bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaccine adherence to vaccination schedule among male HIV-positive patients: a single-center study
Authors: Ragusa P , Orofino G , Guastavigna M , Ianniello A , Remani E , Lo Moro G , Greco G D , Calleri G , Siliquini R , Bert F
Published: October 2023

Background

The study centre collaborated with the public health service to recover the vaccinations missed during the COVID-19 pandemic. Vaccinations against pneumococcus (PCV/PPV), human papillomavirus (HPV9) and herpes zoster (HZric) have been offered to people living with HIV/AIDS (PLWHA) in care at the clinic. This study aims to estimate vaccine adherence in men with HIV/AIDS to the proposed vaccination schedule.

Materials and Methods

In this retrospective observational study, data were extracted from the regional platform of vaccinations, including 941 males LWHA in care in 2022. Chi-squared tests were performed to assess differences in adherence according to the risk of transmission and nationality.

Results

The mean age was 52.97 years (SD = 13.1). Italian patients were 88.6%. Regarding the risk of HIV transmission, 828 (88%) men who have sex with men (MSM) and 113 (12%) heterosexual men (ETX) were included. About anti-SARS-CoV-2 (COV), 884 patients (93.94%) completed the primary cycle, 793 (84.27%) received the 3rd dose, 335 (35.6%) the 4th dose, 120 (12.75%) the 5th dose. The complete vaccination course was carried out by 488 patients (51.86%) for PCP/PPV, 487 (51.75%) for MenACWY, 485 (51.54%) for MenB, 277 (29.44%) for anti-Haemophilus Influenzae, 303 (32.2%) for HPV9, 286 (30.39%) for HZric and 427 (45.38%) for anti-Tetanus and Diphtheria. The adherence to the 3rd and 4th doses of COV, HPV9 and HZ2 vaccines was higher for MSM than ETX (p < 0.05). Italian patients had higher adherence to the 4th dose of the COV and MENACWY vaccines than the foreigners (p < 0.05).

Conclusions

Overall, adherence to the vaccination programme was low, except for the COV vaccine. This study provides an overview of vaccination coverage. It lays the groundwork for a more in-depth analysis to identify determinants of vaccine adherence among PLWHA, which will be further investigated by the studies of the INF-ACT project, aiming to assess all determinants of vaccine hesitancy.

Key messages

• Monitoring adherence to the vaccination schedule is crucial in order to detect critical issues early and take intervention.

• The finding of low vaccination adherence in our study alerts us to the possible risks of low vaccination coverage, particularly in a fragile population such as people living with HIV/AIDS.
Challenging the Immigrant Health Burden Myth: A Comorbidity Analysis in Navarra, Spain - APNA Study
Authors: Guillen Grima F , Guillen-Aguinaga S , Guillen-Aguinaga L , Alas-Brun R , Brugos-Larumbe A , Aguinaga-Ontoso I
Published: October 2023

Background

Anti-immigrant arguments often claim that immigrants burden healthcare systems due to increased health problems and healthcare utilization. This study challenges this assumption by comparing the health status of immigrants and native inhabitants using the Charlson comorbidity index, aiming to demonstrate that immigrants are healthier and will use fewer healthcare services.

Methods

The APNA cohort study includes all inhabitants of Navarra, Spain, with a population of 661,023. A cross-sectional observational study was conducted on 503,392 adults. The Charlson Index was computed as a comorbidity measure. The Mann-Whitney U test compared the index between immigrants and native Spaniards, and quantile regression examined the relationship between immigrant status and Charlson Index, adjusting for age, sex, and socioeconomic status.

Results

Of the population, 18.4% were born abroad. The average Charlson index was higher in Spaniards (1.55, SD = 1.89) than in immigrants (0.45, SD = 0.93; U-Mann-Whitney p < 0.001). The quantile regression showed that, after adjustment, the Charlson Index was higher in Spaniards than in immigrants by -0.071 (95%CI 0.066-0.077).

Conclusions

This study contradicts the myth that immigrants burden healthcare systems. Immigrants in Navarra, Spain, are healthier and have lower comorbidity indexes than native inhabitants. Public health policies should consider these findings to promote evidence-based approaches and challenge misconceptions about immigrants’ healthcare utilization. Immigrants in Navarra, Spain, are healthier than native inhabitants, debunking the myth that they burden healthcare systems. Public health policies should consider these findings for evidence-based approaches and challenge misconceptions about immigrants’ healthcare utilization.

Key messages

• Immigrants in Navarra, Spain, are healthier than native inhabitants, debunking the myth that they burden healthcare systems.

