bluuebunny/crossref_metadata_2025 huggingface dataset:
Operationalization of the One Health approach in two rural municipalities of Niger
Authors: Ben Abdelahfidh L , Rojas Lopez F , Djibo Mazou B , Miller M , Meissner L , Roland M
Published: October 2020

Despite multiple efforts made by its government to improve public health, Niger still regularly faces numerous disasters including epidemics. Between 2017 and 2019, a consortium was established between Doctors of the World and Veterinarians Without Borders to implement a “One Health” project. This approach aims to reduce the populations' vulnerabilities to health risks related to environmental disasters and improve the health system's resilience at several levels. By promoting interdisciplinary between human, veterinary and environmental health issues, it aims to tackle emerging diseases with pandemic risk. The project was implemented in 2 municipalities: Sakoira and Ingall. For the first time, a program focused on preventing health and environmental risks rather than responding to a crisis.

An external evaluation based on 278 interviews identified 5 project's achievements: (1) the increase in availability and accessibility of human and veterinary pharmaceutical products which improved vaccination coverage and medicalization while lowering treatment and prevention costs; (2) the mobilization and coordination of human and animal health professionals, national authorities and municipalities; (3) the strengthening of joint epidemiological surveillance through professional and community actors in order to reduce the response time to epidemics and disasters; (4) the strengthening of communities' understanding of health risks and how to prevent them; (5) the capacity building of professionals regarding the One Health approach at national, regional and local level.

Coordination between human and animal health professionals has made possible the design and implementation of joint actions. These actions have enabled to: build capacity for 43 health providers, 116 community health workers and 41 livestock auxiliaries, vaccinate, de-worm and treat 24311 small and 7590 large ruminants, give primary health care to 4190 people, sensitize 2268 people on human and animal health.

Key messages

The project is innovative as it focuses on preventing epidemic risks instead of responding to crisis. Collaboration between human and animal health actors is the main success factor of the project.
Greenness and physical activity as possible oxidative stress modulators in children
Authors: Squillacioti G , Carsin A E , Borgogno-Mondino E , Bono R , Garcia Aymerich J
Published: October 2020

Background

Green spaces (greenness) have been reported as beneficial to health, mainly mitigating air pollution, hot spots, noise and promoting socialisation, biodiversity and physical activity (PA). This study aims to examine the association between greenness and oxidative stress (OS) in children and to evaluate interaction with PA.

Methods

The cross-sectional study involved 323 subjects (9-11 yrs.) from five schools in Asti (Italy). Parents completed a questionnaire providing home-address, parental education, and PA of children. Urinary samples were collected to measure OS by isoprostane (15-F2t-IsoP). Time-weighted exposure to greenness was calculated from satellite images (Sentinel2 L2A) by Normalised Difference Vegetation Index (NDVI), within buffers around participants' homes and schools, accounting for the individual multi-site exposure during the day.

Results

Overall 323 subjects were included in the analyses, 50% females. An inverse correlation was found between greenness and OS (Pearson -0.162, p = 0.003). A generalised linear mixed model, age-adjusted with schools as random effect, tested the association between greenness and log-transformed(15-F2t-IsoP), reporting decreased OS levels for each unit of increase in greenness (β: -0.50, 95%CI-0.98 to -0.02, p = 0.041). After adding PA in the model, greenness was no longer significant (β: -0.42, 95%C.I.-0.90 to 0.07, p = 0.092), but children reporting low-PA and high-PA showed the highest increase in OS (β: +0.19, 95%CI 0.04 to 0.43, p = 0.02; β: +0.25, 95%CI 0.04 to 0.46, p = 0.018) compared to those with moderate-PA.

Conclusions

Greenness positively impacts health by reducing OS in children. Our findings suggest that PA is partly mediating this association. Noticeably, this is the first study assessing a multi-site greenness exposure and its association with OS accounting for PA in children. The management of urban greenness should be included as preventive Public Health intervention for health and well-being promotion.

Key messages

Greenness exposure may benefit health by reducing oxidative stress in children. The association between greenness and oxidative stress seems partly mediated by physical activity.
Assessing inequities in community health worker’s interaction and its impact in Uttar Pradesh, India
Authors: Gupta S , Tomar S , Dey A , Chandurkar D
Published: October 2020

Given the high Neo-natal mortality in the state of Uttar Pradesh, India, an emphasis has been given to community health workers (CHW). CHW provides behavior push to pregnant women for utilizing health services, through the strategies of household contact and messaging. However, the disparity in health outcomes and interaction of CHW is profoundly affected by socio-economic determinants; still, the evidence is limited. This study aims to explore socio-economic inequities in quantity and quality of contacts by the CHW and its differential effect on health service utilization.

Multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of Uttar Pradesh(n = 3703). Regression models described the relation between household demographics and CHW contact & specific messaging and interactions of demographics and CHW contact & messaging in predicting health service utilization ( > = 4 antenatal care (ANC) visits, Institutional delivery and 100 iron folic acid (IFA) consumption).

No differential likelihood in contact of CHW and specific messaging is found. Further, association of CHW contacts and specific messaging with health outcomes were significantly affected by socio-economic determinants.2 or more contacts along with specific messaging increased the odds of 4+ ANC to a higher degree among illiterate women compared to literate women(AOR:3.39, 95% CI:2.28-5.04 vs AOR:1.44, 95% CI:1.09-1.92). Similarly, the odds of facility delivery increased to a higher degree among lower wealth women compared to higher wealth women (AOR:3.41, 95% CI:2.47-4.71 vs. AOR:1.53, 95% CI: 1.09-2.15).

Specific messaging, along with CHW contacts, have a higher magnitude of effects on the marginalized population. This study provides evidence for adjusting implementation strategies based on socio-economic determinants to achieve equitable health service utilization. However, further research on training of CHW on heterogeneous interaction is recommended

Key messages

There exists differential effects of quantity and quality of contact by community health workers on health service utilization across the different socio-economic strata. Implementation agencies in the LMIC can reduce health inequity by shifting from coverage-oriented target approach towards more prioritized and focused interaction across socio-economic groups.
Combining participatory research and Intervention Mapping to improve adolescents’ sleep behavior
Authors: Vandendriessche Anneke , Deforche B D , Verloigne M V
Published: October 2020

Background

Adolescent sleep deprivation is an important health concern, urging the need to develop effective interventions. Combining a participatory approach (i.e. actively involving the adolescents) and Intervention Mapping (IM) may improve effectiveness. Therefore, the aim of this study was to describe the development of an intervention to improve adolescents' sleep behavior that combined a participatory approach with IM. Secondly, we evaluated the participatory process, based on focus group research in adolescents.

Methods

In three secondary schools in Flanders (Belgium), an action group with 6-8 pupils and an academic facilitator had weekly sessions with the aim to co-create an intervention, following IM. Three focus groups within each action group were organized throughout the development process. Data were thematically analyzed using NVivo 12.

Results

During the sessions, each action group went through the different steps of IM: identifying the problem (step 1: needs assessment), deciding on what should be changed (step 2: program objectives) and how it can be changed (step 3: methods and applications), and designing the intervention (step 4: program development). Most adolescents were positive about the content of the sessions, the methods used, the level of participation and the collaboration with the others. Still, they felt more satisfied during the final, more concrete steps. Also, they seemed to lack support from their schools.

Conclusions

The unique approach of combining participatory research with IM is a promising way to develop an intervention to improve adolescents' sleep. Further research needs to investigate if it leads to more effective and sustainable interventions.

Key messages

Going through the different steps of Intervention Mapping in cooperation with adolescents is a feasible approach to develop an intervention to promote healthy sleep in adolescents. Adolescents mostly describe participating in the development of a healthy sleep intervention through Intervention Mapping as a positive experience.
The importance of respecting accreditation indicators to improve quality of care
Authors: Marino A F , Centurione E , Cofano R , Garau L , Ferrara A , Pannese C , Raimondi A , Verlengia L , Rivolta S , Castelli B
Published: October 2020

Issue

The health and social-care facilities (HSF) of the Lombardy Region provide services specifically conceived for fragile populations, including elderly, disabled, addicts etc. Through its Accreditation Units, the Agency for Health Protection (ATS) in the Metropolitan City of Milan is responsible for overseeing authorization and accreditation indicators of HSFs in all afferent districts. Assessed requirements include the qualitative standard (presence of mandatory professional figures) and the quantitative standard (guaranteed weekly minimum time of care per patient) of operating staff, based on current legislation.

Description of the problem

These standards are evaluated at site-inspection by examining staff qualifications and by matching staff working hours to actual daily presence of patients, randomly selecting a recent past week. The resulting standards may thus not be fully representative of the whole year. In 2019, the Health and Social-care facilities Accreditation Unit of ATS began a retrospective quali-quantitative analysis of health service staffing data for 2017 and 2018. Data were extrapolated from two main databases: “Scheda Struttura”, a data collection tool regarding work hours, qualifications, waiting lists etc. compiled yearly by HSF managers; and economic data detailing reimbursements by the regional health service, based on effective daily presence of patients at the HSF.

