bluuebunny/crossref_metadata_2025 huggingface dataset:
The normalised mortality, a new measure to ensure valid conclusions from cardiovascular mortality
Authors: Stolpe S , Kowall B
Published: October 2024

Background

The quality and efficacy of health systems is assessed by comparing age-standardised mortality (ASM) from cardiovascular diseases (CVD), as they are regarded avoidable by health care. Differences in CVD mortality in West-Europe are surprising and hard to explain: in 2018, ASM for CVD in Germany was much higher (women: 102, men: 155/100,000) than in the Netherlands (65 and 97). Yet, these differences do not root in health system quality, but in different shares of CVD deaths among all deaths (DE: 39%, NL: 25%), which strongly effect CVD mortality. We developed a mortality measure less sensible to differences in shares of CVD deaths to increase plausibility of comparisons and validity of conclusions.

Methods

WHO data on sex-specific all and CVD deaths, ASM for CVD and all-causes for 2000-2018 for Western-European countries was used to calculate the share of CVD deaths among all deaths. ASM for CVD was divided by the share of CVD deaths resulting in a mortality measure normalized for 1% of CVD deaths. ASM and normalized mortality for CVD were used in comparative analyses. Strength of linear association between total and (normalized) ASM for CVD was estimated (adj. R²).

Results

Normalised CVD mortality ranked from 2.0 (CHE in women) to 4.9 (SVN in men) in 2018. While ASM for CVD was lowest in Danish women and Dutch men, Switzerland leads both rankings using the normalised CVD mortality. While ASM for CVD was much higher in Germany than in the Netherlands, the countries had the same normalized CVD mortality (2.6). ASM for CVD was moderately associated with all-cause mortality only in men (adj. R² 0.33; in women: -0.06). Using the normalized CVD mortality yielded an adj R² of 0.66 in women and 0.94 in men. The normalised CVD mortality ensures reliable comparisons of CVD mortality eliminating the effect of different shares of CVD deaths. It yields plausible results and enables valid conclusions about health system quality and better decisions for public health.

Key messages

• Age-standardised CVD mortality rates are effected by different shares of CVD deaths in countries and hinder valid conclusions on health systems efficacy and quality of health systems.

• The normalised mortality rate eliminates the effect of different shares of CVD deaths in countries and allows to validly compare CVD mortality.
Analysis of the mpox outbreak in Europe in 2022: vaccination rollout in the most affected countries
Authors: Paiva Pessoa M , Figueiredo Augusto G
Published: October 2024

Background

The mpox virus spreads through contact with infected material and causes flu-like symptoms and skin lesions. Common in Central and West Africa, a global rise in mpox cases in 2022 was observed, affecting mainly men who have sex with men.

Methods

The study analysed vaccination policies in the most affected WHO-EURO countries during the mpox outbreak, including the Netherlands, France, UK, Spain, Germany, Belgium, Portugal, and Switzerland. Epidemiological data from May to October 2022 (first wave) were compared. Additionally, the role of EU health institutions in assisting member states in controlling virus spread across the region was examined.

Results

By the end of May 2022, three countries (The Netherlands, France, and UK) initiated post-exposure vaccination shortly after the first case identification. Portugal, one of the most affected countries, implemented pre-exposure prophylaxis for high-risk groups by September, followed by Switzerland in November. Vaccination access for non-exposed priority groups varied, with France not requiring a medical prescription. EU cooperation in health was pivotal during the outbreak, with vaccines distributed through the EU4Health program budget via HERA to ensure preparedness. However, detailed information remains limited.

Conclusions

Countries’ responses to the mpox virus outbreak varied significantly, with discrepancies not always aligning with epidemiological data. These differences could stem from various factors, such as behavioural patterns, prior immunisation rates, and neighbouring countries’ policies. However, the unequal access to vaccines across the region underscores existing health disparities, particularly affecting stigmatised populations. Data on immunisation records were notably scarce in most countries, hindering thorough analysis of policy implementation and effectiveness. Additionally, further exploration is warranted into the role of LGBT associations and evidence of stigma surrounding the outbreak.

Key messages

• The mpox 2022 outbreak in Europe provides an important picture of cross-border health policies and public health responses for future emergences in a European cooperative environment.

• Most national authorities provided limited information during the mpox 2022 outbreak; data on immunisation records and vaccine access is pivotal to assess countries’ health policies.
HiCorr: an influenza surveillance model using over-the-counter sales from community pharmacies
Authors: Teixeira Rodrigues A , Duarte Pereira R , Rodrigues N , Moreno J , Mendes Z , Vasconcelos R , Tato Borges G
Published: October 2024

Background

In large-scale community transmission, such as seasonal influenza, monitoring geographic trends and estimating the transmission intensity are critical to support public health decision-making. Previous studies have successfully used sales data from over-the-counter (OTC) products in community pharmacies to detect and monitor different epidemiological outbreaks, developing surveillance systems that are able to anticipate the load on primary care services and hospitals by up to 3 weeks.

