bluuebunny/crossref_metadata_2025 huggingface dataset:
Does precarious situtation impact contraceptive use in a context of full health insurance coverage?
Authors: Congy J , Bouyer J , de La Rochebrochard E
Published: October 2021

Background

To promote their sexual and reproductive health and rights, women need full access to contraception and choice of contraceptive method. Precarious women may have difficulties in accessing contraception even in developed countries with widespread health insurance coverage. It is difficult to explore this issue through national surveys that often include too few precarious women. We aimed to compare contraceptive use among precarious and non-precarious women based on the exhaustive French health insurance database.

Methods

The French health insurance database covers 98% of the population living in France and includes all healthcare reimbursements. Contraceptives are partly reimbursed by the national health insurance. For people in a precarious situation, they are fully reimbursed by a specific system called universal health coverage. We selected all women aged 15-49 years living in metropolitan France in 2019. We compared the prevalence of use of each contraceptive method: pill, hormonal intra-uterine device (IUD), copper IUD and implant, between precarious and non-precarious women.

Results

Among the study population of 14 million women, 11% were in a precarious situation. Fewer precarious women used contraceptives (31%) than non-precarious women (44%, p < 0.001). When using a contraceptive, precarious women used a different method than non-precarious women: under the age of 30 years, they used the pill much less and implants more often; above 35 years, they used hormonal IUDs less often and the pill and implants more often.

Conclusions

Although in France contraceptives are fully reimbursed for precarious women, they used fewer and different contraceptives than non-precarious women. Social inequalities may exist even in such a favorable national context. Further research should explore barriers that precarious women may encounter in accessing and choosing their contraception.

Key messages

Although French national health insurance fully covers contraceptives for precarious women, their use of contraceptives is much lower (31% versus 44%), suggesting possible social inequalities. When using contraception, precarious women do not use the same methods as non-precarious women, suggesting possible differences in their contraceptive choice or differences in medical practice.
'Wherever you are, my son, wait for me.' study on medically assisted reproduction
Authors: Napolitani M , Lorenzini L , Valentini V , Alaimo L , Nante N
Published: October 2021

Introduction

In Italy the use of Medically Assisted Procreation (MAP) is increasingly frequent also because the mean age at which Italian women have their first child has increased in recent decades (31.8 years in 2017) and it is more difficult to have a child for an older woman. The aim of this study was evaluate the maternal and neonatal outcomes of MAP and compare them with those of natural pregnancies.

Methods

The cross-sectional study was performed during the period January 2015-June 2019. All women that gave birth in the Hospital of Siena were included. The sample was divided in two groups (Natural pregnancy/MAP Pregnancy). The outcome variables were: maternal age, number of foetus, type of childbirth, timing of the birth, Apgar Index and necessity of hospitalization in neonatal intensive therapy unit (NITU) or resuscitation. The statistical analysis was performed with Stata 12.

Results

In total 5066 females were included (4.5% MAP pregnancy). The average age (±SD) of females was 32,9±5,56 (min 14-max 61). The mean age (±SD) of women with PMA was significantly higher 38.7 ± 5.7 vs. 32.6± 5.4 of those who had natural pregnancy. In PMA Pregnancy there was a higher probability of multiple pregnancy (OR = 16.13; 95% CI 10.38-25.07; p < 0.001), Caesarean Section (OR:4,54; 95% CI 3.28-6.31; p < 0,001) and preterm birth (OR 3.79; 95% IC 2.80-5.14; p < 0.001). Apgar index at the first minute was significantly lower in children born from pregnancies from MAP (8,6 ±1,4 vs, 9 ±1,4 p < 0.01), the difference was significant even in the 5th minute (9,6 ±0,7 vs. 9,8 ±0,6 p < 0.01). Children born by MAP Pregnancy had higher probability of hospitalization in Neonatal Intensive Care (OR = 3.12; 95% CI 2.12-4.59; p < 0.001).

Conclusions

In our sample we found that MAP is used by women with older average age and it is associated with less favourable maternal and neonatal outcomes than those from natural conception.

Key messages

In Italy the use of Medically Assisted Procreation (MAP) is increasingly frequent because it is more difficult to have a child for an older woman. In our sample we found that MAP is used by women with older average age and it is associated with less favourable maternal and neonatal outcomes than those from natural conception.
Antenatal care access and concerns of pregnant women during pandemic: a population-based study
Authors: Taneri PE , Torun SD , Yavuz M , Sezerol MA , Tasci Y , Aydin HL , Bilir E
Published: October 2021

Background

The COVID-19 pandemic continues to burden the health of vulnerable populations such as pregnant women. It has been estimated that antenatal care coverage has been decreased with workforce, supplies, demand, and access reductions during the outbreak in some countries. The study aimed to investigate the health care access and concerns of pregnant women during the pandemic.

