bluuebunny/crossref_metadata_2025 huggingface dataset:
5.G. Skills building seminar: How to organise and benefit from a public health week in your country, region or continent
Authors:   Organised by: EUPHA,   Chair persons: Debora Miranda (European Observatory), Maaike Droogers (EUPHA)
Published: October 2021

The European Public Health Week (EUPHW) is an annual activity by the European Public Health Association (EUPHA) that began in 2019, inspired by similar initiatives organised in Austria and the USA. This session aims to inspire and guide individuals and institutions to organise a public health day, week or month in a new city, country, region or continent. Having taken place both before and during the COVID-19 pandemic, the EUPHW has demonstrated that public health professionals, institutions and citizens across Europe are strongly committed to deliver its goals: to make the case for public health, amplify existing messages about important health topics, and create innovative ways of collaboration among all professionals contributing to public health - from local to international level. With a rich portfolio, the three editions of EUPHW recorded approximately 400 online and in-person activities hosted by more than 40 countries in multiple languages. In this skills-building seminar we will share examples, tips, best practices and lessons learned. This will be an interactive session combining group dynamics and Q&A to and from the audience, allowing participants to provide suggestions for improvement and share their experiences and perceptions as event hosts, disseminators or participants of past editions. The topics to be covered include governance, choice of themes and key messages, logistics, target audiences, communication, partnerships, stakeholder engagement, involvement types and evaluation, as well as concrete ways of applying the motto of EUPHW: “Joining forces for healthier populations”. Panellists will bring the perspective of organising a public health week at both national and European levels, including the day-to-day coordination work. They will also explain how we can engage with the future generation of public health professionals (EUPHAnxt) and build continuity and sustainable partnerships.

The EUPHW is an initiative by the European Public Health Association (EUPHA), receives co-funding under an operating grant from the European Union's Health Programme and is supported by the WHO Regional Office for Europe.

Speakers/Panelists

Dineke Zeegers Paget EUPHA Thomas Dorner Austrian Public Health Association, Vienna, Austria Marie Guichardon EUPHA Monica Brinzac Cluj School of Public Health, Cluj Napoca, Romania

Key messages

The European Public Health Week is a unique opportunity to make the case for public health, raise awareness about important health themes and promote collaboration among the public health community. This seminar aims to inspire individuals and institutions to organise a public health awareness day, week or month in their own local community, country or even continent.
Predictors of ER access of frail elderly: a way to fighting the COVID-19 outbreak
Authors: Gentili S , Terracciano E , Liotta G
Published: October 2021

Background

The overcrowding of the Emergency Room (ER) by the elderly is still a focus of public health policies, also due to the recent COVID-19 outbreak. Health policies have tried to mitigate the high use of ER by implementing community care on health demand in the absence of a plan to manage the increasing request of out-of-hospital care. This study aimed to investigate the predictors of Emergency Room Access (ERA) and No-Urgent Emergency Room Access (NUERA) of community-dwelling frail older adults.

Methods

An observational longitudinal cohort study was carried out. The cohort was made up of 1246 community-dwelling frail older adults (over 64) residents into the Latium Region. The ER admission rate was assessed over three years from the baseline administration of the Functional Geriatric Evaluation questionnaire to evaluate Bio-Psycho-Social Frailty. The GENLIN ordinal regression model was used to identify the predictors of ERA and NUERA.

Results

Mean age was 73.6 (SD ± 7.1) years, and 53.4% were female. The sample was stratified in Robust (43.5%), Pre-frail (35.8%), Frail (14.0%), and Very Frail (7.3%). The ordinal logistic regression model highlighted the predictive role of comorbidity (OR = 1.13, p < 0.001) and frailty level (OR = 1.29, p < 0.001) for ERA. With regard to NUERA, the predictors were social network (OR 0.54, P-value = 0.015) and) and a medium score of pulmo-cardio-vascular function (OR 1.50, P-value = 0.006).

Conclusions

Comorbidity and lack of social support impacted ER access and the overcrowding of the emergency department. Overall bio-psycho-social frailty represents an indicator of the frequency of ER accesses. This study could support policymakers and public health professionals in implementing community health care and defining and meeting the demand for care of non-frail individuals.

Key messages

The overcrowding of the Emergency Room (ER) by the elderly is still a focus of public health policies, also due to the recent COVID-19 outbreak. Comorbidity and lack of social support impacted ER access and the overcrowding of the emergency department.
Understanding how to improve the use of clinical coordination mechanisms between levels of care
Authors: Esteve-Matalí L , Vargas I , Plaja P , Cots F , Mayer EF , Pérez-Castejón JM , Escosa A , Ramon I , Abizanda M , Vázquez ML
Published: October 2021

Background

Clinical coordination mechanisms (CCM) can play an important role in improving clinical coordination between primary (PC) and secondary care (SC) doctors, being necessary to understand the reasons hindering their use. The aim is to analyse the level of use of CCM, and the difficulties and factors associated to it.