Methods

The subset of OTC products sold in Portuguese community pharmacies was selected by correlating sales data to primary care attendance in previous flu seasons. This data pertained to daily coded episodes of influenza-like-illness (International Classification of Primary Care, 2nd Edition, code R80) in the Portuguese health cluster Oeste Sul. By fitting a moving epidemic method to historical sales data and then applying it to daily collected sales data, the developed index was used to anticipate the relative load to the primary care system as well as the start and the peak of epidemic activity for the current flu season. Results were compared to the public health data available on respiratory infections in Portugal.

Results

The model pinpointed the onset of the 2023-2024 flu epidemic in week 47 and its peak in week 52. The index curve showed a high correlation with the data published by the Portuguese national health service, with no time lag. However, the availability of consolidated public data was delayed, on average, by approximately two weeks.

Discussion and conclusions

Data from community pharmacies significantly enhance the early detection of seasonal flu trends, while reflecting population distribution. This underscores their invaluable contribution to public health assessments and the potential for improving the timeliness and accuracy of seasonal flu surveillance.

Key messages

• Community pharmacy data significantly enhance the early detection of seasonal flu trends.

• Real world sales data maybe useful to support epidemic surveillance in public health.
Examining Cycle Threshold values in Repeat SARS-CoV-2 Cases: A Retrospective Analysis in Ireland
Authors: Kumawat J , Butler F , Jalal R , Codd M , Gormley E , Loughrey J , Conyard K , Wall P
Published: October 2024

Background

Effective public health management during the COVID-19 pandemic requires accurate differentiation between re-infections and residual viral RNA detections in repeat positive cases. This study investigates cycle threshold (CT) trends in repeat SARS-CoV-2 cases to discern between persistent viral remnants and active infections. Collaboration between contact tracing and laboratories is essential for shaping robust public health strategies.

Methods

A retrospective analysis was conducted on 427 individuals with repeat positive PCR tests. Data was collected at a contact tracing centre from March to August 2021. Key variables including age, gender, and biomedical markers (test intervals, CT values) were examined. Regression and correlation techniques assessed CT trends and their implications.

Results

Younger individuals (<60 years) occasionally exhibited significantly lower CT values in subsequent tests, suggesting potential re-infections, while older adults generally displayed higher CT values indicative of residual RNA. These age-specific CT trends were statistically significant and instrumental in refining testing protocols and isolation guidelines. Further analysis is expected to strengthen these findings

Conclusions

Collaborative approaches between contact tracing and laboratories are vital in shaping robust public health strategies for distinguishing between types of repeat infections. Revision of health policies is imperative to prevent unnecessary isolation and optimise healthcare workforce allocation during ongoing transmission periods.

Key messages

• Decisive decision-making skills are crucial in managing repeat SARS-CoV-2 infections.

• Revised health policies align testing and isolation practices with empirical CT data, enhancing public health efficacy.
The practice of defensive medicine among Italian physicians: a cross sectional study in Rome
Authors: Furia G , Alizadeh H A , Sapienza M , Tarsitano M G , Patrizi C , Capelli G , Damiani G , De Vito C
Published: October 2024

Background

To identify the perception and the reason of defensive medicine among Italian physicians, and identify the socio-demographic and work-related determinants of the increased practice of defensive medicine.

Methods

This study is a cross sectional web survey. A questionnaire was sent by e-mail to all the physicians registered to the Order of Physicians and Dentists of the Province of Rome. The collection period was from mar 2024 to may 2024. Descriptive analysis and multivariable linear regression models were conducted to describe differences between groups and to estimate the relationships between variables.

Results

A total of 291 physicians completed the survey and were included in this analysis. Almost 60% of respondents feel under pressure due to the possibility of legal disputes. 73,8% adopted defensive medicine behaviours during the last year. More than 80% are aware that defensive medicine represents a limitation for their profession and a unfavourable factor for patients. Who answered that they practice defensive medicine think that it is a factor limiting their professional activity (OR: 2.3) and an unfavourable factor for the patient’s health (OR: 1.1).

Conclusions

Defensive medicine is an important factor in health care costs without increasing the benefits to the patient. The study contributes to a deeper understanding of the perception of defensive medicine among physicians. Defensive medicine practice is common among physicians with concerns about increasing pattern in the future.

Key messages

• Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice.

• The study contributes to a deeper understanding of the perception of defensive medicine among physicians.
ERIMS assessment Tool Enhances Emergency Response in WHO Europe Region
Authors: Monteiro H , Shapiro M , Tran Ngoc M , Elamein M , Matos C , Smallwood C
Published: October 2024

Issue/problem

The implementation of an Emergency Response Information Management System (ERIMS) assessment tool improves health emergency responses within the World Health Organization - European Region. The tool’s deployment aims to refine data management processes and bolster preparedness strategies. Managing health information systems (HIS) effectively during emergencies is a persistent challenge, as technologies keep innovating and potential challenges are constant. The ERIMS assessment tool addresses this by offering a structured approach, ensuring improved emergency responses and system resilience.