Methods

This cross-sectional study was conducted among 331 pregnant women in one district of Istanbul (Üsküdar) and a random sampling method was applied. The data was collected between November 22nd and December 18th 2020 by telephone interview after verbal consents were taken from the participants. Chi-square and multiple logistic regression analyses were performed. The study was approved by the Bahcesehir University Institutional Ethics Board.

Results

The median age of the participants was 30 years, the median gestational age was 24 weeks. Among the participants 9.6% were previously diagnosed with COVID-19, 15.8% had a chronic disease, 48.2% were nulliparous and 18.6% had a high-risk pregnancy. The frequency of having concern for their own health was 70.7%, for their children's health was 73,0%, for going to visits in healthcare facilities was 81.0% and for giving birth during the pandemic was 83.0%. Also, 17.1% did not go to antenatal visits because of the COVID-19 concerns. According to the logistic regression analysis, women who had chronic disease had higher concerns about their own health; women who had chosen to go to hospitals for antenatal care visits had higher concerns about children's health and giving birth, and women who had concerns about going to health facilities during the COVID-19 pandemic were less likely to go to family health centers.

Conclusions

Our results suggest that the concerns related to the pandemic among pregnant women are at significant levels. Measures should be taken to ensure that antenatal care services are not interrupted throughout the current pandemic.

Key messages

Significant concern levels were detected among pregnant women in our sample. Measures should be taken to ensure to maintain uninterrupted antenatal care services.
Toward resourcefulness: Pathways for community positive health
Authors: Peters L , Shannon G , Kelman I , Meriläinen E , Scobie M , Clark-Ginsberg A , Myhre S
Published: October 2021

Communities play a central role in strengthening their health, but conventional community health promotion often adopts paternalistic and top-down approaches. Conversely, agentic approaches are critiqued for tasking marginalized communities to create change without opportunities. Taking into consideration these shortcomings, we ask how communities may be most effectively and appropriately supported in their pursuit of health. We review community health literature to articulate how community health is understood, moving from negative to positive conceptions; determined, moving from a risk-factor orientation to social determination; and promoted, moving from conventional to agentic approaches. We develop the concept of resourcefulness as a pathway to strengthen positive health, and explore how this approach may be applied in diverse communities through fieldwork in Kenya, Peru, Trinidad and Tobago, and the US. Through resourcefulness-based approaches to community health, communities cultivate agency to 1) conceptualize what constitutes their health and assets and 2) pursue and sustain health agendas driven by local priorities, needs, and learning, while they also work to 3) change power imbalances that drive inequitable patterns of resource distribution and 4) nurture ecologically sound relationships with their local environment. We discuss how resourcefulness addresses tensions between resource use and sustainability, and how communities leverage partnerships for change. We make practical suggestions to apply resourcefulness as a process-based, place-based, and relational strategy, while recognizing that contexts and scale matter and limit the viability of community-based solutions.

Key messages

Resourcefulness-based strategies can forge new pathways to sustainable and self-sustaining community positive health. Resourcefulness builds on agentic approaches, but it also challenges inequitable power relations and environmental practices that degrade local capacities for health.
Serum neutralizing activity against SARS-CoV-2 variants in hospitalized COVID-19 patients
Authors: Marchi S
Published: October 2021

Background

The recent spreading of new SARS-CoV-2 variants, carrying several mutations in the spike protein, could impact on immune protection elicited by natural infection or conferred by vaccination. This study aimed at evaluating the neutralizing activity against the viral variants emerged in the United Kingdom (B.1.1.7), Brazil (B.1.1.28.1), and South Africa (B.1.351) in human serum samples from hospitalized patients infected by SARS-CoV-2 during the first pandemic wave in Italy in 2020.

Methods

Serum samples of 42 COVID-19 patients hospitalized in Italy between March and May 2020, were included in the present study. Samples available for each patient at three time points were selected: hospital admission sample, sample showing the highest neutralizing antibody titre against 2019-nCov/Italy-INMI1 strain (Wuhan strain), and the last sample available during hospital stay. Samples were tested for SARS-CoV-2 neutralizing antibody against B.1.1.7, B.1.1.28.1, and B.1.351 wild type viruses by micro-neutralization assay.

Results

The decrease of neutralizing antibody titre for all three variants was statistically significant at any time point. At discharge/decease, 59.5% of patients showed a decrease (≥2 fold) in neutralizing antibody titre against the B.1.1.7 variant, 83.3% against the B.1.1.28.1 variant, and 90.5% against the B.1.351 variant with respect to the original strain.

Conclusions

The reduction of neutralizing antibody titres against all analysed variants, and in particular B.1.1.28.1 and B.1.351 ones, suggests that previous symptomatic infection might be not fully protective to exposure of SARS-CoV-2 variants carrying a set of relevant spike mutations.