Methods

Cross-sectional study based on an online survey using the COORDENA-CAT questionnaire (October-December 2017). Sample: 3308 doctors of the Catalan national health system. Outcome variables: frequent use of six CCM and difficulties in their use. Explanatory variables: sociodemographic, labour characteristics, organizational and interactional factors. Stratification variable: level of care. Analysis: descriptive bivariate and multivariate by logistic regression.

Results

The level of use differed according to the CCM and level of care, being lower for the different cross-level consultations (via electronic medical record -EMR: 52.36%, email: 26.11% and phone: 21.73%). Shared EMR of the organisation (81.27%) and of the region (65.89%), and joint clinical case conferences (63.28%) were the most frequently used, especially by PC doctors, and the ones presenting more difficulties in use. While the difficulties pointed to organizational problems, mostly related to computer and schedule problems, the analysis of factors pointed also to some individual factors. Working in integrated areas or with local hospitals were factors positively associated with the use of CCM. Interactional factors, such as personally knowing the other level doctor, were associated among SC doctors.

Conclusions

The use of CCM differed across mechanisms and level of care, and was clearly improvable. Difficulties and factors affecting their use were mostly organizational, so managerial support is required to create the appropriate conditions for their use. It is also important to strengthen interaction between doctors of different care levels to improve the use of CCM.

Key messages

The level of use of CCM differed according to the mechanism and level of care, and was clearly improvable. This study identifies difficulties and factors affecting their use, mainly organizational. These results are useful for managers promoting strategies to improve clinical coordination by the effective implementation of CCM, which require managerial support and interaction between doctors.
Socioeconomic differences in metabolic syndrome development and the role of perceived stress
Authors: Hoveling LA , Liefbroer AC , Bültmann U , Smidt N
Published: October 2021

Background

Metabolic syndrome (MetS) incidence strongly varies by socioeconomic position (SEP), but to date, no studies have assessed the mediating role of perceived stress from long-term difficulties (chronic stress) in this association. This study examines the mediating role of chronic stress in the associations between SEP measures education, occupational prestige and income, and incident MetS and whether the associations between chronic stress and MetS are moderated by sex.

Methods

An adult subsample (n = 53,216) of the Lifelines Cohort Study without MetS at baseline was used. MetS incidence was measured at follow-up (median follow-up time 3.9 years) defined according to the NCEP-ATPIII criteria. Chronic stress was measured with the Long-term Difficulties Inventory (LDI) and consists of 12 items evaluating (on a 3-point Likert scale) to what extent various domains of life had been perceived as stressful during the last year. Direct associations between SEP, chronic stress and incident MetS were estimated using multivariable logistic and linear regression analyses, adjusted for age, sex, the other SEP measures and follow-up time. The mediating percentages of chronic stress explaining the associations between SEP and incident MetS were estimated using the Karlson-Holm-Breen method.

Results

At follow-up 7.4% of the participants developed MetS. Years of education and occupational prestige were inversely associated with MetS incidence. Chronic stress suppressed the association between education and MetS incidence (5.4%) as well as the association between occupational prestige and MetS incidence (6.0%). No effect modification of sex in the chronic stress-MetS pathway was observed.

Conclusions

Chronic stress does not explain educational and occupational differences in developing MetS. In fact, individuals with more years of education or a higher occupational prestige perceive more chronic stress, compared to their lower SEP counterparts.

Key messages

Education and occupational prestige are inversely associated with metabolic syndrome incidence. Chronic stress does not explain SEP differences in developing metabolic syndrome.
Sociological approach of differential care in Down syndrome screening based on maternal place of birth
Authors: Sauvegrain P , Cognet M , Azria E
Published: October 2021

Background

In recent years, differential care in the field of perinatal medicine between women from sub-Saharan Africa and natives, such as suboptimal screening of preeclampsia or more frequent use of C-section have been identified. The objective of this study, in connection to the other parts of the BiP project, was to document differential care between these categories in regard with information on Down syndrome screening.

Methods

Prospective qualitative study by audio-recording and/or observation of prenatal visits, ultrasound examinations and genetic screening consultation, and semistructured explicitation interviews with care providers was conducted in 3 maternity units in Paris area. Two midwives and 2 obstetricians in each unit were included, such as their patients who consent to participate. The content of the consultations was classified thematically, and the interviews were analyzed using the grounded theory framework.

Results

47 prenatal visits, 19 ultrasound examinations and 11 genetic screening consultations have been audio-registred and/or observed. Participation rate was 85% for the women. Semi-structured explicitation interviews were conducted among 11/12 care providers. Despite a probable inclusion bias (participants were informed of the purpose of the research and were volunteers), differences in care provider - patient interactions according to women's place of birth have been identified. A tendency to speak more loudly with women with lower French proficiency was noted and less detailed information on the screening strategy and on Down syndrome was provided. The use of an interpreter was very rare in situations of language barrier, challenging the information quality on Down syndrome screening.

