bluuebunny/crossref_metadata_2025 huggingface dataset:
Flu vaccination coverage in a large Italian teaching hospital: the example of the leaders
Authors: Pumpo M Di , Barbara A , La Milia D I , Tamburrano A , Vallone D , Gentili A , Cavalieri S , Viora C , Berloco F , Laurenti P
Published: November 2019

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. In our teaching hospital, flu vaccination rate among HCWs has been growing during last 3 years. The aim of this study was therefore to describe the flu vaccination coverage across the past 3 years and to analyze which factors lead to such increase. We performed a cross-sectional study on all HCWs of Fondazione Policlinico Universitario “A. Gemelli” (FPG) hospital of Rome (Italy) to determine the flu vaccination coverage. Socio-demographic and occupational data were collected from hospital personnel records and included age, gender, previous flu vaccination, profession and workplace unit. On site vaccination plus academic detailing involving leaders have been the main strategies adopted in this last 3 years that have already proved to be effective in increasing vaccination coverage among HCWs. During the 2018-2019 season, we analyzed how the flu vaccination coverage among leaders (nurse coordinators and head physicians) could affect all HCWs coverage rate. Flu vaccination rate increased from 9.57% in the 2016-17 to 14.24% in the 2017-18 and to 22.38% in 2018-2019. A total of 4035 HCWs employed in the FPG were included in 2018-19. Concerning the role played by vaccination of leaders in increasing general vaccination coverage during the 2018-2019, the group of HCWs with a vaccinated leader showed a higher coverage rate (28.65%) than the group with a non-vaccinated leader (16.22%) (p < 0.0001). The results are preliminary. Flu vaccination coverage of HCWs in our hospital during the last 3 years has been increasingly higher. Vaccination of the leaders, in addition to previously implemented effective strategies, resulted to be a key factor in increasing flu vaccination coverage among all HCWs. Socio-demographic and occupational variables can significantly influence the coverage rate as well.

Key messages

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. This study shows the growing flu vaccination coverage rate in our teaching hospital and the effectiveness of the example given by the vaccinated leaders in increasing the coverage among all HCWs.
Monitoring of obesity in the Italian adult population: preliminary results of 1998-2018 trend
Authors: Donfrancesco C , Noce C Lo , Profumo E , Minutoli D , Lonardo A Di , Buttari B , Bellisario P , Vanuzzo D , Giampaoli S , Palmieri L
Published: November 2019

Background

Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project.

Methods

Mean of BMI and prevalence of obesity (BMI > =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee.

Results

In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively.

Conclusions

Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025.

Key messages

Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.
Variants in Neuromedin U pathway genes and risk of cardiovascular disease in an Italian population
Authors: Gianfagna F , Marotta A , Noro F , Gialluisi A , Izzi B , Costanzo S , Castelnuovo A Di , Cerletti C , Donati M B , Iacoviello L ,   on behalf of Moli-Sani Study Investigators
Published: November 2019

Background

Neuromedin U (NMU) is a hypothalamic neuropeptide with several functions, considered to be a potential therapeutic target for diabetes mellitus. The aim of this study was to analyse the association between genetic variants in NMU pathway genes and cardiovascular risk, in Italian adults from the general population recruited for the Moli-sani study.

Methods

A total of 4,039 participants (mean age 55.8±12.1 SD; men 46.1%) were randomly selected from the whole study population (N = 24,325; recruitment years 2005-2010). DNA from blood samples stored in the Moli-sani biobank were genotyped for 14 single nucleotide polymorphisms (SNPs) in the genes encoding for NMU, Neuromedin S (NMS) and their receptors NMUR1 and NMUR2. Cox regression analysis (age, sex, BMI, blood pressure, glucose and lipid levels as covariates) was performed to estimate the associations between SNPs and fatal or non-fatal CVD events (validated myocardial infarction or stroke), identified from death certificates and electronic records during a median follow-up of 4.5 years. A genetic score was then computed.

Results

CVD events (N = 93) were associated with mutant alleles in the NMU SNP rs55796004 (HR = 1.94; 95%CI:1.08-3.48) and rs4856020 (HR = 0.52; 95%CI: 0.29-0.94) and in the NMS SNP rs12474526 (HR = 0.48, 95%CI:0.28-0.81), independently from CVD risk factors. A SNP in NMUR1 showed a borderline association (rs6754952, HR = 0.74; 95%CI:0.54-1.00). The derived genetic score was associated with CVD incidence with a HR of 1.57 (95%CI:1.25-1.96, per 1 score SD). A HR of 7.33 (95%CI:1.68-32.01) was found comparing the last vs the 1st decile of the genetic score.

