bluuebunny/crossref_metadata_2025 huggingface dataset:
Pandemic response credit-claiming and blame-avoidance in Czechia
Authors: Loblova O
Published: October 2021

Credit claiming led in Czechia during the first wave to centralization and during the summer to decentralization. During the second wave, blame-avoidance led again to centralization. First Wave: Similar to other Central and Eastern European countries, Czechia's number of cases and deaths per capita during the first wave were some of the lowest in Europe. The Czech Prime Minister, Andrej Babiš (of the centrist populist ANO) was in a good position to take credit for these results. While this level of centralization of power attracted some criticism, the unprecedented context as well as the undeniable results of the timely intervention translated into genuine political credit. The government's measures enjoyed overwhelming popular support: an April survey found 76% of respondents saw them as “adequate” (and 16% as too lenient). Summer: The Czech government relaxed measures relatively quickly, precipitated by judicial challenges to the procedural aspects of lockdown measures. Thanks to the low prevalence of COVID-19 in the country, rapid reopening did not lead to dramatic increases in infections. Between June and September, there were virtually no restrictions in Czechia. Second wave: In September, the PM admitted the extent to which restrictions had been eased during the summer was a mistake, but explained his decisions by “societal demand” and prioritizing the economy. Explicit blame avoidance strategy through decentralization of responsibility between governments came only one year into the pandemic. The government obliged and, unconstitutionally, declared a new state of emergency (24). In one weekend, a year after total centralization of responsibility for the pandemic, regional governors (mostly belonging to opposition parties) were co-opted into the government's blame game that crossed party lines, ahead of the October 2021 parliamentary elections.
Credit-taking, blame-avoidance as drivers for power shifts: implications for effective emergency responses
Authors: Greer S
Published: October 2021

In this presentation we summarize the results of the empirical research and draw conclusion for politics in the pandemic.

In the first wave, the ‘honeymoon' period of disaster phases coincided with a poorly understood and dramatic period of sinking cases in many countries. Heads of government saw the risk of massive blame- for failure to respond- and the chance of gaining credit for forceful responses. In the second wave, which hit most of Europe in October and spiked in November and December, blame was easier to find than credit. The honeymoon period of the pandemic was long over and disillusionment was likely to set in. Increasing case counts looked like a policy failure, and reinstated public health restrictions ran a higher risk of looking blameworthy. The result was incentive to take decisions tardily- avoiding blame as long as possible- and to try and shift blame onto others, notably by decentralizing responsibility. In the summer of 2020 case counts across Europe as a whole dropped to very low levels and pressure on health systems eased. As a result, Europe exited both a health care crisis and the solidaristic honeymoon phase in June. The temptation for policymakers was to declare a job well done and lift public health measures despite the ongoing risks. In particular, this could mean heads of government taking credit for lifting restrictions and shifting public health responsibilities back to ministries, agencies, and subnational governments.

 

Given the empirical evidence on credit taking and blame-avoidance has implications for pandemic preparedness, knowledge-brokering, media coverage and civil society. Policy makers reflex to seek credit and avoid blame needs to be mitigated to allow for adequate pandemic responses.
Impact of COVID-19 on hospital care, employment and mental health of people with Cystic Fibrosis
Authors: Bhatnagar R , Tecklenborg S , Segurado R , Fitzpatrick P
Published: October 2021

Background

The COVID-19 pandemic has been challenging for many but especially for people with pre-existing co-morbidities such as people with cystic fibrosis (PWCF). The aim of this study was to examine the impact of COVID-19 pandemic on hospital services access to essential medication, employment, and mental health of PWCF.

Methods

A cross-sectional survey developed by University College Dublin and Cystic Fibrosis Ireland was uploaded on SmartSurvey UK and advertised by CF Ireland to CF community via CFI website and social media in October 2020. Logistic Regression was used for analysis.

Results

119 PWCF participated. 56 (47.5%) deferred hospital visits for CF care from 1-6 months: (57.4%) to 3 months; 42.6% 4 months-over 6 months), due to hospital closure (11.5%) & fear (69.8%). When adjusted for gender and location, PWCF aged <35 years were twice as likely to defer hospital visits as compared to those >35 years (P = 0.048). Online consultation and prescription via email was new for >50% of PWCF and >80% found it useful. Amongst those who worked (46.2%), 87.2% (n = 48) worked from home during COVID19. More PWCF <35 years (9.6%) worked onsite as compared to those >35 years (1.9%). 95% of employers were sympathetic for PWCF who cocooned while working from home (41.7%), however, overall, approximately 1/3rd of all employers were considered unsympathetic. 24.4% found access to CF medications challenging and 7 (5.9%) had to find alternative. After adjustment for gender and working, PWCF < 35 years were more likely to feel “nervous” (OR: 3.28; P = 0.017), “nothing could cheer them up” (OR: 3.24; P = 0.038) and “tired” (OR: 2.76; P = 0.016) compared to those >35 years.