Conclusions

Beside showing differences in care provider - patient interaction according to women's place of birth, this study provides an opportunity to discuss the benefits and limitations of qualitative approaches to the study of differential care.
The other side of COVID-19: a cross-sectional study on mental health in a sample of Italian nurses
Authors: Renzi E , Baccolini V , De Vito C , Migliara G , Marzuillo C , Villari P , Massimi A
Published: October 2021

Background

The COVID-19 pandemic and the resulting drastic increase in the workload for healthcare professionals, particularly nurses, has had serious consequences on the psychological well-being of these professionals. Our study aimed at (i) identifying demographic, work-related factors, and clinical predictors of Post-traumatic stress disorder (PTSD) and Generalized Anxiety Disorder (GAD) in nurses employed during COVID-19 pandemic and (ii) assessing problem-focused coping strategies implemented by nurses.

Methods

We carried out a cross-sectional study between December 2020 and April 2021, addressed to nurses employed during the COVID-19 second wave (October - December 2020). PTSD and GAD were assessed by Social Readjustment Rating Scale, Impact of Event Scale - Revised (IES-R) and General Anxiety Disorder -7 scale.

Results

Overall, 359 nurses were included in the study, whose mean age was 31.75 years (SD ± 9.77). Most were female (80.8%), unmarried (53.2%) and employed in the central (52.5%) and northern (36.4%) regions of Italy. A total of 59.7% of all participants had clinical predictors of PTSD, recording a mean score of IES-R of 38.2, SD ± 19.2, range 1- 84 (cut-off >33 for PTSD). Furthermore, 45.6% of respondents reported moderate - severe symptoms consistent with generalized anxiety disorder. Statistical significance was found between GAD and nurses being employed on the front line (Intensive care unit and emergency department) during the COVID-19 second wave (p = 0.016), and between GAD and clinical predictors of PTSD (p = 0.001). Furthermore, we found a statistically significant association between PTSD and nurses who were employed in hospitals or institutions dedicated to COVID-19 (p = 0.028).

Conclusions

PTSD and GAD represent a public health problem to be addressed in the post-pandemic period. Healthcare organizations need to activate specific support and rehabilitation networks and programs for healthcare professionals employed during the COVID-19 pandemic.

Key messages

The levels of PTSD symptoms and anxiety among nurses were high during the pandemic. It is necessary for health systems to differentiate between temporary and long-term mental disorders in order to provide the health workforce with appropriate rehabilitation.
Mapping levels of COVID-19 vaccine hesitancy worldwide: preliminary results of a systematic review
Authors: Massimi A , Renzi E , Baccolini V , De Vito C , Migliara G , Marzuillo C , Villari P
Published: October 2021

Background

Several factors can determine the success of a vaccination campaign, regardless of the availability of an effective and safe vaccine. Among these, vaccine hesitancy (VH) has long represented one of the main barriers to achieving vaccination coverage goals in many countries. The aim of this systematic review was to summarize the global levels of COVID-19 VH and to identify their determinants.

Methods

A systematic review of the literature was carried out following the PRISMA guideline and searching on PubMed, Web of Science, Scopus and PsycINFO for observational studies published up to April 2021 in English or Italian language. Levels of hesitancy and data on determinants, according to the SAGE working group matrix of determinants, were extracted. The systematic review protocol was registered on Prospero (ID: CRD42021235328).

Results

Of the 5447 articles initially retrieved, 89 were included in the qualitative synthesis. The included studies investigated COVID-19 VH on 1.954.331 individuals from 68 different countries (North America 19; South America 23; Africa 3; Asia 18; Europe 55; Oceania 4) between March 2020 and January 2021. Rates of hesitancy, before to the worldwide availability of vaccinations (82 studies), ranged from 84.6% (Cameroon, May-August 2020) to 10.37% (China, March-June 2020). Studies carried out on January 2021 (N = 7) showed rates ranging from 42.8% (Turkey) to 5.3% (UK). A subgroup analysis of data referring to healthcare workers showed the highest hesitancy rates in Honk Kong (60%) and Turkey (26.6%), before and after vaccine availability, respectively.

Conclusions

Preliminary results confirm the wide variability of VH across the world. The ongoing quantitative synthesis on prevalence of VH and the analysis on determinants will allow to update intervention strategies to address VH, both in general population and healthcare workers, orienting public health policies.