• Public health policies should consider these findings for evidence-based approaches and challenge misconceptions about immigrants’ healthcare utilization.
Impact of access to housing on mental health and coping amongst Ukrainian refugees in England
Authors: Seguin M , Deinekhovska T , Fokaf O , Iemelianchuk K , Poppleton A , Roberts B , Sanderson C , Egan M
Published: October 2023

Background

Though the link between war-related trauma and poor mental health is well-established, less is known about stressors due to prolonged displacement, and how these relate to mental health. As the numbers of forcibly displaced persons rise worldwide, the associated mental health burden represents an urgent public health need. This qualitative paper explores housing-related stressors amongst adult female Ukrainian refugees England, mental health impacts, and coping responses.

Methods

We draw on 40 semi-structured interviews: 30 with Ukrainian refugee women, 10 with stakeholders (council staff, mental health professionals, staff/volunteers at relevant charities). Thematic analysis identified macro- and micro-level factors impacting housing access, perceived mental health and coping.

Results

Most of the Ukrainian sample were provided with housing for an initial 6 months. Facing the pervasive shortage in council housing, many were attempting to transfer into rented accommodation at interview time. These efforts were hindered by a lack of employment history, discrimination from landlords, and the language barrier. Interviewees linked these issues to high stress levels and deteriorating well-being, adding to their anxiety over the ongoing war. Coping centred on support-seeking (reaching out to councils, charities, other Ukrainians), distraction (exercise, volunteering), problem-solving (taking a methodical approach to problems), and cognitive restructuring (focusing on the positive).

Conclusions

Ukrainian refugees face significant barriers in accessing long-term housing in England, forcing some to choose between insecure housing and returning to a war zone. This bind has compounded mental health issues attributed to the trauma of leaving Ukraine and the ongoing war. Though refugees took an active approach to coping with housing hardships, resources to support the transition to long-term housing is necessary to better safeguard their mental health from further harm.

Key messages

• Ukrainian refugees face significant barriers in accessing housing in England, forcing some to choose between insecure housing and returning to an active war zone.

• Participants linked barriers to accessing housing to high stress levels and a deterioration of well-being, compounding trauma from fleeing Ukraine and anxiety over the ongoing war.
Israel’s repeal of sugar-sweetened beverages tax harms public health
Authors: Kamin-Friedman S , Davidovitch N , Yang Y T
Published: October 2023

Issue

The consumption of sugar-sweetened beverages (SSBs) exerts negative consequences on both individual and public health. High sugar consumption is associated with the development of non-communicable diseases, increases health care costs, and reduces labor productivity. The WHO and the World Bank thus encourage countries to tax SSBs.

Description

In January 2023, the Israeli government decided to repeal the SSB tax which had been imposed a year earlier. Our study seeks to attain an in-depth understanding of the reasons for the tax repeal by analyzing such documents as parliamentary protocols and media articles.

Results

Israel's SSB tax was criticized severely by the ultra-orthodox community, which maintains a tradition of consuming sweets as part of its customs and culture. In the absence of a plan to change the community's habits, the tax was perceived as a politically motivated economic burden. Moreover, this perception was intensified by the ultra-orthodox political leaders, who portrayed the tax as unfairly targeting the ultra-orthodox community.

Lessons

When considering the implementation of a tax on SSBs, policymakers must ensure that this tax is not perceived as an economic sanction or as a means of targeting a specific community. To this end, it is critical to illustrate that the tax seeks solely to promote public health. The public should thus be informed about the harmful effects of SSBs and about the importance of reducing their consumption. Furthermore, this information should be adapted to different sectors and conveyed through various means. In this respect, it is particularly important to understand the attitudes and potential conflicts of closed communities and to obtain the support of community leaders.

Key messages

• To successfully implement an SSB tax, health authorities must clarify that the tax is a public health tool, not an economic or political sanction.

• Policy makers should endeavor to convince all communities to support and accept the transition to healthier beverages before taxing SSBs.
Embracing public health approaches to gambling? A review of global legislative and regulatory trends
Authors: Ukhova D , Marionneau V , Nikkinen J , Wardle H
Published: October 2023

Background/Issue

The public health community has increasingly called for governments to recognise the health harms associated with gambling, and for prevention policies to include population-based approaches. Whether and to what extent these calls have translated into actual policy-making globally has not been investigated. Our paper fills this gap.

Methods

Using Vixio Gambling Compliance database, we mapped the global availability of legal forms of gambling, changes in its provision, and the prevalence of gambling harm prevention policies. Using global case studies of 33 jurisdictions from across Europe, Asia, Africa, and Americas that introduced major changes to their gambling legislation in 2018-2021, we further analysed the extent to which protection of health and wellbeing is a priority within a changing gambling legislation and explored the extent to which individual- and population-based approaches to gambling-related harms are being integrated into policy.