Conclusions

Fear was a strong reason for essential hospital visit deferrals in COVID19, but hospital closures played an important part also. Prescription by email was novel and popular. There has been a serious impact on the mental health of this vulnerable group.

Key messages

COVID-19 impacted hospital visits due to fear and hospital closures; younger PWCF deferred more and for longer. The negative impact of COVID-19 on mental health was more pronounced in older PWCF.
COVID-19 infection in ethnic minorities: A systematic review of age and gender distribution
Authors: Thompson B , Memon A
Published: October 2021

Background

Currently, there have been 135,646,617 cases of COVID-19 infection and 2,930,732 deaths in the world. Compared with the White populations, members of the ethnic minorities living in Europe and North America are disproportionately diagnosed, hospitalized and dying from COVID-19. The reasons for this relatively increased risk of infection and adverse outcome are poorly understood. The aim of this review is to summarise current epidemiological evidence on age and gender distribution in ethnic minority patients hospitalized with COVID-19 infection.

Methods

Multiple electronic databases were searched. Data from studies, published in any language, reporting the risk factors, incidence and outcomes of COVID-19 infection in hospitalized White and ethnic minorities patients were extracted, reviewed and compiled.

Results

36 studies reporting data on age and 26 on gender were included in the review. Ethnic minority patients hospitalized with COVID-19 were relatively younger than White patients. Within the different minority groups, a greater proportion of Black patients were female, whereas a greater proportion of Asian patients were male.

Conclusions

This review confirms findings from individual studies that with regard to age, the ethnic minority patients hospitalized with COVID-19 infection are relatively younger than the White patients. There is also a disparity with regard to gender within the different minority groups.

Key messages

There is a disparity with regard to age and gender between the different ethnic groups affected with COVID-19 infection in Europe and North America. Potential factors for disparities are genetics, vitamin D deficiency, BCG vaccine, comorbidities, occupation, social gradient, housing, PPE access and understanding/compliance to protection measures.
Introduction and purpose
Authors: Lyshol H , Bogaert P , Tolonen H , Schutte N , Pittet V
Published: October 2021

Dashboards are health information tools, made to illustrate specific indicator sets. They may demonstrate developments over time, geographic distribution, social inequalities or correlations between different factors, use a wide variety of infographics, and are generally updated very frequently. Dashboards can illustrate data for users without statistical knowledge, and are also useful data repositories for more proficient users. Dashboards are a modern approach to an old problem: data visualization. A well-known historical example is John Snow's mapping of cholera cases in London (1854). Current computer technology and the existence of the internet have made it possible to visualize health indicators in close to real time, and dashboards, like Dr Snow's map, are meant to, store, report and illustrate health indicators in order to affect policy. The indicators selected should be the ones amenable to change because their unsurpassed ability to monitor changing conditions and effects of interventions. Indicator selection is vital to set a baseline for such monitoring, and the indicators selected will of necessity be the ones where measures are taken in order to affect change.

Policy will influence the choice of indicators, but indicators will also influence the choice of policies, because these two are intimately intertwined. Dashboards, be they national or regional, open to the public or just open to professional groups, are important implements to reach the policy-making audience and to signal what is defined as important. Dashboards can help to formulate policies that will improve public health for all groups.
Examples and processes from national dashboards: Belgium and Kosovo
Authors: Leroy M
Published: October 2021

The official national COVID-19 dashboard of Belgium was first put online on 31 Dec 2020. 1 year later, it was composed of 12 pages, 35 indicators, 73 charts and 15 tables. Lots of decisions were taken to arrive there: the definition of the indicators, the charts, the pages, the hierarchical order of the information, the colors, the footnotes & annotations... How were all of these decided? Who influenced the decisions and what was the dynamic with the decision makers and the general public? And how did it change over time? What are the particularities of the Belgian dashboard? What makes it different from the dashboard of Kosovo? What are the lessons learned and how would it be different if started from scratch?
Development of cancer policy priorities based on research informed policy
Authors: Ricciardi Walter
Published: October 2021

Research is a cornerstone of any scientific medical specialty and field. In cancer, it is important because research pertains to each and all the elements of the cancer trajectory. The nomination of the Mission on Cancer with the DG RTD and its role in shaping cancer research is of paramount importance for future developments for all cancer research in Europe.
Using personalised avatars as an adjunct to a weight loss management programme: A feasibility study
Authors: Horne M , Hardy M , Murrells T , Ugail H , Hill A
Published: October 2021

Background

Obesity is a global public health concern. Interventions rely predominantly on managing dietary intake and/or increasing physical activity but sustained adherence is often poor. A lack motivation, self-efficacy and poor adherence to behavioural regimens are recognized barriers to successful weight loss. Avatar-based interventions have been found to achieve better patient outcomes managing chronic conditions by promoting more active engagement. We aimed to evaluate if a personalized avatar, as an adjunct to a routine weight-loss programme, could increase motivation, sustain engagement and improve health outcomes.

