bluuebunny/crossref_metadata_2025 huggingface dataset:
Long COVID among Children: Persistence of Symptoms 12 Weeks and More in a Cohort Study from Turkey
Authors: Turunç Ö , Emecen AN , Süner AF , Keskin S , Başoğlu E , Şiyve N , Belet N , Karaoğlu Asrak H , Duman M , Ünal B
Published: October 2022

Background

COVID-19 usually cause a mild infection among children with a low fatality rate. On the other hand, increasing evidence suggests that children may have prolonged symptoms related to COVID-19. This study aims to describe the persistence of COVID-19 symptoms up to 12 or more weeks among children and to investigate associated factors including perceived socioeconomic status and parents’ education level.

Methods

The study group consisted of 759 cases aged <18 years detected as SARS-CoV-2 RT-PCR positive in DEU Hospital between March 2020, and May 2021. Interviews were conducted at 1st 3rd and 6th month of diagnosis. The ongoing self-reported symptoms 12 or more weeks after infection was the dependent variable. Multivariate logistic regression models were used to evaluate associated factors with long COVID, and robust clustering using links algorithm was used to assess long COVID symptoms clusters.

Results

Among 759 COVID-19 cases, 22 children were hospitalized, and 4 died. 9.6% of the children had at least one symptom related to COVID-19 after 12 weeks of the diagnosis, Symptom duration was minimum 84 days, maximum 344 days (mean±SD: 160±68 days). The most frequent symptoms were fatigue, muscle-joint pain, headache, and loss of smell and/or taste. In multivariate analysis, female gender (OR:2,3 95%CI:1.1-3.6) and symptomatic onset (OR:2,7 95%CI:1.7-20.9) were related to increased risk of long COVID. Age, long-term health conditions, socioeconomic status and mother's education level did not predict the risk of long COVID. No cluster of symptoms was found.

Conclusions

About 10% of children suffer from symptoms related to COVID-19 for up to six months. Female gender and symptomatic onset of disease increased the risk of prolonged symptoms. Socioeconomic status and mother's education level was not associated with the risk of long COVID, but the evidence of the effect of social determinants of health on the outcomes of COVID-19 among children is still needed.

Key messages

• One out of ten children may suffer from long COVID represents symptoms such as fatigue, headache, and muscle and joint pain. Girls and children with symptomatic onset have a higher risk of long COVID.

• The effects of social determinants on the susceptibility and outcomes of COVID-19, including death, were well studied among the adult population. There is a need for sound evidence for children.
Innovative Ante-Natal Care: Healthy Teeth Healthy Baby, An Interprofessional Collaboration Initiative In Indonesia
Authors: Adyatmaka I , Lee H
Published: October 2022

Background and problem

SDG 3.1 sets out that by 2030, the global maternal mortality ratio (MMR) should be reduced to 70 per 100,000 lives and no country should have MMR above 140 per 100,000 lives. Indonesia still has an MMR of 177 by 2017 data by the World bank. Urgent action is needed to improve the health and survival of women and babies. The main causes of MMR in Indonesia are Hemorrhage, followed by pre-eclampsia, and others, related with diabetes, stroke, etc.

Importance

Previous studies have shown the association between oral dysbiosis and pre-eclampsia, preterm birth and low birth weight. Oral microbiome of the mother being a key player in pregnancy outcomes. Periodontal disease is considered a possible risk factor for the health of the mother and the newborn.

Solution

Program goal of this program, “Innovative AnteNatal Care, Healthy Teeth, Healthy Baby”, is to create the ecology right from the start, by incorporating oral health diagnosis and prevention into routine antenatal care. This approach achieves a healthy oral condition that can improve systemic health during pregnancy. The program also achieves a healthy and resilient family through oral health empowerment and delivering healthy babies (superior generation 2045- President Joko Widodo). Processes included avocation to provincial health districts, initial survey of the perception and oral health status of pregnant mothers, module preparation, and socialization to health districts and related officers. The program has trained midwives and dental providers and secured governmental budgets for sustainable activities, including socialization and assistance to pregnant mothers and their husbands, field penetration by health professionals, and evaluation of the programs.
Maternal Oral Health and Global Oral Health: Policy Perspective
Authors: Ramphoma K , Lee H
Published: October 2022

Background and problems

The findings of the last South African National Children Oral Health Survey conducted between 1999 and 2002 indicated a national prevalence of dental caries at 60% among 6-year-olds, with over 80% of untreated caries. Various studies have shown that one of the successful strategies in preventing dental caries is intervention during pregnancy by providing prenatal oral health education.

Importance and opportunities

To successfully mitigate the challenge of ECC, South Africa needs a holistic approach strategy that will integrate oral health services into existing general health programmes, especially into antenatal care (ANC). South Africa National Oral Health Policy and Strategy states that “Integrate oral health strategy elements and strategies into programmes and policies of all sectors that impact community health like maternal and women's health.” All government health care facilities offer free essential ANC services, identifying risk factors relating to poor maternal and birth outcomes. This existing infrastructure can be utilized to deliver oral health education and care for expecting mothers as essential ANC services.