Key messages

Vaccine Hesitancy continues to be one of the greatest threats to global health and, in the long term, one of the potential barriers to the success of the global COVID-19 vaccination campaign. Identifying and synthesizing the specific determinants of COVID-19 vaccine hesitancy is essential to guide intervention strategies to promote vaccine confidence and, finally, vaccine acceptance.
Perinatal mental health services for mothers from ethnic minority and migrant backgrounds
Authors: Soltani H , Watson H , Fair F , van den Muijsenbergh M , Papadakaki M , Jokinen M , Sioti E , Raben L , Burke C , Vivilaki V
Published: October 2021

Perinatal mental health disorders are among the most common morbidities of the perinatal period with considerable adverse effects on mothers and their offspring. Members of ethnic minority groups, particularly those from migrant backgrounds, are at higher risk of developing mental illness with evidence of ongoing inequality in access to support. We will present an exploratory mixed-methods study scoping ethnic minority and migrant women's experiences accessing perinatal mental health services in the UK. Results showed how women perceived access to services as very challenging and how they experienced ‘suffering in silence', a ‘need for a safe space to talk and to be listened to', and a ‘need of finding other women like them'. We will complement these findings with the lessons learned from a related project, a three-site European study (ORAMMA) evaluating the feasibility of implementing an integrated perinatal care model for migrant mothers comprising maternity peer supporters (MPSs)-women from migrant backgrounds who had lived in the country for a longer time and were trained to support other migrant women during the childbearing continuum-. Results showed that MPSs supported migrant women accessing maternity care, overcoming language barriers, and advocating for them in their encounters with healthcare professionals. Besides, they provided emotional support and increased women's confidence, helping them overcome loneliness, encouraging them to build relationships with others and promoting bonding with the new baby. Bringing these two projects together, we will discuss how MPSs have the potential to help overcome barriers that immigrant women experience in seeking perinatal mental health and how the benefits of maternity peer supporters have the potential to reduce perinatal mental health risks amongst migrant mothers. Findings will point to the need for future research to evaluate the direct impacts of MPSs on immigrant's mother perinatal mental health.
7.C. Workshop: Dashboards for COVID-19: Lessons learned
Authors:   Organised by: EUPHA-PHMR, PHIRI, Norwegian Institute of Public Health, Sciensano (Belgium), HealthPros Network, WHO/Europe,   Chair persons: Heidi Lyshol (Norway), Petronille Bogaert (EUPHA-PHMR)
Published: October 2021

Visual analytics dashboards illustrate analytic processes, compiling huge amounts of data to visualize trends and occurrences, aiming to present both specialists and the general public with critical information using a quick and efficient modality. The resulting views, that could comprise graphs, time lines, different kinds of charts and diagrams or maps, can be shared with many users and stakeholders, and are meant to help to better communicate statistics, actionable results and disseminate information. During the COVID-19 pandemic, we saw an emergence and rapid development of analytical dashboards for epidemiological and public health monitoring purposes. They were initiated by public health institutes, academia, media outlets, international organisations and/or citizen initiatives, and were generally open to all interested parties, both inside and outside the public health field. Public, web-based COVID-19 dashboards allow for communication on a large scale, to and between data providers and public health organizations, and to citizens, journalists and special interest groups, such as patient organisations and have therefore been widely adopted during the pandemic. The plethora of such dashboards (around 200 in April 2021) have showcased the limitations and difficulties inherent in the format, which may be related to the differing rationales, the heterogeneous definitions and widely varying choice of indicators that are included, along with shifting practices over the waves of the pandemic, from diagnosis to testing to vaccination rates. This has highlighted the need for collaboration between public health authorities, the field of medical informatics and academic groups when developing epidemic dashboard tools opened to a large public. This workshop will address the theoretical aspects behind the use of visual analytical dashboards. We will show examples of dashboards, with the goal of understanding and comparing the main reasons driving their development, maintenance and improvements. We will show how the choices of indicators, the access to data, the technology used as well as how time pressure and expectations, including from policy makers, were handled. Finally, we will make recommendations on how existing dashboards, both pre- and post COVID-19, can be adapted to handle the data needs of the next international incident or pandemic, and also look at the broader picture, namely he policies underlying the whole picture.

Key messages

Dashboards are a useful tool, used extensively to support decision-making during the COVID-19 crisis. These dashboards must be fine-tuned to make policy response possible.
Health-related lifestyles: how they have changed after the COVID-19 pandemic occurring in Italy
Authors: Minardi V , Contoli B , Possenti V , Lana S , Luzi P , Masocco M
Published: October 2021

Background

The COVID-19 pandemic has fully affected the global community and will generate long-term consequences on social and individual life overall.

Methods

Since their start, the two Italian population-based surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) have investigated health-related lifestyles. The continuous monthly data collection allows observation of changes in the short, medium and long terms. We compared prevalence of tobacco and alcohol use, physical activity, PA, or inactivity, PI, before and after March 2020, to evaluate temporal trends with particular concern to changes due to the pandemic.