Results

Preliminary results relating to 2017 showed that around 4% of HSFs do not guarantee qualitative staffing standards, and almost 30% do not guarantee quantitative staffing standards throughout the year.

Lessons

The proposed tool is useful for emphasizing potentially critical situations and may help define the annual inspection schedule with the aim of continuously improving quality of care among regional HSFs.

Key messages

Data management tools can help local health authorities monitor and identify facilities at risk of falling below the defined standards of care. Qualitative and quantitative analysis of health service staffing is useful for emphasizing potentially critical situations and may help define the annual inspection schedule.
For which population groups will strong identification and thus eHealth services use not be possible?
Authors: Vehko T , Lilja E , Parikka S , Aalto A-M , Kuusio H M
Published: October 2020

Background

Digital services are expected to improve the availability of public social and health care services in many European countries as well as in Finland. eHealth and eWelfare services often require strong electronic identification which may form barriers in the availability of care. This study focuses on recognising population groups who are vulnerable to exclusion either by not having access to web or by lacking a strong electronic identification.

Methods

The data were gathered from the cross-sectional survey on well-being among people aged 20-64 with foreign background (PFB) (FinMonik), conducted in Finland 2018-19 (N = 12 877; response rate 53%). The data from the National survey of health, well-being and service use (FinSote 2017-18) were used as reference data for the overall population, (N = 26 422, response rate 45%). Surveys asked respondents “Do you have at your disposal internet access at home, your workplace, library or some other place?” and 'Do you have at your disposal online banking codes or a mobile certificate for electronic identification online?”. PFB were defined by background country into seven country-groups. The age-standardized proportions with confidence intervals were examined by socio-demographic background variables.

Results

Almost all (98%) of the overall population reported access to internet, but the proportion was lower (92%) among PFB (p < 0.001). Proportion of having a strong electronic identification was higher among general population (98%) than among PFB (88%) (p < 0.001). In both populations, younger age increased the likelihood of having a strong electronic identification. PFB students reported lower level of strong electronic identification compared to the employed.

Conclusions

Although most had access to internet and a strong identification, there were statistically significant differences between country-groups and by employment status.

Key messages

Designing and developing of eHealth and eWelfare services must ensure that everyone has the opportunity to have a strong electronic identification. Development of digital services requires user guidance, which takes into account the varying needs and operating environments.
Femtech Fatale: Access to Femtech in Public Health Insurance Systems
Authors: Tonti L
Published: October 2020

From a smartphone ping signifying the start of a fertile window to controlling a breast pump with a few clicks in a mobile app, “femtech” has readily integrated into women's daily lives. Femtech, a term coined to describe the realm of technology catering to female health needs, encompasses a range of digital technology addressing women's health, including fertility tracking, pregnancy and nursing counseling, and online contraception provision. While femtech puts autonomy and information in the hands of its users, access to the technology is not yet equitably distributed.

As insurance reimbursement can increase and equitize that access, this research examines what legal duties exist for increasing access to femtech. In analyzing how insurance schemes have integrated femtech, this research compares how select femtech products fare across reimbursement systems, using fertility algorithm, smart breast pump, and pelvic floor trainer case studies in the U.S, U.K, and Sweden.

Insights reveal a duty to promote access to femtech, as well as varying degrees of integration in respective health systems. Insights also reveal which elements of the female life course are overlooked in reimbursement schemes.

Key messages

Femtech has the power to put agency and information in the hands of millions of women. Yet, access is not equitable given significant financial and regulatory barriers. Comparative studies of fertility algorithms, smart breast pumps, and pelvic floor trainers in international health systems demand increased advocacy to realize the duty to enable femtech access.
Mobile Apps for Vaccination: an in-depth scan of Apple App Store
Authors: Catozzi D , Gualano M R , Voglino G , Corradi A , Bert F , Siliquini R
Published: October 2020

Introduction

In a recent estimation, time spent engaging with smartphones is 3h43m in 2019 in US population, surpassing conventional media such as TV. However, smartphones are not just a distraction from everyday life, but also a powerful tool by which to search for information and interface with institutions and services providers. National Healthcare Systems are not an exception, in particular for tackling vaccine hesitancy and fake news: in this frame, we have focused our research on mobile apps for vaccination.

Methods

We scanned Apple App Store through an API (Application Programming Interface) made available from Apple Inc. itself searching single words related to vaccination (no Boolean operators available) from both Italian and English-speaking markets, then exporting and merging the results. The univocal 121 apps obtained were then classified according by category, description, target population, informative materials and n° of reviews.