Results

We find that over 80% of countries globally now permit gambling. Among the jurisdictions changing their gambling policies, protection of health and wellbeing is often secondary to revenue growth. Most prevention policies focus on individual responsibility and few jurisdictions aim to address the political, economic, or commercial determinants of gambling harms.

Conclusions/Lessons

Addressing gambling as a public health issue, thus, is not yet translating into comprehensive policy action across jurisdictions. This is a concern, given that legislative frameworks set the agenda for the regulation of gambling and the actions implemented. By providing new systematic comparative data on responses to gambling-related harms globally this paper will be useful both for public health researchers, and for health policy-makers and advocates around the globe looking to understand how other countries/jurisdictions are responding to this public health challenge.

Key messages

• While over 80% of countries globally now permit gambling, addressing gambling as a public health issue is not yet translating into comprehensive policy action across jurisdictions.

• Most newly introduced prevention policies focus on individual responsibility and few jurisdictions aim to address the political, economic, or commercial determinants of gambling harms.
Bottom-up approach to set research needs in healthcare
Authors: Ciannameo A , Vivoli V , Paltrinieri F , Negro A , Maltoni S , Rolli M
Published: October 2023

Clinical research is a pivotal element for the Emilia-Romagna (Italy) healthcare system. Since 2004 the regional government has established “regional health research plans” that define priority research topics for the regional health system (RHS). Research on identified topics has been funded by periodic calls for public grants to support not for profit research carried out in regional public Hospitals and Local Health Trusts (LHTs). Until today, in Emilia-Romagna region, a top-down approach was used with regional decision-makers in identifying research themes to be investigated and funded. The goal of this intervention was to promote a bottom-up approach to identify research needs and survey research expectations from different stakeholders. To widely represent research needs and expectations, the research process involved not only decision-makers but also researchers, healthcare and social professionals, a citizens’ advisory committee. To enable every stakeholder to make a concrete contribution to the regional health research plan, innovative qualitative techniques such as focus group (FG) and Open Space Technology (OST) were used. Then, the material was analyzed by content analysis and a narrative synthesis of results was carried out. From January to December 2022, 160 regional stakeholders participated in 8 FGs and one OST. Research on health and social services emerged as the main ‘orphan’ area. Needs focused on the evaluation of services and factors affecting the quality of care, and on the development of new organizational models and research methods to assess organizational innovations. Research on interventions to improve community healthcare was indicated as an urgent need. The work highlights that the research on the organization of social and health services is one of the topic neglected. In particular the need to deepen the methodology and to study effective interventions to be implemented was expressed.

Key messages

• Research on health and social services emerged as the main ‘orphan’ area.

• The work returns results on research needs from a broad sample of stakeholders to policymakers to direct regional funding for research.
Mapping barriers and facilitators to healthcare provider payment reform
Authors: Ndayishimiye C , Tambor M , Katarzyna D J
Published: October 2023

Background

Health care systems are constantly evolving to better meet changing health needs and to adapt to external pressures. Reforms are therefore an integral part of health systems. One of the most common reforms concerns provider payment systems, including changes to payment methods. These are considered one of the most important levers through which policymakers can influence the performance of health system. The objective of this study was to identify, systemize and map the factors (barriers and facilitators) that influence provider payment reforms around the world.

Methods

A scoping literature review was conducted. The study followed the relevant methodological guidelines and the PRISMA-ScR checklist. The authors systematically searched the literature in five databases and manually in relevant organisations and journals. Studies published in English since 2000 were included. Data on factors influencing payment reform were analysed thematically using inductive approach.

Results

The study included 51 publications, mostly from developed countries (n = 36). The most commonly changed payment method was fee-for-service (72%, n = 37). The study identified 43 sub-themes on barriers (grouped into eight major themes) and 51 sub-themes on facilitators (grouped into six major themes). Barriers include stakeholder opposition, challenges related to reform design, hurdles in implementation structures, insufficient resources, challenges related to market structure, legal barriers, knowledge and information gaps, and negative publicity. Facilitating factors include stakeholder involvement, complementary policies, relevant prior experience, good leadership and management of change, sufficient resources, and external pressure to introduce the reform.

Conclusions

Factors influencing payment system reform are often interrelated, contextual, and represent a variety of perspectives, including those of patients, providers, insurers, and policymakers.

Key messages

• The same factor can act as a barrier or facilitator to provider payment reform, depending on the context.

• When planning payment reform, policymakers should anticipate the potential barriers and plan appropriate facilitating measures.
Guidelines for alcohol consumption in the era of ‘no safe levels’ - where do we stand?
Authors: Pulido Valente F
Published: October 2023

Background

Despite claims that moderation consumption could improve health outcomes, namely cardiovascular health, the latest scientific evidence shows there is no safe amount of alcohol consumption.