Results

Sedentariness has been growing among inactive adults but in pandemic time, we observed a 10% significant reduction compared to 2019, due to a significant increase of spare time PA from 42% (2019) to 45% (2020) and a reduction of spare time PI from 42% to 39%. Despite a stable trend, elderly increased significantly PI, from 40% (2019) to 43% (2020). PI goes from 46% to 52% among Southern residents and from 45% to 53% in poorly educated people. Since 2008, at-risk alcohol consumption gradually increased in adults because of binge-drinking and between meals modalities. In 2018, a tendency inversion started and finds confirmation during the pandemic: binge-drinking decreases significantly from dal 9.5% (2019) to 8.2% (2020), between meals from 9.4% to 8.6%. During the pandemic, elderly increase alcohol consumption significantly, from 39% (2019) to 45% (2020), attributable to changes in moderate use by women: 17% in 2019 vs. 25% in 2020 overall; from 20% to 30% in highly educated and from 15% to 21% in poorly educated. It seems the pandemic did not change smoking percentages.

Conclusions

Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases that, even in pandemic, represent the main burden to disability and deaths in Italy.

Key messages

Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases. Having an ongoing Behavioral Risk Factor Surveillance System is an opportunity to misure and evaluate the impact of a shock as Covid-19 pandemic.
Trends in obesity among adults in Estonia, 2000–2018
Authors: Pärna K , Kender E
Published: October 2021

Background

The global rise of obesity has serious health effects as high body mass index (BMI) is an important risk factor for cardiovascular diseases, diabetes, many cancers and musculosceletal disorders. The aim of this study was to describe trends in the prevalence of obesity and to explore prevalence of obesity according to age group, nationality and education in Estonia in 2000 − 2018.

Methods

This study was based on 25 − 64-year-old adults (n = 20,901) of the postal cross-sectional surveys of Health Behaviour among Estonian Adult Population in 2000-2018. The standardized (European population) prevalence of obesity (BMI at least 30 kg/m2) with 95% confidence intervals (CI) was calculated for each study year. Chi-square test for trend was used to find statistically significant changes (p < 0.05) in the prevalence of obesity over the study period. Joinpoint regression analysis was used to calculate annual percentage changes (APCs) to identify whether there was a significant change in the prevalences.

Results

The prevalence of obesity increased significantly in 2000-2018 from 14.3% (95% CI 11.1-17.9) to 22.8% (95% CI 20.1-25.7) among men (p < 0.001) and from 17.7% (95% I 14.8-20.8) to 18.9% (95% CI 16,8-21,1) among women (p = 0.023). Standardized prevalence of obesity in 2018 was 22.2% among men and 17.9% among women. Joinpoint regression analysis showed that the increase in obesity was statistically significant among men (APC=4.4%, 95% CI 0.8-8.1) in 2000-2008 and among women (APC=1.8%, 95% CI 0.1-3.5%) in 2000-2014. Obesity among men increased significantly in older age groups, among Estonians and non-Estonians and in the group with secondary education, but among women among Estonians and in the group with secondary education.

Conclusions

Obesity increased significantly among 25-64-year-old adults in Estonia in 2000 − 2018. To avoid an epidemic of obesity, a well-thought-out health policy should be implemented in Estonia.

Key messages

Obesity increased significantly among 25–64-year-old adults, especially among men, in Estonia in 2000 − 2018. A well-thought-out health policy should be implemented to slow down and to stop the increase of obesity in Estonia.
Concerns and effects of COVID-19 in families with babies: results of a nationwide survey in Finland
Authors: Lammi-Taskula J , Klemetti R , Vuorenmaa M , Helakorpi S , Ervasti E
Published: October 2021

Background

The COVID-19 has changed the everyday life of families. The aim of this study was to examine the concerns and effects of the pandemic on the everyday life of families with babies.

Methods

The data consist of mothers (n = 4550) and fathers (n = 2955) with 3-6-month-old babies who participated in the national FinChildren survey in autumn 2020. The results were analyzed separately for mothers and fathers according to the number of children. One-child parents were compared to parents with several children by logistic regression adjusted for parents' age, education and economic situation.

Results

The response rate was 50% among mothers and 36% among fathers. Mothers worried about COVID-19 more than fathers and one-child parents more than parents with several children. Mothers reported increased loneliness more than fathers regardless of the number of children (48% vs 21%). Adjusted odds ratio (95% confidence interval) for concern related to delivery during the pandemic was 1.98 (1.74-2.25) for one-child mothers and 1.95 (1.66-2.30) for fathers and for concern to the danger of COVID-19 to the baby 1.66 (1.47-1.89) for one-child mothers and 1.97 (1.67-2.34) for fathers, respectively. Coping with everyday life was less likely to change due to the pandemic among one-child mothers (decrease 0.56, 0.48-0.65 / increase 0.59, 0.49-0.70) compared to mothers with several children. Contacts with grandparents were less likely to decrease among one-child mothers (0.75, 0.65-0.86). The amount of time spent with family was more likely to decrease among both one-child mothers (2.63, 2.11-3.28) and fathers (2.22, 1.51-3.27) compared to the parents with several children.