Results

The majority of apps falls under the “organizer” category (49 apps, 40.5%) with almost half of them (22) with vaccination as main topic (vaccine reminders and recorders), the others as part of a health management tool, mostly designed for parents. Just 32% of these apps give information regarding vaccines or preventable diseases. The second one is medical education apps (26.4%) focused on healthcare workers with guidelines and updates, mainly in English, then games (11.6%), Local Healthcare Service booking services (9.1%) of which only 4 from Italy, and lastly travel management apps (2.5%).

Conclusions

Organizers and reminders are a recognised tool to increase vaccine adhesion, but a complete plain-language information should be provided together with the service, to answer the most frequently asked questions from parents and dispel their doubts. In the meanwhile, Italian NHS results rarely adequate in providing a fully digital experience, from planning shots to registration of vaccine status.

Key messages

Mobile vaccination organizers are a helpful tool for parents, but they are undervalued as a first-hand source of knowledge about vaccination programs. Italian NHS should develop a modern mobile interface in order to book vaccination services as a big nudge towards the increase of vaccine adherence.
Socioeconomic inequalities in type 2 diabetes among different population subgroups
Authors: Safieddine B , Sperlich S , Beller J , Lange K , Epping J , Tetzlaff J , Tetzlaff F , Geyer S
Published: October 2020

Background

Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic status (SES) groups being more affected. Considering specific population subgroups to examine prevalence and SES inequalities in T2D is rare. In addition, using only one indicator to depict SES inequalities in health has been a common practice despite evidence on differences in what different indicators measure. This study examines the prevalence of and SES (school education, occupation and income) inequalities in T2D in the three population subgroups: employed individuals, nonworking spouses and pensioners. This study also determines the SES indictor with the highest explanatory power.

Methods

This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in 1,345,841 employed individuals, 180,949 nonworking spouses and 773,427 pensioners. Multivariate logistic regression analysis was applied to examine SES inequalities in T2D in the three subgroups. Explanatory power of the three SES indicators was compared by deviance analysis.

Results

T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. Clear gradients in T2D inequalities emerged for all three SES indicators and were observed in the three population subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses.

Conclusions

Nonworking spouses are an important target group in T2D prevention interventions. The three SES indicators differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between education and T2D.

Key messages

The population subgroup “nonworking spouses” is an important target group for type 2 diabetes prevention interventions. The level of school education is a substantial determinant of socioeconomic inequalities in type 2 diabetes.
Health professional mobility and the Global Code of Practice: joint EUROSTAT/OECD/WHO survey data
Authors: Williams G , Jacob G , Scotter C , Rakovac I , Wismar M
Published: October 2020

Background

This study assesses the impact and continuing relevance of the Code of Practice on the International Recruitment of Health Personnel in the WHO Europe region by analysing trends over time in intra- and inter-regional health worker mobility.

Methods

Data from the joint EUROSTAT/OECD/WHO questionnaire are analysed to determine 1) the proportion of foreign-born and foreign-trained doctors and nurses working in WHO Europe Member States, 2) trends in health workforce mobility over time by country of origin and destination, and 3) how the Global Code has impacted mobility patterns.

Results

The size of the foreign-trained health workforce in Europe varies widely, with foreign-trained doctors comprising over a quarter of the workforce in Norway, Switzerland and the UK, but below 2% in Estonia and Serbia. While annual in-flows across the region have been stable since 2009, the share of foreign-trained doctors and nurses have both increased by over 30%. Mobility between The Commonwealth of Independent States has remained steady, but an increase in East-West and South-North migration is observed, driven by European Union expansion in 2004 and the economic crisis. Migration of health workers into Europe from developing countries covered by the Code has fluctuated, with increased numbers seen from some origin countries (e.g. Nigeria, Pakistan). Some Western countries remain reliant on a foreign-trained health workforce. This contributes to a high outward flow of health professionals from other European countries and creates challenges for sustainable workforce development.