Conclusions

Italian adults carrying variants in NMU pathway genes are at increased CVD risk. Intermediate phenotypes, mediating this association independent of classical risk factors, are unknown and should be investigated. Once confirmed, these results could be useful to improve CVD risk assessment and to plan cost-effective interventions.

Key messages

Polymorphisms in NMU pathway genes are associated with CVD risk independently of classical CVD risk factors, suggesting a potential clinical utility in CVD prediction when added to CVD risk algorithms. The unknown phenotype mediating the association between NMU genes polymorphisms and CVD development could be the neglected CVD risk factor potentially explaining the unpredicted CVD fraction.
Burden of disease of heavy metals in population clusters: towards targeted public health strategies
Authors: Thomsen S T , Herrera J A R , Jakobsen L , Fagt S , Pires S M
Published: November 2019

Background

Humans are exposed to heavy metals from certain foods, thus specific dietary patterns may lead to high burden of disease (BoD). By identifying diet, lifestyle and socio-demographic characteristics of population groups with highest BoD, targeted preventive strategies can be developed. We aimed at identifying clusters and characteristics of Danish individuals with highest BoD due to food exposure to three heavy metals: methylmercury (MeHg), cadmium and inorganic arsenic.

Methods

We collected diet, lifestyle and socio-demographic information of 3,946 individuals in the Danish National Survey of Diet and Physical Activity. Occurrence of heavy metals in food was obtained from Danish food monitoring. We applied machine learning self-organizing maps to group individuals according to similarities in diet, lifestyle and socio-demographics, and estimated BoD due to metal exposure in terms of Disease-Adjusted Life Years (DALY). We will present calculation steps of our approach in a tutorial-like way and demonstrate its applicability to other cases.

Results

We identified 13 population subgroups with distinct dietary and lifestyle characteristics. The estimated BoD varied largely between subgroups, with five subgroups experiencing a BoD > 10 DALY/100,000. The cluster bearing the highest BoD (26.2 (95% uncertainty interval (UI): 10.3, 50.6) DALY/100,000) was significantly different from the cluster with the lowest BoD (5.1 (95% UI: 2.5, 9.2) DALY/100,000) (preliminary). BoD was higher in subgroups with diet and lifestyle considered healthy. Most of the BoD was due to MeHg, particularly in female-dominant subgroups.

Conclusions

Linking machine learning, exposure assessment and burden of disease metrics, this novel approach identified population subgroups with higher BoD due to exposure to three heavy metals. It can be expanded to estimate BoD of other chemicals, and used to develop targeted preventive strategies to reduce BoD in more affected subgroups.
Characteristics and outcomes of clusters of multimorbid patients in UK general practice
Authors: Zhu Y , Edwards D , Kiddle S , Payne R
Published: November 2019

Background

Current clinical specialities, guidelines and quality of care metrics are organised around single diseases and treatments of multiple conditions are rarely coordinated, resulting in insufficient or even conflicting care. This study uses large scale English general practice (GP) records to identify and characterise clusters of patients based on their multimorbidity to allow better design of health services and highlight groups that require additional interventions.

Methods

This is a retrospective cohort study that includes multimorbid adult patients (N = 113,211), from a random sample of 391,669 English patients with valid GP records in 2012 where 38 long-term conditions were defined. Latent class analysis, stratified by age groups, was used to identify multimorbidity clusters. Class solutions are validated and associations between multimorbidity clusters, patient characteristics, public health service utilisation and mortality are assessed.

Results

Poor socioeconomic status is associated with clusters with higher service use and mortality risk. Physical-mental health co-morbidity is a major component of multimorbidity across all age strata. The clusters with highest age-stratified mortality risk in under 65 year olds were linked to alcohol and substance misuse, whereas in over 65 year olds they were linked to cardiovascular disease. The largest cluster in the 85+ years strata (58%) has the lowest number of morbidities, a low degree of service use and mortality. Consistency was seen across identification and validation data.

Conclusions

We find a clear distinction between morbidity clusters, both in the prevalence of long term conditions within them, and in their associations with outcomes (service use and mortality). Specific health services and interventions might be more effective when targeted on the distinct types of multimorbidity we have identified, with a particular focus on the morbidity clusters associated with the worst patient outcomes.