Methods

A feasibility randomised design. Participants were recruited from a community-based, 12-week NHS weight improvement programme. Main outcome measure was weight loss. Quantitative data were subjected to descriptive statistical tests and comparison between intervention/control arms. Acceptability was assessed through interviews and analysed using framework approach.

Results

10 males (7-intervention; 3-routine); 33 females (23-intervention; 10-routine) were recruited. Initial mean weight was greater in intervention than routine arm (126.3 kg vs 122.9 kg); pattern of weight loss was similar across both arms in period T0-T1 but accelerated in period T1-T2 for intervention participants, suggesting that access to the personalized avatar may promote greater engagement with weight-loss initiatives in the short-to-medium term. Quality-of-life and self-efficacy measures demonstrated greater improvement in the intervention arm at both T1 (105.5 routine; 99.7 intervention) and T2 (100.1 routine; 81.2 intervention). N = 13 participants, n = 2 healthcare professionals were interviewed about their experience of using the avatar programme. Overall, participants found the intervention acceptable.

Conclusions

Avatar technology may successfully promote engagement and motivation in a weight-loss programmes, enabling participants to achieve greater weight-loss.

Key messages

The implementation of a personalised avatar as an adjunct to a weight management programme was both feasible and acceptable. Avatar technology may successfully promote engagement and motivation in weight loss programmes.
Digitalizing quality of care control: a Business Intelligence system for COVID-19 inpatients
Authors: Ovchinnikov DA , Potapov IV , Kurapeev DI , Vashenkov VV , Konradi AO
Published: October 2021

Issue

As healthcare systems faced the challenge of the COVID-19, the need for fast and automated quality of care control has grown tremendously. Automatization is widely implemented in the form of Clinical Decision Support Systems (CDS), however, developing such software can take several years of trained IT specialists' work.

Description of the problem

We opted for an analytics and clinical decision support (ACDS) system based on Business Intelligence (BI) software, since it would allow to monitor the necessary clinical data, it was easy to adapt to current tasks and didn't require any special IT-educated specialists to develop and implement. From an individual patient's electronic health record (EHR) was extracted specific clinical data, such as vital signs, laboratory tests and CT scans, respiratory support data; medication prescribed and taken; chronic diseases, etc. Microsoft Power BI software was used to build the ACDS.

The ACDS system consisted of three main elements:

Flat tables (the data from EHR); Data model, connecting tables; Visualizations (tables and charts) depicting patients' condition, which provided the integration of information, the ability to sort data in necessary order, and intuitive marks, such as color indicators for specific parameter values.

Results

Named visualizations were integrated in daily work of the heads of units. Out of 1683 patients admitted with COVID-19, 1415 were undergoing treatment after implementation of ACDS system. It was used to correct the treatment course of 568 patients.

The following corrections were made:

Accuracy of diagnosis (138 cases) and assigned severity (115) Prescribed and delivered medicines (32) Dosage adjustment (25) Transfer to ICU (2) Discharge (412)

Lessons

Thus, engineering analytical and clinical decision support system based on BI appears to be an advantageous way to automate the control of care quality in challenging and time-pressing circumstances.

Key messages

In a situation of unprecedented time pressure and resource shortage, the best option for quality of care control might be a simple BI system, rather than a designated CDS software. The practice of COVID-19 analytics system implementation can become a foundation for designing a bigger transparent analytics system that can be adapted to any patient model or clinical entity.
The public health potential of two popular apps to increase physical activity
Authors: Bondaronek P , Slee A , Hamilton F , Murray E
Published: October 2021

Background

The rise of health apps created novel prospects for public health intervention on a wide scale. Despite the popularity of publicly available physical activity (PA) apps, little is known about their effectiveness. This study aimed to investigate the potential of the apps to increase PA. The objectives were: 1) to determine the feasibility of the trial, 2) explore the effects of the apps on behavioural and psychological outcomes

Methods

Feasibility randomised crossover trial of two popular apps. Inactive adults residing in London (UK) were eligible. The two interventions were: App A - 7 Minute Workout Challenge by Fitness Guide Inc., App B - One You Couch to 5k by Public Health England. After 1-week run-in period, participants were randomly allocated to one of the two assessment sequence (App A, B or App B, A).