Conclusions

The Global Code remains highly relevant, but other factors have more impact on migration flows, such as free movement in the EU. Health workforce mobility data can be improved to support a 'whole of workforce' approach to policy and planning by including more professional groups, and by adding qualitative indicators, e.g. individual perceptions and intention to leave.
Struggles for a universal health system in Brazil: successes, obstacles and setbacks
Authors: Machado C V , Silva G A
Published: October 2020

Brazil is a populous middle-income country, characterized by deep economic and social inequalities. Like most Latin American nations, Brazil historically constructed a health system that included, on the one hand, public health programs and, on the other, social insurance healthcare, which only covered formal workers. This study analyzes the implementation of a universal health system from the mid-1980s to the present, focusing on the context, political agendas, government orientations, and actors. Research techniques included a literature review, interviews with national health authorities, analysis of documents and selected health indicators. In the 1980s, against the backdrop of democratization, Brazil's health reform movement proposed a Unified Health System (SUS), which was incorporated into the 1988 Constitution. The combination of a democratic system with opportunities for interaction between various developmental and social agendas and actors has played a key role in shaping health policy since then. However, the expansion of public services has been hampered by insufficient public funding and by the strengthening of the private sector, subsidized by the state. Private enterprises have expanded their markets and political influence, in a process that has accelerated in recent years. Despite these obstacles, SUS has produced significant health-status improvements and some reductions in Brazil's health inequalities. A combination of long-term structural and contingent factors, international agendas and interests, and domestic political struggles, explains the advances and obstacles to building a universal system in an economically important yet unequal peripheral country. Further consolidation of SUS and reduction of health inequalities hinge on the uncertain prospects for democracy and national development, on enlarging the political coalition to support a public and universal health system, and on strengthening the state's ability to regulate the private sector.

Key messages

The implementation of a universal health system in Brazil has favored health improvements but has been hampered by insufficient funding and by state subsidies to the expansion of the private sector. A combination of structural and institutional factors, international and domestic political agendas and interests explains the advances and obstacles to building a universal system in Brazil.
The Health Survey for England in 2020, tracking children’s health for 30 years
Authors: Moody A , Mindell J , Scholes S , Ng Fat L
Published: October 2020

Background

Prior to their inclusion in the Health Survey for England (HSE), there was a dearth of information about children's health in England. Official data recorded use of health services and uptake of national programmes such as school vaccinations. Birth cohorts provided longitudinal data, including risk factors and non-clinical measures, but were spaced far apart due to cost. The annual HSE has been tracking child health since 1995 and the health of older adolescents (aged 16-19) since the surveys began in 1991. The survey uses a multi-stage design to deliver a nationally-representative random probability sample of the general population in private households in England. Over 110,000 children aged 0-15, and 16,000 16-19-year olds have been interviewed since 1995 and 1991 respectively. Questionnaire content has varied, but includes general health and longstanding conditions, smoking and drinking, fruit and vegetable consumption, physical activity, respiratory problems, childhood diabetes, and parental perception of strengths and difficulties. Regular measurements include infant length, height and weight, blood pressure and cotinine levels.

Results

As well as general monitoring overall and across socioeconomic groups, e.g. height, weight and obesity, HSE data have been used to infer the impact of government policies on child- and adolescent-health, e.g. changes to smoking legal age, advertising, and the smokefree law. This presentation describes in more detail the sample, measurement protocols, questionnaire, published results and research-policy case studies such as the smoking ban. Novel results using the full sample as a synthetic cohort, tracking BMI, smoking, drinking, and general health, are presented for the first time.

Conclusions

Child health monitoring, in terms of trends, inequalities and policy evaluation; is enhanced by regular surveys representative of the general population, which include both subjective and objective measures.
Training physicians in motivational communication to improve behaviour change counselling competency: A behavioural medicine approach to NCD prevention and management
Authors: Lavoie K
Published: October 2020

Background

Despite the importance of changing health behaviours in the context of preventing and managing non-communicable chronic diseases (NCD's), physician use of evidence-based behaviour change counselling (BCC) is low, and BCC skills competency is generally poor.

Motivational communication (MC) is a patient-centred, evidence-based BCC approach used by healthcare providers, designed to increase patient motivation to adopt a healthy lifestyle. MC-based approaches improved a range of health behaviours (smoking, diet, physical activity) in patients with NCDs, leading to increased demand for physician training. Despite the widespread dissemination of training programs, data on their efficacy in achieving competency among physicians is limited. This is likely due to a lack of consensus on the core communication competencies to be achieved, and in the absence of acceptable, valid and reliable tools to measure skill acquisition.

Results

Using an integrated knowledge translation (iKT) approach that engaged 199 international physicians, behaviour change experts and health administrators, we have identified 11 core evidence-based communication competencies that physicians should acquire in the context of NCD prevention/management. They have been incorporated into a basic 4 hr face-to-face MC training program called “LEARN THE BASICs”. To assess MC competency, we have also developed a reliable, engaging, efficient, 'user-friendly' case-based digital assessment tool called the MC-Competency Assessment Test (MC-CAT).

