral agreeements with countries neighbouring the EU were concluded to increase temporary labor migration for seasonal work; while COVID-19 specific occupational health standards were set. In meat-processing, which emerged as a hotbed for COVID-19 in Germany, the public debate problematized the contradictions between migrant workers’ essential contribution to the economy on the one hand, and their poor working and living conditions on the other hand. Here, the pandemic led to new legislation, prohibiting subcontracting in the meat processing industry and requiring higher standards for the housing of temporary migrant workers. While the long-term outcomes of these reforms remain to be seen, enforcement of health standards and other social rights will need attention. The German case, thus, underscores the importance of structural changes for ensuring social protection and dignified working conditions for labor migrants, which can, in turn, improve fairness, sustainability and systemic resilience of the FSC.
It never rains but it pours: COVID-19 pandemic impact on mental health in older adults
Authors: Amerio A , Stival C , Lugo A , Fanucchi T , Cavalieri d'Oro L , Iacoviello L , Odone A , Zucchi A , Gallus S , Serafini G
Published: October 2022

Italy was the first country to be hit by the 2019 coronavirus disease (COVID-19) in Europe holding one of the highest clinical burdens. Older adults are those paying the highest price for the COVID-19 emergency. Within the Lost in Lombardy project, a web-based cross-sectional study assessing the prevalence of depressive and anxiety symptoms, hopelessness and insomnia before and during the COVID-19 pandemic, was conducted on a representative sample of 4,400 older adults aged 65 years or more from the Lombardy region recruited between November 17th and 30th 2020. The prevalence of depressive symptoms increased by + 112% during the pandemic, anxiety symptoms by + 136%, insufficient sleep by + 12%, unsatisfactory sleep by + 15%. Feelings of hopelessness were more frequent among women compared to men (15.1% vs. 10.4%) and increased with increasing age. A worsening in each of the four specific mental health outcomes was more frequently observed in women (OR = 1.50, depression; OR = 1.31, anxiety; OR = 1.57, sleep quality; OR = 1.38, sleep quantity), in subjects who decreased their physical activity during the pandemic (OR = 1.64, depression; OR = 1.48, anxiety; OR = 2.05, sleep quality; OR = 1.28, sleep quantity), and with increasing number of pre-existing chronic diseases (p for trend<0.001 for depression and anxiety; p for trend=0.010 for sleep quality; p for trend=0.012 for sleep quantity). A worsening in depressive symptoms was more frequently observed in more educated subjects (p for trend=0.008), while a worsening in anxiety symptoms in subjects living in main towns compared to outskirt with an economic status below the mean. The use of at least one psychotropic drug - mostly antidepressants/anxiolytics - increased by + 26% compared to pre-pandemic. The protection of the mental health status of this vulnerable segment of population needs to be recognized as a real public health priority.
Attitudes and experiences towards the IMMUNI App among Sapienza university students: a pilot study
Authors: De Blasiis MR , Isonne C , Turatto F , Mazzalai E , Marzuillo C , De Vito C , Villari P , Baccolini V
Published: October 2022

Background

IMMUNI is an app that was created to help fight epidemics, starting with COVID-19. The app has a contact tracing feature but its diffusion in Italy was low. In this pilot study, we investigated university students’ attitudes and experience towards the IMMUNI app.

Methods

This cross-sectional study was conducted at Sapienza University of Rome between 14 April and 19 April 2021. An online survey was administrated to university students of medical area. A multivariable logistic regression model was built to identify app download's predictors. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated.

Results

We collected 247 questionnaires (response rate: 78.2%). More than half of the students (65.0%) didn't download IMMUNI app mostly because of the belief that it was useless (30.0%). By contrast, the main reason for downloading was sense of duty (40.0%). Experience with the app was limited but the process was judged as lacking for the technical difficulties. As for hypothetical incentives, feedback on how the download could help against the pandemic was considered as the most effective (3.5 out of 5). In the multivariable analysis, higher likelihood of download was associated with higher fear of contagion for family and acquaintances (aOR:1.50, 95% CI: 1.01-2.23) and higher rating to the health management of the emergency (aOR: 1.33, 95% CI:1.00-1.76). The highest odds of download were found for participants who have been advised to download the app (aOR: 3.21, 95% CI:1.80-5.73). On the other hand, greater belief that the virus came from a laboratory was negatively associated with the download (aOR: 0.75, 95% CI: 0.60-0.93).

