bluuebunny/crossref_metadata_2025 huggingface dataset:
Opinions and beliefs in vaccine hesitant parents in Italy: what makes the difference
Authors: Cocchio S , Bertoncello C , Fonzo M , Zanovello S , Bennici S E , Baldovin T , Buja A , Napoletano G , Russo F , Baldo V
Published: November 2019

Vaccine hesitancy has been defined as the delay of acceptance or refusal of vaccines. Hesitant parents’ (HP) fluctuate between anti-vaccine (AP) and pro-vaccine parents’ (PP) positions. In the light of alarming results from recent Eurobarometer 488, our aim was to identify sensitive topics harbouring the widest opinion gap between HP and PP.

In 2017, an online questionnaire was administered to parents with children aged 3-84 months. Parents were classified as PP, HP or AP based on self-reported vaccine status and timeliness of vaccinations. Agreement with 25 items was assessed with 5-point Likert scale. Items were combined into 8 topics (benefit/risk of vaccines, trust/mistrust in healthcare workers, administration policies, complacency, sense of community, freedom of choice) and scores calculated. Internal consistency was evaluated with Cronbach’s α; t-tests (sig. <.05) were used (Norman G, 2018).

The study included 3,865 parents (64% PP; 32% HP; 4% AP). Cronbach’s α ranged 0.77-0.92. The widest gap concerned the sense of community: HP (2.7/5.0) cared significantly less than PP (4.7) about the usefulness of vaccine in protecting other children and claimed for a complete freedom in decision to vaccinate (3.6) more than PP (1.8). HP were worried (4.1) about current vaccination schedule (PP 2.1): simultaneous administration and age at vaccination (considered too young) were matter of concern. Among HP, mistrust of healthcare workers (3.7) and fear of side effects (3.8) played an important role, but the gap with PP was narrower compared with abovementioned topics; awareness in vaccine benefits reached 3.7. Agreement with complacent attitudes was low (2.2) with the least difference with PP (1.2).

HP showed to partially consider benefits of vaccines on a community scale, claiming for a private nature of this choice. The existence of a consistent opinion gap about the vaccination schedule may suggest the need for a sharper focus on current communication tools and strategies.

Key messages

While hesitant parents share some concerns with pro-vaccine, relevant opinion gaps may serve as warning lights, pointing at topics potentially harbouring the most sensitive drivers of hesitancy. Communication strategies should primarily focus on raising acquaintance of hesitant parents with benefits arising from herd immunity and compliance with the suggested vaccination schedule.
Child living arrangements following separation and mental health of parents in Sweden
Authors: Fritzell S , Gähler M , Fransson E
Published: November 2019

Background

Father involvement and joint physical custody in post-separation families have become increasingly common. In Sweden, 35 percent of the children of separated parents live equally much with both parents. The associations between child living arrangement and parental health may vary between women and men. This study analyzes the association between children’s living arrangement and mental health of parents, and how this interacts with material and social circumstances.

Methods

Drawing on The Swedish Survey of Living Conditions (ULF) 2008-2013, the association between child living arrangements and mental health (worry/anxiety) of parents in four family structures: nuclear, reconstituted, single with joint physical custody, and single with main or sole custody, were analyzed. Data on 9,225 mothers and fathers with resident children aged 0-17 were analyzed by logistic regressions for average marginal effects adjusting for socio-demographic, socio-economic and social factors. Analyses of interaction effects were made using the synergy index.

Results

Substantial family type differences were found in mental health between nuclear family and all other family types for mothers, and nuclear family and single parents for fathers. For the single mothers, the higher risk for worry and anxiety was reduced following controls for socioeconomic factors. Interaction effects were found for the combination of single motherhood and non-employment, causing a higher risk of mental health problems for single mothers, both with joint (SI 5.25 (2.06-13.39)) and sole custody (SI 1.70 (1.11-2.62)), than would be expected from a simple addition of these exposures, indicating that this is a vulnerable group.

Conclusions

The results indicate that joint custody is associated with higher risk for worry and anxiety for the parents, especially for mothers, both re-partnered and single, but also for single fathers.

Key messages

Shared residence is associated with higher risk for worry and anxiety in parents. Single mothers lacking employment is a particularly vulnerable group.
Development of the guideline ‘Challenging behaviour in adults with intellectual disability’
Authors: Kroezen M , Embregts P , Mulder E , Van Bussel C , Van der Nagel J , Van den Akker N , Wolkorte R , Wieland J
Published: November 2019

Background

Challenging Behaviour (CB) is a common problem among people with intellectual disability (ID), leading to a lower quality of life and a negative impact on the emotional well-being of family, staff and fellow clients. Additionally, reduced access to community services and (avoidable) high consumption of specialist care has been reported. This presentation will offer information on the development and content of the Dutch multidisciplinary guideline ‘Challenging behaviour in adults with ID’ that will be published in 2019.