Conclusions

Strategies for optimizing and tailoring this program, including finding the most cost-effective training dose, the impact of supplemental training components (e.g., in person vs. digital coaching; booster sessions), and delivery modes (e.g., face-to-face vs digital/online), will be discussed in the context of optimizing implementation success.
22.C. Workshop: Digital interventions in public mental health: current impact and future directions
Authors:   Organised by: EUPHA Digital health section, EUPHA Public mental health section,   Chair persons: Anna Odone – EUPHA-DH, Jutta Lindert – EUPHA-PMH
Published: October 2020

As digitalization is permeating all aspects of society, questions arise as to how it can be fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in healthcare and on how digital interventions can contribute to tackle global public health threats.

With an estimated prevalence of around 450 million people currently suffering from mental disorders and 1 in 4 people in the world affected at some point in life, mental health care and prevention is recognized by the World Health Organization as a global public health priority. In this workshop we will specifically focus on the use and impact of digital interventions in public metal health. As evidence on the impact of digital preventive interventions are accumulating in the field of mental health, we believe there is urgent need and scope: i) to present a conceptual framework that identifies when and how the different features of digitalization can support the pursue of mental health and well-being at the population and clinical level: from risk factors' identification and control, to primary and secondary prevention, to diagnosis and access to care, to compliance to treatment, ii) to retrieve, pool and critically appraise the available evidence on the adoption, application and impact of digital solutions to the above, and iii) to collect and share best practices at the European and global level that can be replicated, adapted and scaled up in different socio-demographic and epidemiological settings, for different mental health disorders and target populations. The workshop's structure and content aims at accomplishing with the above by: 1) introducing the topic of digitalization in mental health from the perspective of public health, ii) providing three original contributions on three different innovative aspects of the digitalization of public mental health (see below), iii) engaging the audience in a fruitful discussion on the data presented, stimulating the debate around current gaps in knowledge, as well as system and policy barriers to the design, implementation and evaluation of digital Interventions in public mental health. As detailed in the presentations' abstracts below, the three original contributions will, respectively focus on: 1) the current use of telemedicine for mental health care and prevention, the digital features enabling its adoption and the assessment of its impact on clinical and public health outcomes, 2) the potential offered by digital biomarkers in defining digital phenotyping so as to inform personalized prevention and care in mental health that and 3) technology and mobile health for high-risk populations with the presentation of selected best practices.

Key messages

Digital interventions are supporting mental health care and prevention in different settings. The impact of digital interventions for mental health needs to be measured.
Digital biomarkers and digital phenotyping in mental health care and prevention
Authors: Andrea A , Agulia A , Serafini G , Amore M
Published: October 2020

Biomarkers are physiologic or pathologic characteristics that can be objectively measured and evaluated as indicators of biologic processes, or biological responses to therapeutic interventions. Traditionally, psychiatry has suffered from a relative paucity of these, with no lab tests or medical devices available for the diagnosis or monitoring of mental health disorders. The widespread adoption of personal digital devices including smartphones and wearables allow to retrieve, record and store large amounts of user-generated data that have been hypothesized to play as “digital biomarkers” - intended as a new type of medical information that can produce actionable insights into the biological state of individuals, just as “normal” biomarkers, but collected through digital tools.

As well described by Onnela in 2015, digital biomarkers can define a digital phenotyping characterized by a “moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices,” in particular smartphones and mobile devices. Simpler said, digital biomarkers, can provide a comprehensive representation of people and patients' functioning. Their use in health research, prevention and practice is particularly relevant in the field of mental health being mental disorders highly heterogeneous in nature and over time. In the next years these novel ways of measuring mental health status will provide observations and perspectives into disease that were unavailable before and which will fruitfully inform personalized prevention and care. The presentation will introduce the concept of digital biomarkers and digital phenotyping, it will provide the state of the art on their identification and use in the field of mental health and will discuss the way forward to ensure their potential is exploited through effective collaboration between clinicians, public health researchers and the tech world in a joint effort to promote population well-being.
Has the European Union created a healthy food environment for its citizens? Application of the Food Environment Policy Index (Food-EPI)
Authors: Djojosoeparto S K , Kamphuis C B M , Vandevijvere S , Murrin C , Stanley I , Romaniuk P , van Lenthe F , Harrington J M , Poelman M P
Published: October 2020

Background

European Union (EU) Member states' food environments are shaped by both national and EU policies. To date however, studies assessing food environment policies developed and set by the EU are scarce. The aim of this study was to assess the strength of EU policies to improve food environments as well as to assess the extent these policies could lead to a decrease or widening of socio-economic inequalities in dietary intake.