Key messages

A reduction in neutralizing antibody titres against B.1.1.7, B.1.351, and B.1.1.28.1 variants was observed. Previous symptomatic infection might be not fully protective to exposure of SARS-CoV-2 variants carrying a set of relevant spike mutations.
Sex differences in the risk of coronary heart disease associated with socioeconomic status in Turkey
Authors: Turunc O , Zwas DR , Calderon-Margalit R , Unal B
Published: October 2021

Background

Studies in high-income countries have demonstrated that low SES status is associated with increased risk of CHD, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries.

Methods

The database of the Chronic Diseases and Risk Factors Survey In Turkey from 2013 and 2019 was used. Education level and employment status were chosen as proxy indicators for SES. Cox regression analyses were conducted to assess the effect of SES on incident CHD controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess multiplicative interaction between sex and SES on the occurrence of stroke.

Results

The study included 13 975 participants (7 450 females (53.3%) and 6525 males (46.7%)). During 74.2±9.87 months of follow-up, 474 CHD cases occurred among females (10.28 cases per 1000 person-year) and 445 CHD cases occurred among males (11.05 cases per 1000 person-year). Incident CHD was not associated with education level among either sex. Retirement was associated with increased risk of CVD (HR = 1.31, 95%Cl: 1.18-1.66) among males. Both retirement (HR = 2.12, 95%Cl: 1.16-3.88) and unemployment (HR = 1.93, 95%Cl: 1.14-3.25) were associated with increased risk of CHD in females after adjustment for behavioral and biological risk factors. There was no multiplicative interaction between sex and employment status on the risk of CHD (p = 0.091).

Conclusions

This study of health outcomes in Turkey did not find sex differences in CVD in association with educational status but did show sex differences in association with employment status. This finding suggests that social determinants in middle-income countries may affect men and women differently than in high-income countries.

Key messages

Social determinants in middle-income countries may affect men and women differently with regards to the risk of CHD than in high-income countries. Employment status can predict the risk of CHD in middle-income countries.
Contextual factors in premature CHD mortality in selected African countries within the SDG framework
Authors: Dotun-Olujinmi O , Johnson J , Greenhill R , Wuenstel W
Published: October 2021

Background

The sustainable development goal number 3, target 4 (SDG 3.4) seeks by 2030, a 30% reduction in four premature chronic disease mortality (4CHD) from 2015 values. Since the implementation of SDG 3.4 in 2016, the highest risk of dying from CHD was observed in low and lower-income countries mainly in Africa. This study examined the relationship between contextual factors and diabetes-related deaths as an example of the 4CHD; to enable an improved contextualized evidence-based approach, to attain in part the SDG 3.4 among United Nations Member States in Africa region (UNMSAFR).

Methods

Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected UNMSAFR located in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to ascertain the association between diabetes-related deaths in individuals 20-79 years in UNMSAFR and contextual factors identified in the SDGs framework. Two regression models were tested by conducting unweighted and weighted data analysis.

Results

The unweighted analysis showed that diabetes-related deaths in individuals 20-79 years/1,000 varied across the selected UNMSAFR in IDF East and West Regions (n = 31), with a range of 0.06 - 0.48/1,000 and an average of 0.24/1,000. Contextual factors, i.e., unemployment rate and geographical region explained 23% variability in diabetes-related deaths across the selected UNMSAFR. However, in the weighted data analysis, voice and accountability explained 47% variability in diabetes-related deaths across selected UNMSAFR in IDF East and West Region (n = 32).

Conclusions

Contextual factors such as unemployment rate, geographical region, and voice and accountability (governance) were associated with diabetes mortality; identifying that salient modifiable features can inform targeted interventions and policies to reduce premature CHD mortality.

Key messages

Contextual factors should be considered in policies and interventions for a comprehensive approach to premature CHD mortality reduction. Spatial clustering of CHD is critical for region interventions.
2.G. Workshop: The European Health Data Space (EHDS): future opportunities and current challenges
Authors:   Organised by: EUPHA-DH, EUPHA-PHMR,   Chair persons: Anna Odone (EUPHA-DH), Petronille Bogaert (EUPHA-PHMR)
Published: October 2021

The creation of a European Data Space is one of the priorities of the Commission 2019-2025, including the health sector. A common European Health Data Space will promote better exchange and access to different types of health data (electronic health records, genomics data, data from patient registries, etc.), not only to support healthcare delivery (so-called primary use of data) but also for health research and health policy-making purposes (so-called secondary use of data). The COVID-19 pandemic has further underlined the importance of having timely access to health data within the Members States and across Europe. The EHDS would give a valuable contribution to research activities on new preventive strategies and effective treatments and medical devices, thus contributing to improving citizens' health and their quality of life. The European Health Data Space will require a common framework that should be based on three pillars:

a strong system of data governance and rules for data exchange; data quality; strong infrastructure and interoperability

A concerted effort is needed to overcome some of the difficulties that are arising and that relate to: different levels of health digitalization and infrastructure quality at national levels; fragmentation of data standards and limited interoperability between healthcare systems; limited access and operability due to legal (GDPR) issues.