Solution

The Public Oral Health Forum, a non-profit organization in South Africa, seeks to develop maternal and oral health policies that can be aligned with its research and policy development strategy. It proposes maternal oral health policy and strategies, which could be applicable in the South African context: Education of pregnant women, prenatal providers, and dental and medical students about perinatal and infant oral health, integration of oral health in primary health care services, interprofessional workforce development and research to improve oral health and access to dental care among pregnant women and new mothers. This presentation will demonstrate how such maternal oral health policy and strategy are developed, aligning with existing policy and infrastructure in South Africa.
4.P. Workshop: Health promotion policy implementation evaluation: tools, challenges and futures directions
Authors:   Organised by: University of Limerick (Ireland),   Chair persons: Aurélie Van Hoye (Ireland), Catherine Woods (Ireland)
Published: October 2022

Background

Public policies can enhance opportunities for the whole populations to be more health promoting. They are important tools as they tackle the upstream component of health promotion behaviours to influence the environment and opportunities for the general population. Research has focused on policy development and content, but less on its implementation process and s evaluation. These latter steps are necessary for policy accountability, would serve policy-making process and strengthen policy impact for real change.

Objectives

The objectives of the workshop are to present different methods and toolkits allowing the evaluation of policy implementation at national level.

Workshop format

The workshop will include 4 presentations, with two systematic reviews and two tool presentation, to offer opportunities to the audience to understand both theoretical and methodological perspective and applied process in regard to health promotion policy evaluation and implementation evaluation. First, a systematic literature review considering the fitting framework for implementation of policies promoting health nutrition and physically active lifestyle will describe the components and scope of 18 policy implementation frameworks. Second, a systematic literature review on methods of physical activity policy monitoring will help us to learn from the analysis of 112 studies on research-driven, government-driven or co-production approaches, their strengths and weaknesses. The third presentation will introduce the Physical Activity Environment Policy Index, a tool to monitor and benchmark policies to improve the healthiness of physical activity policy environment, as well as provide guidance on how to use it. The fourth presentation will present the health promoting sports clubs national audit tool, aimed at reviewing policy supporting sports clubs to promote health, and present preliminary results from its use in Ireland. During the presentation we will pose questions to the audience, encouraging them to apply the theory/tools to their own context, and to spark conversation and interaction as part of the workshop. After the presentations, questions from the audience will be discussed with each presenter, and a discussion will be open in terms of future challenges for health promotion policies implementation evaluation.

Key messages

• Guidance is needed to evaluate health promotion policies implementation to improve practice, as well as development of framework and methods to build toolkits.

• Policy implementation evaluation is key for improving policy making process.
Impact of COVID-19 on hospitalisation for diverse conditions in European countries
Authors: Lyons RA , Schmidt AE , Aldridge S , Mathis-Edenhofer S , Estupiñán-Romero F , Thissen M , Gissler M , Palmieri L , Majek O
Published: October 2022

Background

The COVID-19 pandemic has had an unprecedented impact on Europe. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care seeking has been reported, for fear of infection with SARS-CoV2. Yet, the scale of this impact remains under researched. This study aims to compare indirect effects of the pandemic in a European cross-country study aiming to highlight the potential of Population Health Information Research Infrastructures (www.phiri.eu).

Methods

Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) as well as (iii) serious trauma this study analyses individual level hospital data in a standardised harmonised data model. We compared pre-pandemic incidence rates (2018-2019) with rates for 2020 and 2021. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index.

Results

A drop in hospital discharge rates was observed during the pandemic in all countries but differing by condition and month. Socio-economic differences also varied by condition. Our evidence suggests that periods of more severe policy measures also correlated with more dramatic drops in regular hospital activities.

Conclusions

Our findings provide new insights on the dramatic level of de-prioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on to avoid negative mid and long-term health and financial consequences of indirect effects. The study demonstrates the tremendous potential in exploiting health information systems in a systematic way across countries and the value of the PHIRI system. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic and variations in health service resilience for future pandemic preparedness.
Impact of the COVID-19 pandemic on perinatal health and perinatal health inequalities in Europe
Authors: Zeitlin J , Philibert M , Rihs TA , Draušnik Ž , Gatt M , Engiom HM , Recape J , Szamotulska K , Barros H , Gissler M
Published: October 2022

Background

The COVID-19 pandemic and lockdowns may adversely affect pregnancy outcomes due to disrupted healthcare provision and increased stress, anxiety and economic hardship. We assessed changes in perinatal outcomes in 2020 using population birth data in Europe.