Description of the problem

Adopting a systems approach, the ERIMS tool was designed to be flexible, allowing adaptation to various HIS architectures and emergency coordination mechanisms. Its design and development process included consultations with digital health and emergency management experts and field testing across three WHO member states.

Results

Field applications of the ERIMS assessment tool demonstrated its capacity to evaluate, including, digital capability and knowledge management with focus on emergency scenarios. The tool identified systemic gaps, offered strategic guidance on enhancing data processes, and fortified decision-making protocols. These outcomes not only highlighted the tool’s utility in assessing HIS readiness but also its impact in improving emergency response mechanisms.

Lessons

The deployment of the ERIMS assessment tool enhanced HIS by providing an evaluation of emergency preparedness and response capabilities with a focus at the national perspective level. The tool’s application showcased its role in advancing public health emergency preparedness, illustrating how assessments can lead to substantial improvements in health information management and emergency response readiness.

Key messages

• ERIMS assessment implementation improves emergency data management.

• Better preparedness relies on boosting digital capabilities and knowledge management.
Hybrid accountability in global health public-private partnerships: a literature and case study
Authors: Hein J , Bekker M
Published: October 2024

Background

Recent global health public-private partnerships (PPPs) offer novel approaches to public health issues, yet they lack clear public accountability. Hence, it remains unclear how accountability is organised and practiced. This research examines accountability in global health PPPs, how it is manifested, and derives lessons for developing an accountability framework.

Methods

The study utilized both a scoping literature review, examining the databases SCOPUS, Web of Science and MEDLINE, which yielded 35 eligible articles from 334 records, and an exploratory case study focused on an accountability event within the Global Stop Tuberculosis Partnership (STBP), incorporating a document analysis and an expert interview to enhance insights from the literature review.

Results

Authors studying PPPs often conceptualized accountability broadly and favoured a view tied to hierarchical state-led governance and democracy. However, at the global level, this political accountability is largely absent. In PPPs, it is replaced by a mix of bureaucratic, legal, social, audit, fiscal, and rather soft accountability mechanisms. Also, PPPs' accountability landscape is dynamic, shaped by different normative considerations and by the interdependence among partners. In 2020, the allegations for misconduct at the STBP exemplified public reputational accountability, followed by audit accountability leading to an enforced soft accountability to STBPs' mission & purpose.

Conclusions

This study highlights the necessity for rethinking accountability in global health PPPs due to the limitations of existing structuralist frameworks. A new hybrid accountability framework is proposed. It considers a strong accountability focus on PPPs' purpose, their processual dynamics, and normative aspects. Lastly, it is recommended to further investigate the trade-off between transparent accountability mechanisms and the practical necessity for confidential backstage processes in PPPs.

Key messages

• Exploring a hybrid accountability framework in global health PPPs beyond only static accountability snapshots, helps to understand PPPs’ true dynamic, purpose-driven and individualized accountability.

• Without regulatory mechanisms and state governance, individual action and new collaboration become essential, requiring soft accountability mechanisms as increased trust and cooperation among partners.
Governing the Slovenian National Cancer Control Programme - Key Lessons Learnt
Authors: Tomsic S , Duratovic Konjevic A , Plantosar K , Torkar K , Zgajnar J , Zakotnik B
Published: October 2024

Issue

Strategic documents addressing major public health concerns should extend beyond health sector. Cancer control is commonly perceived only as a health issue, thus involving diverse stakeholders is challenging.

Description of the problem

The inclusion of stakeholders within and beyond the health sector is crucial in the preparation, and through implementation of National Cancer Control Programmes (NCCP). Lessons learned on how to involve and maintain fruitful collaboration with diverse stakeholders in Slovenian NCCP are presented.

Results

Over the past 14 years Slovenia’s NCCP has built a reliable and reputable partnership with diverse stakeholders, a collaboration that continues to evolve. Efforts extend across multiple sectors, encompassing health, education, employment, research, environment, technology, and non-governmental organizations. NCCP has set up multistakeholder governance structures: an advisory board, board of experts, specialised expert groups, and a group of representatives of cancer hospitals. These groups engage a diverse range of experts and institutions nationwide. Whenever feasible, representatives of patient organizations are included. All these structures hold regular meetings, complemented by an annual event that convenes all stakeholders and also provides an invaluable platform for informal networking. To ensure seamless coordination of all activities, a dedicated team is essential. Our approach has evolved to embrace a dual leadership, comprising both a public health specialist and a clinical expert. Additionally, we benefit from the expertise of communication experts, who offer valuable insights into effectively reaching diverse audiences.

Lessons

Governing Slovenia’s NCCP by involving diverse stakeholders in planning and implementation activities has demonstrated its effectiveness. Furthermore, we are witnessing an increasing number of new stakeholders actively seeking out to participate in the NCCP.