Results

Out of 104 participants who were eligible and consented, 63.5% (66/104) were enrolled and randomised. The primary analysis of the accelerometer data showed that there were no significant differences between baseline and the interventions using the continuous variables. Sixteen of 51 participants (31.4%) increased their time in moderate to vigorous PA (MVPA) by 20% from baseline following the introduction of the intervention (95% CI = 19.1% to 45.39). Self-reported PA outcomes showed significant increase and sedentary behaviour decreased. Exercise self-efficacy and intentions increased whilst PA outcome expectancy decreased.

Conclusions

The impact of this two PA apps showed promising results with an impact observed for 20% increase in MVPA, self-reported PA, intentions and exercise self-efficacy. Yet, there was a variability in the outcomes observed.

Key messages

This pragmatic trial with participants classed as inactive showed that physical activity apps can increase physical activity. There was a variability of the physical activity outcome and there is a need to tailor digital tools to the users to impact physical activity on a wide scale.
Feasibility of an artificially intelligent vaccines chatbot in Pakistan: A mixed methods evaluation
Authors: Munir M , Miraj F , Raza H , Hussain OA , Khan AA , Siddiqi DA , Khan AJ , Habib A , Chandir S
Published: October 2021

Background

Despite free vaccination services, gaps in information access impede immunization uptake in low and middle-income countries (LMICs), including Pakistan. We developed Bablibot (Babybot), a local-language, text-based chatbot to connect caregivers with immunization-related information in real-time, and evaluated its feasibility and acceptability in resolving immunization-related queries among Karachi's low-income communities.

Methods

We developed Bablibot using Natural Language Processing (NLP), Machine Learning, and Human in the Loop features. We conducted a sequential mixed-methods pilot in Karachi where caregivers were recruited when visiting selected immunization centers for any childhood vaccine except Measles 2 (last vaccine visit) or were informed through targeted text messages. We assessed Bablibot's feasibility and acceptability through user-engagement metrics and thematic analysis of qualitative interviews conducted with 20 pilot participants.

Results

Between March 9, 2020 and April 15, 2021, Bablibot accrued 677 users and participated in 874 conversations. Of 2,202 pilot-enrolled caregivers, 210 (10%) interacted with the bot; other 467 users were not pilot participants. Most queries were about due dates (25%; 221/874), delaying vaccination (17%; 146/874), or side-effect management (16%;137/874). The conversations now constitute a valuable training database for future local-language bots. Over 90% (277/307) of responses to text-based exit surveys indicated user satisfaction. Qualitative analysis showed caregivers appreciate Bablibot's convenience, reliability, and responsiveness.

Conclusions

Our results demonstrate the feasibility and acceptability of local-language NLP chatbots in providing immunization information. Text-based chatbots can minimize workload on helpline operators, in addition to quickly resolving queries that otherwise lead to delay or default. Bablibot's conversation data provides learning infrastructure for future health-related bots.

Key messages

An AI-based NLP chatbot is a feasible and acceptable intervention for providing immunization-related information to large number of caregivers 24/7 in limited resource setting. By serving as a remote, low-cost and confidential bi-directional channel, chatbots can address gaps in information access, especially for women, and have long term impact on immunization uptake.
7.H. Workshop: Knowledge Translation and Burden of Disease, from theory to practice
Authors:   Organised by: RIVM (Netherlands),   Chair persons: Henk Hilderink (EUPHA-FS), Elena Pallari (UK)
Published: October 2021

Knowledge translation (KT) is an important concept to bridge the gap in health information between research and policy making. Also in Burden of Disease (BoD), with the Disability-adjusted Life Years (DALYs) as its main indicator, this gap exists. KT provides the theory and tools to better link researchers and policy makers to support evidence-informed policy making. The European Burden of Disease Network (COST Action CA18218), serves as technical platform for integrating and strengthening capacity in BoD assessment across Europe and beyond. The network promotes an interdisciplinary approach that integrates KT in the classical BoD framework. One of the work packages working groups focusses on the application of existing KT theory to BoD assessments. Several European countries are undertaking their own National Burden of Disease (NBoD) study, some of them already for many years. They have built up a substantial amount of knowledge on the practical side of KT in relation to BoD assessment. The joint workshop aims to bring together the more theoretical concept of KT with the more practical experiences in three different countries: Scotland, Germany and the Netherlands. The workshop will begin with a presentation on the different concepts of KT in relation to BoD. This will be followed by three presentations of NBoD experiences. Exchange with the audience will be facilitated by using an interactive Mentimeter poll during the session, In this poll, delegates will be asked what they consider to be good elements of KT, and what they consider as main obstacles for KT, in relation to BoD.