Methods

25 Countries in the Euro-Peristat Network implemented a federated analysis using routine national data. Countries generated anonymised aggregate data files using R scripts from individual-level data formatted to a common data model with 22 variables. We compared preterm birth, stillbirth, neonatal death and caesarean delivery rates in 2020 to 2015-2019 for 2 periods: full-year (FY) and pandemic (March-September [MS]). Data from October onward were not included in the MS period because potentially declining pandemic-related fertility may affect perinatal indicators. Country-specific relative risks (RR) for the periods, adjusted for linear trends, overall and by socio-economic (SES) group, were calculated and pooled using random effects meta-analysis.

Results

Preterm birth rates decreased slightly (pooled RR: 0.97FY [95% confidence interval (CI) 0.95-0.99]; 0.98MS [0.96-1.00]) in 2020. Heterogeneity was high (I2FY=85%; I2MS=70%), with 5 countries experiencing significant declines. Neonatal mortality rates were unchanged (0.97FY [0.92-1.01]) while stillbirth rates were higher (1.05FY [1.01; 1.09]; 1.10MS [1.02; 1.19]). Caesarean rates were slightly raised (1.02FY [1.00-1.03]; 1.02MS [0.99-1.04], 5 countries had significant increases). Increases for stillbirth were more pronounced in the lowest (1.08FY [0.99-1.16]) versus highest SES group (1.05 FY [0.93-1.17]).

Conclusions

In 2020, there was an unexpected decline in preterm birth in some countries, while increases in stillbirths and caesarean occurred in others. High country-level heterogeneity suggests that some government policies to mitigate the pandemic might have been more protective of pregnant women and newborns than others.
Policy to cover perinatal care costs: a quasi-experimental study on adverse newborn health outcomes
Authors: Epure AM , Courtin E , Wanner P , Chiolero A , Cullati S
Published: October 2022

Background

Low birth weight (LBW) and preterm birth are associated with an increased risk of neonatal death and chronic conditions across the life course. Reducing LBW is a global public health priority and requires strategies to improve healthcare during pregnancy. We aimed to assess the effect of a health policy providing full coverage of illness-related costs from 13 weeks of gestation through 8 weeks postpartum on birth outcomes and neonatal mortality in Switzerland.

Methods

We applied a regression discontinuity design to administrative data gathered as part of a Swiss research program (NCCR on the Move). We included all children (N = 166,709) born between March 1, 2013 and February 28, 2015. The outcomes were birth weight (BW), gestational age (GA), LBW (<2,500 g) and very low birth weight (VLBW; <1,500 g), preterm (<37 weeks of gestation), and extremely preterm (<28 weeks), and neonatal (≤ 28 days) death. Children were exposed to the policy if they were born from March 1, 2014 onwards. We estimated the intention-to-treat effect of the policy using parametric regression models.

Results

Children had a mean BW of 3,291 g and mean GA of 275 days. The prevalence of LBW was 6.4%, VLBW 1%, preterm 7.2%, and extremely preterm 0.4%, respectively. Some 0.3% newborn died within one month. The policy increased BW (mean difference =13 g [95% confidence interval (CI): 1, 25]) and decreased the risk of LBW (odds ratio [OR]=0.89; 95% CI: 0.82, 0.98) and VLBW (OR = 0.81; 95% CI: 0.64, 1.01). Additionally, the policy slightly decreased the risk of preterm birth (OR = 0.94; 95% CI: 0.87, 1.03), while it did not affect GA. Effect estimates for extremely preterm and neonatal mortality were imprecise and inconclusive.

Conclusions

This quasi-experimental and population based-study of 166,709 live births between 2013 and 2015 in Switzerland provides evidence of a reduction in the risk of LBW, VLBW and preterm birth thanks to a health policy that fully covered healthcare services during maternity.

Key messages

• Free access to healthcare during pregnancy may mitigate adverse newborn health outcomes.

• A Swiss health policy that fully covered healthcare services during pregnancy reduced the risk of low birth weight and preterm births.
Monitoring the reproduction number of COVID-19 in France: estimates compared from 3 datasets
Authors: Bonaldi C , Fouillet A , Sommen C , Lévy-Bruhl D , Paireau J
Published: October 2022

Background

The effective reproduction number (Rt) represents the average number of secondary cases generated by an infected person. During an outbreak, near-real-time monitoring of Rt constitutes a key indicator for detecting changes in disease transmission and assessing the effectiveness of interventions. The estimation of Rt usually requires identifying infected cases in the population which is in practice challenging from available data. The purpose of this study was to compare Rt estimates for COVID-19 surveillance in France based on three data sources of different sensitivity and specificity for identifying infected cases.

Methods

By applying a statistical method developed by Cori et al., we estimated Rt using (1) confirmed cases identified from positive virological tests among the tested population (2) suspected cases recorded by a national network of emergency departments (3) hospital admissions for COVID-19 recorded by a national administrative system to manage hospital's organization.