Key messages

The first study to derive age stratified multimorbidity clusters from a large GP record system, whose patients are representative of the English population. Knowledge about particularly dangerous clusters of multimorbidity, such as those involving alcohol and drug use in 18–64 years old, and cardiovascular disease in those 65 years or older.
The health of people in prison in Europe
Authors: O’Moore E , Sturup-Toft S
Published: November 2019

This presentation will explore the rationale behind a public health approach to prison health covering aspects such as the socio-demographic composition of the prison population in Europe, its health status and main health needs, based on the current sources of data. The link between the prison population and the wider community will be analyzed alongside the concept of community dividend, defined as the benefit of prison-related intervention for general population health.
Countering anti-vaccination trends and changing online opinion
Authors: Signorelli C , Odone A
Published: November 2019

We reported the case study of Professor Roberto Burioni, a medical microbiologist and virologist who, in 2015, started a personal social media campaign to contrast anti-vaccinists, using Facebook and other social media to disseminate the science behind vaccines and disseminating scientific data to refute rumors about their dangers. With over 500,000 people following his Facebook profile, Burioni has become a popular role model and influencer in the field of vaccines, openly criticizing vaccines’ refusers and fighting fake news. He used a rather aggressive tone, claiming they are ignorant and that “science is not a matter of democracy”. Although it is methodologically difficult to quantitatively estimate the so-called ‘Burioni effect’ in influencing vaccines’ confidence, we report a drastic rebalance of the number of Italian social media pages supporting vaccines after 2015 suggesting his action on the web has been successful. In fact in 2015 Fakebook pages with the highest amount of contacts were anti-vax, while in 2018 pages with the highest number of contacts were those of supporting the scientific rationale of immunization. We are studying this phenomenon inside a project considering areas of Italy with high prevalence of no-vaxxers and hesitants.
The real inequalities
Authors: Bambra C , Reeves A
Published: November 2019

Background

The ‘greedy geezer’ and ‘poor elderly’ narratives both assume that the older population are homogeneous and that the experiences of older people are universal. This ignores the fact that there are significant health inequalities (i) amongst the older population and (ii) in terms of who gets to be ‘old’ (and for how long). Further, the focus on intergenerational inequality is a deliberate distraction from the far more significant health inequalities that exist in terms of gender, geography, ethnicity, socio-economic status etc across the whole population - regardless of age.

Methods

Health inequalities amongst the older population and inequalities in terms of who gets to be ‘old’ will be examined through health inequalities across the population by gender, geography, ethnicity, socio-economic status etc.

Results

Given, for example, that total intergenerational transfers incorporating private transfers are from the older to the younger, it is quite possible that if we reduce public intergenerational transfers (working age to older) then all we are doing is increasing inherited inequality.

Conclusions

Policy focused on ‘intergenerational equity’ and ‘intergenerational accounting’ will often exacerbate inequalities within generations, to the benefit of the wealthiest and the detriment of much of the population. Win-win solutions only emerge if there is a focus on addressing the many and more profound health inequalities that cross-cut generations.
The politics of bad policy: Why don’t governments pick win-wins?
Authors: Falkenbach M , Greer S L
Published: November 2019

Background

Why, fundamentally, are the politics and public opinion of ageing and health so badly mis-aligned with facts about the costs of ageing societies? The literature has for decades characteristically divided between an old politics of expansion and the post-1990s new politics of recalibration and austerity. The problem for understanding the politcs of health and ageint is that a mix is also plausible: recalibration with an element of expansion in long term care. This mix then leads to a further thought: When do governments expand mature welfare states to deal with risks not covered in traditional male-wage-earner welfare programs?

Methods

A narrative review was conducted on the thin literature available attempting to answer the question as to why governments are not picking win-wins (e.g. keep people healthy so they can actually retire at their formal retirement ages, or ensure informal care is valued).

Results

There were a handful of hypotheses identified in the review, including: the “old politics” of welfare expansion where “credit claiming” is used for highly popular initiatives, the “new politics of the welfare state” also known as the “blame avoidance thesis” where politicians will attempt to avoid blame by making cuts less transparent, “blame buffering” and the “median voter theory” as well as “negative policy feedback”.

Conclusions

Mature welfare states are not expanding. In fact, the theories on the politics of ageing are focused on how welfare states are retrenching or reforming, as they call it. Blame avoidance and blame buffering are the most common explanations for decisions, often counterproductive ones, about how to recalibrate welfare states in the face of ageing.
Adverse outcomes of sick leave due to mental disorders: prospective studies of discordant twin pairs
Authors: Mather L , Narusyte J , Ropponen A , Bergström G , Blom V , Helgadóttir B , Svedberg P
Published: November 2019

Background

Sick leave due to mental disorders is common. We investigated if sick leave due to mental disorders increased the risk of reoccurring sick leave, disability pension, unemployment, in- and specialized outpatient care, and mortality, using a co-twin design, taking genetics and shared environment (familial factors) into account.