We believe there is an urgent need to discuss with relevant stakeholders about strategies to:

Establish an appropriate legal and governance framework to cover the access to and exchange of health data for healthcare provision, research, policy-making and regulatory activities. Lower technical barriers hindering data use and re-use, in particular those related to infrastructure, interoperability, data quality and standards in the health field. Ensure access and control of patients and citizens over their own health data.

The workshop's structure and content aim at accomplishing with the above by: 1) introducing the principles and potential of the European Health Data Space (EHDS) project, ii) providing contributions from stakeholders on the three pillars of the EHDS, stimulating the debate around current gaps in knowledge, as well as system and policy barriers to the design and implementation of the EHDS.

Key messages

The European Health Data Space (EHDS) will have a strategic importance for public health, supporting policy makers and researchers all across Europe. To fully develop the potential of the EHDS, some main challenges need to be addressed within the legal and technical frameworks.
How can population health research benefit from a European Health Data Infrastructure?
Authors: Schutte N , Bogaert P , Saso M , Abboud L , Van Oyen H
Published: October 2021

Health is a cross-border issue, recently demonstrated by the COVID-19 public health crisis. Now more than ever, the healthiness of European populations requires the use of the full capacity of the European research community to generate evidence in these uncertain times for better health system preparedness and pragmatic approaches to interventions in the health care system. However, data on population health is fragmented across institutions, projects and research networks. To bring evidence and scientific consensus to the attention of policy makers and inform their actions, researchers should have facilitated access to high quality comparative data to answer urgent research questions and the generation of new research hypotheses; improved streamlining of research efforts and international comparison; learning through exchange and priority-setting. Population Health Information Research Infrastructure (PHIRI) for COVID-19 facilitates research and supports policy making across Europe through the implementation of a research infrastructure to generate the best available evidence for research on health and well-being of populations as impacted by COVID-19. PHIRI will form a cornerstone of the emerging European Health Data Space, as there is a need to pilot the premises of sustainable federated research infrastructure that will ultimately contribute to improved population health.
Impact of the Covid-19 pandemic on health services utilization: a cross-sectional study
Authors: Isonne C , Migliara G , Turatto F , Mazzalai E , De Vito C , Marzuillo C , Villari P , Baccolini V
Published: October 2021

Background

Health services disruption during the COVID-19 pandemic has forced to postpone or cancel most scheduled health visits. Within this context, disadvantaged people may have been suffered the most from the indirect consequences of the emergency. The aim of the study was to quantify the pandemic impact on health services utilization in the Roman population based on the economic, sociodemographic and cultural characteristics.

Methods

In January 2021, an online survey was administrated to 640 patients attending a Roman general practitioner. The questionnaire investigated sociodemographic characteristics, working and living conditions, COVID-19 experience, consequences of lockdown or policy responses, and health literacy. A multiple logistic regression model was built to investigate factor associated with a reduction in the healthcare use.

Results

Overall, 451 respondents were surveyed. More than 60% were women and mean age was 55 years. In total, 211 patients referred to have cancelled one or more scheduled health visits (14 vaccinations, 60 screening exams, 168 medical examinations and 23 surgeries). At multivariable logistic regression analysis, the loss of at least one visit seemed to be associated with lower perceived wealth (aOR=1.60, 95%CI: 1.07-2.39), pre-existing comorbidities (aOR=1.60, 95%CI: 1.04-2.45), and older age (aOR=1.03, 95%CI: 1.01-1.04). No association was found for sex, education, or health literacy.

Conclusions

A few socio-demographic characteristics seemed to identify people that may have suffered the most from the health services disruption during the COVID-19 pandemic, contributing to worsen the existing health inequalities. Future research is needed to devise strategies aimed at containing the negative effects of the pandemic on vulnerable populations.

Key messages

The COVID-19 pandemic seemed to have a greater impact on health service utilization among disadvantaged people. The COVID-19 pandemic may have exacerbated health inequalities.
Health Literate Schools (HeLit-Schools): Organizational Health Literacy in the School Setting
Authors: Okan O , Kirchhoff S , Bauer U
Published: October 2021

Background

Health literacy of schoolchildren has been recognized as an important target for school health promotion. Yet, the environmental and organizational health literacy (OHL) capacities of the school setting has not been addressed so far. The aim of this project is to adapt the “health literate organization-approach” to school settings, including a self-assessment tool to measure the OHL capacity of schools. In terms of sustainability, intersections and links with the health promoting school will be explored.

Methods

The adaption work is carried out by a cooperative and intersectoral approach including different experts from the school setting, the education sector (teachers, principals), and health experts in various circulating phases of commenting, revision and feedback. We jointly developed attributes and indicators of the health literate school, see fit to integrate the concept into the health promoting school framework and consider gender and diversity aspects critical to health literacy. To assess the degree of OHL, school principals will fill out a survey based on a self-assessment tool.