Conclusions

The COVID-19 has had both negative and positive effects on the everyday life of families with babies. During and after the pandemic, it is necessary to pay attention to the coping of mothers and fathers, and to the support and services offered to them.

Key messages

Mothers of small babies worry more and are more lonely than fathers during the COVID-19 pandemic. Coping in everyday life is more polarised among families with several children than in one-child families.
Impact of the COVID-19 pandemic on emotional status of the adult and older population in Italy. Data from the behavioural risk factor surveillance systems PASSI and PASSI d’Argento, 2020-2021
Authors: Costa G
Published: October 2021

PASSI and PASSI d'Argento are two nationwide ongoing population-based surveillance systems in Italy which targeting, respectively, adults aged 18-69 and over-65, aim at monitoring people health profile, as per health behaviours and their determinants. The Italian National Institute of Health is in charge of the central coordination, but the Local Health Units (LHUs) develop these surveillances. Specifically trained LHUs personnel conduct phone-interviews on gender and age-representative monthly samples of residents in Italy by using a standardised questionnaire. Within both systems, depressive symptoms are under investigation through the Patient Health Questionnaire-2. Since August 2020 to date, PASSI and PASSI d'Argento annexed a specific COVID module in addition to the standard questionnaires' sections. In this way, we have been studying the impact of the COVID-19 pandemic on economic and working conditions, emotional status and other health-related aspects, as well as those concerning contagion risk perception and its outcomes or citizens compliance with pandemic control measures. In detail, two questions detect the impact of the pandemic on emotional status: ‘intrusive thinking' as dimension of psychological stress associated to experiencing COVID-19 emergency, and ‘degree of concern' about the current situation as a dimension of anxiety. Even if the two items are not precise tools to assess mental health symptoms, they are in the condition to give hints for an estimation of the pandemic impact on the psychological well-being in the general population. Preliminary findings, from the analysis of 5,000 interviews, show quite direct experience of COVID (bereavements in family or COVID-positive friends), worsened economic resources among the working-age individuals, and social isolation in the elderly, as the main determinants of intrusive thinking. Being worried about pandemic also correlates with experience of COVID, showing significant differences by gender.
Risk of Sars-CoV-2 infection and disease severity in people at socioeconomic disadvantage in Italy
Authors: Mazzilli S , Chieti A , Casigliani V , Forni S , Nannavecchia A , Bisceglia L , Voller F , Tavoschi L
Published: October 2021

Background

Evidence accumulated in the past months indicating that COVID-19 affects people at socioeconomic (SE) disadvantage more strongly. This is embodied by the COVID-19 syndemic concept, i.e., the biological, economic, and social interactions between non-communicable diseases and COVID-19 increase a person's susceptibility to infection and worse health outcomes. Here, we explored the relationship among the SE position and the risk of Sars-CoV-2 infection and disease severity in Tuscany and Apulia, two Italian regions, during the 1st(Feb-Jun2020) and 2nd(Sep-Dec2020) epidemic waves.

Methods

We included all individuals tested (only for Apulia) and/or resulted positive for SARS-CoV2(for Tuscany and Apulia) and reported to regional surveillance system. We linked surveillance data with the deprivation index (DI)(1-5 scale; DI = 5 highest deprivation) of the area of living. We calculated the relative risk (RR) of acquiring Sars-CoV-2, COVID-19-related hospitalization, and death of deprived individuals compared with people in the highest SEP-we adjusted for gender and age.

Results

A total of 159507 (82897 F; 76610 M) individuals with prior or current Sars-CoV-2 infection were included in our study, 71320 from Apulia and 88187 from Tuscany. For people aged over 30, and with a DI > 2, the RR of acquiring the infection increased for individuals with higher DI. The RR of being hospitalized and of death, were significantly higher for people over 30 with DI = 5. In Apulia, test positivity rate was comparable across all population groups during the 1stwave, while it increased among individuals with higher DI during the 2ndwave.

Conclusions

According to our results, SE disadvantage is associated with an increased risk of acquiring Sars-CoV-2, and to suffer from severe outcomes when infected. Based on available data, diagnostic test access was more equitable during 1stepidemic wave. This study calls for targeted health policies and actions to protect those with the greatest SE vulnerability.

Key messages

Available Italian data, indicate that higher socioeconomic disadvantage is associated with an increased risk of acquiring Sars-CoV-2, and to suffer from severe outcomes when infected. Our study highlights the importance of adopting targeted health policies and action to protect those with the greatest socioeconomic vulnerability and enhance equity.
A green sustainable architectural model for the suburbs
Authors: Grossi G , Garzonio F , Vozzella EA , Scotti G , Iodice L , Scamardo MS , Sanso C , Buondonno E
Published: October 2021