Methods

The guideline was developed on the basis of the methodologic strategy of the AGREE II instrument. Two systematic reviews were conducted. Additionally, healthcare professionals were surveyed through an online questionnaire, interviews (n = 14) and focus groups (n = 6), and interviews were conducted with adults with ID (n = 20) and their family (n = 16). The draft guideline was reviewed by stakeholders and underwent a practice test.

Results

The first module of the guideline describes the assessment of (1) the CB itself, (2) potential factors that contribute to the presence or continuation of CB, and (3) the context in which CB occurs. Implementation will lead to a comprehensive, integrated diagnosis and assessment of the CB, the person and context.

Module 2 enables health professionals to systematically and transparently select and apply interventions to resolve CB, whilst taking into account multiple factors as well as the specific context in which the CB occurs.

Module 3 provides the medical, legal and ethical framework for (off-label) prescription of psychotropics. It explains the process for starting and discontinuing (off-label) psychotropics, the selection of appropriate medication and dosages, and the monitoring and evaluation of effects and side-effects.

Conclusions

The guideline is based on state of the art scientific and practice-based evidence and will contribute to a more structured approach in the care for people with ID and CB.

Key messages

Challenging behaviour is a common problem among people with intellectual disability and can have a negative impact on quality of life and the emotional well-being of family, staff and fellow clients. The development of the multidisciplinary guideline ‘Challenging behaviour in adults with ID’ can help to better understand and treat challenging behaviour in people with ID.
The decomposition of life expectancy for age and cause of death in Tuscany, Italy
Authors: Nante N , Kundisova L , Gori F , Martini A , Battisti F , Giovannetti L , Messina G , Chellini E
Published: November 2019

Introduction

Changing of life expectancy at birth (LE) over time reflects variations of mortality rates of a certain population. Italy is amongst the countries with the highest LE, Tuscany ranks fifth at the national level. The aim of the present work was to evaluate the impact of various causes of death in different age groups on the change in LE in the Tuscany region (Italy) during period 1987-2015.

Material and methods

Mortality data relative to residents that died during the period between 1987/1989 and 2013/2015 were provided by the Tuscan Regional Mortality Registry. The causes of death taken into consideration were cardiovascular (CVS), respiratory (RESP) and infective (INF) diseases and cancer (TUM). The decomposition of LE gain was realized with software Epidat, using the Pollard’s method.

Results

The overall LE gain during the period between two three-years periods was 6.7 years for males, with a major gain between 65-89, and 4.5 years for females, mainly improved between 75-89, <1 year for both sexes. The major gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (1.76 in males and 0.83 in females) and RESP (0.4 in males; 0.1 in females). The major loss of years of LE was attributable to INF (-0.15 in females; -0.07 in males) and lung cancer in females (-0.13), for which the opposite result was observed for males (gain of 0.62 years of LE).

Conclusions

During the study period (1987-2015) the gain in LE was major for males. To the reduction of mortality for CVS have contributed to the tempestuous treatment of acute CVS events and secondary CVS prevention. For TUM the result is attributable to the adherence of population to oncologic screening programmes. The excess of mortality for INF that lead to the loss of LE can be attributed to the passage from ICD-9 to ICD-10 in 2003 (higher sensibility of ICD-10) and to the diffusion of multi-drug resistant bacteria, which lead to elevated mortality in these years.

Key messages

The gain in LE during the period the 1987-2015 was higher in males. The major contribution to gain in LE was due to a reduction of mortality for CVS diseases.
Solidarity and reciprocity in data governance: information sharing among gamete donors and recipients
Authors: Maia T , Silva S , De Freitas C
Published: November 2019

Background

Decreasing fertility rates have spiralled a growth in demand for assisted reproduction technologies, including reproduction through donated gametes. Gamete donation is grounded on solidaristic practices traditionally focused on the gift of gametes. However, solidarity and reciprocity between donors and recipients may also be enacted through the sharing of other types of information (e.g. donation outcomes, medical and identifying information). Little is known, however, about these stakeholders’ preferences regarding information sharing, which is crucial to promoting people-centred policy for data governance in gamete donation.

Methods

A self-report structured questionnaire was completed by 69 donors and 161 recipients (participation rate: 77.4%) between July 2017 and April 2018 at the Portuguese Public Bank of Gametes. Opinions about access to donation outcomes and medical, extended profile and identifying information about recipients, donors and children were analysed using descriptive statistics.

Results

Most participants considered that recipients should not have access to donors’ identifying (92%) and extended profile (79%) information, but that they should access donors’ medical information (58%). Donors stated more frequently that they should receive information about the outcomes of donation (e.g. pregnancies and births) than recipients (32% vs. 12%). Participants also disagreed with donors’ access to recipients’ medical (83%) and extended profile information (92%) and children’s identifying information (98%).