Results

From June 2020 to March 2022, the estimates of Rt in France showed similar temporal trends regardless of the dataset. Estimates based on the daily number of confirmed cases provided an earlier signal that the two other sources, with a lag of 3 and 6 days compared to estimates based on emergency department visits and hospital admissions, respectively.

Conclusions

The COVID-19 experience has proven that monitoring temporal changes in Rt was a key indicator to help public health authorities controlling the outbreak in real time. Having data on infected people in the population to estimate the Rt is not straightforward in practice. As this study has shown, the opportunity of using more readily available data, provided that it is highly correlated with the spread of infection, gives a practical solution for monitoring the COVID-19 epidemic and any epidemic in general.

Key messages

• The effective reproduction number (Rt) is a key parameter to monitor transmission during epidemics but its estimation from available data is often a critical issue.

• Based on COVID-19 experience, data sufficiently correlated with the spread of infection may be appropriate to estimate Rt and monitor its temporal trend.
Establishing intersectoral ‘Schools Teams’ to mitigate SARS-CoV-2 school transmission, 2020/2021
Authors: Kelly C , Naughton P , Kennedy E , Ward M
Published: October 2022

The SARS-CoV-2 pandemic disrupted the lives of up to 100,000 school-going children in Ireland. Consequently, intersectoral ‘Schools Teams’ were established for the 2020/2021 school year to reduce SARS-CoV-2 transmission in school settings. This novel public health intervention provides learning to inform future cross-sectoral collaborative work in Public Health in responding to infectious disease threats. For the 2020/2021 school year in Ireland, intersectoral Schools Teams were formed within each of eight regional Departments of Public Health to manage mitigation of SARS-CoV-2 transmission in school settings. These teams comprised of staff from Departments of Public Health and redeployed staff from the Department of Education. A nationally agreed schools process was followed by Schools Teams to manage SARS-CoV-2 cases and outbreaks in schools. Relevant cases were referred to the regional Schools Team for a public health risk assessment (PHRA). Close contacts were determined using appropriate definitions of close contact within a school setting through the PHRA. This model with centralised procedures and linked health/education teams was novel and adaptable to additional settings. Results from the East region of Ireland showed testing of close contacts of COVID-19 was conducted in 71.8% (676/942) of schools, with 43881 tests completed. Most Schools Team members reported efficient communication within the team (88.7%), a positive team culture (96.3%) and feeling comfortable in their roles following training (82.7%). The majority of members felt the team was able to effectively support schools to reduce COVID-19 transmission (92.5%). Lessons learnt include the synergistic working of educational and health professionals towards a common goal, maximising the skills of all, ensuring a better outcome for school children. Involving educational teams in active contact tracing of COVID-19 cases in schools maximised engagement of the educational sector in the COVID-19 response.

Key messages

• Establishing intersectoral ‘Schools Teams’ pooled skills, resources and expertise, enabling development of synergistic solutions to a complex problem.

• This exemplifies a large national cross-sectoral collaborative working process involving education and public health sectors, providing a model for future responses to infectious disease threats.
Risk of SARS-CoV-2 reinfection 18 months after first infection: population-level observational study
Authors: Flacco ME , Acuti Martellucci C , Soldato G , Di Martino G , Carota R , Caponetti A , Manzoli L
Published: October 2022

Background

Current data suggest that SARS-CoV-2 reinfections are rare. Uncertainties remain, however, on the duration of the natural immunity, its protection against Omicron variant, and on the impact of vaccination to reduce reinfection rates.

Methods

In this retrospective cohort analysis of the entire population of an Italian Region, we followed 1,293,941 subjects from the beginning of the pandemic to the current scenario of Omicron predominance (up to mid-February 2022). We assessed the proportion of reinfections overall, and by demographic and clinical characteristics, time after primary infection, and predominant circulating variant. Cox proportional hazard analysis was used to compute the relative hazards of reinfection.

Results

After an average of 277 days, we recorded 729 reinfections among 119,266 previously infected subjects (overall rate: 6.1‰), eight COVID-19-related hospitalizations (7/100,000), and two deaths. Importantly, the incidence of reinfection did not vary substantially over time: after 18-22 months from the primary infection, the reinfection rate was still 6.7‰, suggesting that protection conferred by natural immunity may last beyond 12 months. The risk of reinfection was significantly higher among females, unvaccinated subjects, and during the Omicron wave.

Conclusions

This study confirms and expands previous findings reporting a low risk of SARS-CoV-2 reinfection, and a very low risk of severe or lethal COVID-19 for those who recovered from primary infection, suggesting that the protection conferred by the natural immunity lasts beyond 12 months. Although the marked increase of the reinfection rates during the Omicron wave is concerning, the risk of a secondary severe disease or death remained close to zero. Vaccines were able to significantly reduce the likelihood of reinfection in both pre-Omicron and Omicron waves, although the risk-benefit profile of multiple vaccine doses for this population should be carefully evaluated.