The Goal 11 <> is crucial in the increasing Europe urbanization context. By altering cities and the surrounding countryside, urban growth is having several consequences on ecosystem and human health. The urban density alludes to the idea of the cities as a ‘sick bodies', now reemerging because of the recent climatic and health crises. This concept should be contrasted with the idea of the ‘city as a cure', that can limit the consumption of soil and energy, reducing our ecological burden on the environment. Recently, in Europe many urban development projects have been implemented according to sustainability principles as the Eindhoven demonstration case where, a central square was transformed into a small green oasis. Reforesting, even at the cost of demolishing to create large avenues for green area, is essential for air quality and for intervening on the climate. To intervene on abandoned urban canals by creating new waterways may redevelop entire areas and affect traffic and temperature. To contain the negative impact of the built space on the environment is in fact aimed at increasing the green space. However, recent studies demonstrate the criticalities of the fragmentation of landscapeto analyze the link between urban form and landscape heterogeneity to establish renewed relationships between the forms of architecture and the natural void and to devise urban projects to control building density and population. In particular, to develop models for redeveloping the suburbs by building new urban parts from scratch, with a view to urban polycentrism. The recomposition of ecological corridors and of the municipal, provincial and regional environmental network may connect to the great ‘green lungs' of natural parks and to areas with a high degree of naturalness in a progressive succession of habitats to mitigate ever new forms of overall mutations of natural and anthropised environments.
A tool to assess the registries quality: The Registry Evaluation and Quality Standards Tool (REQueST)
Authors: Guilhaume C
Published: October 2021

Background

The use of registries is increasingly common in HTA as interest grows in the use of observational data to complement trial data and optimize access to new technologies. Registry data quality has been criticized, leading to reluctance to embed their use in HTA. During EUnetHTA Joint Action 3 the HTA network has produced a draft standard tool to assess registry quality.

Methods

The development phase included: analysis of the current use of registry data by HTA bodies (HTAb), HTAb consultation on the first draft of the tool, HTAb and stakeholder consultation on the second draftl, tool testing by three HTAb. Finally, the near-final version was submitted for public consultation. The feedback helped prepare the final version of the tool, available at https://eunethta.eu/request-tool-and-its-vision-paper/.

Results

The standards in REQueST are universal and essential elements of good practice and evidence quality that are relevant and applicable to different registry types. It includes three sections: 8 ‘methodological' items relating to suitability of the registry for a specific purpose; 13 ‘essential standards' relevant to any registry for HTA and 3 additional considerations for specific purposes. REQueST builds upon existing guidance and provides a means to adopt and implement best practice. It can be used by both evidence developers to assess the quality of their registry and HTA bodies and Regulators when considering whether to use them. EUnetHTA partners are encouraged to use the tool in all joint activities in which registry quality is to be defined or assessed. Moreover, EUnetHTA partners can use the tool on individual basis when assessing the quality of registries for HTA purposes. Since its publication REQueST has been used in two EUnetHTA registry qualifications and several national HTA activities related to Post Launch Evidence Generation (PLEG). Some of the national PLEG activities reported very positive feedback on the tool from registry holders.
The Bergen Declaration 2018: Did it drive the Migration Health Agenda forward in Norway?
Authors: Kumar B , Nordstrom C , Diaz E
Published: October 2021

The growing body of migrant health research at all levels focuses around disease burden, risk factors/behaviours and on distal factors but research on policy issues remains limited. Internationally published declarations and recommendations to take the migrant health agenda forward address policy issues. However declarations at country are few and not systematically followed up.

The Bergen Declaration was endorsed at Norway's' First National Conference on Migration Health (2018) by the multi-disciplinary participants. The declaration reflects the ‘upstream' and ‘downstream' areas addressed and discussed at the conference and includes concrete recommendations for key areas. It was widely disseminated, including high-level policy makers. Prior to the second Migration Health Conference (2020), the progress of the recommendations were reviewed. Since 2018, Migrant Integration Policy Index (MIPEX) in Norway from 2015 was updated in 2019 and a Country Assessment as part of the WP7 of Joint Action on Health Equity Europe (JAHEE) was conducted providing the basis to review the recommendations of the Bergen Declaration. In addition, the 2020 Committee conducted a desk review and search to follow up the recommendations. The review revealed that among identified ‘upstream' areas most progress had been made with data collection and research and the least in policy and governance. Among the ‘downstream' areas some progress was observed regarding practise and access to health services. Education and Training had received some attention. The Bergen Declaration reflects the consensus regarding migrant health and recommendations to address these issues in Norway. Monitoring the progress made through data that included policy review revealed progress and gaps. Progress in research, education and practise was evident whereas policy change was not. Policy makers have not paid heed to the Bergen Declaration.

Key messages

The Bergen Declaration was a useful tool for initiating and monitoring progress in research, education and practice. Declarations do not support advancement of policies and other means are required to push the policies forward.
Informing policy on school and daycare operations during COVID-19 with a living rapid evidence review
Authors: Siqueira IF , Clark E , Neil-Sztramko SE , Belita E , Dobbins M
Published: October 2021

Background

To support evidence-informed decision making (EIDM) for safe re-opening and operation of schools and daycares, the National Collaborating Centre for Methods and Tools (NCCMT) has maintained since May 2020 a living rapid review answering the following question: “What is the role of schools and daycares in COVID-19 transmission”. Traditional rapid review methodology was modified for the COVID-19 context. This presentation will describe the global reach and usefulness of this living rapid review.