Conclusions

Strategies aimed at raising students’ awareness on the importance of health technologies, restoring confidence in health authorities, and limiting disinformation around SARS-Cov-2 should be devised. In addition, the app could be enriched with positive feedbacks for users, and some technical issues should be fixed.

Key messages

• The spread of digital technologies for public health purposes is fostered by trust in health institutions and improving health literacy and user engagement.

• An efficient and user-friendly technology is recommended.
The Italian investment in telemedicine: a breakthrough model of care in primary care
Authors: Borghini A , Mantoan D , Paone S , Leta I , Siccardi G
Published: October 2022

Issue/Problem

Aging populations, worsening burden of chronic disease and recent pandemic has accelerated awareness and the importance of telemedicine in providing continuity of healthcare.

Description of the problem

AGENAS is the public body responsible for the implementation of telemedicine investment (€1 billion) in the context of the NextGenerationEU plan. AGENAS has built up a working group expert panel to define the technical and informatics features of the investment. The project consists of the realization of the national telemedicine platform and the regional telemedicine services. Italian regions will implement telemedicine services based on the national guidelines defined by AGENAS, that will also monitor it through key performance indicators outlined on the basis of best practices and scientific evidence of multidimensional evaluation.

Results

National telemedicine platform will improve, optimise and standardise telemedicine services throughout the Country, considering what may already be available in regional and local healthcare contexts. Regarding telemedicine services in regional context, that will be implemented within the NextGenerationEU, they will be focused on the telemonitoring of high prevalence conditions (i.e. cardiological, respiratory, diabetes, neurological and oncological) as well as other services such as televisit, teleconsultation and teleassistance. Connecting patient's home with healthcare system provide benefits for patients and their families, who will be able to interact with healthcare professionals, obtaining consultation and monitoring of their health.

Lessons

The implementation of the investment, aiming at improving equity and integration of care, will contribute to provide real world evidence about usage, benefits and potential risk of the telemedicine in primary care for the management of chronic diseases.

Key messages

• The investment under the Next Generation EU plan it is the lifetime chance to transform Italian healthcare service and draw a new framework to cope with the high demand in telemedicine.

• Improving telemedicine services will determine a breakthrough in management of patient with chronic diseases in the Italian primary care sector.
Validation of a national checklist for continuous service improvement in a decentralised framework
Authors: Cardinali F , Carzaniga S , Martini L , Loiudice M , Carinci F
Published: October 2022

Background

Previous studies allowed defining a novel checklist for the participatory evaluation of person-centredness in hospital care using 243 items, grouped in 4 main areas, 12 sub-areas and 29 criteria. We aimed to validate a reduced set of core items that could be continuously used for service improvement in Italy.

Methods

Validation was performed using data collected during the last national survey carried out in 2017-2018 in N = 387 acute care hospitals from 16 out of 21 Italian regions. Descriptive measures for each item were used to assess eligibility for factor analysis, applied separately on each of the 4 main areas originally identified. Varimax rotation with eigenvalues>1 was used to optimise factor structure. Items with an item-total correlation>0.30 and factor loadings>0.4 were attributed to individual factors. Items with inter-item correlation coefficient>0.70 were included in a list of candidate mergers, submitted to expert opinion. Cronbach's alpha was used to assess overall internal consistency.

Results

A total of 183 out of 243 items included in the original checklist were submitted to factor analysis. Overall values of Cronbach's alpha ranged between 0.77-0.90, indicating a high consistency. A total of 67 items were finally attributed to 4 main areas, allocated as follows: 16 items in 4 sub-areas for ‘Person-oriented organisational and care processes’, 16 items in 4 sub-areas for ‘Physical accessibility, livability and comfort of the facilities’, 15 items in 3 sub-areas for ‘Access to information, streamlining and transparency’, and 20 items in 4 sub-areas for ‘Taking care of the relationship with patients and citizens’.

Conclusions

A simplified checklist including a manageable number of items that can be easily managed to evaluate hospital services was identified through an objective validation process. The national experience can provide valuable lessons for the application of participatory approaches of person-centred care.

Key messages

• A standardised checklist has been validated using survey data collected through a participatory process in Italian regions.

