bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between children’s food insecurity and a Healthy Eating Index in Portuguese children
Authors: Maia I , Oliveira A , Severo M , Santos AC
Published: October 2021

Background

Evidence on the association between children's food insecurity (FI) and a priori-defined dietary patterns is scarce, particularly in Europe. This study assessed the association between children's FI and a diet quality index in a population-based sample of children.

Methods

A cross-sectional study including 2800 children from the 10-year-old follow-up of a Portuguese birth cohort, the Generation XXI study, was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for Children (SAFSSMC), dietary intake, assessed by a validated FFQ, and socio-demographic characteristics were collected. An adaptation of the Healthy Eating Index (HEI) was used, by including 7 food groups (fruit and vegetables, dairy products, fish and eggs, meat and meat products, sweet snacks, salty snacks and soft drinks) scored from 1 to 4 according to increasing quartiles of daily consumption. For the last 4 groups, a reverse score was assigned. Scores were summed up (the highest the score, the highest diet quality). Linear and logistic regression models (HEI score and its food groups divided by the sample median) were performed.

Results

The FI prevalence was 9.4%. The median (P25;P75) HEI score was 18.0 (15.0;21.0). Children's FI was inversely associated with diet quality (β=-0.671;95%CI:-1.129;-0.213), independently of maternal education, caregivers' unemployment and child's sex. By using the SAFSSMC raw score, FI increased the odds for lower (below the median) fruit and vegetables intake (OR = 1.069;95%CI:1.002-1.139), and higher intake (above the median) of meat and meat products (OR = 1.075;95%CI:1.011-1.144) and soft drinks (OR = 1.074;95%CI:1.008-1.145), independently of maternal education, caregivers' unemployment, child's sex and the other food groups consumption.

Conclusions

Food insecure children have poorer diet quality, specifically a lower fruit and vegetables consumption, and higher intake of meat and meat products, and soft drinks.

Key messages

FI was reported by 9.4% of children, and poorer diet quality was observed among food insecure children, when compared to food secure ones. Public health interventions targeting food insecure children should be developed to promote healthy dietary habits in the context of populations vulnerable to FI.
Prenatal mental and physical health, behaviours, and maternity care experiences during the COVID-19
Authors: Matvienko-Sikar K , Pope J , Olander E , Leitao S , Meaney S
Published: October 2021

Background

During pregnancy, women's mental and physical health, health behaviours, and experiences of maternity care can have significant implications for obstetric, maternal and child outcomes. These factors can be impacted by adverse life-events, such as the COVID-19 pandemic.

Aim

This study examined pregnant women's mental and physical health, health behaviours, and experiences of maternity care during the COVID-19 pandemic.

Methods

An international online survey was conducted in June and July 2020. Pregnant women self-reported levels of general stress, pregnancy-specific stress and COVID-19 related stress. Women also self-reported their mental and physical health, general health behaviours and COVID-19 related health behaviours. Maternity care experiences were reported using closed and open-ended questions. Descriptive statistics and thematic analyses were used for quantitative and qualitative data respectively.

Results

573 pregnant women from 15 countries participated. Women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Women reported distress related to restrictions implemented in their maternity care that limited in-person interactions with healthcare professionals and partner attendance at antenatal appointments. Lack of information on COVID-19 and pregnancy also led to uncertainty for women about pregnancy and birth. Encouragingly, pregnant women reported high levels of adherence to public health advice and healthy prenatal behaviours.

Conclusions

The COVID-19 pandemic is having significant adverse effects on the mental and physical health of pregnant women. Population level interventions targeting pregnancy- and pandemic-specific stress are needed to better support the mental and physical health of women during the on-going pandemic and minimise adverse outcomes for women and children.

Key messages

The COVID-19 pandemic is significantly adversely impact the mental and physical health of pregnant women, indicating need for population level interventions for prenatal mental and physical health. Restrictions in maternity care and uncertainty about COVID-19 impacts are key determinant of adverse prenatal physical and mental health outcomes.
Mental health in Swiss university students during the COVID-19 pandemic
Authors: Zysset A , Dratva J , Volken T
Published: October 2021

Background

University students were confronted with abrupt changes by the COVID-19 lock-down in their personal and academic lives. The “Health in Students during the Corona pandemic” study investigated the impact on mental health and health behaviors of Swiss university students.

Methods

April 2020 all students of the Zurich University of Applied Sciences (N = 12,431) were invited to a repeated cross-sectional open cohort survey, participation ranged from T0 20% - T5 13%. Generalized anxiety (GAD-7), stress (PSS) and depression (PHQ-9) were investigated with descriptive and multivariate analyses. Latent class analyses (LCA) was applied to identify groups who differed in perception of impact on daily and student life. PHQ-9 results were compared with pre-pandemic data matched for age, sex and education.