Conclusions

People-centred policy on data governance in gamete donation should be informed by donor and recipients’ preferences. Sharing donation outcomes with donors and medical information from donors with recipients can foster solidarity and reciprocity between them. This requires the development of a matching mechanism (via consent) to accommodate their preferences.

Key messages

Policy on data governance should be informed by gamete donors and recipients’ preferences. Sharing desired information with donors and recipients can foster solidarity and reciprocity between them.
Introduction to the Environmental Burden of Disease concept – history, methods and selected results
Authors: Plass D , Tobollik M , Wintermeyer D
Published: November 2019

Background

The Environmental Burden of Disease (EBD)-concept was introduced by the World Health Organization to quantify the impacts of environmental risk factors on population health in a comprehensive and comparable way. Since the first Global Burden of Disease (GBD)-study the EBD-methodology was used in numerous global, regional and national assessments.

Methods

In the EBD-concept data from different sources are joined using a standardized framework. To calculate the EBD several steps need to be taken into account. First, the exposure of the selected population towards an environmental risk factor is estimated. In a second step, exposure data and information from an exposure-response-function are combined by using the population attributable fraction formula. In a last step, the attributable fraction (percentage) is multiplied by the disease burden resulting from a selected health outcome to estimate the share of disease burden attributable to the environmental risk factor.

Results

Since the first GBD-study several stakeholders have used the EBD-concept to estimate the disease burden attributable to environmental risk factors. This lead to an increased number of available data sets, which - due to the varying assumptions used in the models - are not ad hoc comparable among each other. Generally, the results of EBD-assessments are presented using disability-adjusted life years (DALY) as the core measure of burden of disease assessments. However, e. g. due to lack of data, assessments also focus on the number of attributable deaths, illnesses or single components of the DALY such as the years of life lost due to premature mortality (YLL).

Conclusions

The EBD-concept allows to compare the impact of environmental risk factors on population health. Though the general concept is widely standardized, assumptions on model parameters can lead to varying results. Therefore, when communicating EBD-results it is necessary to be very transparent about data and model inputs.
Organizational Culture and Readiness for Change in German pediatric outpatient centres
Authors: Georg S , Görig T , Eichinger M , Hoffmann D , Urschitz M S , De Bock F
Published: November 2019

Background

Organizational readiness for implementing change (ORIC) is presumed key for successful change in healthcare settings. At the same time, ORIC is theorized to depend on cultural and other factors of the organizational context. Within the process evaluation of the PART-CHILD intervention in interdisciplinary pediatric outpatient centres (IPOC) for children with chronic health conditions in Germany, we assessed to what extent ORIC is associated with organizational culture and further contextual factors.

Methods

In 2019 data was collected from health care professionals in 12 IPOC, using a questionnaire comprising subjectively perceived ORIC (measure: ORIC, 5-point Likert scale), the organization’s culture (measure: Competing Values Framework, four domains: Group, Developmental, Rational, and Hierarchical Culture) and further contextual factors (e.g., size of the facility, number of patients per year).

Results

In all, responses from 206 health care professionals were included in the analyses (response rate: 47%; preliminary results). Analyses show a moderate ORIC (3,4; SD = 0,6), positively associated with Group Culture (r2=0,178, p = 0,01) and negatively associated with Rational Culture (r2=-0,273, p < 0,001). We found no correlations between ORIC and Developmental or Hierarchical Culture. In congress presentation we report to what extent ORIC depends on further contextual factors (e.g., size of the facility, patients’ demographic characteristics).

Discussion

IPOC with a strong Group Culture show a higher ORIC than those with prevailing Rational Culture. To potentially increase effective implementation of interventions in healthcare facilities in future, a preceding evaluation of the organizational culture might be valuable. Thereby, settings with prevailing Rational Culture could be identified at an early stage and receive additional implementation support, e.g. through enhancing the Group Culture among the health care professionals on-site (e.g, executive coaching).

Key messages

Both organizational readiness for implementing change and organizational culture are presumed to be important for implementing change in healthcare facilities‘ routine care. Assessing both constructs prior to implementing a costly intervention with demanding change processes within healthcare settings could be valuable.
Benefits of performing same day discharge lead and varicose interventions in active patients
Authors: Hamid A , Lamirault G , Gouëffic Y , Meur N Le
Published: November 2019

Background

In France, 90% of varicose vein interventions are performed in ambulatory setting while it concerns 7% of angioplasty for lower extremities arterial disease (LEAD). In this study, we made the hypothesis that such disparities may partly be due to the burden of the post-procedural rehabilitation and its relation to patients’ care-pathway and coordination.