Results

The health literate school concept comprises of eight dimensions, addressing aspects of OHL development including the organisational level (policies and structures enabling health literacy development), the personal level (promoting student health literacy and in school staff), the classroom and education level (materials and principles for classroom learning) as well as networking and cooperating with relevant actors (parents). The assessment of OHL is currently being prepared.

Conclusions

This is the first-time adaption of the OHL concept to schools in Germany, including its assessment. The health literate school shares various intersections with the health promoting school framework, which is partly being implemented in Germany. This systems approach will facilitate both the uptake and promotion of health literacy in students, teachers, and principals.
Profile of unobservant women regarding contraception in Sousse (Tunisia)
Authors: Bannour I , Frigui R , Bannour R , Khairi H
Published: October 2021

Background

The contraceptive prevalence rate in Tunisia is estimated around 62.5%meanwhile the rate of voluntary termination of pregnancy is constantly increasing. The aim of this study was to define the profile of unobservant women regarding contraception and to assess their knowledge about oral contraception.

Methods

A cross-sectional study was conducted during the month of March 2018 at the Obstetrics and Gynecology Service in Sousse (Tunisia). This study included 100 women who had undergone voluntary termination of pregnancy. All the participants were using contraceptive means.

Results

Roughly 49% of participants were aged between 30 and 38 years, 64% came from an urban environment, 68% had low socio-economic status and 34% had a secondary level of education. Most of them (98%) were using progestin-only pills. Approximately 40 % did not know what ‘back-up' measures they should take after missing a dose of the contraceptive pill.

Conclusions

We cannot extrapolate these results to the whole Tunisian women but we are facing a lack of minimal knowledge about contraception among at least this category of women. Those patients should be more educated and monitored by the prescribers of contraception such as midwives.

Key messages

The rate of voluntary termination of pregnancy is constantly increasing. Patients should be more educated and monitored by the prescribers of contraception such as midwives.
Intersex human rights, sexual orientation, gender identity and the Yogyakarta Principles
Authors: Carpenter M
Published: October 2021

Background

Intersex people are at risk of human rights abuses because their bodies do not fit medical and social norms for female or male bodies. The 2006 Yogyakarta Principles aim to promote good practices in protecting the rights of LGBT and intersex people by applying human rights law in relation to ‘sexual orientation' and ‘gender identity'. They were ineffective in protecting the rights of intersex people, including due to an inappropriate framing around sexual orientation and gender identity. In the same year, a group of clinicians published a ‘consensus statement' reframing intersex traits as ‘disorders of sex development', reinscribing medical authority over intersex bodies. In 2015 a first country (Malta) enacted protections of rights to bodily integrity and physical autonomy and freedom from discrimination, associated with a new attribute of ‘sex characteristics'.

Methods

In January 2017, the International Service for Human Rights and ARC International issued a call for submissions to supplement the Yogyakarta Principles, and brought together a drafting team. The Asia Pacific Forum of National Human Rights Institutions and United Nations Development Program also held a gender- and geopolitically-balanced conference to mark a decade of the original Principles and produce recommendations. An expert meeting was held in Geneva in September 2017 to agree the update.

Results

The ‘Yogyakarta Principles plus 10' elaborated a new attribute of sex characteristics and recognised rights to bodily integrity, truth and legal recognition. These directly respond to the human rights situation of intersex people, with relevance to intersex populations, healthcare workers, advocates, and policymakers.

Conclusions

Adoption of the new attribute and attention to the new Principles can help address the human rights of people with intersex variations within health, education, and other social policy settings.
Partial care: the need to uncover cultural bias to reach intersex wellbeing
Authors: Prandelli M
Published: October 2021

Background

The umbrella term Variations of Sex characteristics (VSCs), also known as Intersex variations, indicates the lived experience of the socio-cultural consequences of being born with a body that does not fit the normative social constructions of male and female (Van der Have, 2016). Currently, there is not a universal consensus on the ‘management' of VSCs, and the existing guidelines and recommendation vary depending on the chosen disciplinary perspective. However, normalising interventions are still guided by sociocultural reasons.

Methods

Starting from a qualitative research involving 65 semi-structured interviews with health professionals and ethnographic observations in 2 hospitals and 2 patients' associations conducted in Italy between 2015 and 2017, this presentation explores how beliefs systems play a crucial role in maintaining the medical status quo through cultural and gender biases.

Results

Whether it be sexual health, psychological wellbeing, physical features, other syndromes, transgender identity or sexual orientation, participants' beliefs frequently drifted to cultural rather than clinical interpretations of VSC. Results show that health professionals' experience of VSC include (1) social, (2) medical and (2) gender biases as guiding principle in the assessment of intersex variations, denoting cultural concepts of ‘abnormal' behaviours, identities, sexual orientation and gender roles as VSCs' frames of meaning.