Key messages

• Slovenia’s NCCP is recognized for its credibility and strategic approach.

• Involving diverse stakeholders in cancer control endeavours has proven effective, fostering trust and partnerships.
How to improve the inclusion of the elderly in the local community for better mental health?
Authors: Stanojevic-Jerkovic O , Oreski S
Published: October 2024

Issue/problem

Social exclusion, ageism and low health/digital literacy intertwine with growing trends in mental disorders, including abuse in Slovenian elderly. To cope with these issues, besides rising competencies, there is a need for stable and continuous partnerships of all relevant stakeholders in the local communities.

Description of the problem

Despite previous efforts of the Interdisciplinary Working Group (IWG) for mental health promotion in the elderly (established according to the Resolution of the National Mental Health Program, 2018-2028), there was a need for reconsidering approaches in the next Action plan (2024-2028). A national conference on decreasing social exclusion in the elderly contributed as a road map.

Results

Previous activities (events in the local communities, supported materials) were upgraded with a broad destigmatization campaign, (recruitment of the >>ambassadors <<) and collection of culturally adapted good practices. Better availability of information through >>info-spots << and easier participation of the elderly in cultural events was enabled. Activities of the reinforced IWG were promoted.

Lessons

Empowerment of key actors and their continuous cooperation could improve information flow, competencies, the inclusion of the elderly in the local community, and decrease ageism and discrimination. Developing local strategies with the crucial involvement of elderly representatives is the opportunity for more intensive and better cooperation between local policy/stakeholders, public health experts, and the target population. Regular financial support will prevent additional inequities.

Key messages

• The empowered, connected, and proactive community is key to preventing the elderly’s exclusion.

• Approaches should be fresh, accessible, and tailored to the heterogeneous population.
Content validation of a test battery for assessing sleep quality in adolescents in Slovenia
Authors: Mlakar A , Kukec A , Rejc T , Šmigoc M , Gril Rogina K , Gnidovec Stražišar B
Published: October 2024

Background

Sleep constitutes a fundamental biological necessity, occupying approximately one-third of our lifespan. Consequently, the field of sleep research has experienced an increase in interest, prompted by the recognition of insufficient sleep as a significant public health challenge. As the majority of existing questionnaires in Slovenia have yet to undergo official translation and validation processes, the aim of our study was to conduct content validation of a questionnaire designed to assess the sleep quality among adolescents.

Methods

We developed a test battery for assessing the sleep quality of adolescents by combining a diverse array of questionnaires. We employed the Adolescent Sleep-Wake Scale, Pediatric Daytime Sleepiness Scale, Epworth Sleepiness Scale for Children and Adolescents, and Children’s Morningness-Eveningness Scale. Following the development of the entire test battery, a process of back-translation from English to Slovene occurred, followed by cultural adaptation.

Results

The designed questionnaire underwent content validation by a panel of 10 experts drawn from diverse disciplines. Evaluation of questionnaire items followed a planned methodology tailored for the content validation of measurement instruments, focusing on content relevance, clarity, and classification into subscales or factors. Our analysis revealed that the individual questionnaires demonstrate content validity, supported by notably high indices of content validity.

Conclusions

Translated questionnaires demonstrate decent content validity, thus rendering them valid clinical and research tools for assessing sleep quality in adolescents in Slovenia.

Key messages

• Our research indicates the availability of content-valid tools for sleep research.

• Further investigation is needed to determine the reliability, specificity, sensitivity, and appropriateness of the factorial structure of measures for the quality of sleep.
Protocolizing social prescribing in mental health and addiction services: barriers and opportunities
Authors: Olivella-Cirici M , Casajuana Kögel C , Segura L , Alonso J , Colom J
Published: October 2024

Issue

Social Prescribing (SP) is a structured approach where health professionals recommend community activities to enhance well-being. Starting in Catalonia in 2012, it expanded to the entire primary care network by 2016. By 2023, 23,338 patients received SP, showing a 2.3-fold increase from 2022. Two-thirds experienced improvement in mental well-being. Now, efforts focus on applying SP to mental health and addiction services (MHAS), where SP can be used for restoring health and well-being.

Description

A literature review was conducted and a working group was initiated with MHAS professionals was initiated to exchange experiences and identify needs and best practices. This was done in preparation for designing a pilot experience, which will include a qualitative study through focus groups to validate the action plan and determine barriers and facilitators in MHAS. The groups will be segmented into MHAS users and frontline professionals.

Results

The results of the review process and the working group sessions demonstrated that SP can be useful and beneficial for the health MHAS users. However, barriers and opportunities were identified. The main barriers detected include: the need for strong support during referrals to community activities; increased awareness of addiction among activity providers to reduce stigmatization; define inclusion and exclusion criteria; determining monitoring and evaluation tools; and mapping and updating community assets. Regarding opportunities, the following were highligthed: the interest of MHAS professionals in promoting and implementing a SP program in this area; the existence of organizations already conducting community activities focused MHAS users; and political prioritization of this issue.