Results

At T0 mean age was 26.5 (sd 5.6), 69% were female. Participants were similar across all surveys. LCA yielded three classes of perceived impact: 1 (low, n = 675), 2 (moderate, n = 1098), and 3 (strong, n = 656). At T0 adjusted proportion of moderate to severe anxiety was significantly higher in class 3 (45% (95% CI: 28.0-62.0), compared to 2 (15.5%, 95% CI: 13.1-17.9) and 1 (5.1%, 95% CI: 4.7-5.6). Class 3 showed significantly higher odds of high stress levels (class 3: OR = 28.4; 95% CI: 15.5 - 52.0; p = 0.000; class 2: OR = 2.8; 95% CI: 1.5 - 5.3; p = 0.002) compared to other students. Anxiety and stress levels declined with time. The adjusted prevalence of depressive symptoms in females (30.8% (95% CI: 28.6-33.0)) and males (24.8% (95% CI: 21.7-28.1) was substantially higher than in a matching pre-pandemic national sample of young women (10.9% (95% CI: 8.9-13.2)) and men (8.5% (6.6-11.0)). Depressive symptoms between T0 and T3 did not decline.

Conclusions

Students reported high anxiety, stress and depressive symptoms during the pandemic. Depressive symptoms did not decline with time, indicating a continuing impact on mental health throughout the pandemic.
Training for cultural mediators on mental health - a way to increase mental health literacy?
Authors: Wångdahl J , Åkerman E , Engström K
Published: October 2021

Background

Many refugees have poor mental health and limited health literacy, which can complicate establishment. In a Swedish EU project, cultural mediators who are working with newly arrived refugees in the community were trained to become study circle leaders in mental health. The aim of this study was to examine what the cultural mediators perceived that they learned through participation in the course.

Methods

Ten individual interviews were conducted with cultural mediators who participated in the course on mental health in the year 2020. All interviews were recorded and transcribed verbatim, before they were analysed through thematic analysis.

Preliminary results

Two themes - theoretical and practical knowledge - were found. Theoretical knowledge consisted of three subthemes: 1) In-depth knowledge and increased understanding of mental health, 2) New specific facts knowledge, and 3) How to obtain and assess health information. Practical knowledge consisted of two subthemes: 1) Increased knowledge of practical exercises and methods, and 2) How to assess participants' mood, respond and guide.

Conclusions

Participation in a six-days course on mental health could contribute to increased knowledge, reflection, practical skills and confidence regarding promotion of mental health of newly arrived refugees at group level, i.e. to increased mental health literacy for cultural mediators.

Key messages

Cultural mediators mental health literacy can be increased through training in mental health. Increased knowledge regarding mental health increase cultural mediators' confidence in working with mental health promotion.
COVID-19 workplace impacts - Irish OSH professionals experience and observations
Authors: Buggy C , Chen Y , Roe M , Ingram C , Buttner F , Perrotta C
Published: October 2021

Background

COVID-19 has had a significant impact on workers, arising from adaptations to control measures and consequent behaviour changes that minimise disease spread in the workplace. From an occupational safety & health (OSH) perspective, understanding how adaptations and behaviour changes have impacted workers is relevant to how organisations can preserve the health of their workers when adapting to future health emergencies.

Methods

Semi-structured qualitative focus groups were conducted during April/May 2021. Participants were Irish OSH practitioners. Participants volunteered from industrial sectors (public & private) as defined by the Central Statistics Office. Participants (n = 60) partook in one of sixteen, two-hour focus groups (4-6 participants per focus group) with each comprising four themes for discussion: organisational preparedness; organisational impacts; worker impacts; and the future of OSH. Thematic analyses were performed using NVivo.

Results

Most participants started developing adaptation measures in February/March 2020. Organisations with an international presence started developing adaptation measures earlier. As OSH professionals, most participants felt personally prepared for the challenges induced by the pandemic but did not anticipate the impact it had on their workload. Nearly all participants indicated that isolation, loneliness, fear, and anxiety had a negative impact on their co-workers' mental health. Many OSH practitioners indicated that their co-workers had responded well to the pandemic, and that positive behaviour changes and new adaptation measures had been sustained from the first wave through the third wave of the pandemic in Ireland.

Conclusions

Workplace mental health evaluations and worker wellbeing initiatives must be prioritised post-pandemic. OSH will need to re-evaluate its relationship with organisational human resources in the future.

Key messages

Irish OSH practitioners responded well to the challenge presented by COVID-19 to protect their co-workers and maintain organisational continuity. COVID-19 has had a negative impact on the mental health of Irish workers as they respond to preserve their organisation’s operations. This will need to be addressed by organisations post-pandemic.
Research capacity strengthening in health and care delivery through housing for chronic diseases
Authors: Hernandez-Garcia E , Chrysikou E
Published: October 2021

Background

From all buildings, houses are where we spent most of our lives. The impact of housing conditions on health was evident during the COVID-19 pandemic. Despite the 2018 Astana Declaration placing integrated delivery of primary health care and public health services across all sectors, a framework that explores health and care in relation to housing remains unexplored. The aim was to determine relevant evidence gaps to building capacity in supportive housing-health care research about chronic diseases and multimorbidity, identify ongoing strains and offer potential solutions.