Methods

A retrospective study was conducted on 18 to 65 years old active population who benefited from varicose or LEAD interventions from January 2013 to June 2016 using data from the French National Health Insurance System. Post-procedural rehabilitation measure was the number of cumulated workday break and their renewals within 180 days after intervention. Negative binomial regressions, adjusted for age, gender, and comorbidities, were applied to test associations. The degree of coordination among health care professionals for post-procedural follow-up was tested using the continuity of care and the continuity of prescription indices.

Results

Compared to inpatient care, day interventions decrease the incidence rate ratio (IRR) of cumulated workday breaks by 14% in both varicose vein and LEAD interventions. The decrease in the degree of coordination between care providers increase the IRR of cumulated workday breaks and renewals by 37% and 29% respectively for varicose, and 11% and 9% for LEAD interventions. The increase in the number of work break prescriptions delivered by the same category of providers decreases the IRR of cumulated workday breaks and their renewals in varicose by 25% and 21% but increases them in LEAD interventions by 240% and 106%.

Conclusions

Day interventions have similar impacts on rehabilitations after varicose vein and LEAD interventions. However, coordination is critical. Our results highlight the need to pursue health regulatory agencies and healthcare professionals’ works on multidisciplinary ambulatory care networks for better follow-up of acute day care interventions.

Key messages

Day intervention reduces cumulated workday breaks in endovascular interventions. Multi-specialty coordination of the qualified health care professionals is required in endovascular interventions, especially after angioplasty for LEAD in outpatient settings.
Career satisfaction of Polish physicians – evidence from a survey study
Authors: Domagała A , Peña-Sánchez J N , Dubas-Jakóbczyk K
Published: November 2019

Background

Understanding physician satisfaction and the factors associated are relevant for physicians, their patients and decision makers. We conducted the first national-wide study evaluating the satisfaction of Polish doctors using a multidimensional approach. The aims of this study were to: 1) measure the career satisfaction of physicians working in Polish hospitals, and 2) identify the factors associated with higher levels of career satisfaction.

Methods

A quantitative, on-line survey among 15 nation-wide distributed Polish hospitals (7 general, 5 specialists, and 3 university) was conducted between March and June 2018. A 17-item questionnaire was used to measure satisfaction on a scales from 1.00 to 6.00, as well as their personal, professional, performance, and inherent satisfaction levels. In total, 1.003 questionnaires were included in the study (response rate=38%). Unconditional associations and multivariable regressions models were used to evaluate associations between satisfaction levels and their demographic and work-related factors.

Results

The mean level of physician satisfaction was 4.10 (SD = 0.69). Almost 57% of the doctors reported being from “somewhat satisfied” to “very satisfied” with their careers; although, only 8.2% reported being satisfied or very satisfied with their career (≥5.00). Doctors reported high levels of inherent satisfaction (mean=4.4, SD = 0.66) and low levels of personal satisfaction (mean=3.78, SD = 0.98). Age and work experience were positively and significantly associated with satisfaction.

Conclusions

The satisfaction of Polish physicians is moderate. Doctors reported higher levels of satisfaction with their interactions with direct supervisor, other physicians, nurses, doctor-patient relationships and the lowest satisfaction with the salary and work-life balance. Gender, numbers of working hours/week; years of work experience and the stage of professional development were the factors associated with higher satisfaction.

Key messages

The satisfaction of physicians working in Polish hospitals is moderate. The current shortage of Polish physicians makes their satisfaction especially significant for motivation and retention. Physician satisfaction is an important indicator for managers. Attention regarding levels and factors affecting doctors’ satisfaction should be one of the key issues of health workforce management.
What doctors and nurses think about the residents’ role within the Academic Hospital of Udine?
Authors: Ruscio E , Smaniotto C , Del Pin M , d’Angelo M , Perri G , Fabricci M , Brunelli L , Londero C , Castriotta L , Brusaferro S
Published: November 2019

Background

Residents have a significant role in both patient’s care and daily ward activities; thus, they should be trained to adhere to hospital procedures and to guarantee best clinical practices and patient’s safety. A survey was carried out to assess healthcare workers’ (HCWs) opinions about residents’ role and performance.

Methods

Between February and March 2019, a paper-based/online survey was developed and distributed among both doctors (d) and nurses (n) in 17 (10 medical, 7 surgical) wards of Udine Academic Hospital, Italy. 22 Likert Scale questions (1-totally disagree, 5-totally agree) investigated 5 areas: respect of patient safety and privacy, healthcare quality, clinical risk management, role played within medical team, satisfaction concerning training activities planning. Profession, ward (medical/surgical), age and sex were considered as exposures. Descriptive analysis, median(M)±interquartile range, and ordered logistic regressions were performed with Stata software.