Methods

The register-based open cohort studies contained twin pairs 18-64 years old discordant for sick leave due to a mental disorder. First, 2202 pairs were followed up to 8 years from the end of the sick leave spell for reoccurring sick leave, disability pension and unemployment. Second, 4979 twin pairs were followed up to 9 years from the beginning of the sick leave spell for death, inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for familial factors, was used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI).

Results

Those with sick leave due to mental disorders had 3.64 (CI: 3.24-4.08) times higher risk of reoccurring sick leave the first two years and the first year, they had 12.24 (CI: 8.11-18.46) times the risk for disability pension. The risk of unemployment was 1.99 (CI: 1.72-2.31). The HR for inpatient care was 1.90 (CI: 1.66-2.17) among men but lower among women. For men the risk of outpatient care was higher the first 2 years (HR: 2.08, CI: 1.87-2.31), and for women the HR was 1.57 (CI: 1.47-1.68) for the whole study time. There was an increased risk of death among men (HR: 2.91, CI: 1.70-4.99), but not among women.

Conclusions

By adjusting for familial factors we could investigate if the same factors that predispose to sick leave due to mental disorders also predispose to morbidity, mortality and unemployment and hence explain the associations. But, sick leave due to mental disorders was associated with a higher risk of work related and health outcomes, independent of familial factors. The risks varied over time and differed among women and men.
Skills building seminar: Capacity-building for implementing integrated care
Authors:   Organised by: Scottish Government, EUPHA (CHR),   Chair persons: Iveta Nagyova - EUPHA (CHR), Andrea Pavlickova - UK
Published: November 2019

Rationale

The significance of integrated care as a means for improving health outcomes and effectiveness and sustainability of health and care systems is widely acknowledged. Integrated care is a central element in many on-going or planned healthcare system reforms, however, the main challenge remains of how to build relevant capacity and know-how for the successful implementation of integrated care. Capacity-building is both the foundation and aspiration of SCIROCCO Exchange EU Health Programme funded project. The project aims to facilitate access to tailored, evidence-based support and improvement planning by recognising different staring points, or levels of maturity of healthcare systems in Europe.

Objectives

This round table aims to explore different levels of local maturity and capacity to implement integrated care in three European regions; Basque Country, Flanders and Poland. The workshop will be a practical opportunity to dispute what actions and activities should be prioritised in these regions in order to improve their capacities for the adoption and scaling-up of integrated care. The workshop also aims to raise awareness about different levels and mechanisms of capacity-building support for integrated care that exists at European level. In particular, the workshop will feature SCIROCCO Exchange Knowledge Management Hub as one of the capacity-building tools and its application in the real-life settings.

Added value

Sharing learning more widely will help to build sustainable integrated care systems and tackle the risks of people working in isolation or re-inventing the wheel.

Format of the workshop

The workshop will consist of two keynote presentations, providing necessary background into the existing European policies, programmes and initiatives to support the adoption and scaling-up of integrated care. The introductory presentations will then follow by three snapshot presentations of 5 minutes featuring the main findings on the maturity and capacity of three European regions to implement integrated care. In the second part of the meeting, the participants will have the opportunity to discuss interactively with the representatives of the regions the use of SCIROCCO Exchange Knowledge Management Hub in the real-life settings, its added value and implications of the outcomes for future actions and improvement planning. The ultimate objective is to stimulate the discussion and knowledge on how to address the existing difficulties in implementing integrated care.

Key messages

Integrated care is considered as fundamental element driving transformation of healthcare systems. The challenge remains how to address different levels of capacities to implement integrated care. SCIROCCO Exchange can facilitate the access to capacity-building support that is needed for transition and/or improvement of existing systems for the adoption and scaling-up of integrated care.
SCIROCCO Exchange - Capacity-building support for integrated care
Authors: Pavlickova A
Published: November 2019

Issue/Problem

Integrated care is a recognised solution to address the challenge of ageing population. Hence, it is important to commit to opportunities that increase the readiness and capacity of regions to implement integrated care. Knowledge transfer has been greatly recognised as an effective enabler of capacity-building support. However, effective knowledge transfer and capacity-building support requires dedicated support and infrastructure to ensure that the flow of appropriate information and knowledge between adopting and transferring entities is tailored to the local context and maturity of the particular healthcare system seeking the support. This is a precondition to help health and care authorities to build their capacity for the successful transition towards integrated care.