Methods

An integrative review was conducted through multiple systematic searches in electronic databases. We employed an interdisciplinary approach integrating several research fields -built environment, clinical and human physiology, environmental health, and public health and health care services- around chronic illness and multimorbidity to understand the depth and scope of linkages. Inductive content analysis was used to describe emerging domains from evidence meeting inclusion criteria.

Results

We defined a multifaceted framework with priority eight building blocks for action: 1) expanding capacity for chronic care model into the primary care setting; 2) scaling up environmental determinants to cover residential spaces; 3) implementing acute methodologies for indoor environment risk assessment; 4) increasing clinical research applicability into built environment studies; 5) recognizing chronic conditions-promoting inflammation physiology; 6) qualifying reliable surrogate disease biomarkers in human monitoring; 7) enforcing technologies for new forms of outpatient care; and 8) renewing evidence-based healthcare design.

Conclusions

Future research needs to prioritise articulating these emerging insights through systematic, translational and multisectoral approaches to strengthen health and care delivery through housing design solutions for people living with chronic morbidity.

Key messages

Integrating the evidence-based design in future interventions may promote transformative changes in housing and public health programmes engaging primary healthcare services for chronic patients. This eco-biopsychosocial supportive framework informs practice to advance research capacity development in enabling health-conducive environments across various levels of care and health promotion.
Risk of SARS-CoV-2 infection in people living with Multiple Sclerosis in the Lazio region, Italy
Authors: Acampora A , Cascini S , Calandrini E , Agabiti N , Davoli M , Bargagli AM
Published: October 2021

Background

Multiple Sclerosis (MS) patients might represent a vulnerable population to SARS-CoV-2 infection due to several factors, including the immunosuppressive or immunomodulating disease-modifying therapies (DMT) they use and the young age that expose them to a high number of contacts. This study aimed to estimate incidence of SARS-Cov-2 infection in a cohort of MS patients living in the Lazio region and to identify the risk factors for the infection.

Methods

A retrospective cohort study was performed based on regional health administrative databases linked to the new integrated surveillance system of SARS-CoV-2 infection. MS patients residing in Lazio region and aged ≥18 years on 31 December 2019 were enrolled and followed-up to 31 March 2021. Age- and gender-standardised incidence ratios (SIR) was calculated to compare the infection rate of MS cases with that of the regional general population. A large number of socio-demographic and clinical variables were explored as potential risk factors using a multivariable logistic regression model.

Results

In the Lazio region lived 10,248 individuals affected by MS (mean age 49.2±12.9; 32.2% males; 67.8% females). During the follow-up period the overall incidence of SARS-CoV-2 infection was 5.0% (n = 510), 5.2% and 4.8% among males and females, respectively. An overall SIR of 0.92 (95%CI 0.84-1.00) was estimated, and 0.97 (95%CI 0.83-1.12) and 0.89 (95%CI 0.80-0.99) for males and females, respectively. The multivariable logistic regression model identified the use of antidiabetic drugs as unique predictor of SARS-CoV-2 infection (OR = 1.69; 95%CI 1.19-2.40). No association with any DMT was observed.

Conclusions

No difference was observed in the incidence of SARS CoV-2 infection in MS patients compared with the general population. DMT does not seem to affect the risk of infection, while the higher incidence in individuals using antidiabetics could reflect the higher prevalence of diabetic population in infected people.

Key messages

This study supports previous research suggesting that the incidence of SARS-CoV-2 infection in MS population does not seem to be higher than that in the general population. Disease Modifying Therapy at the moment of infection does not appear to affect the risk of became infected from SARS-CoV-2.
Evidence Synthesis to support the public health response during the COVID-19 pandemic
Authors: Ryan M
Published: October 2021

Background

In January 2020, the Irish National Public Health Emergency Team (NPHET) for COVID-19 was established. NPHET oversees and provides national direction, guidance, support and expert advice on the development and implementation of strategies to contain COVID-19 in Ireland. Since March 2020, HIQA's COVID-19 Evidence Synthesis Team has provided research evidence to support the work of NPHET and associated groups and inform the development of national public health guidance. From September 2020, as part of the move towards a sustainable response to the public health emergency, HIQA also provides evidence based advice in response to requests from NPHET. The advice provided to NPHET is informed by research evidence developed by HIQA's COVID-19 Evidence Synthesis Team and with expert input from HIQA's COVID-19 Expert Advisory Group.