• The checklist can be used to evaluate and improve person-centered hospital services through a manageable number of items and factors.
7.H. Workshop: Lessons Learned Workshop from JAHEE- the importance of evaluation
Authors:   Organised by: JAHEE,   Chair persons: Raffaella Bucciardini (Italy), Bernadette Kumar (EUPHA-MIG)
Published: October 2022

Joint Action Health Equity (JAHEE) was a Joint Action financed by the Third Health Programme 2014-2020 of the European Union. It was developed in the period June 1, 2018 - November 30, 2021, and involved 24 countries. It represented an important opportunity for member states to work together to address health inequalities and achieve greater equity in health outcomes across all groups in society in all participating countries and in Europe at large. The results of JAHEE show that almost all participating countries have increased their level of action to address health inequalities and strengthened their capacities in some important policy domains. 76 actions to contrast health inequalities were started during the Joint Action and a final Consensus Policy Document was produced including a set of cross-cutting recommendations. The proposed workshop will discuss the 3-year JAHEE project in the European region and through presentations and active participation review JAHEE actions, results of internal and external evaluations and discuss the main lessons learned. The session will go beyond sharing information and disseminating results and focus on what the JAHEE evaluation has taught us and how it can help improve health equity interventions in the future.

We plan to have:

a) Presentations

1. Short introduction to JAHEE and Actions

2. Presentation Internal Evaluation

3. Presentation External Evaluation

After the presentations there will be opportunity for interactive sessions with the participants to further explore the case studies and issues raised around evaluation and equity

b) Interactive Group Discussion

• What do the JAHEE evaluations findings add?

• What aspects of the evaluation were missing? What could have been improved?

• How can the lessons learned from the evaluation be applied to interventions in equity/ migrant health?

3) Feedback from Groups

4) Summary and Conclusions

Key messages

• No data no progress.

• Apply an equity lens: Evaluation in health equity actions is important for the sustainability of actions and contributes to the implementation of good practices.
Interventions on health equity in the future
Authors: Eikemo TA
Published: October 2022

A final reflection on the importance of evaluation aspects will be proposed at the end of the workshop.
The influence of onset of disease on exit from paid employment among workers in The Netherlands
Authors: Hijdra RW , Robroek SJW , Burdorf A , Schuring M
Published: October 2022

Background

This study investigates the influence of onset of disease on exit from paid employment, and whether this differs across diseases and sociodemographic groups.

Methods

Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010, and who did not use medication for the selected disease in 2009 (n = 5,889,036) were followed-up during 9-years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, psychological disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Cause-specific Cox Proportional Hazards regression analyses were performed, with interaction terms for age, sex, and migration background.

Results

Onset of disease increased the likelihood to exit paid employment, with strongest associations for psychotic disorders (HR 2.91, 95% CI 2.81-3.02) and psychological disorders (HR 2.01, 95%CI 1.98-2.04). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of psychological and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males.

Conclusions

Onset of diseases, especially mental health disorders, is a risk for early exit from paid employment. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment.

Key messages

• Onset of all diseases increased the likelihood of exiting paid employment, through disability benefits, followed by unemployment.

• Onset of psychological and psychotic disorder had the strongest association with exiting paid employment, especially among males and workers with a migration background.
Citizens’ perspective on ‘the right care in the right place’
Authors: Damen L , De Jong JD , Van Tuyl L , Korevaar JC
Published: October 2022

Background

Healthcare systems around the globe are facing challenges, from increasing demand and costs to a diminishing health workforce. Without change, healthcare will become unsustainable. In the Netherlands, the government aims to organize sustainable healthcare by among others the policy ‘the right care in the right place’. An important part of this policy is relocating healthcare, for instance, from the hospital to the general practitioner (GP) or from the GP to other healthcare providers or to citizens themselves. Relocation of care is expected to reduce costs and manpower shortages. There is, however, little known about how citizens think about this topic, although they are an important stakeholder. This research aims to investigate citizens’ perspectives on the right place for care.

Methods

A questionnaire was sent in December 2021 to 1.500 members of Nivel's Dutch Healthcare Consumer Panel, including 4 questions about the right care in the right place. The response was N = 796 (53%). In addition, two citizen platforms were organized in March 2022, to discuss the right care in the right place. A total of 23 citizens participated.

Results

First results indicate that most citizens related expertise and accessibility to the right care in the right place. Participants said that non-complex care could be relocated from the hospital to the GP if the GP has the right expertise. Expertise was mentioned as the most important aspect of care delivery. According to participants, care could be shifted from the GP to other primary care professionals, to social services or to self-sustainability, given that citizens know who to visit or what to do with health problems/worries. More results will be available by November.

Conclusions

Relocating care could be a possible solution to keep healthcare sustainable in the future in terms of costs and manpower. Among citizens, there seems to be support when certain conditions are met.

Key messages

• Citizens support the substitution of non-complex care from hospitals.

• Citizens are willing to improve self-sustainability when they have the tools.