Lessons

The implementation of a SP program protocol in MHAS is considered beneficial. It is necessary to analyse barriers to effectively address them and to identify opportunities to leverage them.

Key messages

• Social Prescribing has significantly enhanced mental health outcomes in Primary Care, which can imply a potential improvement in well-being of mental health and addiction services users.

• Implementing Social Prescribing in mental health and addiction services offers promising integrated care opportunities, requiring barriers resolution and maximizing existing prospects.
An integrated approach to enhance vaccine uptake in chronic patients – the VacciNetwork project
Authors: Adamo G , Colaiocco G , Diedenhofen G , Amoriello Lamberti P , Gherardi S M , Trani F , Mallamace N R , Isidori C , De Angelis G , Fano V
Published: October 2024

Issue/problem

Individuals with chronic illnesses are at a higher risk of infections and their complications. Vaccinations are crucial in reducing this risk and their integration in chronic care pathways can enhance vaccine uptake, but it requires a collaborative approach and increased awareness in care personnel, caregivers and patients.

Description of the problem

The Local Health Authority of Rome 2 (ASL Roma 2, with approx. 1.3 million residents) initiated an active promotion plan for recommended vaccinations in chronic patients in January 2023, and a Clinical Vaccinology Workbook was produced to guide healthcare workers in promoting vaccinations across various care settings. The plan aims to establish collaborative agreements with hospitals and territorial structures that manage these patients, integrating vaccination plans with clinical and healthcare pathways for a more holistic approach to chronic disease management, a model that could benefit similar populations globally.

Results

Data was extracted from administrative databases regarding vaccinations performed in 2022 and 2023 on fragile subjects, i.e., those with a marked ‘risk condition’, aged ≥18 years. The results showed that vaccine uptake was more than doubled (6675 vs. 2041; +227%). Notably, vaccinations rose among those with oncological-hematological diseases (+212%), asplenia (+185%), chronic kidney failure or on dialysis (+190%) and those with an HIV infection (+160%). Increases were also significant in other immunocompromised conditions (+194%).

Lessons

The practice underlines the importance of targeted vaccination programs within chronic care management. Collaborative healthcare frameworks can significantly improve vaccination rates, reducing the burden of infectious diseases in high-risk populations. These results underscore the potential applicability of such a model in other regions and countries, highlighting the universal relevance of integrated healthcare solutions.

Key messages

• Collaborative, integrated frameworks between clinical and vaccination services can represent a model for increasing vaccine uptake in chronic disease patients.

• Strategic partnerships and education in healthcare settings can improve vaccination rates and contribute to more holistic chronic disease management.
Active aging, autonomy, and mental health among older adults with chronic illness - focus on optimism
Authors: Karai V , Rózsa S , Kiss ECS
Published: October 2024

Background

In the active aging framework, the focus has shifted to the quality of life of the elderly, where autonomy plays an important role. Chronic illnesses often lead to autonomy limitations, impacting activities of daily living (ADL) and increasing the risk of depression. Fostering an optimistic outlook can mitigate depression’s severity and promote healthy aging.

Methods

The data is from a cross-sectional survey in Hungary (n = 832). 60,1% of the sample had at least one chronic illness. Measurements included the EQ-5D-5L, Mental Health Continuum-SF, Life Orientation Test, and the Geriatric Depression Scale.

Results

We found worse mental health (p = 0,024), lower levels of optimistic outlook (p = 0,002), and higher levels of depression (p < 0,001) among those who reported ADL limitations. ADL limitations (ß = -0,27, p < 0,001) showed the strongest association with perceived health status, followed by mobility (ß = -0,22, p <; 0,001) and self-care (ß =-0,14, p < 0,001). Considering mental health, only ADL limitations (ß = -0,15, p < 0,001) were a significant predictor from the above-mentioned dimensions. Additional analysis showed that depression affected mental health both directly (effect = -1,90, p < 0,001) and indirectly, mediated by an optimistic outlook (effect = -0,88).

Conclusions

1. Limitations in autonomy were negatively linked to perceived health status and mental health. 2. The optimistic orientation toward life can mediate the association between depression and mental health among the elderly with chronic conditions. 3. The Implications of the results could enlighten the necessity of preventive initiatives on autonomy preservation and enhance an optimistic outlook to maintain healthy aging and a favorable quality of life.

Key messages

• Preventive interventions focusing on health-preserving behaviors could be designed for specific groups with a higher risk of ADL limitations in the future.