Key messages

Knowledge translation is crucial to bridge the gap between burden of disease research and evidence-informed policy making. Combining the theoretical approach with the practical experience of different countries give valuable complementary insights in effective knowledge translation.
Burden 2020: The German Burden of Disease Study Informative, comprehensive, appealing and digital: Providing health data to users. Accessibility of scientific results in the burden context
Authors: Anton A , Fleckenstein T , Von der Lippe E , Rommel A
Published: October 2021

The aim of the BURDEN 2020 project is to calculate the Burden of Disease for Germany at the national and regional level. Based on the methods of the Global Burden of Disease study, the results will assess the impact of diseases on population health thus providing a freely accessible information basis for policy making and health care planning. How can the transfer from science to society take place on a low-threshold basis? We will talk about our strategy reaching out to decision-makers within health care planning in Germany and Europe. In addition, it will be examined how we wanted our results to be accessible, which possibilities of publication we choose beyond scientific articles and what options we had when talking about research marketing. We will also have a closer look on our demands for data visualization and transparency. In an ongoing process, two things were at stake: how do we define our target groups and how we address them. It has been proven to be a good strategy to continuously build up (international) networks, to share our knowledge and implement feedback. When publishing scientific results, it has turned out to be helpful for the project to approach a well-known bi-lingual journal with a wide range of coverage. We aimed to present the pilot project online with an appealing data visualization and graphic formats. This type of presentation made it easier to approach members of the press. Also, the inclusion of current topics such as COVID-19 helped to increase the media response. There are plans to include the use of the data in media formats such as webinars. Burden of Disease assessments can be challenging in implementation and communication. Before the start, the use of the metrics for Germany had to be thoroughly explained to national stakeholders. Within the project, we had to discuss how our data should be communicated to the public, to explain strength and weaknesses, and to produce publication formats that suit different target groups.
Country experiences with data linkage initiatives
Authors: Allin S , Ghafur S
Published: October 2021

This session highlights the experience from two countries in data linkage: Canada and the UK. Canada's ten provinces and three territories have primary responsibility for the organization and delivery of health care services and for the supervision of health care providers. As such, many data linkage initiatives are at the provincial level, and the recent Health Data Research Network aims to facilitate access to multi- province data for researchers. Also the Social Data Linkage Environment (SDLE) represents a national effort led by the federal government (Statistics Canada). The SDLE has a centrally maintained ‘key register' containing new identifiers based on a number of identifying characteristics which are used to link a wide range of data sets, including the Labour Force Survey, national health surveys, the hospital discharge database, census data, and a range of provincial data on crime, education, mental health, etc. Thus, the SDLE is not a consolidated database per se, but a tool to link other databases, and has potential for use in scientific research. Similar to Canada, the different nations of the UK operate separate data linkage initiatives. One internationally renowned national database, the Clinical Research Practice Datalink (CPRD), reflects the important role of GPs. The CPRD brings together de-identified microdata data from GP practices in the UK on the basis of the respective electronic practice information systems. The data collected includes demographic details, information on service providers, clinical presentation, referrals, vaccinations, laboratory findings and medication prescriptions, with the ability to link to other data sets to research the care pathway. As of 2019, the CPRD data covers 42 million patients and has been used for more than 2000 scientific publications that have researched issues such as drug safety, drug use, the effectiveness of health policy measures, the organization of service delivery and the development of risk factors.
Impact of COVID-19 on drug use disorders and provision of drug related interventions in prison
Authors: Montanari L , Vandam L
Published: October 2021

Introduction

With the emergence of the COVID-19 epidemic, most European countries implemented measures to prevent the spread of infections inside prison, including: use of personal protective equipment (PPE), hygiene practices, limits to mobility, reduction of overcrowding. Their implementation affected the drug related interventions. The EMCDDA has conducted a rapid assessment to evaluate the impact of those measures on the provision of drug treatment and harm reduction services in the European prisons of 15 countries between March and June 2020.

Methods

The study was based on a mixed method approach that triangulated the results of an on-line survey, the outcome of a focus group with prison and drugs experts and case studies from four European countries.

Results and discussion

Most countries reported a reduction in the provision of drug treatment and, to a lesser extent, of harm reduction interventions inside prison during the early phase of the pandemic. The drug services tried to adapt to the new context. Innovations were introduced, including the use of telemedicine in counselling and pharmacological treatment, a better partnership between security and health staff and a more individualised approach to drug treatment. Concerns were expressed around reduction of some interventions, such as group-based interventions, services provided by external agencies, interventions in preparation for release, continuity of care and possible reduction in testing and treatment of drug related infections such as HIV, HCV and HBV due to the priority given to the COVID-19 emergence.

Conclusions

With the emergence of COVID-19, drug services had to address various challenges, making efforts to maintain the provision of drug-related interventions inside prison, while introducing the COVID-19 containment measures. Ensuring the equivalence and continuity of health care provision for those in prison with drug problem remains of central importance.
Prisons, drugs and COVID-19: Early releases and continuity of care
Authors: Shirley-Beavan S
Published: October 2021

Introduction

Detention settings are high-risk environments for the spread of infectious diseases. Since 2020, COVID-19 has posed unprecedented challenges for governments and prison administrations. In some jurisdictions, this has catalysed early release programmes to decongest prisons to minimise the harm of COVID-19 in prison systems.