Results

The survey involved 153/785 HCWs’ (112/477 nurses and 41/308 doctors). All the units were represented with at least 1 HCWs; answers from both categories were collected in 82% of wards. Data analysis showed that nurses gave lower scores about residents’ respect of patient privacy than doctors: patient privacy protection: M(d)=4±0, M(n)=4±1, OR(d/n) 2.60, [95%CI, 1.04-6.52]; sensitive data management: M(d)=4±0, M(n)=3±1, OR(d/n) 2.97, [95%CI, 1.26-7.02]. The same resulted regarding clinical risk management: patient record management: M(d)=4±0, M(n)=3±2, OR(d/n) 13.64 [95%CI 5.30-35.12]; proper hand hygiene: M(d)=4±1, M(n)=3±1, OR(d/n) 5.56 [95%CI 2.35-13.17]; incident reporting: M(d)=4±1, M(n)=3±2, OR(d/n) 7.05 [95%CI 3.14-15.86].

Conclusions

Nurses appeared to be more critical than doctors about residents performances in safety and privacy and clinical risk management areas. Reasons behind these different opinions should be investigated in order to improve constantly healthcare’s quality.

Key messages

Residents hold a key role in healthcare quality, therefore it is significant evaluate their practice regarding patient’s safety and privacy. Doctors and nurses opinions on residents adherence to hospital procedures in order to guarantee best clinical practices and patient’s safety differ significantly.
Nurse’s job satisfaction and organization’s innovation propensity: organizational climate in Italy
Authors: Barchielli C , Seghieri C , Vainieri M
Published: November 2019

The concept of job satisfaction positively correlates with many areas investigated by the organizational climate. We focused on nurses’ perception towards job satisfaction, as it is relevant regarding nursing care delivery’s quality, which is directly linked to patients’ safety. Additionally, we provide a measure of the relative importance that each investigated factor has on nurses’ job satisfaction and their willingness to recommend the organization they work in to other professionals.

A validated census survey was administered in eight different Italian Regions. A total of 35.156 observations were the object of different analysis preformed using STATA. The questions/statements were Likert scaled from 1 to 5 and were compared to the exposure one “I am satisfied with my work in my structure/unit”. The research population has an average age of 47 years (females 80.36% ,men are 19.64%) and men are more satisfied than women with their work. There are various factors that impact the area of “job satisfaction” with different importance (all statistically significant): feeling of encouragement to react after the experience of a failure (OR 2.23), empowerment over quality job results (OR 1.68), sustainable work pace (OR 1.47), firm’s propensity towards innovation (OR 1.36), and experience discomfort while working (OR 1.05). Other factors impacted the area “I would recommend to a colleague to work in my firm” with different importance (all statistically significant). These factors include: firm’s propensity towards innovation (OR 2.84), feeling of encouragement to react after the experience of a failure (OR 1.43), sustainable work pace (OR 1.32), empowerment over quality job results (OR 1.31), experience discomfort while working (OR 1.02).

The two most important levers, innovation and inclusion can be beneficial to improve workforce experience and care delivery. Managerial implications: data can show which levers to use in order to achieve the most desired goals.

Key messages

nurses’ perception towards job satisfaction is relevant regarding nursing care delivery’s quality, which is directly linked to patients’ safety. Innovation and inclusion can be beneficial to improve workforce experience and care delivery.
National survey of UK general practice pharmacy services
Authors: Savickas V , Foreman E , Iqbal M , Ladva A , Bhamra S K , Sharma R , Corlett S A
Published: November 2019

Background

The Clinical Pharmacists in General Practice (CPGP) initiative aims to recruit over 2000 clinical pharmacists in general practice (GP) surgeries in England by 2020. This study aimed to explore the services delivered by all GP pharmacy professionals (GPPPs; pharmacists/pharmacy technicians) across the UK.

Methods

30-item e-questionnaire was developed using SurveyMonkey platform and piloted during one-to-one cognitive interviews with GPPPs. The survey was distributed via the Primary Care Pharmacy Association, social media sites, collaborating GP organisations and via emails to participants of CPGP pilot. Three reminders were sent out 1 week apart. University ethics approval was obtained.

Results

Ninety-one responses were received between November 2018 and March 2019 (89% pharmacists, 52% from CPGP pilot). Participants provided an average of 9 services (95% CI 8.3-9.9). Over 90% of pharmacists delivered medication reviews and over 80% managed patients with polypharmacy. More pharmacists within than outside of the CPGP pilot managed repeat prescribing requests (70% vs. 47%, p = 0.035). Technicians took responsibility for primarily non-clinical services such as service commissioning (90%), management of safety alerts/drug recalls (80%), standard operating procedures (80%) and education & training (80%). Over 40% of GPPPs not providing care home services wished to do so by 2024. Four technicians wanted to be more involved in medication reviews. The main perceived benefits of GP pharmacy services included identifying medicines-related issues (93%), utilisation of pharmacy professionals’ skills (93%) and a reduction in medication waste (92%).