Methods

This presentation describes the establishment and organisation of the COVID-19 Evidence Synthesis Team, with an overview of the processes and methodological approaches involved. The role of HIQA's COVID-19 Evidence Synthesis Team in informing the public health response during the COVID-19 pandemic is discussed, along with the challenges and opportunities this presents. The relevance now and for future pandemic preparedness is outlined.

Results

As of 19 April 2021, HIQA has produced, and in some instances has regularly updated, 25 evidence summaries, 11 advice documents, 9 reviews of international guidance, 3 scoping reports, 5 reviews of care pathways, 2 analyses/models and 2 databases.

Conclusions

In the context of the COVID-19 pandemic, HIQA has developed and implemented a process to ensure rapid access to the best available evidence relevant to the COVID-19 outbreak to inform decision-making at each stage of the pandemic.
Decreasing trends in suboptimal prescribing in older people: a French nationwide study
Authors: Drusch S , Le Tri T , Ankri J , Zureik M , Herr M
Published: October 2021

Background

Potentially Inappropriate Medications (PIMs) and polypharmacy are widely used indicators of suboptimal prescribing in older people. These indicators have been associated with an increased risk of adverse drugs event, hospitalization and healthcare use. However there is no recent evaluation of the evolution of these indicators in France. The aim of this study was to describe the prevalence of PIM and polypharmacy and its evolution among older people between 2011 and 2019 in France.

Methods

A repeated cross sectional study was conducted every two calendar years between 2011 and 2019 using the French health insurance data system. People aged 75 years and over and not deceased in a given study year were included. Sixteen PIM criteria from the 2015 Beers or STOPP lists were assessed. Moderate polypharmacy (5 to 9 drugs) and hyper-polypharmacy (≥10 drugs) were defined based on the average number of drugs dispensed per quarter. Age and sex-standardized prevalence of PIMs and polypharmacy were assessed and stratified by age (75 to 84/85+) and sex. To estimate trends over time, the Annual Percent Change (APC) was calculated with linear regression models.

Results

The study population included 5,777,645 individuals in 2011 and 6,328,155 in 2019. The prevalence of PIMs decreased from 49.6% to 39.6% over the study period (APC=-1.2%). Benzodiazepines were the most frequent PIMs (APC=-1.3%), followed by drugs with anticholinergic effects (APC=-2.1%), oral non-steroidal anti-inflammatory drugs (APC=-2.0%), and antihypertensive drugs (APC=-1.1%). Overall, women and individuals aged 85 years and older were more likely to receive PIMs. The prevalence of hyper-polypharmacy decreased from 30.5% to 25.9% over the study period.

Conclusions

Prevalence of PIMs and hyper-polypharmacy declined in France between 2011 and 2019 and may reflect an improvement in prescribing practices. Still, suboptimal prescribing remains frequent in older people and often involves benzodiazepines.

Key messages

The prevalence of most potentially inappropriate medications decreased between 2011 and 2019 in France, consistently with trends previously reported in European countries, although still high. The observed diminution of hyper-polypharmacy over the study period also sends a positive and original signal.
Mental health and access of care during Covid-19 pandemics: an italian cross-sectional study
Authors: Previti C , Gualano MR , Lo Moro G , Voglino G , Dogliani S , Bert F , Siliquini R
Published: October 2021

Background

COVID-19 emergency forced nations to introduce containment measures to reduce the spread of the virus. This study assessed the possible effects of the pandemic on mental health and care access.

Methods

A cross-sectional study was conducted in Italy in two observation periods in 2020: April-May (first lockdown) and November-December (no lockdown). Categorical variables were compared with χ2 tests. Mental health outcomes (PHQ-2 ≥ 3; or GAD-2 ≥ 3) and outcomes related to care access were considered. Multivariable logistic regression models were performed.

Results

Participants were 2673 (66.8% female; mean age=44 years, SD = 15). Depressive symptoms were found in 24.7% of participants, while 24.2% showed an anxious symptomatology. A total of 12.5% said they voluntarily gave up scheduled medical service, 6.4% avoided acute treatments, and 5% changed therapy themselves. Comparing the two periods, there were no significant differences in the outcomes under study. Students were at higher risk of depressive symptoms (OR = 2.23; 95% CI 1.42-3.52; p = 0.001). Women and those who increased the time on internet presented an increased risk of developing depressive and anxious symptomatology. The scheduled medical service was mainly postponed by those who said they were afraid to go out of necessity (OR = 2.49; 95% CI 1.87-3.32; p < 0.001) or to cause themselves an injury (OR = 1.78; 95% CI 1.32-2.40; p < 0.001). Foreigners (OR = 4.24; 95% CI 1.70-10.55; p < 0.002) are more likely to avoid acute treatment. Workers and those with anxious disorders appear to be more inclined to self-medicate (OR = 2.05; 95% CI 1.29-3.26; p = 0.003).