This study sought to determine the current definitions of standard drink and alcohol consumption guidelines across different nations.

Methods

Based on information from the WHO and the authors’ own judgment, a pool of countries with available data was created. In order to gather the required information, structured internet searches of relevant terms for each country were conducted.

Results

In 2015, a similar study was conducted but no actualizations were made afterwards. Currently, there has yet to be a standard drink definition agreed upon by every national government, and there are differences between what constitutes this standard drink. Countries have different guidelines for how much alcohol is safe to consume, and low-risk consumption guidelines vary considerably. There are also double standards for men and women. There are few governments that explicitly state that alcohol consumption should be zero.

Conclusions

National drinking recommendations and guidelines and standard drinking units differ considerably from country to country. It should be evaluated how this impacts public health since this is information available to the general public and can influence how citizens view what they should consume. Public dissemination of messages about so-called safe alcohol consumption levels, moderate alcohol consumption, or protective effects of alcohol consumption is against WHO recommendations, so state governments and national health institutes should consider this matter.

Key messages

• Countries do not have standardized public health definitions and messages concerning alcohol consumption.

• Public health practitioners should update the content of alcohol guidelines accessible to the public to accommodate the latest scientific evidence.
3.H. Workshop: Climate change and older people: a public health perspective with a focus on equity
Authors:   Organised by: EUPHA-ENV,   Chair persons: Andrea Schmidt (Austria), Angelique Mavrodaris (UK)
Published: October 2023

The climate crisis has been recognized as the largest threat to human health in the 21st century, with frequent and prolonged heat waves and the related health consequences being a key concern in European countries. While in the public health discourse related to the climate crisis, older people have been identified as a vulnerable group in general, the needs, views and vulnerabilities of older people and the responsive actions required are currently poorly defined and lacking in detail. In addition, equity aspects are often neglected as older people are often addressed (only) as a broad target group (e.g. as the 65+). This workshop session will foster a knowledge, research and experience exchange on the situation of older people in the context of the climate crisis and increasing heatwaves in different European countries with a focus on lessons for implementation in public health. The contributions in the session use both quantitative and qualitative research methodologies to highlight the heterogeneity and vulnerabilities of different subgroups of older people; and the inequalities driving and resulting in the specific impacts of rising heat and climate change in this growing demographic group. The session will also review current heat wave policies and share evidence and best practice to inform the development of responsive public health solutions.

Key messages

• Older populations are more vulnerable to the impacts of climate instability and extreme weather events. Understanding which subgroups are at greater risk will enable better public health responses.

• Current policies provide limited insights on actions, barriers and enablers for building resilience in older population groups in response to climate change for equitable public health responses.
Why so far ahead? Climbing the participation ladder in public health foresight
Authors: Den Broeder L , Couwenbergh C , Baâdoudi F , Elberse J
Published: October 2023

Issue

In the Netherlands, the National Public Health Foresight Study (PHF) is published every 4 years, as starting point for national and local public health policy development. As these policies impact citizens’ health and lives, it is important to include their voices. We piloted an approach to strengthen this engagement to learn and to inspire PHF in other (country) settings.

Problem description

PHF is usually expert-based. Citizen engagement, beyond consultation, is not yet common practice. In the Dutch PHF-2024, we engage citizens both as advisors (citizen council, N = 30 and panel, N = 500) and as target group (focusgroups N = 40). Intentionally the scope is diffuse, allowing for unexpected input. What can we learn from this approach, and how do the citizens contribute to the PHF?

Results

- Citizens of all ages, backgrounds and education types are well able to discuss health (determinants), data and indicators;

- They have intrinsic motivation to contribute to better knowledge, feel responsible for effective engagement and are eager to engage across different backgrounds and population groups;

- Integration of outcome into the PHF process is valuable, enriching scientific with experiential knowledge and facilitating results communication;

- Fundamental questions, e.g., about foresight time frames (“why look so far ahead as the world is in crisis right now!”) are raised by the citizens, showing that these need to be better addressed in order to make PHF relevant for a broader public.

Lessons

- More permanent engagement of the citizens is needed to enable learning and development;

- earlier engagement in the PHF process may enable joint development of core questions and issues to be addressed;

- The results are highly encouraging; piloting this approach in other foresight types and in various contexts is therefore needed to refine and further develop it.

Key messages

• Citizen engagement can and should be strengthened to include citizen voices in the PHF process, informing policies that impact on their lives.