Methods

We compiled evidence on the EU policies for each of the Food-EPI 47 indicators. A European panel of independent, non-government experts (N = 30) specialized in nutrition, obesity or chronic diseases, using the Food-EPI evidence, rated the strength of EU policies to improve food environments during an online survey in February-March 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve EU food environment policies, which were prioritized during a follow-up online survey.

Results

The overview of EU-level policies resulted in a 79-pages document, describing policies (or the lack thereof) for each of the 47 Food-EPI indicators. This document has been verified for completeness and accuracy by EU governmental officials. The evidence document shows that the EU has mainly binding legislation on the food labelling whereas policies on the other Food-EPI domains are mostly voluntary. Results from the online survey and the formulated prioritized actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to EU officials and public health advocates in their efforts to improve the food environment policies set by the EU.
Flu vaccination among health workers in Italy: results from the nationwide surveillance PASSI 2015-18
Authors: Gallo R , Minardi V , Contoli B , Possenti V , Carrozzi G , Trinito M O , Ramigni M , Fateh-Moghadam P , Masocco M , D’Andrea E
Published: October 2020

Background

Influenza causes a significant health and socio-economic burden every year. Healthcare workers (HCWs) are at higher risk of exposure to respiratory pathogens than general population, including seasonal influenza virus, with potential threats to their health and patients' safety. We aimed to estimate the adherence to flu vaccination of health workers in 2015-2018 seasons in Italy.

Methods

We analyzed data collected between 2015 and 2018 from the Italian Behavioral Risk Factor Surveillance System (PASSI). PASSI collects data on health behaviors in the adults (18-64 years) through telephonic administration of standardized questionnaires to a representative sample of Italian population. The answers related to flu vaccination refer to the vaccination campaign preceding the interview

Results

Preliminary data show that overall 11.9% (CI 10.3% - 13.7%) of HCWs reported to have been vaccinated vs 7.2% (CI 6.9% - 7.5%) of the total population sample. Physicians showed a higher overall adherence compared to other healthcare professionals (22.4% [CI 18% - 27.5%] vs 9% [CI 7.4% - 10.9%], respectively). Differences of adherence were found also across age groups: 18.3% [CI 15% - 22.2%] of respondents between 50-64 years reported to have received a vaccination compared to 10% (CI 7.9% - 12.5%) and 4.3% (CI 2.8% - 6.4%) of 35-49 years and 18-34 years age groups, respectively. The annual influenza vaccination coverage for people working in healthcare has increased over the years (9.8% in 2015 vs 14.1% in 2018).

Conclusions

Although coverage rates are increasing over time, adherence to influenza vaccination is still too low, especially among younger HCWs and non-medical HCWs. Strategic actions, such as local and national programs to increase self-awareness of being an at-high-risk category for contracting and transmitting infections and/or mandatory vaccination, should be adopted to sharply achieve an optimal coverage rate for HCWs.

Key messages

Adherence to seasonal influenza vaccination is still very low among Italian HCWs. A participatory attitude towards vaccination for HCWs should be pursued. Monitoring and reporting process should be improved to provide further detailed evidence for adopting targeted programs.
Influenza D virus: a potential threat for humans?
Authors: Trombetta C M
Published: October 2020

Influenza D virus (IDV) is a novel influenza virus, first isolated from an ailing swine in 2011 in Oklahoma. Several studies have isolated IDV in cattle from multiple geographic areas, suggesting cattle as a possible primary natural reservoir for the virus. To date, few studies have been performed on human samples and there is no conclusive evidence on the ability of the virus to infect humans.

This serological study aimed to assess the IDV prevalence in archived human serum samples collected in Italy from 2005 to 2017. The serum samples were tested by haemagglutination inhibition assay (HI) and confirmed by the virus neutralization assay.

The results clearly show that specific HI antibodies against IDV were present in at least a small subset of serum samples taken in every single year between 2005 and 2017, although IDV was isolated and described for the first time in 2011. IDV antibodies displayed low levels, between 5.1% and 9.8%, in the years 2005 to 2007, followed by a sharp increase in 2008; the highest levels (33.9% - 46.0%) were reached in 2008, 2009, 2010, 2013, 2014 and 2016, while the lowest levels (11.9% - 25.7%) were seen in 2011, 2012, 2015 and 2017. In addition, the highest levels of HI seropositivity (HI titers ≥ 1:40) were found in serum samples collected in 2008, 2009, 2012, 2013, 2014 and 2016.