Methods

From March to June 2020, HRI monitored the adoption of prison decongestion measures in response to COVID-19 in Europe and worldwide. HRI tracked criteria for eligibility and implementation of the measures and distributed online expert surveys as part of the Global State of Harm Reduction 2020 that included questions on harm reduction in prisons and the response to COVID-19. Survey data was supplemented by a review of academic, governmental, and non-governmental literature. A review to update the data will be carried out by mid-2021.

Results and discussion

Results show prison decongestion schemes initiated in 17 countries in Europe and 109 countries worldwide. Overall, by July 2020 decongestion measures reduced the global prison population by 16% in Europe and just 6% worldwide. In a quarter of countries (including at least four in Europe), people incarcerated for drug offences were explicitly excluded, regardless of whether they suffered from health condition or belong to a vulnerable group. We found no evidence of expanded access to harm reduction programmes to address the risk of overdose after release. Issues that exacerbate overdose risk included interruptions to the provision of opioid agonist therapy (OAT) and the unavailability in most jurisdictions of naloxone on release.

Conclusions

People who use drugs and are in detention settings have been inadequately served during the COVID-19 pandemic. To address the unique health risks of detention settings, there is a need for greater commitment to the adoption of non-custodial measures, and diversion from criminal justice towards a health-led response to drug use.
Impact on invitation and participation in the CRC screening in the Basque Country due to Covid19
Authors: Idigoras Rubio I , Portillo Villares I , Bilbao Iturribarria I , Aguinaco Garcia C , Gomez Lopez M , Santos Zorrozua B , Gonzalez Nieto N , Herrero Hernandez JJ
Published: October 2021

Background

The colorectal cancer screening programme (BCSP) obtains excellent participation rate, reflected in early detection and treatment of pre & malignant lesions, objectifying a downward trend in incidence & mortality rates

Objectives

To compare invitation coverage and impact on participation with faecal immunochemical test (FIT) pre&post pandemic. To compare the participation rate in Primary Care Units (UAP) in which the invitation and FIT pickup was interrupted with those that were not, in order to design prioritization strategies in the face of another lockdown

Methods

Retrospective cohort study of invitations from 2018-2020. Indicators of coverage and participation rate to COVID 19, during the interruption due to lockdown, and subsequent invitations sent out without interruption afterwards. Data analysis R version 4.0.1 stats and MKinfer

Results

40% of the planned invitations were taken up (81,097/200,000) showing a decrease in participation rate (71.9/68.8%) P ≤ 0.05 95% CI(2.79-3.52), with significant differences in all groups by age and sex. In the comparative analysis between UAPs that interrupted test collection in March resumed in June or when the invitation was made without interruption (September to December), higher participation rates were observed in the group that did not interrupt the screening (68.1/69.8%) P ≤ 0.05 95%CI (1.18-2.23), with differences in all groups of age and sex. In order to reorganize the activity, agreements were made:1)prioritization of screening colonoscopies, 2)reduce the burden of follow-up colonoscopies based on the evidence. Advanced lesions, has passed from 1 to 3ys, and only the resection in piecemeal ≥20mm sessile is done in under 1y

Conclusions

The Covid-19 pandemic has affected the BCSP with a decrease in scheduled invitations, but only a slight decrease in the participation rate. The impact is lower if the collection of FIT samples is not interrupted. If a new lockdown is needed, we will not stop the collection of FITs

Key messages

The Covid-19 pandemic has affected the BCSP adn will impact in incidence and mortality of CRC. The impact is lower if the collection of FIT samples is not interrupted.
Sedentary behaviour and risk of breast cancer according to occupation and family size
Authors: Pinto-Carbó M , Vanaclocha-Espí M , Hernández-García M , Ibañez J , Salas D , Molina-Barceló A
Published: October 2021

Background

Nowadays there is a lack of consensus on the relationship between sedentary lifestyles and breast cancer (BC). In this study we aim to shed light by analysing the relationship between a sedentary lifestyle and breast cancer in women participating in the Breast Cancer Screening Programme of the Valencian Community (BCSP-VC) (Spain) according to occupation and Family Size (FS).

Methods

Cohort study with women aged between 45-70 years participating in the BCSP-VC. The sample consists of 506 cases and 120853 controls. Multivariate logistic regression models (M) were performed to study the relationship between sedentary lifestyle and BC. The explanatory variables were: M1: sedentary behaviour adjusted for age and family history; M2: M1 + reproductive variables (menopausal status, hormone replacement therapy, months breastfeeding); M3: M2 + lifestyles (Body Mass Index, smoking); M4: M3 + gender variables (child burden, FS) and M5: M4 + social variables (educational level, occupation). These M are implemented in the total sample and stratified by occupation (manual, non-manual, housewives and non-working) and FS (small, medium, large). Results are given in terms of Odds Ratio (OR) and 95% confidence interval (CI).