Conclusions

GPPPs provide a range of clinical and non-clinical services which may benefit public health at an individual and healthcare system levels. Pharmacists within the pilot are more likely to deliver repeat prescribing services. Future GP pharmacy landscape will likely include additional services to care homes.

Key messages

GPPPs including pharmacy technicians provide clinical and non-clinical services, appropriate to their scope of practice, to benefit patients, healthcare systems and themselves. Developing future GP pharmacy services to care homes offers further opportunities to benefit a vulnerable group of patients with long-term illnesses.
The potential of economic evaluation studies to improve health screening and assessment policies for asylum seekers in Germany
Authors: Biddle L , Wahedi K , Bozorgmehr K
Published: November 2019

This presentation will discuss the potential for conducting economic evaluation studies in the field of migration and health, by focusing on health screening and assessment for newly arriving asylum seekers. We use three economic case studies from Germany to illustrate this potential, reflecting on the benefits of an economic approach, the contribution of modelling studies, the quality and reliability of the underlying data sources and other lessons learnt in the research process. Screening for illness among newly arriving individuals has the potential to expand access to essential services and overcome access barriers, thus improving efficiency by preventing costs of late presentations. This is demonstrated by a recent modelling study on the cost-utility of screening for depression. However, an overview of different screening policies in Germany shows that unnecessary procedures which are not supported by sound scientific evidence may lead to inefficiencies in excess of €3.1 million, which could be more effectively invested in other parts of the health system. Finally, efficiency gains could be made by assessing who benefits most from screening, and designing targeted screening approaches for these groups, as in the case of targeted screening for active tuberculosis by country of origin. We will end the presentation by reflecting on the potential role for economic evaluations health policy-making, and the challenges of communicating and translating the nuances of economic evidence into practice.
Ethics, economics and migration: intersections, synergies and tensions
Authors: Trummer U , Gottlieb N
Published: November 2019

The presentation will provide food for thought on the relationships between value-based discussions and economic evaluations of healthcare provision for marginalized migrant groups along two different lines of thought. First, while economic analyses are often interpreted as objective and neutral pieces of evidence, it can be argued that every economic model and analysis has its starting point in specific ethical values that are set as basic assumptions. This, in turn, has inevitable impacts on possible results and conclusions. The presentation will use examples to illustrate the value-based foundations of economic analyses in migrant healthcare; and it will propose options for the more explicit reflection of value-based assumptions in economic evaluations. Secondly, the presentation will reflect on existing research on the rationales shaping political decision-making processes in the field of migrant healthcare. In specific, it will examine the concepts of “health-related deservingness” and of “political decisions”, which both postulate that eventually values tip the scales in political decisions on migrant healthcare; and it will discuss the meaning of these concepts for the role of economic evidence in policy-making processes. In doing so, the presentation will relate back to the workshop’s overarching question on how to build synergies and bridges between migration and health research, economic analysis, and policy making to overcome inherent tensions.
Role of Social Media in vaccination debate about HPV: the VAC Medi+Board study
Authors: Artus D , Larson H , Kostkova P
Published: November 2019

Whilst it has long been known that anti-vaccination sentiment is widely disseminated through digital networks, 2019 has seen seismic shifts in the landscape. As viral videos originating on Youtube spread across social networks, HPV vaccine uptake tumbled in a number of countries. In Japan, the government came under sufficient pressure that they de-recommended HPV vaccine, seeing a 70% uptake rate in 2013 fall below 1%. However, there have been some reports of successful interventions - a recent campaign run by the HPV Alliance in Ireland has seen a rate back up to a national average of around 75%. A combination of hard-hitting personal testimonials, social media and traditional media looked to promote the HPV vaccine. Social media platforms such as Twitter enable near real-time understandings of vaccine sentiment and information flows at scale. VAC Medi+Board project developed an innovative approach for Twitter data collection, integration, analysis and visualisation to support rapid responses through identifying key influencers and flashpoints in articles about vaccination going viral. This pilot study evaluated the debate about HPV on Twitter in a period of several month and developed methods for analysis and visualisation of the content, key influencers, information diffusion throughout the network and size of audience. Through complex network analysis, VAC Medi+Board piloted identification of individuals for targeted public health interventions to combat misinformation. In this talk, we will present the VAC Medi+Board HPV study and explore the challenges and opportunities that social media can provide for public health policymakers.
A fresh look at national health policy issues
Authors: Onderstal D
Published: November 2019

Young Forum Gastein (YFG), the young professionals’ network of the European Health Forum Gastein (EHFG), enables promising young health professionals to become a part of an inspiring network of almost 500 members working in different positions all over Europe. In recent years, activities throughout the year have been focussed on workshops bringing together high-level national policymakers and Young Gasteiners (YGers) to discuss specific national health systems challenges in Austria and in Croatia. These formats have allowed a fresh look at issues senior policy makers may have developed a blind spot for, have resulted in eye-opening learning on both sides of the spectrum and have led to concrete recommendations for major health policy issues.