Conclusions

Compared to the pre-pandemic period, higher levels of anxiety and depression were observed. No differences in mental health and care access were shown between the two observation periods. Being afraid to go out of necessity and avoidance of physical activity for fear of injury is related to reduced access to care, but not to self-medication.

Key messages

The 24.7 % of the sample reported depressive symptoms, and 24.2 % anxious symptoms. Similar increases were observed in both periods: April-May (first lockdown) and November-December (no lockdown). During the pandemic, delayed access to planned and acute care, avoidance of physical activity for fear of injury, and self-medication pose a major public health challenge in the coming period.
10.I. Workshop: Lessons from funding programmes for the development and testing of new care and payment models
Authors:   Organised by: European Observatory,   Chair persons: Nick Fahy (UK), Dimitra Panteli (Belgium)
Published: October 2021

To keep health care sustainable while ensuring that patients receive the best possible care, there is a need to find suitable ways of organising and structuring health care that are better applicable to for example the treatment of non-communicable diseases and multimorbidity. Improving coordination processes across different health and social care actors is crucial and as pressures on health systems have mounted, there has been increasing interest in how different methods of delivering or paying for healthcare can help in achieving overall health system goals. Some countries have set up specific ‘Innovation funds' to support the testing of new care and payment models. In this workshop we will have a closer look at how such dedicated funding programmes can be used as a tool to foster this particular type of innovation. This is especially valuable for participants who are interested in the initial or further development of such funding streams. The workshop will have the format of a regular workshop and will start with four presentations followed by ample time for an interactive discussion on specific subtopics or questions raised by the audience.

Key messages

This workshop will allow for cross country learning and evaluation of funding programmes that invest in new care and payment models and create opportunities for shared learning and collaboration. This workshop will also draw more attention towards current developments on how new care and payment models can be developed, invested in and implemented.
The French innovation funding programme (Article 51)
Authors: Lemaire Natacha
Published: October 2021

The “art 51” of the social security financing act was launched in 2018 and created an experimental framework to test a programme for healthcare delivery and payment innovation. Its aim is to fund projects that promote coordination, group practices, integration of care, through adequate payment mechanisms. Projects emerge from the field, identifying unmet needs and proposing innovative health care organisations and payment schemes. This presentation will provide insights into this new experience, into the obstacles and the lessons learned.
The German Innovation Fund (Innovationsfonds)
Authors: Pfaff Holger
Published: October 2021

The Innovationsfonds was launched by the German Federal Government in 2016 and funds both experimental new care models and health services research projects. The applicants respond to annual funding announcements with a broad range of topics. Insights from more than five years of experience encompass prioritisation of topics, types of projects funded, governance pathways and potential future directions.
Closing the preparedness-response gap in time: Operational readiness at points of entry in Europe
Authors: de Rooij D , Janse J , Raab J , Timen A
Published: October 2021

Background

As points of entry (POE) - ports, airports and ground-crossings - are important structures for international travel and trade, their timely activated capacity to respond to infectious disease threats is of utmost importance. How can POE timely adjust their capacity from generic preparedness to specific response?

Methods

We developed a conceptual framework for public health response at POE, based on a military used model, leading to a step-wise approach from preparedness to response. Subsequently, our framework has been used to analyze interview data of professionals working at European ports (n = 12), airports (n = 15) and ground-crossings (n = 4) in 11 European countries in June - August 2020 covering the activation of the response to COVID-19.

Results

By integrating the military model, we learned that in preparedness frameworks the pre-defined time expected to activate required capacity is missing. While combining time with capacity creates the possibility of defining a readiness range for different capacity requirements. E.g. information provision to passengers is arranged within hours, while entry-screening may take up to days to be operational. We hypothesized that this readiness range provides the opportunity to split strategic thinking from operational readiness, and may support proactive thinking. The interviews confirmed a very implicit and non-formalized reference to the time needed to activate the response. POE differed highly as regards proactive or reactive response strategies. A much stated problem was fast and often changing strategies on measures, leading to extreme required flexibility and workload in operations.

Conclusions

Explicitly acknowledging the time needed to activate appropriate capacity during the transition from preparedness to response can contribute to a better definition of the operational consequences of readiness. These findings may also be of added value in other public health area than POE.
Promoting and preserving safe and active mobility in Istanbul during the COVID-19 pandemic
Authors: Demir O , Rojhani A , Hung C
Published: October 2021