Key messages

• After primary infection, the risk of SARS-CoV-2 reinfection and of severe/lethal COVID-19 was low, suggesting that natural immunity lasts beyond 12 months.

• Despite increasing reinfection rates with Omicron, the risk of a secondary severe/lethal disease was close to zero, and vaccines reduced the likelihood of reinfection before and during Omicron waves.
The Austrian Public Health Week & the European Public Health Week
Authors: Dorner T
Published: October 2022

How did the Austrian Public Health Week start and what does it have to do with the European Public Health Week?
Health, Architecture and Wellbeing: building bridges between health and the design of living spaces
Authors: Leão T , Neiva A
Published: October 2022

Background

Health is determined by where we live. Nevertheless, medical and architecture students often ignore the relation between health, housing and urban planning. In order to bridge these areas, we designed an interdisciplinary course for students of University of Porto Medical and Architecture schools, winning a 2021 Pedagogic Innovation courses call.

Objectives

”Health, Architecture and Wellbeing” aimed to explore the effect of living spaces in health, combining the health and architecture perspectives in the analysis of case studies, and discussing strategies to improve health and wellbeing of the population. By exposing students to tools for designing healthy, sustainable, efficient and accessible spaces, and to public participation strategies, we aimed to foster awareness and share knowledge among complementary scientific fields.

Results

Students were exposed to theoretical and practical sessions with experts from the medical, architecture, landscape architecture, and geography areas, as well as to field visits in social neighbourhoods, collective housing, and green spaces. Besides introducing students to concepts, as health needs and determinants, and to healthy and accessible design methods, students interacted with inhabitants, gathering experiences on how they lived in those spaces, understanding its impact on their wellbeing, while exploring the enablers and barriers of participation strategies. Students were encouraged to complement technical architecture competences with public health evidence, and social participation leading to the development of design proposals improving the existing living environments.

Conclusions

“Health, Architecture and Wellbeing” interdisciplinary course connected public health expertise with architecture, promoting knowledge dissemination and awareness among health and architecture students. This experience may be reproduced in other countries, as health continues to be determined by living and public spaces.

Key messages

• Bridging public health with other disciplines is fundamental to understand the origin of health issues, namely living conditions, and maximise the opportunities of acting near their root causes.

• This course allowed architecture and medical students to gain awareness about the impact of housing and urban design on people’s health, and to learn how to propose and design healthier environments.
Clustering of unhealthy behaviours and subsequent sickness absence among Finnish municipal employees
Authors: Salmela J , Lahti J , Kanerva N , Rahkonen O , Kouvonen A , Lallukka T
Published: October 2022

Background

Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have explored these associations using person-oriented approach. We aimed to identify latent classes of unhealthy behaviours among female and male employees and examined their associations with subsequent SA.

Methods

Health behaviours (leisure-time physical activity, sedentary behaviour, fruit and vegetable [F&V] consumption, sleep, binge drinking, and use of tobacco products) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19-39-year-old employees of the City of Helsinki, Finland. The questionnaire data were linked to employer's SA register. Latent class analysis was used to identify underlying profiles of unhealthy behaviours and negative binomial regression was used to examine their associations with subsequent SA (≤7 days, >7 days, and all lengths) among 3228 women and 771 men. The mean follow-up time was 2.1 years.

Results

Among women, we identified 3 latent classes: 1) healthy behaviours (81% of women), 2) binge drinking and tobacco use (12%), and 3) inadequate F&V consumption and insufficient sleep (7%). Classes 2 and 3 showed increased rates for subsequent SA compared to class 1, regardless of the length of SA spells (age-adjusted rate ratios [RR] 1.37-1.42 and 1.35-1.64, respectively). Among men, we identified 3 latent classes: 1) healthy behaviours (51% of men), 2) binge drinking and tobacco use (19%), and 3) inadequate F&V consumption, binge drinking and tobacco use (30%). While classes 1 and 2 were not different in terms of subsequent SA, class 3 had increased rates of subsequent, particularly short-term SA (RR 1.24, 95% CI 1.03-1.48).

Conclusions

Preventive actions should consider simultaneously several unhealthy behaviours while aiming to reduce employees’ SA. These actions might benefit from regarding potential gender differences in the clustering of unhealthy behaviours and their associations with SA.

Key messages

• Preventive actions to reduce sickness absence should consider clustering of unhealthy behaviours among employees.