This increase was not constant over the years, it shows sharp rises in some years followed by drops in subsequent years. The seroprevalence peaks detected in humans appear to follow IDV epidemics in animals. Moreover, as the titers did not remain high in the years following the increase, but dropped to lower levels, it is likely that a spill over event from an animal reservoir occurred, and that the virus does not circulate primarily in humans. Ultimately, the virus showed the ability to infect and elicit an immune response in humans and not to persist in the human population.

Key messages

Current knowledge of influenza D virus in humans is still limited. Neither potential threats to exposed individuals nor public health issues can be fully excluded.
Effectiveness of PEHRs use to increase vaccine uptake: a systematic review
Authors: Balzarini F , Oradini Alacreu A , Frascella B , Gaetti G , Signorelli C , Odone A
Published: October 2020

Background

The digital transformation provides tools to empower individuals and enable feedback and interaction between users and healthcare providers. Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on their impact is scant.

Methods

We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention, ii) PEHR access vs access with additional features.

Results

Of identified 3125 citations, 8 studies were included, the majority published in the US before 2015. Four studies assessed differences between subjects with and without access to PEHR. Access to PEHR was reported to be an effective tool to increase vaccine uptake: when accessing PEHR, study participants were 6.7% more likely to receive influenza vaccine, parents to have children vaccinated, lifetime pneumococcal vaccination was reported to be higher in diabetic patients, a positive impact on preventive behaviors was reported. Four included studies reported on the effect of access to PEHR with or without additional communication features. In one study, the effect of electronic messages delivered through PEHRs wasn't differentially distributed in the arm receiving tailored messages on influenza, and in the arm receiving educational messages on other diseases. In other studies, active PEHR users were more likely to be vaccinated against influenza and Herpes Zoster, subjects who in addition received reminders had higher rates of influenza vaccination.

Conclusions

While immunization programs are struggling to achieve optimal coverage targets, our findings can partially outline the association between PEHR access and vaccine uptake and further experimental research is needed.

Key messages

PEHRs offer great potential to support population health and in particular immunization programs, helping to put people and patients at the center of care delivery, supporting patient empowerment. Although our findings suggest immunization coverage might benefit from people accessing PEHR, there is an urgent need to produce solid experimental evidence to quantify such effect.
Migration and outbreaks of vaccine-preventable disease in Europe: a systematic analysis (1990-2019)
Authors: Hargreaves S , Deal A , Mounier-Jack S , Campos-Matos I , Edelstein M , Hayward S , Friedland J , Carter J , Rustage K , Majeed A
Published: October 2020

Background

Migrant populations (defined as foreign-born) in the EU/EEA may be one of several under-immunised populations yet their role in outbreaks of vaccine-preventable diseases (VPDs) has been poorly defined to date.

Methods

We did both a temporal analysis to map published reports of migrant-related outbreaks against data from the ECDC's Surveillance Atlas of Infectious Disease, and a systematic review (PROSPERO CRD42019157473; 1990-2019) adhering to PRISMA guidelines, to explore whether migrants are involved in outbreaks in Europe and which particular subpopulations may be at increased risk. Studies on VPD outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, N meningitidis, and H influenzae) in migrants residing in the EU/EEA were included.

Results

46 studies were included, reporting on 50 VPD outbreaks across 13 EU/EEA countries, of which 98% (n = 49) occured since January 2000. Measles had the highest number of reports of outbreaks involving migrants (n = 21; 5043 cases), followed by varicella (n = 10; 595 cases) and hepatitis A (n = 10; 1226 cases). 21 (40%) of outbreaks were reported from shelters for asylum seekers and refugees (mainly varicella or measles). Of 27 outbreaks where the index case was defined, 20 (74.1%) were migrants, including 9 (33.3%) from Eastern Europe and 6 (22.2%) from Africa. When mapped against the ECDC timeline of measles outbreaks, migrant-related outbreaks coincide with Europe-wide peaks in measles incidence (in 2006, 2010, and 2018).

Conclusions

Migrants represent one key group involved in VPD outbreaks, with refugees/asylum seekers residing in shelters or camps particularly at risk. Measles accounted for 38% of all reported outbreaks. Improved data collection on migrant status across Europe is crucial to understanding the complex relationship between migration and occurrence of VPD outbreaks to inform policy decisions on the most effective strategies to prevent future outbreaks.

Key messages

Migrants represent one key group involved in vaccine-preventable diseases outbreaks in Europe. Refugees and asylum seekers may be particularly at risk.