Conclusions

Despite the increasing international awareness around intersex human rights, results show the critical role of belief systems in maintaining VSC's surgical and social erasing processes, reinforcing the need to consider the mediating aspects - culture, religion and social factors - that affect different social contexts when assessing intersex human rights, social policies and professional training.
Depression among higher education students in Greece during the first C19 lockdown
Authors: Stathopoulou T
Published: October 2021

Background

The imposition of containment measures internationally during the first wave of the Covid-19 pandemic has indicated the need for data on the psychological impact of quarantine. We use the C19 ISWS Greek dataset to examine self-reported depression in relation to alcohol and tobacco use, social contacts, relationship status and perceived risk of infection.

Methods

Online survey data was collected between May-June 2020. Eligible participants were higher education students in Greece and 889 students participated. We performed frequency analysis on the participants who completed the questionnaire (N = 585). Weights were applied to eliminate response bias and adjust the sample survey means and proportions to the student population in the country.

Results

Findings suggest that depressive symptoms are more frequent among female students, first generation migrant students and those in their first year of study. Students who were anxious about getting infected with COVID-19 reported higher rates of depressive symptoms. However, students with slightly higher rates of depression were not very worried about getting severely ill from an infection. The share of students who drunk systematically did not change during the COVID-19 outbreak, their rate is low (0% - 2.2%) and they do not report high rates of depressive symptoms. Depression scores seem to be affected by relationship status, the degree of contacts with friends, and the availability of a trusted person. Results indicate that the fewer the contacts with friends are, the higher the mean depression score is.

Conclusions

The results confirm the gender-gap in depression and are in line with evidence indicating the high prevalence of depression among women in Greece in the aftermath of austerity and recession. As Greece was one of the South-European countries hardest hit by economic crisis, it is possible that negative effects of the crisis have had a cumulative effect on students' mental health in the pandemic.
European Green deal and Climate Pact: A roadmap for digital public health
Authors: Jevtic M
Published: October 2021

The Covid-19 pandemic crisis caused a serious ‘tectonic' disturbance in all sectors, especially pointed out weaknesses of the healthcare systems. The recently adopted European Green Deal (EGD). It should take into account the Covid-19 pandemic challenge and maintain its primary objectives. The pandemic crisis has shown not only individual health risks, but also global health threats (direct and indirect). The SARS-CoV-2 virus causes an insufficiently known infectious disease. The subsidiary health effects are still countless: mental health, health-economic costs, deadlock in the other diseases treatment, etc. One of the main messages regarding environment, is that society should find new economic models less damaging to the environment and to biodiversity, implying circular economy, a less consumerist and active society: e.g. a 4 days-working week. Covid-19 took us to the extreme of being confined at home, either working or taking care of our families. However, the Covid-19 global quarantine and confinement (and huge reduction of travelling, mainly flights) had a great impact on decrease of CO2 levels, on the quality of air and on biodiversity. Vulnerability and lack of efficient action in many countries, is a strong warning for Europe (and globally) to insist in strengthening public health and convert lessons learned into action. The Coronavirus, originating from destruction of wildlife and intensive animal farming, will bring more pandemics in the future. We need more public health consideration towards effects of climate change on public health. It is possible to keep economy functioning by promoting remote work supported by digital platforms and innovation for international networks. Strategically, the European recovery plan should be aligned with the EGD.

These challenges open the way to digital health, and as such, can be defined a roadmap to tackle climate change.
The critical role of Digital Health in Public Health
Authors: Buttigieg S , Vital Brito D , Wong B
Published: October 2021

Digitalization in itself is not simply a means to an end but involves an operational change in workflows that is on the critical-path to the digital transformation of public health. The COVID-19 pandemic has been a unique opportunity to put a shining light on all the different technologies that were available and also consider a large number of new and innovative technologies that were developed in a breath-taking place over a period of one year. These different initiatives also brought relevant advances in public health needs such as epidemiological surveillance, rapid case identification, interruption of community transmission and communication with different audiences. Moreover, social media channels, blogs and websites confirmed to be a fertile ground to find data for research, but also to spread misinformation - and public health professionals should be ready to counter that threat effectively. This presentation aims to provide a comprehensive background on digital tools and strategies that can be used in national and local public health services and how stakeholder alignment across different sectors could propel forward the implementation of digital solutions.
High-resolution spatiotemporal analysis in 6,791 English areas reveals declines in life expectancy
Authors: Rashid T ,   On behalf of Pathways to Equitable Healthy Cities London
Published: October 2021

Background

Health inequalities in the UK and other advanced economies are receiving renewed attention by the public and governments in light of the Covid-19 pandemic. Current data on mortality and longevity in England lack precision either in space or in time. We estimated trends from 2002 to 2019 in life expectancy for all 6,791 English Middle-layer Super Output Areas (MSOAs, median population 7,985 in 2019).