• Potential gender differences need to be regarded in these actions.
What do employees on long-term sick leave experience, as barriers for returning to work?
Authors: Strømstad K , Skarpaas LS , Wiik SE , Haslerud SI , Aas RW
Published: October 2022

Background

The financial burden long-term sick leave places on society are immense and amounted to an annual cost of 180 billion NOK in Norway. Epidemiological and sociodemographic risk factors related to sickness absence and return to work (RTW) are well studied, less is known regarding self-perceived biopsychosocial barriers for RTW. The aim of this study was to investigate the diversity of barriers for RTW as experienced by long term sick listed employees.

Methods

The study is a large-scale qualitative interview study (n = 85), using semi-structured telephone interviews. Participants were eligible to participate if they had received sick leave benefits >6 months and <1,5 years at the time of recruitment, for at least 50% of their employed work hours. The data was analysed with a directed qualitative content analysis combined with a summative approach. A deductive approach, guided by the theoretical framework provided in Model of Human Occupation (MoHO) were used in the analysis process. In MoHO, the main categories are person specific components and environmental components.

Results

The study generated 952 coded meaning units describing barriers for RTW. Of these, we were able to deductively code 917 within the framework of MoHO. In the person specific concept, performance capacity barriers were dominant (n = 530). Volitional barriers (n = 164) were related to personal causation, hereunder self-efficacy (n = 24), and one's sense of capacity (n = 91). Barriers related to habituation (n = 64) was expressed as habits, both necessary habits and undesirable habits. Barriers related to the environmental component amounted to 388. The majority was linked to occupational environment (n = 217), including availability of adequate work tasks and barriers related to the healthcare system.

Conclusions

The experienced RTW-barriers extended beyond health-related barriers, for most of the participants the barriers were related to both person specific components and environmental components.

Key messages

• By gaining a greater understanding of the experienced RTW-barriers we could possibly provide more tailored RTW-services and help sick listed to a safe and sustainable return to work.

• The experienced RTW barriers for long term sick listed were primarily related to person specific and environmental components, and thus extended beyond health-related barriers.
Mental health impact and mental health care among first responders following the Paris terror attacks in November 2015
Authors: Motreff Y , Pirard P , Vuillermoz C , Rabet G , Petitclerc M , Stene L , Baubet T , Vandentorren S
Published: October 2022

Introduction

During the evening of 13 November 2015, a terror attack occurred in France in the Paris area. Overall, 130 people were killed, 643 were injured and several thousands were psychologically impacted. Thousands of first responders (FRs), including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on FRs, and its associated factors 12 months after the 13 November 2015 terrorist attacks, as well as their engagement in mental health care and its associated factors.

Methods

FRs who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of Post Traumatic Stress Disorder (PTSD). PTSD and partial PTSD were measured using the PTSD checklist for DSM-5 (PCL-5) and depression with the hospital anxiety and depression (HAD) scale.

Results

Overall, 663 FRs were included in the analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers. Low educational level, social isolation, intervention on unsecured crime scenes and lack of training were associated with PTSD. Among FRs with PTSD, partial PTSD or depression, 38% sought mental health care. Mental health care engagement was associated with a history of mental health care, post-immediate support and the presence of PTSD, partial PTSD or depression.

Conclusions

Our results highlight that improving access to mental health care for FRs after terror attacks is needed. Efforts should be made before and after potentially traumatic events to ensure mental health education for FRs. Special attention should be given to FRs living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes.
Do regional characteristics predict developmental delay? Analyses of German school entry examination
Authors: Hoffmann S , Tschorn M , Michalski N , Hoebel J , Förstner BR , Rapp MA , Spallek J
Published: October 2022

Background

Children's health and development are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living region. However, research on the impact of the living region on children's development beyond family SEP is scarce. This study evaluated whether rurality and regional socioeconomic deprivation (DEP) are associated with children's development independently of family SEP.

Methods

The study used population-based data of 5-6.5 years old children (n = 22,801) from mandatory school entry examinations (SEE) in the German federal state of Brandenburg, which were examined in 2018/2019. The SEE data have been linked with data on i. rurality that was defined by an inverted population density and ii. regional DEP that were provided by the German Index of Socioeconomic Deprivation. By binary multilevel models, the predictive values of rurality and regional DEP for global developmental delay (GDD) were evaluated, while adjusting for family SEP.

Results

Children with high family SEP showed reduced odds for GDD compared to medium family SEP (female: OR = 4.26, CI95=3.14-5.79, male: OR = 3.46, CI95=2.83-4.22) and low family SEP (female: OR = 16.58, CI95=11.90-23.09, male: OR = 12.79, CI95=10.13-16.16). Regional DEP additionally predicted GDD, with higher odds for children from more deprived regions (female: OR = 1.35, CI95=1.13-1.62, male: OR = 1.20, CI95=1.05-1.39). Rurality did not predict GDD beyond family SEP and regional DEP.

Conclusions

In addition to family SEP, the regional DEP has an effect on children's developmental delay. Hence, Public Health should take into account regional socioeconomic conditions as determinant of health over the life course in addition to family SEP.