Presenters: Sinisa Varga, former Minister of Health, Croatia

Damiet Onderstal, Ministry of Health, Welfare and Sports, The Hague, Netherlands

For the benefit of young professional networks, please see also: https://academic.oup.com/eurpub/article/24/5/704/2837380
Youth Alliance - a new model for health policy development
Authors: Ayuandini S
Published: November 2019

The work of the “Youth Alliance” (as part of the EU funded CO-CREATE project) introduces a new model for health policy development which sees young people and health policy experts from academia coalesce to form a ‘Youth Alliance’ considering the broader social and commercial environments which result in childhood obesity and other health problems, and what this means for policy development. The CO-CREATE project is a partnership between 14 European health and academic institutions and civil societies in five countries. The project will demonstrate the democratic engagement of youth in facilitating intergenerational and interorganisational cooperation.

Presenters: Christian Bröer and Sherria Ayuandini, University of Amsterdam
Young health leaders shape their future policies
Authors: Gatialová K
Published: November 2019

The European Health Parliament (EHP) is a movement connecting and empowering the next generation of European health leaders to rethink EU health policies. The initiative connects promising young professionals and challenges them to develop solutions for European health policy that are both innovative and actionable. The EHP answers Europe’s need for fresh ideas in health and believes that the solutions required must come from young European health leaders who influence the policies that will ultimately concern their generation as they become senior decision-makers. Participants work together for six months to develop policy recommendations that address today’s most pressing European health issues which are picked in cooperation with the European Commission.
Workshop: The changing politics of ageing and welfare state: Connecting politics with realities
Authors:   Organised by: Observatory Chair persons: Scott Greer - USA, Jonathan Cylus - UK
Published: November 2019

Societies are ageing, in Europe and elsewhere. This is an effectively unprecedented development in human history and one that many think could pose a real threat to welfare states’ political bases and sustainability. In some countries this has been taken as evidence that the welfare state will become unsustainable, and in others that the welfare state has been turned to serve the interests of the elderly at the expense of the young.

The purpose of this workshop is to present the new evidence on how and why political systems respond to the challenges of ageing and health. Research indicates that the extent that population ageing creates difficulties for economies, public finances, and health systems is complex and, importantly, conditional on a host of modifiable factors. Furthermore, a focus on divides between generations distracts us from other, important, inequalities within generations. Not only does science have a part to play in busting many ageing-related ‘myths’, but there is also a key role for policy intervention.

This workshop, based on findings from the European Observatory’s “Economics of Healthy and Active Ageing” study brings together research on why population ageing is often (erroneously) viewed cataclysmically from a health financing perspective, and reviews relevant policies that may improve health system financial sustainability. The workshop will have 5 presentations followed by debate on why countries may or may not prioritize policies that support the health of older people. Presentation #1 sets out the problems and broad trends on costs and projections associated with older people and ageing societies, drawing on the other parts of the series, as well as intergenerational transfers. It then lays out the framework for the rest of the presentations.

Presentation #2 expands on the first presentation by looking at country contexts. The focus will be on the politics and consequences of ageing in southern and central-eastern Europe. Having established the problem, Presentation #3 will determine how different publics understand and frame ageing and health, what priorities do publics identify, and why. Presentation #4 will look at political manifestos and voting patterns to see how/if public opinions are translating into changes in government that want to tear down the welfare state and blame it on ageing. Lastly, Presentation #5 will address the core issue obscured by intergenerational accounting: to what extent are the politics of ageing actually being shaped by, and reproducing, social inequalities?

Debate including audience members will be facilitated by an expert from the Observatory.

Key messages

Excessive focus on the costs of ageing is a distraction from real inequalities and an obstacle to better policy. Institutional and policy responses play a crucial role in determining how health systems, economies and societies more broadly are affected by population ageing.
The future generation’s act: Wales
Authors: Weatherup C
Published: November 2019