• Citizens of all backgrounds, with their experiential knowledge, can be valuable partners in PHF, that provide important input.
Development and validation of food and nutrition literacy survey
Authors: Zelenkova V , Krobot M , Hawk V , Kapounova Z , Bartoskova Polcrova A , Jancekova K
Published: October 2023

Background

Food and nutrition literacy (FNL) are of growing interest in the field of public health and health promotion. Several tools have been developed to measure the FNL in different populations. However, there is no such tool applicable across different countries and populations due to cultural or geographical specifics. Therefore, we aimed to develop and validate a general FNL assessment tool, which will be used to measure FNL in the adult population and will be applicable across different countries and cultures - The Food and Nutrition Literacy Survey (FANSy).

Methods

The Research Team took inspiration from the conceptual model presented in the European Health Literacy Survey created by the World Health Organization and from the Food Literacy Wheel. The process involved the identification of domains, item development, and consultation with an expert panel. This panel provided feedback on 52 questions and on the survey as a whole. Following the review from the panel, we validated the survey, and then through piloting and statistical analysis we identified the questions best representing the domains.

Results

We applied 4 main domains of FNL - cooking skills, preserve and analyze, choice and acquisition, search and plan. We created and validated a self-reported scale (FANSy) as a novel and universal FNL assessment tool.

Conclusions

We developed a general tool that will allow researchers and stakeholders to collect data on FNL and compare them between different countries. We anticipate the data gathered from FANSy will identify opportunities for improving nutrition education with an overall goal of improving the health of the population.

Key messages

• FANSy is a general tool for assessing food and nutrition literacy, it is not country specific.

• FANSY can be used for gathering comparable data across different populations.
Performance indicators in long-term care for older people in 38 countries: a scoping review
Authors: Poldrugovac M , Wammes J D , Bos VLLC , Ivanković D , Vroomen-MacNeil J D , Merten H , Klazinga N S , Kringos D S
Published: October 2023

Background

A large number of performance indicators in long-term care have been developed and tested. However, the use of such indicators for regular monitoring of long-term care at regional and national level presents a number of challenges related to coordination of stakeholders, regulation and data collection capabilities. Our aim was to review the performance indicators in long-term care that are currently in use for regular monitoring by 38 OECD member states.

Methods

We used a scoping review approach that included a systematic search of scientific publications, review of multi-country reports and an internet search of relevant websites of the countries included. The scoping review protocol was registered before starting paper selection and web searches.

Results

We retrieved 12.776 papers, of which 10 were kept after selection for data extraction. Preliminary results of the review of reports and internet resources led to the retrieval of 399 performance indicators in long-term care from 24 OECD member states, while no indicators could be found for 14 member states. Performance indicators most often relate to falls, pressure ulcers, unplanned weight loss and use of restraints, which are collected by 7 or more of the 24 countries. The definitions of the indicators differ considerably between countries, as well as the definitions of long-term care and hence the settings in which these indicators are used.

Conclusions

Consideration of indicators often used in several countries may be of interest to decision-makers establishing or updating indicator sets in this area. There is considerable heterogeneity in the nature, definitions and settings of long-term care performance indicators used by OECD member states. These differences are a significant challenge to establish international comparability of the indicators reported.

Key messages

• The indicators most frequently used for regular monitoring of long-term care performance are related to falls, pressure ulcer, unplanned weight loss and use of restraints.

• There is considerable heterogeneity in the nature, definitions and settings of long-term care performance indicators used in different countries, which make comparisons of results challenging.
A time series of tobacco use in Belgium based on a critical appraisal of data sources, 1997-2020
Authors: Nayani S , De Pauw R , Devleesschauwer B , Guariguata L
Published: October 2023

By being the leading risk factor for most of the leading causes of death worldwide, tobacco use represents an important public health issue that causes a significant health and economic burden. Despite policy regulations, the prevalence of the use remains substantial in many countries, such as Belgium. A comprehensive framework for the quantification of the health impact of tobacco use, based on representative data, is however still lacking. As a preliminary step, we aimed to map and critically assess the past and current trends of tobacco use from 1997 to 2020 in Belgium for establishing a time series of the true extent of tobacco use. Data sources assessing tobacco use in Belgium, meeting our inclusion criteria: frequency, type of survey, international comparability, consistency over time, and representativeness of the sample were included in the critical appraisal. The selected data source forms the basis for a time series of tobacco use from 1997 to 2020. We applied a Bayesian inference model using the integrated nested Laplace approximation, to estimate the distribution of tobacco use by age, sex, and region. We identified four data sources containing information on tobacco use in Belgium. The best available data source for creating a time series of tobacco use was the Belgium Health Interview Survey. The modelled time series based on this data shows a decrease in the prevalence of daily smoking from 1997 (25%) to 2020 (15%). In 2020, daily smoking was estimated to be the highest in the Walloon region (19%) followed by the Brussels region (16%) and the Flemish region (14%). In 2020, the prevalence of daily smoking was estimated to be higher among men (19%) and in the age category 45-59 (20%). This study provides a critical review of data sources monitoring tobacco use in Belgium. Time trends derived from modelling show the overall smoking trends are decreasing but the use remains a public health concern in Belgium.