Key messages

• Regional socioeconomic deprivation contributes to inequalities in children's development and health.

• Besides family SEP, regional socioeconomic circumstances are of particular interest to promote health over the life course.
6.A. Workshop: Strategies to build up health system resilience: Legacy of the COVID-19 pandemic
Authors:   Organised by: Finnish Institute for Health and Welfare, Tampere University, Trinity College Dublin, University of Copenhagen, EUPHA-HSR,   Chair persons: Ilmo Keskimäki (Finland), Johan Hansen (EUPHA-HSR)
Published: October 2022

Health systems are the central part of infrastructure in societies and their smooth operation is important for the continuation of a wide range of critical operations in any country. The COVID-19 pandemic has actualised questions on health system resilience defined as the system's ability to prepare for, manage (absorb, adapt and transform) and learn from external shocks.. However, economic recessions as well as long- and short-term stresses related to aging, climate change and migration, and most recently a war have underlined that also in Europe the governments need to prepare their health systems to face different types of threats in order to guarantee effective protection to population health in their countries. The importance of the task to strengthen health system resilience has been comprehended at national and international level. International actors including WHO, OECD and World Bank have designed policy advice on strengthening health systems against external shocks, the European Union has launched programmes for preparing for future health emergencies, and individual countries are designing policy and system reforms allowing for health crises. In the workshop we address policies to strengthen health system resilience drawing on the experiences in three countries: Ireland which entered the COVID-19 pandemic with a legacy of the recent economic crisis hitting hard health care financing, Finland which has been implementing a major health care reform concomitantly with the pandemic, and Denmark which offers a case study on organisational learning from the pandemic within the hospital sector and chronic patient care. Based on these three case studies the workshop also contemplates whether learning from shocks is always helpful in terms of system transformation or whether they can also create path dependencies that weaken the systems’ ability to prepare for unknown threats. The workshop will broaden the view by discussing the trends of health system reforms in European countries and considering international advice on system and policy reforms to strengthen health system resilience.

Key messages

• Shocks create opportunities for reform and better performance and challenges through overloaded systems and fast decision-making.

• Assuming all shocks are like the last weakens preparedness and adaptability.
Strategies for developing preparedness and building legacy – learning from the experience of building Health System Resilience in Ireland
Authors: Thomas S , Fleming P , O'Donoghue C , Almirall-Sanchez A
Published: October 2022

Health system resilience to shocks is perhaps the biggest global challenge facing health systems in the 21st Century. Health systems face an increasing prevalence and likelihood of a broad range of shocks (including economic crises, pandemics, climate-related events, political upheavals, mass migration, conflicts and cyberterrorism) that can each undermine the ability of a health system to function well. In particular, the twin processes of dealing with the legacy of a health system shock and preparing for the next shock are distinct but related challenges that face policy makers today. In this presentation the authors will present key findings on improving preparedness and building a constructive legacy drawing from:

• the results of a recent systematic review on how health system resilience has been measured in high income countries over the last twenty years;

• the results of a recent realist review exploring the legacy of the economic crisis for the resilience of the response of the health system to COVID-19, and

• analysis of interviews with Irish policy makers, managers and analysts as they reflect on the different shocks encountered by the Irish system over the last fourteen years.

Triangulating these findings, the authors will reflect on the merits and challenges of measuring resilience and what the focus should be moving forward. Key strategies and approaches will be outlined to best prepare a system for a shock and to leave a positive legacy for the future.
Nutritional and non-nutritional dietary factors affecting obesity and chronic related disorders
Authors: Grosso G , Bonaccio M
Published: October 2022

There is convincing evidence that diet quality represents one of the most important public health targets to prevent non-communicable diseases. Dietary risks alone have been estimated to be responsible for about 10 million deaths due to cardiovascular diseases, metabolic disorders, and certain cancers worldwide, with trends not expected to decrease. Results from meta-reviews and expert assessments are quite in line with robust key messages to deliver to the general public. From a nutritional point of view, lack of fibre, vitamins and antioxidants, and unsaturated fatty acids together with high content in free added sugars, sodium, and saturated/trans fats represent key features for unhealthy dietary patterns and are responsible for most diet-related non-communicable diseases. While the role of animal-derived foods is still controversial due to the registered excess consumption and the environmental impact, a general low intake of plant-derived foods remains a major detrimental factor for health. The concept of diet quality should thus overcome the over simplistic calorie-count when coming to prevent obesity and related non-communicable diseases, while an adequate communication on this matter to the public is highly warrant. Together with these general dietary recommendations relying on nutritional aspects affecting human health, emerging evidence is now also exploring the role of non-nutritional dietary factors. The level of processing, the alteration of the food matrix, the presence of additives (such as flavor enhancers, colorants, emulsifiers, artificial sweeteners, thickeners, foaming/anti-foaming agents, and preservatives) have been demonstrated to play a role in metabolic health and inflammatory-related disorders. These aspects are currently under investigation, but they might represent an underrated concern for public health due to the food market drive and a perfect fit into the obesogenic modern society.
Health literate settings in Austria
Authors: Gugglberger L
Published: October 2022

Issue/problem

Health literacy (HL) depends largely on how easy or difficult it is in a given situation to find, understand, evaluate and apply health-related information. HL is thus an interplay between personal skills and organisational requirements.