Results

M1 shows that sedentary women are more likely to have BC (OR = 1.25 CI=1.01-1.55). This association is maintained in M2 (OR = 1.25 CI=1.00-1.57) and M3 (OR = 1.25 CI=1.00-1.57) but not when adjusting for gender and social variables. When stratifying by occupation and FS, we observe that, regardless of the variables taken into account in the M, housewives and women with small FS who are sedentary are more likely to have BC (p < 0.05). No statistically significant results were observed in the rest of the occupational and FS strata.

Conclusions

Sedentary behaviour increases the risk of developing BC, with this relationship being observed in housewives and those with small FS. Further work is needed on how gender and social variables modulate this effect.

Key messages

Sedentary behaviour increase the risk of breast cancer, and this relationship is affected by gender and social characteristics. The positive relationship between breast cancer and sedentary behaviour is observed in housewives and those with small family size.
1-year impact of COVID-19 on childhood immunizations in Pakistan: analysis of > 3.7 million children
Authors: Chandir S , Siddiqi DA , Mehmood M , Iftikhar S , Siddique M , Jai S , Dharma VK , Khan AA , Akhter MA , Khan AJ
Published: October 2021

Covid-19 has universally disrupted primary health care, but routine childhood immunizations are one the most affected services. We analyzed big data in vaccines for measuring the 1-year impact of Covid-19 on outline childhood immunizations for the 48 million population in the Sindh province of Pakistan. We extracted and analyzed >3.7m real-time immunization records of 0-23 months old children from the Sindh Government's Electronic Immunization Registry (EIR). Using a 6-month baseline preceding the COVID-19 lockdown, we quantified the lockdown's (March 23-May 9, 2020) impact on daily immunization rates by geographical area and the change in coverage rates at the one-year mark since the lockdown. The lockdown resulted in 53% drop in the number of immunizations. The impact in rural areas as more than in urban areas (54.9% decline vs 47.5% decline from baseline), and slums had a slightly larger decrease in immunization coverage than non-slum areas (53.8% vs. 51.3%). Of 1,246,321 children who missed immunizations during first year of the pandemic, 76% of these children were eventually vaccinated by the end of March 2021. Similarly, of the 417,553 children who had dropped out during the initial 7-week national lockdown (March 23-May 10, 2020), 79% were immunized by March 2021. Our analysis of EIR data shows that the catch-up and recovery of coverage rates have primarily been driven through intensive outreach vaccination efforts instead of an increase in demand. One year since the onset of the pandemic, the average daily immunization doses administered through outreach increased by 121 percent above baseline estimates. In contrast, vaccines administered at immunization clinics were still 22 percent below baseline. The example of Pakistan shows LMICs can successfully deploy mitigation strategies to catch up with missed children during Covid-19 and sustain routine childhood immunizations to close immunity gaps.

Key messages

Although the lockdown resulted in a 53% drop in immunizations, at the 1-year mark since the pandemic started, 76% of children who missed immunizations are vaccinated. Pakistan data shows LMICs can rectify routine immunization coverage and immunity gaps and rebound successfully to their pre-COVID-19 coverage rates.
7.P. Workshop: Mental health during the Covid19 pandemic & corresponding national health promotion measures
Authors:   Organised by: BZgA (Germany), Santé Publique (France), Epidemiologia Piemonte (Italy),   Chair persons: Yvette Shajanian Zarneh (Germany)
Published: October 2021

Background

To an initially non-expected degree, the wellbeing of the population in European countries has been affected by the containment measures during the course of the COVID-19 pandemic. The longer the pandemic holds the more visible become also the economic effects, which in turn will affect the populations mental health and wellbeing on the longer term and have the potential to dramatically increase health inequalities. Whether the psychosocial burden of containment measures will be followed by a significant increase of mental illness is hotly debated and yet to be determined. National institutions have the task to promote health during such crises. Therefore, mental health and wellbeing was monitored in most European countries, and in many countries, approaches to support the population and its subgroups under the burden were developed, acknowledging the monitoring data and dynamics within the pandemic and containment activities. In this workshop the data on population wellbeing during the pandemic from Germany, Italy and France will be presented and the different approaches to promote mental health explained and discussed. The input from the three countries will be the basis for a discussion with the audience: What similarities can be identified from the measures and programs presented? What lessons can be learned for their further development? What synergies could arise in the future?