The COVID-19 pandemic severely impacted all facets of daily life, including and especially mobility within urban centres. As part of efforts to control the virus by encouraging citizens to stay at home, local governments imposed public health and social measures (PHSMs) restricting the availability and use of public transit. The result was an immediate, sharp decline in the use of public transit, and later as the pandemic was brought under control in certain geographies, a reluctance to return to using public transportation due to sustained fears of virus transmission. In Istanbul, Turkey, the use of public transportation decreased by over 90%, coupled with a significant rise in the use of private motorised transportation. To counter this trend, the Istanbul Metropolitan Municipality (IMM) joined cities around the world in implementing a two-pronged strategy to support safe and active mobility during the pandemic. IMM first launched a communication campaign to promote adherence to PHSMs, to rebuild trust in the safety of public transportation as restrictions eased, and to educate citizens on transportation alternatives. Billboards, social media and digital screens on public transportation promoted continued mask use, hand-washing and physical distancing and encouraged citizens wary of returning to public transit to consider walking or cycling as a safe and healthy alternative to private car use. IMM simultaneously enhanced their cycling infrastructure, creating new temporary and permanent bike lanes that closed connectivity gaps within the city. This talk will further elaborate on IMM's actions and the results and explore how they and other cities can sustain the focus on safe and active mobility as a longer-term strategy to reduce private car use and improve health outcomes.
Competences in the management of health regions: Hungary, Bulgaria, Austria
Authors: Kollányi Z , Horváth G , Movia M , Amort F , Todorovska N , Yordanov H , Iltschev V
Published: October 2021

Background

Competences were analysed through desktop research and semi-structured/guided interviews with relevant stakeholders and experts. Subsequently the results of Hungary, Bulgaria, and Austria will be presented and discussed.

Results

Hungary has 9,9 Mio inhabitants. The health status of the population is generally poor and characterized by inequalities. The country has one of the highest mortality rate in the EU. The public health system contains elements compatible with the concept of RHNM. Based on expert opinions main competency areas needed would be of Communication, Management, Public Health and Data Management and Analysis. Bulgaria's population is 6.9 Mio. The mortality rate is highest among the EU. The country has laid down foundations in terms of essential structures, facilities and academic programmes. Identified competences for RHNM are Management, digital health qualifications and soft skills. Austria has 8,9 Mio inhabitants. The mortality rate is close to the EU average. Austria is already aware of the concept of RHNM as it exists on small scale within the country. Identified competences from expert interviews are project management, Public Health and Health Promotion, social skills and communication.

Discussion

The function of RHNM is already existing in AT on small scale, in HU it is in function but diverse and in BG it is not existing. The countries are facing similarities in terms of health needs e.g. aging population, chronic diseases but there are differences in terms of the health status as BG and HU have higher mortality rates than AT. In Austria and Bulgaria there is more focus on management competences for RHNM, Hungary has greater emphasis on the health competences.

Main message

Overall, the function of RHNM would add a value in all countries and overall there is a good prospect for the introduction or reinforcement.
“Health Situation of Women in Germany 2020” - The new report of the Federal Health Reporting is published
Authors: Sass AC , Krause L , Hintzpeter B , Ludwig S , Prütz F
Published: October 2021

Introduction

In Germany, there are more than 35 million women. The German Women's Health Report being published in December 2020 by the Federal Health Reporting Unit at the Robert Koch Institute describes their health status.

Methods

The report uses a broad data basis and shows differences and similarities in the health of women and men (‘differences between') as well as within the group of women (‘differences within'). It includes an overview on their health status, health behaviour and health care. Focus chapters are devoted to health over the life course, specific groups of women, e.g. women with disabilities, and specific health topics, e.g. sexual and reproductive health.

Results

Women's average life expectancy has been increasing for many decades. Two thirds of women rate their health as good or very good. The most common cause of death among women are cardiovascular diseases, accounting for around 40% of all deaths. Nevertheless, they are still considered as ‘male' diseases, thus women often underestimate their risk of disease. Women are in general more health conscious than men, e.g. they have a healthier diet. Women use prevention measures, health promotion and health care services more often. Two thirds of those in need of care are women and it is mainly women who are responsible for the care of others. Data gaps exist for certain conditions such as benign gynaecological diseases as well as for certain groups of women, e.g. migrant women.

Conclusions

In Germany, the health status and health care for women are at a high level. But inequalities in the opportunities for a healthy life exist: socio-economic factors such as age, education, occupation, income, family type, migration background and many other aspects have an important impact on their health status. The report provides current data and information for policymakers, science and practice and raises the awareness and the need for sex and gender-appropriate health promotion, prevention and care.
“Better for women. Improving the health and wellbeing of girls and women” (2019) - Towards a women's health strategy for the UK
Authors: Regan L
Published: October 2021

The following key questions will be addressed in the presentations: 1. What women's health issues are of particular concern in the report? 2. What is the data situation on important women's health topics in the UK, are there data gaps? 3. On which groups of women is there a particular focus in the report? 4. How can the findings be translated into policy? What has happened so far?
The importance of smoking cessation during pregnancy and its association with perinatal outcomes
Authors: Silva AI , Camelo A , Madureira J , Reis AT , Barbosa F , Teixeira JP , Costa C
Published: October 2021