Key messages

• Understanding the role of tobacco on population health as an attributable burden can improve health monitoring.

• Tobacco use is still a public health concern in 2020 with an estimated prevalence of daily smoking of 15% in the population. Different patterns of tobacco use can be seen at the regional level.
A pilot of the InterRAI Family Carers Needs Assessment form in Ireland
Authors: Carney P , Harrison M
Published: October 2023

Background

The health impact of providing informal care in Ireland is significant. Over ten years (2009-2019) among carers in Ireland poor health increased by 24%, depression increased by 70%, those experiencing anxiety rose by 26%. Access to respite services decreased from 57% to 29% with less support being provided in 2019 from GPs, PHNs and care workers than in 2010 (Family Carers Ireland, College of Psychiatrists of Ireland & UCD, 2019). InterRAI have developed a module to assess the needs of family carers (FCNA) and is being tested across a number of countries, including the West of Ireland. This assessment is conducted with the needs assessment on the person applying for services.

Methods

The FCNA was collected at 2 time points, baseline and 6 month follow-up. At baseline, carer preferences for services was obtained and, within current service capacity, carers were referred to their specified service. The FCNA captures demographics, mood, cognition, social needs, function, general health, carer characteristics, caregiver experience, supports for the carer and those in place for the care recipient. Regression analysis is carried out to estimate the effect of service provision on health outcomes over the period.

Results

62 completed FCNAs were obtained for the two periods from family carers across five care groups: carers of: older persons, person with dementia, person with mental health difficulties, person with physical and sensory difficulties and a person with an intellectual disability. At baseline, 51% of carers felt too exhausted to carry out normal day-to-day activities on a regular basis, 52% feel little interest or pleasure on an ongoing basis, 67% feel anxious, restless or uneasy and 67% indicated that they experienced major life stresses in the last 90 days.

Conclusions

The HSE can objectively identify and assess family carer need across all care groups to inform resource allocation, policy decision-making, service planning and service provision.

Key messages

• Standardised informal carer needs assessment leads to better understanding of issues faced by carers.

• Increased understanding of the service requirements of informal carers to support them in their roles to inform resource allocation, policy decision-making, service planning and service provision.
Reweighting in panel surveys: machine learning techniques for the Health Care and Social Survey
Authors: Cabrera-Léon A , Castro-Martín L , Rueda M , Sánchez-Cantalejo C , Ferri-García R
Published: October 2023

Background

Healthcare statistical services have used probability surveys to respond to such information needs. The Health Care and Social Survey (ESSOC) research project arises from the need to provide data on the evolution of the COVID-19 impact. This survey has an overlapping panel survey design with 4 measurements throughout 1 year with random samples.

Objective

To develop a new reweighting method for overlapping panel surveys affected by non-response.

Methods

Each ESSOC measurement is composed of two samples: a longitudinal sample from previous measurements and a new sample at each measurement. In each measurement, missing units are substituted by new surveyed units, allowing the obtention of cross-sectional and longitudinal estimates. The advantage of this design is that, in addition to being able to obtain longitudinal estimates, cross-sectional estimates are more accurate because of the larger sample size. However, the problem of non-response is particularly aggravated in the case of panel surveys, due to the fatigue of the population to be repeatedly surveyed.

Results

Considering the design, timing and objectives of this survey, our reweighting method produces suitable estimators for both cross-sectional and longitudinal samples. The weights are the result of a two-step process: the original sampling design weights are corrected during a 1st phase by modelling the non-response with respect to the longitudinal sample obtained in a previous measurement using machine learning techniques. Then, during a 2nd phase, they are calibrated using the auxiliary information available at the population level. The proposed method is applied to the estimation of totals, proportions, ratios, and differences between measurements as well as gender gaps.

Conclusions

For addressing future health crises like COVID-19, it is therefore necessary to reduce potential coverage and non-response biases in surveys by means of utilising reweighting techniques as proposed in this study.

Key messages

• It is therefore necessary to reduce potential coverage and non-response biases in surveys.