Results

A key aspect of the SCIROCCO self-assessment tool is that of context and transferability. In particular, the Tool considers the context in which an integrated care solution has been developed and context into which that solution will be transferred. The Tools also helps to understand the maturity of local conditions enabling the adoption and scaling-up of integrated care and inform about the strength and weaknesses of particular region and organisation in integrated care. This in turn informs about the priorities improvement and focus of the capacity-building support.

Lessons

The experience of regions in using the SCIROCCO tool to facilitate knowledge transfer and capacity-building support demonstrates the clear benefits of the tool in stimulating multi-stakeholder involvement and learning on future directions of integrated care and transformation of health and care delivery systems in Europe.
The Swedish national public health policy and its achievements after ten years
Authors: Lindqvist N
Published: November 2019

Public health issues and their equality aspects have been on the political agenda in Sweden since the early 1980s. Already in the 1990s, the Government presented the first public health policy bill. This highlighted the conditions for a sustainable development from a public health perspective. Increased equality was set to be the overriding objective in prioritizing public health work and that priority should be given to efforts that would improve the situation of the most disadvantaged.

The foundation of today’s public health policy was laid in 2003 when the parliament decided on a new bill in which an overall goal for national public health policy was established: ‘Creating social conditions for good health on equal terms for the entire population’. The bill also established a cross-sectoral target structure for the overall public health work with eleven target areas. It also pointed out that public health policy is cross-sectoral and must be a part in all policy areas. In June 2008, the parliament adopted the bill A Renewed Public Health Policy. Changes made were (among other things) a rewording of the target areas, but many of the starting points were kept.

The Swedish Commission for Equity in Health was set up in 2015 and given two main tasks, to produce a proposal that can help to reduce the health inequalities in society and to work for raised awareness of health inequalities in society and among stakeholders. The work of the commission was finished in 2017 and presents an analysis of how the public health policy works in practice, with regard to the intentions of policy framework. A number of problems or areas of development appear which the Commission considers need to be addressed.

The presentation will first give a short overview of the Swedish public health policy from 2008 and will then present the commission’s conclusions and proposals for development areas.
The public health system in France and the structural developments during the last ten years
Authors: Arwidson P
Published: November 2019

In 2009, the hospitals, health and territories act has entrusted the responsibility for care and public health to the regional health agencies. This decentralisation aims to adapt strategies to local situations. These regional agencies have a very strong autonomy.

In 2013, it was stated in the national health strategy that it was necessary to develop a scientifically based prevention. Two tracks are to be followed: either by importing and adapting validated or promising programs by identifying effective programs in the international literature; or from existing French initiatives (tobacco, alcohol, psychoactive substances, physical activity).

The high prevalence of smoking motivated the establishment of a National tobacco reduction program in 2014, which was then relayed by a national tobacco control program.

In 2016, the Health System Improvement Act created a major national public health agency combining surveillance, prevention, health promotion and emergency response. The motivation was to achieve greater synergy and collaboration between the different functions in public health. A report from the Inspectorate General of Social Affairs has recommended that this agency should establish a national portal with evidence-based prevention and health promotion programmes.

Established in 2018, the Priority Prevention Plan is a major interdepartmental project to improve the health of the population, and is part of the National Health Strategy. This interdepartmental approach reflects the Government’s desire that all ministries should be able to contribute to prevention and health promotion.

The increased investment in prevention and health promotion is starting to bear fruit with 1.6 million fewer smokers between 2016 and 2018. Immunisation coverage has also been improved. NutriScore, a nutritional information on the front of food containers, very easy to understand, has been put in place with partnership with 100 companies.
Skills building seminar: Skillscamp: from soft skills to health for all
Authors:   Organised by: EUPHAnxt, EuronetMRPH, Young Forum Gastein Chair persons: Alexei Croitoru - Austria, Gisela Leiras - Portugal
Published: November 2019

Soft skill-intensive occupations will account for two-thirds of all jobs by 2030. [1] Soft skills, also known as “people skills” or “interpersonal skills” are personal attributes that enhance an individual’s interactions, career prospects and job performance. Those skills are of crucial importance for problem solving, teamwork, leadership development, mentoring, etc. They are also actively applied and broadly fostered in both public and private sectors as well as NGOs, social entrepreneurship, media, etc. These actors play an essential role in achieving Universal Health Coverage (UHC) along with health inclusion and equity due to their contribution to public economy, involvement toward specific population and advocacy power.