The Wellbeing of Future Generations (Wales) (WFG) Act 2015 is ambitious legislation that enables a step change in the way public services tackle health and societal problems. The WFG Act includes clear requirements for public bodies to share a common purpose, by setting seven wellbeing goals focused on improving social, economic, environmental and cultural wellbeing. The Act requires public bodies to act collectively, plan for the long-term, involve people and communities in decision making, prevent problems occurring and take a joined-up approach to assessing wellbeing and planning. Monitoring and accountability structures include the establishment of a Future Generations Commissioner, whilst progress is monitored and reported against using National Indicators and reporting as part of the UK to the United Nations International Sustainable Development Goals. The Act represents a milestone for public health, with health and equality goals on par with goals for the environment and economy and a clearer articulation of the social and economic determinants of health. The presentation will provide a short introduction to the background and development of the legislation, but the main focus will be on what is being done to drive and support implementation at various levels of operation; for individuals, for teams, for organisations and for government and systems in order that the potential reach of the legislation is realised.
Challenges and opportunities for health professional providing care for refugees and migrants
Authors: Chiarenza A
Published: November 2019

Health professionals face specific challenges providing care for migrants and refugees, including communication barriers, misunderstanding due to cultural differences, patient’s low health literacy. Rather than relying exclusively on a preconceived knowledge about migrant cultures, health professionals should invest more in the relationship with the patient listening and giving prominence to the patient’s story. This part of the WS will explore the soft-skills needed to establish a trustful and effective care relation with migrant and refugee patients. (20’)
Soft skills to improve the health of homeless people
Authors: Spinnewijn F
Published: November 2019

Issues that homeless people may face during access to healthcare will be presented. The group will discuss skills needed to overcome those gaps, how they can be developed and ideas to use then in an effective way when interacting with homeless population. (20’)
Systematically introducing the ‘health factor’ in decision-making is possible: The success case of Andalusia
Authors: Rodríguez Rasero F , Moya Ruano L A , Madrid Verdugo E , Vela Ríos J
Published: November 2019

Health Impact Assessment (HIA) as a stand-alone report integrated in environmental assessments has been compulsory for the last 5 years in Andalusia. In this time, it has been proven as a successful tool for implementing the Health in All Policies strategy, delivering consistently better outcomes for the examined projects.

We will describe the tools and methods used to achieve these results through the presentation of three examples. In so doing, it will be shown how HIA allows us to consider issues often neglected in decision-making processes and how it provides with an added value over other assessments already being carried out.

The first example deals with a food industry. HIA focused on the depiction of affected population, singling out vulnerable traits using geographic information systems and open social and demographic data. Combined with a study of air dispersion of pollutants, it enabled us to find inequities in the distribution of impacts, propitiating thus the inclusion of additional measures of emissions abatement.

HIA also helps raising awareness in other sectors. The second case shows a big change of attitude experienced in the urban planning department of a big city. After some initial reserves, the municipality based the decision about the relocation of a social centre on the assessment of expected positive impacts on social determinants of health. Bringing together these outcomes and the results of public consultation, a new optimal location was chosen.

Finally, HIA also allows for greater transparency and accountability in public policies. The report for the Andalusian Air Quality Strategy not only provided health outcomes (morbidity and mortality) but also turned them into monetary values, as experience has shown that policy-makers find it difficult to understand standard health measures. This approach makes possible to contribute to cost-benefit analysis and keeps in line with EC guidelines on Public Policies Assessment.

Panelists: Bart Bautmans

Environment and Health Department, Flemish Agency for Care and Health, Flanders, Belgium

Contact: bart.bautmans@zorg-en-gezondheid.be

Ana M Carriazo

Health Department, Regional Ministry of Health of Andalusia, Seville, Spain

Contact: anam.carriazo@juntadeandalucia.es

Odile Mekel

NRW Centre for Health, North Rhine-Westphalia, Bochum, Germany

Contact: Odile.Mekel@lzg.nrw.de
Operationalisation of gender and migration in epidemiological research – a systematic review
Authors: Wandschneider L , Batram-Zantvoort S , Razum O , Miani C
Published: November 2019

Background

Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective beyond biological sex in migration-related epidemiological research would contribute to adequately analyse, assess and interpret the health situation of migrants.

Methods

The systematic review synthesises how gender is conceptualised, operationalised and used for interpretation in migration-related epidemiological research. We search PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO as well as the reference lists of the included studies. Eligible studies actively aim to understand, identify or explain the influence of gender on health.

Results

20 cross-sectional studies met the eligibility criteria. The majority of studies analysed gender effects on mental health (e.g. depression) and sexual health (e.g. risk behaviour). The majority of the study population is made up of male sexual minorities with Latin American background living in the USA. Gender is mainly operationalised through gender roles, attitudes and gender-based discrimination. These dimensions are mostly conceptualised at the individual level, only a minority of studies applies meso- or macro-level indicators to measure structural gender effects.

Discussion

We identified research gaps with regard to macro-level mechanisms of gender, immigrant populations in Europe and interactions of migration and gender in epidemiological research. The majority is restricted to sex- or sexual orientation related issues, but this systematic review helps to identify good practice examples that may contribute to the development of a guideline on how to integrate a gender perspective in migration-related epidemiological research.

Systematic Review Registration: PROSPERO CRD42019124698