• Optimism could mediate depression’s impact on the mental health of the elderly with chronic illnesses, suggesting that interventions should target enhancing optimism for improving active aging.
Association between a new healthcare access index and life expectancy in Japan: A nationwide study
Authors: Nakamura A , Takezawa K , Satoh E , Kotani K
Published: October 2024

Background

Access to medical institutions is crucial to healthcare systems. Japan has universal health coverage and unrestricted access to medical institutions; patients can visit any medical institution without requiring referral letters. We developed the Japan- Spatial Accessibility Scale for Medical Institutions (J-AMI) to provide integrated spatial accessibility to multiple sized healthcare institutions. We also examined the association between the J-AMI and life expectancy.

Methods

This study included 220,621 administrative census mesh blocks defined by address; 89,248 clinics and 8,181 hospitals across 47 provinces in Japan, with a total population of approximately 126 million. The road distance between the centre of each block and the nearest clinic was calculated and scored every 1 km. Hospitals were classified as secondary and tertiary hospitals based on the availability of emergency and critical care centres. Secondary and tertiary hospitals were scored every 2 and 4 km, respectively. The scores for clinics and secondary and tertiary hospitals (1-8 points each) were aggregated and scored using a mesh. The population-weighted municipal J-AMI (PWM-J-AMI) scores were calculated for each municipality. Correlations between the PWM-J-AMI scores and life expectancy by municipality were examined. Geographic information was analysed using ArcGIS Pro.

Results

Median life expectancies for male and female individuals were 81.4 years (interquartile range [IQR]: 80.9-81.9 years) and 87.5 years (IQR: 87.2-88.0 years), respectively. The median PWM-J-AMI score was 9.5 (IQR: 5.4-14.5). The PWM-J-AMI scores were negatively correlated with male and female individual’s life expectancy by municipality (r=-0.29, p < 0.01 and r = 0.18, p < 0.01, respectively).

Conclusions

The results suggest that the better a region’s access to medical care, the longer its life expectancy. Efficient medical institution allocation and telemedicine promotion may be essential to improving access.

Key messages

• We developed the Japan- Spatial Accessibility Scale for Medical Institutions (J-AMI) to provide integrated spatial accessibility to multiple sized healthcare institutions, using ArcGIS Pro.

• The PWM-J-AMI scores were negatively correlated with male and female individual’s life expectancy by municipality, which suggest that the better a region’s access, the longer its life expectancy.
Contemporary understanding of health literacy across the Island of Ireland
Authors: Smith C , Murray M , Behan S , Goss H
Published: October 2024

This presentation will detail two reviews that provided contextual understanding for this project. The first, an umbrella review which explored i) How is health literacy currently defined and operationalised nationally and internationally? And ii) What are the key components and principles of health literacy? The search was limited, most notably, to systematic reviews published after 2012. A total of 12 studies were included for data extraction and narrative analysis. Findings provided an update of the conceptual understanding of health literacy, emphasising the complex and multidimensional nature of the concept. Dimensions are common, but growing, and moving beyond just individual capabilities. The second, moving beyond the definition, details a systematic review that aimed to gain a contemporary understanding of health literacy through identifying and appraising existing research conducted in an Irish context. Seven electronic databases were searched between October and December 2023. Initial search identified 551 records, following screening, 37 studies were included in this review. Narrative analysis indicated that across the Island of Ireland in the last decade, many studies had narrow populations of focus (i.e. Dublin based, adults, chronic illness populations), limited research design and methodologies (cross-sectional, narrative, and primary research with short time frames), and lacked rigorous monitoring and evaluation of health literacy as a primary or secondary outcome. While studies highlighted clinical, education and community implications, a limited focus on mental health was also observed. Findings from this systematic review offer valuable insights and recommendations for future efforts to enhance health literacy and the health and well-being of individuals across the island of Ireland.
Creating opportunities for community voices to be heard
Authors: Murray M , Smith C , Meegan S , Behan S , Goss H
Published: October 2024

This presentation will showcase the importance of community based participatory research in developing health literacy in Ireland. Purposeful sampling (n = 105: 71% female) in two contrasting Sláintecare Healthy Community areas in Ireland (Finglas & Cabra and Mayo), recruited participants to take part in semi-structured focus groups, or individual interviews. Using reflective thematic analysis, and a critical friend approach, five key themes were identified that demonstrated the strengths, needs and challenges in health literacy in urban and rural communities in Ireland. This included: i) Accessing and understanding health information; ii) Health literacy changing over time; iii) Perceiving health literacy as an individual responsibility; iv) Interpersonal and community influences on health literacy; and v) Health access through a rural or urban infrastructure. There were many similarities between rural and urban, young and old. Equally, there were unique challenges that required local solutions. As such, the next phase of this project utilised a co-design process to check, challenge, collaborate and create recommendations for health literacy solutions in each case study area. A specific method of experience-based co-design, the Double Diamond Design Approach (DDDA) was used. With DDDA, stakeholders progress through a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Two Co-design Workshops took place in March 2024 aiming to revise the strengths, barriers, needs, and propose potential recommendations for health literacy in each Sláintecare Healthy Community, using an adapted DDDA. Within the rural setting, solutions to promote health literacy spanned across transport, health access, and community based needs. Within an urban context specific suggestions around community engagement, information sharing, and earlier educational intervention were called for.
Cohort retention in a pandemic response study: Lessons from the SIREN study
Authors: Howells A , Munro K , Kamal A , Haywood J , Aquino E , Russell S , Foulkes S , Islam J , Hopkins S , Hall V
Published: October 2024

Background

Cohort studies represent an important research-tool, yet participant retention is difficult. SIREN followed a cohort of healthcare workers across 135 NHS sites in the UK during a pandemic. We designed an evolving retention programme, underpinned by our Participant Involvement Panel (PIP). We aimed to evaluate cohort retention over time and identify learnings.