Objective

The goal is to present, compare and critically review the mental wellbeing of populations and subgroups in the three countries since the beginning of 2020, to assess its association with the pandemic waves and the according containment measures and discuss the resulting health promotion activities (with a focus on national-level interventions and approaches). Selected interventions to promote mental health and wellbeing will be presented that were developed based on the monitoring data available in the countries. The interventions will be discussed in terms of their relevance to reach subgroups and improve wellbeing in the dynamic situation of the COVID-19 pandemic.

Key messages

The longer-term effects of the pandemic and its containments measures on mental health and wellbeing of populations is yet to be defined. The psychosocial burden is higher in certain subgroups and demands specific interventions that improve access to preventive (partly preexisting) mental health services.
7.Q. Workshop: Empirical insights on understanding of Othering and its impact on refugee health
Authors:   Organised by: PH-LENS (Germany),   Chair persons: Oliver Razum (Germany), Theda Borde (Germany)
Published: October 2021

The workshop is held by the PH-LENS Research Unit Refugee Migration to Germany: a magnifying glass for broader Public Health challenges. PH-LENS is an interdisciplinary research group that blends expertise from various disciplines such as public health, medicine, psychology, sociology, statistics to examine the challenges of forced migration for Germany's health system and their effects on refugee health. Forced migration, and resulting challenges relating to refugee health, are currently treated as highly exceptional, as a singularity. This constitutes a socially as well as scientifically impoverished approach in two respects. Firstly, a singularity perspective may ultimately have adverse effects on the health of refugees because of the resulting Othering processes and further social marginalization of forced migrants. Othering serves as an essential analytical perspective in examining the relationship between minority status and health inequalities. The recourse on Othering enables to explore how refugees are positioned along with categorical distinctions and social attributions and how health inequalities arise from this ordering. Othering is a complex phenomenon based on power hierarchies that leads to social exclusion and health inequalities. The workshop explains Othering through synthesizing insights from our empirical quantitative and qualitative research, and theoretical analysis. The first presentation analyses attitudes towards refugees in Germany based on three representative studies run between 2014 and 2019. It sheds light on rejecting attitudes towards refugees that are present in the political center of Germany, and discuss how they contribute to Othering. The second presentation covers a qualitative survey concerning Othering processes from the perspective of refugees and professionals in obstetric care. Here, both rejective and benevolent processes of Othering come into play. Following on from this, we discuss whether benevolent Othering has an inclusive potential. Based on a theoretical analysis, the third presentation provides an in-depth reflection on Othering, focusing on the concept of Inclusionary Othering. By centering the discussion on Othering, the workshop seeks to shift the focus to society and the structural health care patterns that determine the intensity and extent of marginalization along categorical lines in addressing challenges of the health system.

Key messages

Othering provides an essential analytical perspective for examining the relationship between minority status and health inequalities. We show that exclusionary and inclusionary effects of Othering are relevant for Public Health but are so far under-appreciated.
Potential life years lost to COVID-19 in 17 countries during the pandemic period, up to August 2020
Authors: Achilleos S , Pagola Ugarte M , Quattrocchi A , Gabel J , Kolokotroni O , Constantinou C , Nicolaou N , Rodriguez-Llanes JM , Demetriou CA
Published: October 2021

Background

COVID-19 pandemic is affecting populations and regions in different ways. In this study, we assess the Potential Years of Life Lost (PYLL) to COVID-19 across different regions.

Methods

We used age-group and sex-specific weekly COVID-19 deaths (from January to August 2020) from national primary sources of 17 countries from the C-MOR consortium (Australia, Brazil, Cape Verde, Colombia, Cyprus, France, Georgia, Israel, Kazakhstan, Peru, Norway, England & Wales, Scotland, Slovenia, Sweden, Ukraine, and the United States). PYLL were calculated by summing up the numbers of deaths in each age group multiplied by the remaining years of life up to age 80. Age-standardized PYLL rates (per 100,000 population), using the World (WHO 2000-2025) Standard population as the reference population, were estimated to facilitate comparison across countries.

Results

Countries in South America displayed the highest PYLL rates (567-1,377 PYLL/100,000). Countries in Asia & Middle East (besides Kazakhstan), Australia, and some European countries (Georgia, Norway, and Slovenia) observed <50 PYLL/100,000. Furthermore, the male to female PYLL rate ratio was above one in all countries [1.3 (Ukraine) - 14.4 (Cyprus)], besides Georgia (ratio = 0.5).

Conclusions

South America, and males were found to be the most affected by COVID-19. Ongoing monitoring of the COVID-19 mortality impact is essential in order to assess health system performances, control measures, and identify vulnerable populations. Differences in mortality burden among populations will help public health officials in their efforts to minimize the COVID-19 mortality burden on a local, and on a global level.

Key messages

Up to August 2020, COVID-19 was a cause of premature mortality in all the participating countries, with South America and males to be more affected. The timing of the pandemic, seasonal trends, the control measures enforced, and underlying social conditions are probable explanations for the differences observed among countries.