Description of the problem

In 2018 the Austrian platform for HL initiated the focal point ‘organisational framework conditions for strengthening health literacy’. Since then the needs of organisations are being assessed regularly and several strategies and initiatives have been launched to support organisational HL.

Results

To support organisations and settings with the implementation of HL a “starter kit” consisting of a general practical guide and several settings specific self-assessment tools (SAT) has been developed. SAT currently exist for hospitals, primary care units, businesses, open youth work, schools and municipalities. For the settings of primary care units as well as open youth work certification processes have been developed, based on the SAT, distribution of high-quality health information and proof of communication trainings. Currently tools for general practitioners are being developed.

Lessons

Experiences from workshops and pilot testing have shown that organisations need a variety of different tools and measures to help with the implementation of HL. Any type of support needs to be flexible and customisable to different needs and have a low threshold. What is needed most - apart from financial incentives - are settings-based workshops and personal consultation to raise awareness of what health literate organisations can achieve.

Main messages: Settings and organisations are important to increase HL in the population. Several settings in Austria have started to implement HL and are at different implementation statuses.
Burden of infectious diseases in prison settings and services offered
Authors: Alves da Costa F
Published: October 2022

Introduction

The WHO Prison Health Framework was developed to assess prison health system performance and support Member States (MS) in improving their prison health systems. Moreover, it shall enhance MS capacity to evaluate: the impact of changes in governance models, progress in service provision and improvements of the health status of people in prison (PiP).

Methods

The framework informed the 2021 data collection round of the Health In Prisons European Database Survey. Invitations were sent to all 53 MS of the WHO European Region. Those MS nominating a focal point and providing valid answers were included in the analysis.

Results

Answers were obtained from 36 MS, representing a total of 613,497 PiP. Access to immunization was very good across all MS, with the highest for COVID-19 (90% of MS provide it in all prisons). Vaccination against HBV was only available in all prisons of 25 MS. Access in all prisons to HIV post and PrEP were reported, respectively, by 78% and 58% of MS. Screening for diseases at entrance was common for HIV, HCV and HBV. In all prisons of 35 MS soap was provided for free, while needles & syringes and lubricants were only provided free of charge, respectively, in 3 and 4 MS. 5 MS did not have therapeutic spaces to tackle drug problems in any prison, in 73% of those having, accessibility was restricted to some prisons. HIV prevalence ranged from 0-16% and treatment was accessible to 55-100% of those diagnosed. Prevalence of HCV ranged from 0-34%, with access to treatment ranging from 0-91%. The most common format of health records in European prisons was paper based (44%).

Conclusions

Prison-based data collection systems resulted in limited capacity for extraction so that some countries were unable to provide any data on disease prevalence or treatments offered. Given the scarcity of data on this topic obtained from real-world and not from ad-hoc studies, this snapshot provides an important contribution to public health.
Health equity and worker justice: the food supply chain during the COVID-19 pandemic
Authors: Forst L
Published: October 2022

The COVID-19 pandemic has brought into stark relief the health, safety and security threats facing people in the US and around the globe. As stay-at-home orders were instituted, most economic activities closed or required work from home; however, companies in the Food Supply Chain (FSC) continued to operate, considered “essential businesses.” The meatpacking and agriculture sectors in Illinois - 79,000 and 55,000 workers, respectively - are largely populated by (im)migrant workers, some on short-term work visas and many of whom are part of the informal (cash) economy. Only a tiny percentage of meatpacking and no agriculture businesses are unionized in Illinois or most of the USA. Initially, FSC workplaces were not re-configured for social distancing; sanitation and entry procedures were not instituted; workers were not offered personal protective equipment (PPE); and no plans were made for quarantine of infected workers or isolation of COVID-exposed workers. Lack of paid sick leave for these workers, who earn subsistence wages and whose employment is extremely precarious due to immigration status, added pressure for them to continue to work while infectious. Investigation and enforcement of health and safety was taken on by local health departments rather than the occupational safety and health enforcement agency. Finally, these workers, who live in congregate housing and share transportation, carried the virus from work to community and community to work. We review US laws related to immigration, labor, and occupational health and safety before and during the pandemic, as well as epidemiological data. We will highlight the changes required to address “work” in the web of contagion during an infectious disease epidemic. Protection of workers’ rights, as well as a clearer understanding of the integral connection between workplace and community, will be a likely “side effect” of these efforts.