Key public health (PH) interventions require health professionals with strong soft skills. For example, a vaccination programme can be strengthened by health professionals who are able to address patients’ concerns about vaccination and explain its benefits. Having PH teams with a wide variety of perspectives, multidisciplinary backgrounds and skills, adds significantly to the improvement of provided services and medical results.

The demand of soft skills requires contextually appropriate PH interventions, depending on the population’s needs, socioeconomic and societal structures. Hence, in order to solve the persisting problems and achieve actionable results, the intervention shall be tailored to fit the concrete target group. In order to reach Goal 3 of the Sustainable Development Goals (SDGs) and particularly “health for all”, soft skills are essential to empathise and interact with social groups with specific needs.

The workshop will address the challenges faced by medical professionals in the interaction process with three specific social groups. To optimise PH interventions in the most inclusive and equitable manner, adequate soft skills are required. Therefore, the focus will be on highlighting the skills which are essential to successfully perform PH interventions.

Within the scope of the session, the necessary soft skills will be defined and analysed. Also, their application in the context of PH will be demonstrated and exemplified. The attendants will be invited to discuss real-life examples and have the possibility to exchange their own experience and expertise with each other.

[1] Deloitte Access Economics “Soft skills for business success”, DeakinCo, May 2017

Key messages

Soft skills are increasingly needed in achieving successful public health interventions. PH professionals need more awareness of the powers of soft skills.
Soft skills for esearch on gender and sexual minorities
Authors: van der Star A
Published: November 2019

LGBTQI+ individuals and the healthcare system. Arjan will present a variety of issues that LGBTQI+ individuals may face when trying to access healthcare or during interactions with healthcare professionals. The group will discuss how and which soft skills would tie into these issues and will brainstorm about ideas for strategies tackling LGBTQI+ discrimination in healthcare systems across Europe. (20’)
Workshop: To regulate or not to regulate: that is still the question
Authors:   Organised by: EUPHA Chair persons: Natasha Azzopardi Muscat - EUPHA, Dineke Zeegers Paget - EUPHA
Published: November 2019

Public health has always had a close relation with regulation. In the middle ages, the spread of infectious diseases was regulated by imposing a quarantine on travellers, this measure is still the first step to containment of an infectious disease. In the last century, public health regulation was also aimed at smoking, for instance implementing laws to ban smoking in public places (e.g restaurants). These regulations are very often combined with public health information campaigns on how to quit, the negative effects of smoking and passive smoking. In recent years, public health still calls for regulations now aiming at food, such as the fat tax, soda tax and sugar tax.

Regulating for public health is a complex and sensitive issue. Sometimes it is used to solve public health’s failings at promoting a healthy lifestyle. For instance, the information campaigns to overcome obesity and invite people to eat healthily and exercise were not as successful as planned and the obesity epidemic remains an increasing problem. So, law kicked in and taxation policies to change dietary behaviours were introduced. Taxation policies, however, are controversial and widely discussed. The term ‘Nanny-State’ where the government is regarded as overprotective or as interfering unduly with personal choice, comes to mind and this has a negative impact on public health.

The question remains: should we regulate for healthier behaviour or not. In this workshop, we are going to try answer this question. After two general presentations, we have 3 country examples of the relation between law/regulations and public health, followed by a discussion with the audience.

Key messages

Regulation can be one of the tools to promote public health. Careful consideration should be given before regulating for public health.
An emerging trend to tax sugar sweetened beverages and other junk foods: overregulation or an effective way to modify dietary behaviours?
Authors: Romaniuk P
Published: November 2019

Dietary behaviours have an important impact on rising prevalence of noncommunicable diseases responsible for 71% of deaths globally/year. Dietary behaviours also have a growing impact on quality of life, disabilities, as well as economic stability of health systems. In order to overcome the growing impact, many countries are looking for instruments to modify dietary habits of individuals. In the study presented here, we looked at solutions implemented in different countries in terms of junk food taxation, with regard to the political processes related to their implementation, adopted models of taxation, as well as their impact on social and economic reality. Throughout the world, several countries have adopted dietary taxes, such as sugar, fat, salt and soda taxes, while the other are planning or considering doing so. So far there is only one example of withdrawal from the tax that has been implemented. There are different models of taxation, including flat rates, percentages of the basic price and progressive rates on the amount of the component being subject to taxation. These solutions continue to be controversial and subject to intensive discussions in many countries. Nonetheless, the existing evidence shows that the impact on dietary habits seems to be positive.
Example 1: Danish regulations to phase out smoking
Authors: Pisinger C
Published: November 2019