Methods

Mixed method evaluation of our evolving retention programme in the 12 and 24-month cohort. We described cohort retention by demographics and site, using odds ratios from logistic regression. Withdrawal reasons were collected by survey. We collected participant feedback via cross-sectional survey using a behavioural science approach. We conducted focus groups with research teams and conducted thematic analysis.

Results

37,275 (84.7%) participants at 135 sites completed 12-months of follow-up. 12,635 (85.5%) participants at 87 sites completed 24-months. Retention increased with age (24-months: >65 vs < 25 years OR = 2.92; 95%CI: 1.78-4.88; p < 0.001) and was highest in the Asian and Black ethnic groups (24-months OR = 1.78; 95%CI: 1.42-2.25; p < 0.001, and OR = 2.12; 95%CI: 1.41-3.35; p < 0.001, respectively, Ref=white). SIREN scored highly in participant feedback. Lessons for future studies include the need to monitor changing participant motivation; using inclusive and comprehensive communication; acknowledging the contributions of participants and investing in the skillset of research teams.

Conclusions

Despite challenges to running a large multicentre cohort study in an evolving pandemic, retention in SIREN has remained very high. Some factors impacting retention were outside of study control, including the altruistic motivation of participants. Participant feedback was positive, suggesting SIREN methodology will provide useful learning for future retention programmes. Site feedback provided learning for future multicentre research studies, offering insights into key facilitators and common challenges.

Key messages

• Cohort retention is difficult. Mixed methods evaluation shows SIREN achieved high retention while following a cohort of healthcare workers across 135 NHS sites in four UK nations during a pandemic.

• Lessons learned include the need to monitor changing participant motivation; using inclusive communication; acknowledging participants contributions and investing in the research team skillset.
Assessing the contribution of smoking to the disease burden in Belgium, 2013-2020
Authors: Nayani S , De Pauw R , Devleesschauwer B , Guariguata L
Published: October 2024

Tobacco use remains a challenge given its substantial role in contributing to disability and premature death globally. Understanding its impact on population health, as an attributable burden, can help monitor progress on the effectiveness of tobacco policies. In this study, we used the Comparative Risk Assessment (CRA) method to estimate the share of the disease burden due to smoking in Belgium from 2013 to 2020. Population attributable fractions (PAF) were computed for risk-outcome pairs by age, sex, and region in Belgium for 2013-2020. Exposure estimates were extracted from a time series of the Belgian Health Interview Survey. Dose-response curves or relative risk estimates were drawn from the Global Burden of Disease Study 2019. In Belgium, smoking-related deaths decreased from 12,851 deaths (PAF=11%) in 2013 to 9,413 deaths (PAF=7%) in 2020. Deaths among men (2013: PAF=18%, n = 9859; 2020: PAF=11%, n = 7041) were three times higher than among women (2013: PAF=5%, n = 2991; 2020: PAF=3%, n = 2341). Over time, larynx cancer (2013: PAF=72%, n = 185; 2020: PAF=63%, n = 125), trachea, bronchus, and lung cancer (2013: PAF=60%, n = 4,899; 2020: PAF=60%, n = 3,682), other pharyngeal and oropharyngeal cancers (2013: PAF=47%, n = 118; 2020: PAF=40%, n = 100), mouth cancer (2013: PAF=37%, n = 172; 2020: PAF=30%, n = 122), and aortic aneurysm (2013: PAF=40%, n = 268; 2020: PAF=33%, n = 209) emerged as the primary contributors to smoking-related deaths in Belgium. While the ranking of contributing causes stayed mostly consistent in both genders over the years, cervical cancer (2013: PAF=23%, n = 53; 2020: PAF=21%, n = 64) ranked fourth instead of mouth cancer (2013: PAF=22%, n = 28; 2020: PAF=14%, n = 15) among women. Despite decreasing trends over time, smoking remains a significant contributor to cancer deaths in Belgium, particularly among men. Results from this study can help inform the development of strategies for smoking prevention and reinforce the need for continued efforts in prevention initiatives.

Key messages

• Cancers are the primary cause of smoking-related deaths in Belgium, with a decline in the death toll over time.