• This study proposes the utilisation of reweighting techniques based on calibration and XGBoost.
Feasibility of Health and Fitness Data Collection in Online Behavioral Intervention of Elderly
Authors: Kosutzka Z , Borosova S , Beblava E , Beblavy M
Published: October 2023

The global increase in life expectancy has led to a growing elderly population, which necessitates novel strategies to promote healthy ageing and maintain optimal quality of life. Lifestyle coaching has emerged as a promising intervention to address these challenges by offering tailored guidance and support for seniors to make sustainable lifestyle changes. This study investigates the feasibility of collecting health and fitness data reported by the elderly population participating in an online behavioural intervention. We recruited 60 community-dwelling elderly individuals between the ages of 55-80 (including both men and women) for a 14-week online intervention promoting healthy lifestyles using coaching principles. The main criteria for inclusion were a diagnosis of arterial hypertension with or without medication and/or overweight or obesity as defined by BMI. We collected health-related data (arterial blood pressure, weight, waist circumference, quality of life using EQ-5D-5L questionnaire) and fitness-related data (30-second chair test, 2-minute step test). All data were self-recorded by the participants and reported via an online system with the help of a health coach. Forty-seven participants were able to complete the entire 14-week intervention. The initial data set resulted in only 51% (24 out of 47) of the participants having reported the full dataset. We then used written and spoken reminders to notify participants to submit the collected data, which brought the percentage up to 70% (33 out of 47). The main obstacle in health and fitness-related data collection was the forgetfulness of participants to do the self-reported measurements and tests. Among other factors affecting the amount of collected data, we experienced a lack of understanding of the process of the fitness tests, as well as a low questionnaire completion ratio. Almost 80% of participants managed to report all of the health-related data which was also considered the least complicated to collect.

Key messages

• Elderly people with higher cardiovascular risk are able to self-report health and fitness data in online behavioral intervention but thorough guidance and reminders need to be applied.

• Elderly people are willing to participate on the online lifestyle behavioural interventions.
Austrian Health Expenditure Projections and Excess Health Expenditure due to COVID
Authors: Lackner S , Bachner F , Zuba M
Published: October 2023

According to System of Health Accounts (SHA) data total health expenditures in Austria have grown on average by 3.9% per year from 2000 to 2019. This was followed by high growth rates of 5.1% and 11.9% in 2020 and 2021, respectively. The steep increase was caused by the global COVID-19 pandemic. However, quantifying the effect of the pandemic on health expenditures is not straightforward and significant uncertainties remain about how future health expenditures will be affected and how they can most accurately be projected, particularly given recent high economic uncertainties. In this project we developed several models to predict Austrian health expenditures. Most importantly, we compare models based on demand and cost driving factors with a simple GDP-linked model. We assess the performance of the different models by predicting past health expenditure data up to 2019. Comparing the model predictions for the pandemic years with the actual SHA data provides an approach to estimate the net impact of the pandemic. Several different dynamics play a role in how COVID-19 has been affecting health expenditures. We find that the pandemic has caused sizeable one-time costs in the years 2020-2022, but “regular” health expenditures partially decreased during that time due to forgone elective and preventive care. As COVID-19 becomes an endemic disease it also becomes an additional long-term burden on the health system, but the main driver of health expenditure is currently inflation. The shock of the pandemic has created a structural break for the health sector with many not yet well-known consequences such as systematic changes in work conditions or salaries for health sector employees. With the currently available data and information, many of these effects cannot be directly built into the prediction models. However, we compare our models in their projections of future health expenses until 2030 with past projections from 2019 for the year 2030 under different scenarios.

Key messages

• The pandemic has caused sizeable one-time costs in the years 2020-2022, but “regular” health expenditures partially decreased during that time due to forgone elective and preventive care.

• As COVID-19 becomes an endemic disease it also becomes an additional long-term burden on the health system, but the main driver of health expenditure is currently inflation.
Co-production in public health research: The UK MAMAH Study involving underserved migrant mothers
Authors: Stevenson K , Ogunlana K , Alomari M , Agoropopoola R , Stevenson F , Knight M , Aldridge R
Published: October 2023

Problem

Research suggests some migrant women are at higher risk of mortality and morbidity in the perinatal period, however there is a gap in co-produced research to improve care.

Description of the Problem

The UK National Institute for Health and Care Research defines co-production as ‘an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility'. Here we summarise learning from the Migration and Maternal Health (MAMAH) Study which aims to co-produce solutions to improve maternity care for migrant women in the UK.

Results

We struggled to access comprehensive training on co-production, particularly in how to counter power dynamics and recruit a broad range of public participants. Early in the study we appointed a ‘Lead Patient Advisor’ (a migrant women with experience of pregnancy in the UK) who manages the relationship between the academics and the patient advisors. Additionally, we reimburse women's time, childcare, and travel. We have found that online meetings are preferable as women do not need to travel or arrange childcare. We meet our patient advisory panel four times per year. Some women have been directly involved in research such as systematic review screening and qualitative interviewing and have been given formal research training.