In utero exposure to tobacco smoke is associated with an increased risk of multiple adverse perinatal outcomes. Smoking cessation during pregnancy has been related to the improvement of these outcomes, but often relies on self-reporting, impairing an accurate assessment of smoking cessation impact on newborńs health. Building on data obtained in the frame of the NEOGENE project, this work aimed to estimate the association between smoking cessation among pregnant women, confirmed by maternal urinary cotinine concentrations, and perinatal outcomes. The study population included 595 pregnant women who sought prenatal care in a public hospital in Porto (Portugal), from April 2017 to July 2018. Data on tobacco consumption and cessation was obtained in a face-to-face interview, during the hospital stay. Perinatal outcomes, namely birth weight (BW), length (BL) and head circumference (HC) were retrieved from the hospital medical records. Maternal self-reported tobacco use was validated by urinary cotinine concentrations, using the solid-phase competitive ELISA technique. Maternal active smoking was associated with a significant decrease in BW, BL and HC of 157.66 g (p < 0.001), 0.78 cm (p = 0.001) and 0.39 cm (p = 0.016). Notably, maternal smoking cessation led to a significant increase in BW of approximately 172 g (p = 0.006), when compared to mothers who have not ceased. Increases in BL and HC did not reach significance. This study upholds that tobacco consumption is still an important public health threat in Portugal and that smoking cessation during pregnancy reverses smoking-associated deficits in perinatal outcomes, emphasizing the crucial need for awareness campaigns to promote smoking cessation during pregnancy.

Acknowledgments: This work was supported by FCT and FAPESP (FAPESP/19914/2014). AIS, JM and CC also acknowledge FCT for individual funding (SFRH/BD/145101/2019, SFRH/BPD/115112/2016 and SFRH/BPD/96196/2013 grants, respectively).

Key messages

Maternal active smoking was significantly associated with lower birth weight, length and head circumference. Maternal smoking cessation reverses the smoking-associated deficits in birth weight.
10.P. Workshop: Mental health of older people
Authors:   Organised by: EUPHA-PMH,   Chair persons: Johan Bilsen (EUPHA-PMH), Jutta Lindert (EUPHA-PMH)
Published: October 2021

Due to a general health deterioration, decline in functional ability, accumulated stressful events related to loss and bereavement, and unfavorable socio-economic circumstances, older adults are known to be vulnerable to the development of mental health problems, sometimes leading to serious mental disorders. Approximately 20% of adults aged 60 and over, suffer nowadays from a mental or neurological disorder. This problem is possibly even more distinct in the context of the recent Covid-19 pandemic where health protecting measurements like restricting physical and social contact, disproportionally affect the mental health of older people who are already at higher risk of social isolation and loneliness. However, according to the WHO, mental health impairment in older people is still a highly under-identified, and under-estimated public health issue, often surrounded by shame and stigma, which hinders an adequate mental health promoting approach in this population. This workshop wants to contribute to new findings in the role that certain factors can play in protecting and promoting the mental health of older people. Research during circumstances of a crisis, like the Covid-19 pandemic, may reveal new insights in this context, although the long-term effects are not yet clear, and longstanding factors may not be overlooked.

Dr Sunwoo Lee (Czech Republic) performed a large survey about mental health of older adults in 27 European countries and will discuss the important role that resilience and optimism can play in promoting mental health in older adults in the midst of a pandemic crisis.

Dr. Cynthia Engels (France) investigated changes in daily activities and mental health of older adults during the lockdown period in France. She will report about the most important changes found and what it meant for peoples' wellbeing and social contacts.

Prof. Patricia De Vriendt (Belgium) further focused on the daily activities of older men and women during the Covid lockdown in Belgium and discovered a significant gender difference in the extent to which they succeed to engage in meaningful activities during this crisis. She will discuss how crucial this meaning in activities is for older adults to maintain in good mental health.

Finally, Prof. Jutta Lindert (Germany and US) will share the rather surprising findings of a large nationwide study in the United States among older adults showing how daily discrimination is related to impaired cognitive functioning in older men and women. She points to the importance of reducing discrimination, especially when the Covid-crisis is behind us, as an important factor in supporting mental health in this older population.

Key messages

Resilience, optimism and meaningful activities are important factors in mental health promotion for older adults. Discrimination has a negative impact on older adults' cognitive function.
Resilience and optimism associated with mental health to subjective well-being in older adults 65+ during pandemic outbreak
Authors: Lee S
Published: October 2021

Background

During the ongoing COVID-19 pandemic, older adults are more likely to experience limitations in activities for daily living and social isolation and thus at greater risk for decline in mental and cognitive health. The current study examined how older adults' resilience and optimism affected mental and emotional well-being in the midst of pandemic crisis.