In recent years, progress in Danish tobacco control has come to a halt and there has been an increase in smoking prevalence. A capacity assessment report on the implementation of effective tobacco control measures concluded that there is no overall strategy or plan to protect children, adolescents and adults from the harms of tobacco, despite the national vision of no children and adolescents smoking by 2030. Another finding was that the tobacco industry is influential in Danish policy-making and not properly regulated. Key recommendations were: 1) Develop an overall, comprehensive strategy and implement a well-designed plan. 2) Increase tobacco taxes. 3) Adopt plain packaging and a point-of-sale display ban. 4) Ensure protection from exposure to second-hand smoke and 5) Protect public health policy from the influence of the tobacco industry. The Danish Government, however, is very reluctant and there is no sign of implementation of the recommendations, despite strong public support. On the other hand, there is progress at local level as many municipalities and private workplaces have implemented smokefree working hours (no smoking at all during working hours, even if you work at home), schools have implemented smokefree school hours (no smoking from 8 to 16, even if pupils go home for lunch or break) and large supermarket chains have implemented point-of-sale display bans.
Example 2: The Italian law on compulsory vaccinations
Authors: Signorelli C
Published: November 2019

In March 2017, the so-called “Lorenzin law” (named after former health minister Beatrice Lorenzin who was responsible for the bill) was introduced to implement compulsory vaccination for children six years old and younger to be allowed into the school system. Without proof of the required immunizations, including those for measles, mumps, rubella, chickenpox and polio, children were not eligible to attend kindergarten. But the Five Star Movement and the League, which formed a ruling coalition in 2018 to form the current government, pledged to scrap the vaccination obligation during the run-up to elections in March, courting the so-called “anti-vax” vote. The newly appointed minister of health, Giulia Grillo, adopted a temporary measure relaxing these vaccination requirements until the end of March 2019. The temporary measure allowed children to stay in school as long as their parents attested that the children had been vaccinated. A doctor’s note was not needed.

The temporary measure was adopted pending a complete revision of the law on compulsory vaccinations. As no new law was adopted in March 2019, the previous law returned to force, leading for instance to around 300 children in Bologna, Italy, not being admitted to kindergarten as they did not have the required immunizations. Amid confusion over the rules as the new school year begins, the governing Five Star Movement (M5S) presented parliament with an amendment that effectively halts its own reform and reinstates the previous vaccination requirements.
Country Report: How do Serbian municipalities currently promote health and health equity?
Authors: Karadzic V , Jovanovic D , Vasic M
Published: November 2019

A legal framework set in Serbia provide good basis for creating healthy living environment and health promotion at local level. The present system of local government in Serbia, with its 174 units is regulated by the Law on Local Self Government. In accordance to this Law each municipality has got a certain level of decision-making. Creating healthy living environment is one of the key objectives of municipal policy and its agenda. However, the extent of their inclusion and implementation is very heterogeneous between municipalities. Unequal municipalities’ capacities (financial, technical, human resources) for coordination and development of healthy living environment on the municipality level are crucial challenge. In order to support the activities at the local level, the Network of 24 regional institutes of public health, led by the Institute of Public Health of Serbia, develops public health guidance, participate in drafting local strategies, programs and activities. Additional support is provided by the Local Health Councils, increasing a political sensibility for prioritizing issues to achieve healthy living environment. The coherent framework of mandates, local strategies and action plans for improving the public health have been established through widespread cooperation between the institutes of public health, health councils, and other stakeholders (e.g. nongovernmental organizations and governmental bodies such as the ministries responsible for education, environmental protection, youth and sport). In spite of that, their implementation is restricted by low awareness of importance of health equity and health promotion. In that sense, training and education on health promotion and health equity issues are crucial to raise the awareness, increase health literacy and enable satisfactory and quality implementation of defined strategies, programs and activities at the municipality level.
Global cardiovascular risk assessment: a national training course for General Practitioners
Authors: Palmieri L , Unim B , Mattei E , Tijhuis M , Fehr A , Corrao G , Lavicoli I , Grisetti T , Bogaert P , Donfrancesco D
Published: November 2019

Background

Identification of high risk individuals is one of the main goals of the primary prevention of cardiovascular disease (CVD) and constitutes the basis for implementing actions aiming at reducing modifiable risk factors at individual level through changing life styles or drug interventions. The most appropriate method for identifying high risk individuals is the absolute risk assessment, a probability indicator of incidence, predictable on the basis of risk factors levels.