Methods

We used data for all deaths in England from 2002 to 2019 with information on age, sex and MSOA of residence and data on population by age, sex and MSOA. We used a Bayesian hierarchical model to obtain stable estimates of age-specific death rates by sharing information across age groups, MSOAs and years. We used life-table methods to calculate life expectancy at birth by sex and MSOA.

Results

In 2002-2006 and 2006-2010, the vast majority of MSOAs experienced a life expectancy increase for both sexes. In 2010-2014, female life expectancy decreased in 322 (5%) of MSOAs for women. By 2014-2019, the number of MSOAs with declining life expectancy was 1,178 (17%) for women and 635 (9%) for men. The life expectancy increase from 2002 to 2019 was smaller where life expectancy had been lower in 2002, mostly northern urban MSOAs, and larger where life expectancy had been higher in 2002, mostly MSOAs in and around London. As a result of these trends, the gap between the lowest and highest MSOA life expectancy increased from 2002 to 2019, to reach 20.6 (95% credible interval 17.3-24.4) years for women and 27.2 (23.4-31.7) years for men.

Conclusions

This study highlights not only rising inequality, but also declining life expectancy in a large proportion of English communities. The post-Covid rebuild policies in England must include pro-equity economic and educational policies, and expansion of public health and healthcare.

Key messages

Between 2014 and 2019, 17% and 9% of communities in England underwent a decrease in life expectancy for women and men respectively, highlighting the immediate need for equity-focussed policies. For women, 2% of small areas in England have experienced a long-term decline in life expectancy between 2002 and 2019.
Refined avoidable mortality for comparative health systems performance assessment: an impact study
Authors: Hrzic R , Vogt T , Burazeri G , Brand H
Published: October 2021

Background

Avoidable mortality is headline indicator of relative health system performance in European Union policy processes. However, the reliability of this indicator for cross-national comparisons of health system performance is limited by the lack of control for cross-country differences in population health status, and the challenges in selecting causes of death and age limits. This study examined the feasibility and impact of several refinements of avoidable mortality addressing these concerns.

Methods

Using a sample of 30 European countries, including EU Member States, United Kingdom, Norway, and Iceland, we examined the feasibility and impact of adjusting avoidable mortality for cross-country differences in disease prevalence and disease stage, using extended age thresholds, and calculating the avoidable burden of disease. We measured the impact of the feasible adjustments by calculating the average absolute change in country ranks compared to the 2014 country ranking based on the standard avoidable mortality.

Results

Given publicly available data, only the calculation of years of life lost due to avoidable causes of death and using different age thresholds to calculate avoidable mortality are currently feasible. The impact of the feasible adjustments varied between countries with no visible geographic pattern. Including deaths due to avoidable causes at all ages changed the country ranks by an average of 1.9 places in men and 2.8 in women. Using years of life lost due to avoidable causes of death changed the rank by an average of 8.1 places in men and 8.7 in women.

Conclusions

Country rankings are highly sensitive to the type of refinement. However, a full assessment of refinements was not possible due to missing data. To ease the implementation of morbidity-based refinements of avoidable mortality, we recommend that a shorter list of avoidable causes of death is developed.

Key messages

A continuous refinement of relative health system performance measures and improving the availability of internationally comparable health data are critical to effectively support policy making. Updating the age thresholds used to calculate avoidable mortality and using years of life lost due to avoidable causes of death are currently feasible and have a sizeable impact on country rankings.
School-based sexuality education in Italy 2016-2020: a highly heterogeneous scenario
Authors: Chinelli A , Salfa MC , Cellini A , Rancilio L , Farinella M , Galipò R , Ceccarelli L , Caraglia A , Suligoi B , Tavoschi L
Published: October 2021

Background

In Italy, sexuality education (SE) is not part of school curricula. SE and, specifically, comprehensive SE (CSE), as defined by UNESCO, is one of the most important means of promoting sexual well-being among young people and a key component for sexually transmitted infections' (STI) prevention. School-based SE has the potential to reach most young people, is cost-effective and valued by students. The aim of this study was to describe school-based SE educational activities (EA) implemented in Italy during 2016-2020.

Methods

An online survey was developed and piloted to collect information on duration, content and methods used to implement the EA. The survey was disseminated at national and regional level between August-October 2020. IBM SPSS Statistics 26 was used to perform descriptive analysis of the data, while a framework from UNESCO was adapted to perform a qualitative analysis.

Results

A total of 219 reported EA were carried out in secondary schools. The analysis describes a highly heterogeneous scenario in terms of EA geographical coverage across the country (most EA delivered in 4/20 regions), providers (70% private, 30% public) and objectives. The qualitative analysis of content, objectives, and methodology identified 62 EA (29%) classifiable as CSE, with median duration of 3 days. The remainder EA had a risk-based approach, largely focussing on STI prevention (35%). Many EA (29%) were single-session interventions. Limited time availability for extra-curricular activities was reported as a key challenge. Only 97 EA performed evaluation (44%). In 53 EA (24%) both pre and post knowledge assessment were delivered and in 114 (52%) satisfaction was evaluated.