Methods

The study used data sampled from two waves of the Eurofound COVID-19 survey collected from 27 European countries in April, during the first lockdown, and July 2020 when restrictions and measures were mildly lifted-up. The first round sample included 11,211 older adults (Mean age = 69.71 ± 5.15, 70% females, 86% retired) and second round sample included 4,424 (Mean age = 69.93 ± 4.47, 61% females). Analysis focused on resilience, optimism, WHO Well-being Index, psychological distress, and subjective well-being (self-rated health, life satisfaction, happiness). Covariates included socio-demographic information and financial and health care situations since pandemic crisis.

Results

Mental health, subjective well-being, and psychological distress in older adults tended to change over time, while resilience and optimism were relatively stable. Regression analysis indicated that older adults who scored higher for resilience and optimism reported greater life satisfaction and happiness, better health perception, higher levels of mental health, and lower psychological distress when controlled for socio-demographic variables and adversities related to pandemic outbreak.

Conclusions

Resilience and optimism might have a potential to help older adults cope with exposure to stressful life events and later life adversity, but inconclusive. Future studies should more precisely examine the role of resilience and optimism in promoting mental health in older adults, its formation and protective mechanism, to better incorporate these factors into life-long education and interventions for older adults.
The impact of parental migration background on cardiometabolic health in European children
Authors: Lindblad A , Ahrens W , Winkler V , Lissner L , Mehlig K
Published: October 2021

Background

There is accumulating evidence that children from migrant families have higher risk of developing overweight and obesity than their peers in the host population. This study aims to investigate the association between parental migration and cardiometabolic health, including the metabolic score and its components, in children and adolescents in Europe.

Methods

Data was collected from 8,828 children (aged 2-17) in eight European countries included in the multicentre IDEFICS/I.Family cohort. Multilevel linear regression models were used (accounting for correlations between siblings) to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and the cardiometabolic health outcomes body mass index (BMI), metabolic score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We controlled for socioeconomic indicators, maternal weight status, as well as lifestyle and dietary patterns.

Results

We found a higher mean BMI z-score (+0.24 SD, p < 0.001) and overall metabolic z-score (+0.28 SD, p < 0.001) among children with two migrant parents in comparison to children with two native parents. No differences could be seen between children with one versus no migrant parent. The effects were attenuated when controlling for maternal weight status and levels of sport club activity. Parental education modified the associations for some health outcomes (BMI and waist circumference) such that they were more pronounced in children with low parental education.

Conclusions

European children and adolescents with two-parent migration background seem to be at higher risk of developing adverse cardiometabolic health than their peers. Children with one migrant parent seem to have similar risk as children with native parents. Maternal BMI and levels of physical activity partly explained the higher risk, a risk which was more prevalent in families with lower education level.

Key messages

European children and adolescents with two-parent migration background have higher risks of developing adverse cardiometabolic health than their peers with one or two native parents. The higher risk of being overweight and having cardiometabolic risk factors among children with two-parent migration background was most pronounced in families with low level of education.
The impact of the epidemiology of multimorbidity on health policy across settings and countries
Authors: Nicholson K , Stranges S
Published: October 2021

Issue/Problem

The epidemiology of multiple health conditions (also known as multimorbidity) is increasingly being studied across many settings and countries around the world. More specifically, prevalence and predictors of multimorbidity are being explored among clinical and population-based samples from high-, middle- and low-income countries in rural and urban settings. While the prevalence of multimorbidity tends to increase among ageing populations, a growing proportion of adults under the age of 65 years are also living with multimorbidity, indicating a need for effective interventions.

Description of Problem

There is a need to identify consistent and distinct epidemiological patterns of multimorbidity across different settings and countries. More specifically, the prevalence and consequence of multimorbidity may have different implications in high-, middle- and low-income countries, as well as between rural and urban settings. This understanding can be informed by extracting information from relevant publications and conducting a survey of multimorbidity researchers on the impact of this research on subsequent health policy priorities and decisions in their specific setting or country.

Intended Results

The responses and insights provided by multimorbidity researchers from the completion of the survey (consisting of both open- and closed-ended questions) will be presented, including how the epidemiology of multimorbidity has been conducted to date and how this research may or may not be informing policy priorities and decisions in their respective countries. As well, the focus of interventions to prevent multimorbidity occurrence will be explored across settings.

Lessons

Overall, this presentation will aim to summarize key patterns in both epidemiology and policy responses to multimorbidity occurrence and implications across settings and countries. This work will also aim to create a more formal community of multimorbidity researchers around the world.
Multimorbidity and Health Systems: Challenges and Priorities
Authors: van den Akker Marjan
Published: October 2021

Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. Effective approaches are needed to manage such complex patients in primary care. The paper will discuss different models of care as well as major health care challenges in the management of multimorbidity in primary care with focus on interactions (disease-disease, treatment-treatment, and treatment-disease) extrapolated from (disease specific) guidelines and the feasibility to apply these guidelines for and with patients who have multimorbidity.