Methods

Following completion of each update of the living rapid review, findings were disseminated broadly with the aim of informing policy and public health practice. Key dissemination strategies include e-mails to key contacts and a subscriber list; highlight in a monthly newsletter; media outreach; and social media. The review's reach was analyzed using Google Analytics, citation tracking, and qualitative feedback.

Results

Between May 2020 and April 2021, the living review has been updated 14 times. The posted review has been viewed over 5000 times across 46 countries. The review has been cited and indexed in over 40 sources, including key governmental and non-governmental reports and guidelines. The NCCMT has received positive qualitative feedback on the review's value in informing the public health response related to schools and daycares in various jurisdictions across Canada. Key stakeholders have expanded the review's reach organically as they use the evidence in practice and share the review with their networks.

Lessons

Using a living rapid review to continuously provide high-quality synthesized evidence amidst the evolving COVID-19 research literature demonstrates a responsive approach to decision makers' requests for evidence. An emerging challenge is reaching the proper stakeholders responsible for EIDM, particularly during public health emergencies with many competing high-priority questions and decisions to be made.

Key messages

As the evidence landscape changes due to a surge in literature, evidence-informed decision making can be supported by rapid but rigorous syntheses that evaluate quality and emerging recommendations. A long-standing, trusting relationship with decision makers is key to optimizing living rapid review methodology to meet the evidence needs of decision makers despite the changing literature.
How are the causes of gambling harm conceptualised by people who gamble?
Authors: Marko S , Thomas S
Published: October 2021

Background

Messages to prevent gambling harm traditionally focused on individualised responsibility which stigmatise those who experience harm. Shifts have occurred among researchers, advocates, and some governments towards public health approaches which recognise broader determinants of harm. This includes the social practices of gambling and the tactics used by the industry to increase profits. This exploratory study aimed to identify how people who gamble conceptualise the causes of gambling harm.

Methods

A qualitatively led online panel survey was conducted via Qualtrics. A sample of 427 adults in two Australian states who gamble using electronic gambling machines or sports betting in a typical month provided text responses to the question “What do you think causes gambling harm?”. A reflexive thematic analysis was conducted.

Results

The vast majority of participants viewed gambling harm as being an issue of personal responsibility or addiction, with some making moral judgements about those who experience harm. Only a small portion of participants recognised the broader determinants beyond the individual that produce harm.

Conclusions

Gambling is still viewed by people who gamble as an issue of individual behaviour and addiction among a stigmatised sub-group of gamblers. The broader determinants of harm were generally not identified as causes of harm. This suggests the shift towards public health understandings of harm has not extended to the public. There are discrepancies between how the general public understands gambling harm and how it has been conceptualised by experts. Public health messages need to be reconsidered so they are relevant to and understood by the general community. Strategies to shift public understandings of harm also need to be identified.

Key messages

People who gamble understand gambling harm differently to how it has been conceptualised by experts. This has implications for how harm should be communicated in public health strategies. This study demonstrates the benefits of collecting qualitative data through online surveys.
What makes life enjoyable at an older age? Daily activities and satisfaction with life in general
Authors: Jarosz E
Published: October 2021

Objectives

This study uses a broad range of activities to examine how the type of activity, its social context, associated stress, importance, and the level of effort required are linked with activity enjoyment. Using aggregated data from all activities, it analyses the association between the experiential wellbeing of individuals and their satisfaction with life in general.

Methods

The dataset included 1809 activities, reported by 200 non-institutionalised adults, aged 65 and above, living in Poland. Activity data were collected using the experience sampling method. Multilevel mixed effects models examined what makes an activity enjoyable for older adults. Linear regression models examined the relationship between aggregated subjective activity characteristics and satisfaction with life in general.

Results

The most enjoyable activities were religious practice, childcare, and socialising. Enjoyment was positively associated with perceived activity importance, inversely associated with stress, and formed a U-shaped association with effort. On the aggregated level, a higher mean enjoyment predicted a higher satisfaction with life in general, whereas the opposite was the case for the mean importance. However, having greater variance in importance was associated with higher satisfaction with life.

Conclusions

Enjoyable daily activities may boost the global wellbeing of older adults. Balancing high-effort and low-effort activities may provide additional benefits. This study points to new directions for research and shows that activities rarely studied in the existing literature have significant effects on the wellbeing of older adults.

Key messages

Some activities having significant effects on the wellbeing of older adults have not received sufficient research attention. Balancing low-effort and high-effort activities and prioritizing enjoyable activities seems to boost evaluative wellbeing.