Conclusions

Italy is one of a few European countries still lacking a dedicated policy for school-based SE. According to available data, SE is not systematically and equally delivered across the country. Action is urgently needed to incorporate SE in school curricula. (Funding: Italian Ministry of Health)

Key messages

This study shows the absence of a comprehensive and shared approach to SE in Italy, with heterogeneous geographical coverage and providers and a lack of systematic objectives and evaluation. The results highlight the need to develop theoretical and practical guidelines for the implementation of CSE in Italy and the integration of sexuality education in school curricula.
Food and lifestyle education in Tuscan schoolchildren: 2018-2019 follow-up of a long-term campaign
Authors: Tarroni M , Messina D , Balestri C , Cocchi F , Messina G , Nante N
Published: October 2021

Background

Nutritional profile, physical activity level and sedentary behaviours, in preteen age, are determinants able to influence both short and long-term state of health, therefore succeeding in health education campaigns addressed to this age group is critical for the interested population. Is currently underway the multiannual follow-up of the Italian “sCOOL FOOD - Per un Futuro di tutto Rispetto” project of Monte dei Paschi Foundation of Siena, Tuscany, which offers year-round cycles of classes and workshops about the themes listed above. Our objective was to assess whether this intervention could significantly influence over time healthy, and unhealthy, behaviours of the participants.

Methods

We structured the follow-up as a prospective cohort study with one-group pretest-posttest design. We used the CAWI technique, building a questionnaire based on the Italian “OKkio alla Salute” survey, and collected data from the whole population of students enrolled in the project (in the school year 2018-2019 they were 3787, aged from 7 to 12) before and after the intervention. Afterwards, we conducted paired data analysis on the frequencies of specific behaviours.

Results

We analysed paired data from 310 respondents. Improvements were gained in: afternoon TV watching (OR 0.54; 0.34 - 0.84; p < 0.01), consumption of sweet (OR 0.39; 0.16 - 0.88; p < 0.05) and salty (0.42; 0.18 - 0.90; p < 0.05) snacks, attitude to play outdoors after school (OR 2.6; 1.21 - 6.04; p < 0.01), sedentary behaviour in leisure time (OR 0.27; 0.16 - 0.44; p < 0.0001), mean weekly sport activity (+0.14 days; +0.02 - +0.27; p < 0.05). No variable has deteriorated.

Conclusions

The improved compliance with healthy behaviours in the participants at this project suggests its viability as a health promotion campaign. Further parallel surveys on control groups are pending, in order to control potential confounders such as the seasonality of some habits and the awareness of the participants on the addressed subjects.

Key messages

A coordinated and cross-disciplinary food and lifestyle year-round education campaign at school can affect health determinants of children. School can correct unfavourable eating and lifestyle behaviours determined by family habits.
Disaster response and COVID-19: was safety and health a priority among medical doctors in Serbia?
Authors: Mandić-Rajčević S , Dinić M , Tripković K , Šantrić Milićević M
Published: October 2021

The coronavirus disease (COVID-19) pandemic has an unimaginable impact on the global health workforce. Health workers are deployed as frontline workers to rapidly respond to increasing patient needs. This study aimed to examine the preparedness of healthcare workers during the COVID-19 pandemic to protect their own safety and health. An online survey was conducted among physicians licensed by the Serbian Medical Chamber in September 2020. The Ethics Committee of the Serbian Medical Chamber approved this study (Decision No: 1462/September 15, 2020). The sample consisted of 1,553 physicians who completed the online questionnaire. Almost two thirds (64%) of the physicians worked with COVID-19 patients, and around one third (34%) were deployed to a different work position. Physicians working with COVID-19 patients were younger, less-experienced (mean work experience 14 years vs. 19.5 years) and more commonly non-specialists. Less than 39% of physicians deployed to work with COVID-19 patients had gone through the training on the use of personal protective equipment (PPE), 60% had adequate PPE available daily, and 86% reported using the PPE according to the recommendations. Having proper training regarding the use of PPE and using the PPE according to the recommendations was less common in private compared to public health institutions (31% vs 40% for training, and 89% vs 75% for adequate use, respectively). Workers engaged to work with COVID-19 patients, compared to those who were not engaged, indicated the need for professional changes to respond to the COVID-19 emergency, especially in the areas of workforce planning, education and training, workload measurement and tracking. Younger and less experienced physicians with questionable training and availability of PPE were deployed to work in COVID-19 hospitals and units, and their health and safety was a secondary priority to the primary duty of caring for patients in need.

Key messages

Younger and less experienced physicians with questionable training and availability of PPE were deployed to work in COVID-19 hospitals and units. Health and safety was a secondary priority to the primary duty of caring for patients in need.