Lessons

Our initial research priorities didn't align with those of the women, and this has helped us to reshape our work. Women say that having a Lead Patient Advisor has made it easier to participate, particularly given some of the issues discussed are traumatic. To mitigate this, we have created additional support resources and offered formal debriefing. Using online interpreters has been challenging, and we have recently split into different language groups to maximise engagement. Overall, we have learned that taking a truly co-produced approach is expensive and time-consuming but has ensured our research prioritises the views of migrant women giving birth in the UK.

Key messages

• Co-production approaches are increasingly important to funders and represent a key opportunity for researchers to ensure their work has real-world impact.

• There is an urgent need for improved training and resources to better equip public health researchers to take a co-production approach.
Understanding the concerns of people living with Heart Failure in Portugal - a qualitative approach
Authors: Raposo B , Avelar F G , Cunha A S , Martinho H , Almeida M , Pardal M , Bernardo F , Pedro A R
Published: October 2023

Background

Heart failure (HF) is a complex chronic clinical syndrome that results of cardiac functional impairment secondary to many aetiologies, leading to significant struggles to an optimal care management. Person-centred care is an effective approach to integrate care and shared decision-making. Understanding the health concerns of the people with the disease, is fundamental to adapt and establish an integrated disease management. This study aims to comprehensively identify the main concerns of people living with HF.

Methods

Three focus group and two group interviews were conducted, involving 23 individuals where: 12 were people with HF and 11 healthcare professionals (HCP) following people with HF in Portugal. A convenience sampling (nonprobabilistic) was used to maximize the differences within participants’ characteristics. The inclusion criteria for people with HF were documentation of reduced or preserved ejection fraction, with or without decompensation for more than one year with different NYHA classifications. Regarding HCP were included physicians and nurses following people with HF. Data were analysed using thematic analysis and performed in MAXQDA®.

Results

Following data analysis, nine themes of concern were identified. Each theme was composed of several items of concern (codes) and were related to: 1) personal and family; 2) monetary costs; 3) changes in lifestyle; 4) autonomy and functionality; 5) health status; 6) symptoms and signs; 7) medication; 8) surgical procedures; 9) healthcare.

Conclusions

Several aspects of the daily life of the person with HF were identified. Those were not limited to concerns related to clinical conditions. Data reinforce the complexity of HF with several and broad implications in daily life. Based on these results we recommend a quantitative approach to measure the relevance and impact of each concern, enhancing the creation of more effective healthcare strategies that prioritize people’ needs and management.

Key messages

• The concerns of people with HF are not limited to clinical aspects, they cover several areas of the person's daily life.

• Heart Failure is a complex, high-prevalence disease, with several implications in daily-life, requiring specific coping mechanisms to face different challenges.
Reaching Consensus on a core outcome set for patient safety in perioperative care: SAFEST Project
Authors: Nunes A B , Teixeira J P , Seyfulayeva A , Casaca P , Leite A , Schäfer W , Valli C , Rodríguez A , Orrego C , Sousa P
Published: October 2023

Background

In the European Union, 8 to 12% of patients admitted to hospitals experience adverse events, imposing a considerable burden on the health systems. The lack of standardised indicators to comprehensively analyse perioperative patient safety limits the evaluation of interventions to tackle this public health problem. This study aims to prioritise the most relevant and feasible core indicators to assess patient safety in perioperative care to develop a Core Outcome Set.

Methods

A two-round eDelphi was conducted. Sixty-seven experts were invited to participate and asked to independently rate indicators in importance and feasibility on a 9-point Likert scale. The indicators were grouped by the perioperative period and subgrouped by Donabedian's quality of care conceptual model Structure - Process - Outcome. Consensus to include was defined as ≥75% of experts scoring an indicator as 7 to 9, and 15% or less scoring 1 to 3.

Results

Forty-eight experts completed the Round 1 eDelphi survey, and 8 started the survey but did not complete it. Round 1 survey was answered by a diverse range of targeted categories of experts, including healthcare professionals (76.8%) and patients (10.7%). From the 247 indicators included in Round 1, 15.8% reached a consensus to include regarding both importance and feasibility. Across the perioperative period and Donabedian's quality of care conceptual model subgroups, a higher consensus to include was achieved regarding importance than feasibility. The results of Round 2 have yet to be available, as the study is ongoing.

Conclusions

A consensus of a broad and heterogeneous panel of experts on core indicators for reporting perioperative patient safety was developed. While the experts highly punctuated the indicators' importance, the indicators' feasibility aspect needs to be further explored to implement effective and efficient monitoring and evaluation of surgical-related patient safety systems in clinical practice.

Key messages

• Prioritising indicators important for patients and the clinical practice is crucial to monitor and evaluate patient safety.

• This consensus facilitates benchmarking across EU countries.