• Understanding the role of smoking on population health as an attributable burden can improve health monitoring.
Creating good career prospects for professionals in the infectious disease control in the Netherlands
Authors: Hop-Boxhoorn M , Krijgsman N , de Munter A , Linthorst M
Published: October 2024

Background

A strong public health system in the Netherlands requires sufficient and motivated professionals. In preparation for new large outbreaks and pandemics, a strong workforce is essential. Providing good career prospects is crucial to attract, engage and retain professionals at the 25 Dutch Regional Public Health Services (RPHSs). However, it is unclear what opportunities and barriers professionals experience concerning their career prospects in the infectious disease control.

Methods

We aimed to identify these barriers and opportunities using focus groups with infectious disease medical doctors, nurses and assistants. Tangible solutions to address barriers and strengthen facilitating factors were gathered using in-depth interviews with key figures within the board, management, training coordinators and human resources of the RPHSs.

Results

Forty-six professionals participated in six focus groups. Barriers and opportunities for good career prospects included whether or not professionals experienced: personal development opportunities, achievement appreciation, and opportunities for (financial) growth. Interviews with key figures identified solutions to career prospect barriers, which were grouped into five themes: 1) Engage in conversations about career prospects, 2) Provide sufficient achievement appreciation, 3) Ensure connectivity between RPHSs, 4) Develop a perspective on career prospects, 5) Improve the image of RPHSs.

Recommendations

A guideline was developed for RPHSs to improve the career prospects of infectious disease control professionals including 17 recommendations. Implementation of these recommendations will contribute to the attractiveness of working in the public healthcare.

Key messages

• Addressing barriers and encouraging opportunities for good career prospects is essential to captivate, engage and retain public health professionals for pandemic preparedness.

• Career prospects can be improved by developing and communicating a perspective on career prospects, increasing appreciation of achievements, and improving the image of working in public health.
From Data to Decisions: Analyzing PaRIS for Health Policy Insights
Authors: Groenewegen Peter
Published: October 2024

To inform countries on how well they perform from the perspective of people living with chronic conditions in comparison with other countries, we propose an analytical framework for the data collected in the PaRIS survey, detailing how the data will be analysed in a multilevel approach for cross-country comparison. The data structure of the PaRIS survey represents three levels: countries/health systems, primary care practices and patients. Multilevel analysis is used because of its accuracy in estimating country-level outcomes, its flexibility in modelling relationships, and its opportunities in connecting to relevant policy questions. Country-level outcomes will be estimated to facilitate cross-country comparison and (future) within-country comparison over time. A first indication for areas for cross-country learning and policy making is the distribution of variation over patients, care providers and countries. Characteristics of patients that potentially explain variation in patient-reported outcomes and experiences can be linked to primary care practice and country/health system characteristics. The second indication for areas for cross-country learning and policy making is the variation in the slope of the association between patient and practice characteristics and patient-reported outcomes and experiences. This makes it possible to address policy-relevant questions relating, e.g., to whether some health systems or providers are better able to produce positive outcomes and experiences for (e.g.) older patients, and to the impact of chronic care management on patients with a specific chronic condition. To ensure fair cross-country comparisons, all outcomes will be estimated for an OECD (age and sex standardised) reference population, also including case-mix adjustment where necessary. Analyses will be repeated using a country-specific standard population.
The EU Health Task Force, supporting preparedness and response in the European Union and globally
Authors: Romani Vidal A , Severi E , Cauchi D , Obach D , Lof E , Forato S , Hofmann T , Lefevre V
Published: October 2024

The COVID-19 pandemic revealed shortcomings in the European Union (EU) mechanisms for managing public health threats. In 2022, the European Centre for Disease Prevention and Control (ECDC) was mandated to establish the EU Health Task Force (EUHTF) to strengthen preparedness and response at country, EU and global levels. The EUHTF is coordinated by an ECDC Permanent Capacity and relies on pools of experts including ECDC experts, ECDC fellows and European public health experts that can be mobilized for specific assignments or broad public health emergencies. Members from EU/ Economic European Area (EEA) countries, EU agencies, the European Commission, WHO and non-profit organizations advise ECDC on the EUHTF establishment. From May 2023 to April 2024, the EUHTF addressed 13 requests for support from seven EU countries and three non-EU countries. The requests were related to preparedness (e.g. after-action reviews, simulation exercises, mass gathering preparation, capacity building) and emergency response activities (e.g. risk assessment, operational research during crisis, emergency and outbreak response). The EUHTF is operational and able to mobilize expertise from ECDC, the ECDC fellowship and EU/EEA countries. The EUHTF Pool of External Experts, comprised of public health professionals across various levels and institutions of the EU/EEA, is poised to offer comprehensive and robust expertise. Through these resources, the EUHTF is collaborating with and reinforcing the work of EU institutions and other international partners in strengthening preparedness and response.

The EUHTF is a new and structured EU-level approach to public health crises, ensuring tailored in-country support to EU and non-EU countries in preparedness strengthening and crisis response.