Objectives

The CUORE project score of the National Institute of Health-ISS is adopted in Italy; since 2007 ISS has implemented a national training course for General Practitioners-GPs with the aim of supporting and facilitating the use of CVD risk assessment in clinical practice as a preventive action in the general population.

Results

The training course is based on five sequential packages linked to educational credits: packages 1-2 facilitate the adoption of standardised methodologies for the assessment of CVD risk score; in package 3 patients are invited by GPs to assess the risk score; packages 4-5 evaluate and discuss data collected with GPs and stakeholders. A cascade training was implemented: ISS personnel provided training to local GPs who in turn provided the same training to other GPs. Two manuals for the training course were published.

Since 2007 about 4,300 GPs were trained; about 320,000 10-year CVD risk assessments were performed in 260,000 men and women aged 35-69 years. Feedback was provided to all GPs participating to the 4th-5th packages of the training courses.

Conclusions

Implementation of the training course for the use of CVD risk assessment in the population represents a primary preventive action according to the recommendation of the EU Guideline on CVD prevention. The collected data may play an important role in the identification of strengths and weaknesses of preventive actions and represents the first step to improve good clinical practices standards.
Lessons from the field: Gender roles and researcher reflexivity in smoking cessation in South Asia
Authors: Boeckmann M , Noor M , Zahid R , Firoze F , Shresthra P , Khanal S , Regmi S , Baral S , Elsey H
Published: November 2019

Background

In South Asia, dual epidemics of smoking and tuberculosis (TB) have contributed to a high burden of lung disease. To address these health risks, the TB & Tobacco study uses the TB diagnosis as a teachable moment and implements a behaviour support counselling intervention, conducted by TB health workers, for patients in Bangladesh, Nepal and Pakistan. In this region, smoking tobacco is perceived as problematic for women, and being confronted with questions on smoking from a health professional may be uncomfortable for men and women. Anticipating these challenges, we incorporated gender sensitivity into training of health workers.

Methods

During implementation of the cessation support in routine TB care, a process evaluation assessed interactions between participants and the intervention through interviews with health workers and patients with TB participating in the cessation program. This presentation focusses on a retrospective self-reflection on how we conceptualized gender roles based on prior research, and how research findings partially challenged these assumptions.

Findings

While parts of our interview findings point towards smoking as a stigmatized practice for women and some men in South Asia as expected, several male and female respondents across socio-economic and geographical spheres contradicted this assumption. We discovered that health workers’ self-efficacy and perceived smoking stigma among health workers influenced whether they discussed smoking with women or minors. Many patients, on the other hand, told us that they were interested in receiving help to cure their TB and were willing to talk to about smoking with their health workers and their family members.

Conclusions

Patients in this study were more open to talking about smoking than anticipated. When including gender sensitivity into the standard training for health workers, we should be careful not to increase doubts in health workers about addressing smoking with women.
Skills building seminar: Building skills and capacity for a future health workforce
Authors:   Organised by: EUPHA (HWR) Chair persons: Ronald Batenburg - Netherlands, Ellen Kuhlmann - EUPHA (HWR)
Published: November 2019

Background

It is increasingly recognised that there is ‘no health without a workforce’ and that action has to be taken to develop an integrated and sustainable future health workforce. However, training and education opportunities are lacking for all those engaged in health workforce development. There is an urgent need for health systems and policy to foster skills building and institutional capacity for health workforce development to respond effectively to changing healthcare needs of the population and to the labour market shortages in many countries.

Objectives

This seminar will address these issues and help reducing the knowledge gaps. The seminar is arranged around for major topics: the WHO framework for action to guide health workforce planning and governance, the competences framework to strengthen the education and professionalisation of public health developed by the WHO Coalition of Partners and ASPHER, the internationalisation of health professional education using medical education in Romania as a case study, and finally a framework for strengthening health workforce research. The seminar aims to help PhD students and early career researchers to develop skills in the field of health workforce research and development. It also provides knowledge and tools for policymakers and practitioners who are responsible for health workforce education and governance. This seminar will promote the development of training programmes for health workforce research and thereby contribute to public health leadership in health workforce development. There will be ample time for discussion and teaching material will be made available for the participants.

Key messages

Building skills and institutional capacity is key to improve health workforce research and policy. People-centred care and universal healthcare coverage call for new skills and education programmes.